Facing Up To The Health Challenge: Resource Books For LGUs

HEALTH
Writer
Simon Peter Gregorio
Editors
Chay Florentino-Hofileña
Giselle Baretto-Lapitan
Project Management
Amihan Perez
Ateneo Center for Social Policy and Public Affairs (ACSPPA)
Technical and Editorial Team
Rene “Bong’Garrucho, LGSP
Mags Maglana, LGSP
Fe Salcedo, LGSP
Myn Garcia, LGSP
Florencia Dorotan
Art Direction, Cover Design & Layout
Jet Hermida
Photography
Ryan Anson
HEALTH
FACING UP TO THE HEALTH CHALLENGE
Facing Up To The Health Challenge
Service Delivery with Impact: Resource Books for Local Government
Copyright @2003 Philippines-Canada Local Government Support Program

(LGSP)
All rights reserved
The Philippines-Canada Local Government Support Program encourages the

use, translation, adaptation and copying of this material for non-commercial
use, with appropriate credit given to LGSP.
Although reasonable care has been taken in the preparation of this book,
the publisher and/or contributor and/or editor can not accept any liability
for any consequence arising from the use thereof or from any information
contained herein.
ISBN 971-8597-06-9
Printed and bound in Manila, Philippines
Published by:
Philippines-Canada Local Government Support Program (LGSP)

Unit 1507 Jollibee Plaza
Emerald Ave., 1600 Pasig City, Philippines
Tel. Nos. (632) 637-3511 to 13
www.lgsp.org.ph
Ateneo Center for Social Policy and Public Affairs (ACSPPA)

ACSPPA, Fr. Arrupe Road, Social Development Complex
Ateneo de Manila University, Loyola Heights, 1108 Quezon City
This project was undertaken with the financial support of the Government
of Canada provided through the Canadian International Development
Agency (CIDA).
A JOINT PROJECT OF
Department of the Interior National Economic and Canadian International

and Local Government (DILG) Development Authority (NEDA) Development Agency
IMPLEMENTED BY
Agriteam Canada Federation of Canadian

www.agriteam.ca Municipalities (FCM)
www.fcm.ca
CONTENTS
FOREWORD 1
ACKNOWLEDGEMENTS 2
PREFACE
ACRONYMS
EXECUTIVE SUMMARY
INTRODUCTION
CHAPTER 1: OVERVIEW OF THE HEALTH SECTOR

Health Status of Filipinos
Financing: Sources and Uses
Health Human Resources and their Distribution
Health Facilities
Health Sector Reform Agenda
CHAPTER 2: LGU MANDATES ON HEALTH SERVICE DELIVERY

The Local Government Code
Laws and Policies Governing Local Health Service Delivery
CHAPTER 3: IMPLEMENTATION & POLICY ISSUES AND RECOMMENDATIONS

Institutional Development
Health Care Financing
Delivering Quality Health Services
CHAPTER 4: GOOD PRACTICES IN HEALTH SERVICE DELIVERY

Planning Health Service Delivery
Financing Health Service Delivery
CHAPTER 5: REFERENCES AND TOOLS

References
Resources for Health Service Delivery
Resources for Inter-Local Health Zones
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
FOREWORD
T
he Department of the Interior and Local Government is pleased to acknowledge the latest
publication of the Philippines Canada Local Government Support Program (LGSP), Service
Delivery with Impact: Resource Books for Local Government; a series of books on eight (8)
service delivery areas, which include Shelter, Water and Sanitation, Health, Agriculture, Local Economic
Development, Solid Waste Management, Watershed and Coastal Resource Management.
One of the biggest challenges in promoting responsive and efficient local governance is to be able to
meaningfully deliver quality public services to communities as mandated in the Local Government Code.
Faced with continued high incidence of poverty, it is imperative to strengthen the role of LGUs in service
delivery as they explore new approaches for improving their performance.
Strategies and mechanisms for effective service delivery must take into consideration issues of poverty
reduction, people’s participation, the promotion of gender equality, environmental sustainability and
economic and social equity for more long- term results. There is also a need to acquire knowledge, create
new structures, and undertake innovative programs that are more responsive to the needs of the
communities and develop linkages and partnerships within and between communities as part of an
integrated approach to providing relevant and sustainable services to their constituencies.
Service Delivery with Impact: Resource Books for Local Government offer local government units and
their partners easy-to-use, comprehensive resource material with which to take up this challenge. By
providing LGUs with practical technologies, tested models and replicable exemplary practices, Service
Delivery with Impact encourages LGUs to be innovative, proactive and creative in addressing the real
problems and issues in providing and enhancing services, taking into account increased community
participation and strategic private sector/civil society organizational partnerships. We hope that in using
these resource books, LGUs will be better equipped with new ideas, tools and inspiration to make a
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T I
FOREWORD
difference by expanding their knowledge and selection of replicable choices in delivering basic services
with increased impact.
The DILG, therefore, congratulates the Philippines-Canada Local Government Support Program (LGSP)
for this milestone in its continuing efforts to promote efficient, responsive, transparent and accountable
governance.
HON. JOSE D. LINA, JR.

Secretary
Department of the Interior and Local Government
II S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
ACKNOWLEDGEMENTS
T his publication is the result of the collaboration of institutions and individuals committed
to supporting the improvement of the delivery of health services by local governments
to their constituents
The Philippines- Canada Local Government Support Program led by Alix Yule, Marion Maceda Villanueva
and Rene "Bong" Garrucho for providing the necessary direction and support
Florencia Dorotan and her team at LIKAS Incorporated, particularly Dr. Suzanne Halum and Lorenzo G.
Ubalde for undertaking the research and roundtable discussion and preparing the technical report which
was the main reference for this resource book; and for assisting in the review of the manuscript
Participants to the Roundtable Discussion on Exemplary Practices in LGU Health Service Delivery held
on August 6, 2002 in Davao City. Their expertise and the animated exchange of opinions helped shape
the technical report on which this publication is based:
Mayor Fernando C. Corvera San Jose Buenavista; Mayor Valente Yap of Bindoy; Mayor Dicken Otero of
Sta. Josefa; Melanie V. Tolentino of Kalibo; Dr. Jarvis Punsalan of Capiz; Dr. Fidencio Aurelia of Bayawan
District Hospital; Ma. Laurisse Gabor of Butuan City; Tomas Cruiz of Cantilan; Florencio Q. Liray of
Quezon, Bukidnon; Dr. Ma. Corazon S. Ariosa of Zamboanga del Sur; Ray Roquero of the LMP; and Jose
Corenales of NEDA XI/SEDS
Earl Enrico Alcala of WHSMP; Dr. Jose Rodriguez of PMTAT-Management Sciences for Health; Dr. Eddie
Dorotan of Management Sciences for Health; Mel Villacin of Quedan-KAISAHAN; Florante Villas of
XAES; Dam Vertido of Mindanao Land Foundation; Rory Villaluna of PCWS-ITNF; Ratan Budhathoki of
PCWS-ITNF/NEWAH; Aida Lananjo of Pipuli Foundation, Marites Quiñonez of CERD, Inc. and Ma. Sheila
Labos of KALIWAT Theater Collective;
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T III
ACKNOWLEDGEMENTS
LGSP Managers Evelyn Jiz, Teresita Gajo, Abe de la Calzada, and Victor Ozarraga; Program Officer
Abduljim Hassan
Fe Salcedo for providing feedback that helped ensure that the resource book offers information that
is practical and applicable to LGU needs and requirements
Simon Peter Gregorio for effectively rendering the technical report into a user-friendly material
Chay Florentino-Hofileña and Giselle Baretto Lapitan for their excellent editorial work
Amihan Perez and the Ateneo Center for Social Policy and Public Affairs for their efficient coordination
and management of the project
Mags Z. Maglana for providing overall content supervision and coordinated with the technical writers
Myn Garcia for providing technical and creative direction and overall supervision of the design, layout
and production
Sef Carandang, Russell Fariñas, Gigi Barazon and the rest of the LGSP administrative staff for providing
support
IV S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
PREFACE
S
ervice Delivery with Impact: Resource Books for Local Government are the product of a series
of roundtable discussions, critical review of tested models and technologies, and case analyses
of replicable exemplary practices in the Philippines conducted by the Philippines-Canada Local
Government Support Program (LGSP) in eight (8) service sectors that local government units (LGUs) are
mandated to deliver. These include Shelter, Water and Sanitation, Health, Agriculture, Local Economic
Development, Solid Waste Management, Watershed and Coastal Resource Management.
The devolution of powers as mandated in the Local Government Code has been a core pillar of
decentralization in the Philippines. Yet despite opportunities for LGUs to make a meaningful difference
in the lives of the people by maximizing these devolved powers, issues related to poverty persist and
improvements in effective and efficient service delivery remain a challenge.
With LGSP’s work in support of over 200 LGUs for the past several years came the recognition of the need
to enhance capacities in service delivery, specifically to clarify the understanding and optimize the role
of local government units in providing improved services. This gap presented the motivation for LGSP
to develop these resource books for LGUs.
Not a “how to manual,” Service Delivery with Impact features strategies and a myriad of proven
approaches designed to offer innovative ways for local governments to increase their capacities to better
deliver quality services to their constituencies.
Each resource book focuses on highlighting the important areas of skills and knowledge that contribute
to improved services. Service Delivery with Impact provides practical insights on how LGUs can apply
guiding principles, tested and appropriate technology, and lessons learned from exemplary cases to their
organization and in partnership with their communities.
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T V
PREFACE
This series of resource books hopes to serve as a helpful and comprehensive reference to inspire and
enable LGUs to significantly contribute to improving the quality of life of their constituency through
responsive and efficient governance.
Philippines-Canada Local Government Support Program (LGSP)
VI S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
ACRONYMS
AO Administrative Order
BFAD Bureau of Food and Drugs
BHPDP Bureau of Health Policy Development and Planning
BIHC Bureau of International Health Cooperation
BLHD Bureau of Local Health Development
BTL Bilateral Tubal Ligation
CBMIS Community-Based Monitoring and Information System
CHCA Comprehensive Health Care Agreement
CHD Center for Health Development (formerly Regional Field Office or Regional
Health Office)
CHO City Health Office; City Health Officer
CHW Community Health Worker
CIDA Canadian International Development Assistance
CSO Civil Society Organization
DOH Department of Health
DSWD Department of Social Welfare and Development
DTI Department of Trade and Industry
EHS Environmental Health Service
EO Executive Order
EPI Expanded Program on Immunization
FAMUS Family Health By and For Poor Settlers
FP Family Planning
GSO General Services Office
HAMIS Health Management Information System
HEALTHDEV Health Alternatives for Total Human Development Institute
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T VII
ACRONYMS
HSRA Health Sector Reform Agenda

IEC Information, Education and Communication
ILHZ Inter-Local Health Zone
IRA Internal Revenue Allocation
IRR Implementing Rules and Regulations
LCE Local Chief Executive
LGSP Local Government Support Program
LGU Local Government Unit
LIKAS Lingap Para Sa Kalusugan ng Sambayanan, Incorporated
LPP LGU Performance Program
MCH Maternal and Child Health
MGP Matching Grant Program
MHO Municipal Health Office; Municipal Health Officer
MOA Memorandum of Agreement
MOOE Maintenance and Other Operating Expenses
MSH Management Sciences for Health
NGO Non-Government Organization
NHIP National Health Insurance Program
OTC Over The Counter
PCHD Partnership for Community Health Development
PDI Parallel Drug Importation
PHC Primary Health Care
PHIC Philippine Health Insurance Corporation (also PhilHealth)
PHO Provincial Health Office; Provincial Health Officer
PITC Philippine International Trading Corporation
VIII S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
ACRONYMS
PITAHC Philippine Institute for Traditional and Alternative Health Care

PMCC Philippine Medical Care Commission
PNDF Philippine National Drug Formulary
PNP Philippine National Police
PO People’s Organization
RHU Rural Health Unit
VSS Voluntary Surgical Sterilization
WHSMP Women’s Health and Safe Motherhood Project
WHSMP-PC Women’s Health and Safe Motherhood Project – Partnership Component
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T IX
EXECUTIVE SUMMARY
THE HEALTH SECTOR
H
ealth service delivery has always been an important concern of the government, assuming
even greater significance after the devolution of health services to Local Government Units
(LGUs) in 1992. More than ten years after devolution, LGUs continue to grapple with the
challenges of devolution while at the same time confronting new issues and problems emerging from
the changing times.
The renewed emphasis on poverty reduction and sustainable economic and social development has
brought to the fore the need for a healthy citizenry.
While significant gains have been achieved in the last half-century in reducing maternal and infant
mortality, the country still lags behind its neighbors in these key indicators. Preventable communicable
diseases like diarrhea, pneumonia, and bronchitis continue to afflict millions of Filipinos. Tuberculosis
and hypertension are becoming more and more prevalent among the population. Lifestyle diseases
like diseases of the heart and the vascular system and malignant neoplasms are rising as causes of death.
Access to health care remains very limited. People are constrained in improving their health-seeking
behavior by the location of health facilities, low levels of education, limited income, and high prices of
medicines and hospital care. Overall public spending in health remains below international standards.
In the absence of universal health insurance coverage, health expenditures continue to be financed largely
from the pockets of patients and their families. Spending is still heavily in favor of hospital or curative
care to the neglect of preventive and promotive health services. Human resources of the health sector
are poorly distributed across regions, with many doctors and nurses found in urban centers like Metro
Manila.
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T XI
EXECUTIVE SUMMARY
LEGAL FRAMEWORK
The Local Government Code of 1991 devolved the delivery of basic services and the operation and
maintenance of local health facilities from the Department of Health (DOH) to provinces, cities, and
municipalities. This means that each local government unit is now responsible for the performance of
functions that were previously vested in the national government, specifically the Department of
Health (DOH). These functions comprise the following: (1) general control and supervision over devolved
personnel and facilities, (2) the operation and maintenance of local health facilities like provincial
hospitals and health centers, (3) service delivery such as the implementation of promotive, preventive,
curative, and rehabilitative health programs and services, and (4) regulatory functions such as the
formulation and enforcement of local ordinances related to health, nutrition, sanitation, and other health-
related concerns. In a devolved set-up, the DOH exercises oversight and regulatory functions, provides
technical assistance, formulates standards and guidelines, and manages the operation of retained
hospitals, regional medical centers, regional training and/or teaching hospitals, specialized health
facilities, and national government hospitals.
Besides the Local Government Code, there is a whole compendium of laws and policies governing various
aspects of health service delivery by LGUs. These laws are categorized in this resource book under six
headings: Local Health System Development, Public Health Reform, Hospital Reform, Drug Management
System, Health Care Financing/Social Health Insurance, and Specific Concerns
In 1999, the DOH crafted a Health Sector Reform Agenda (HSRA) to address the abovementioned
situation. The HSRA describes the major strategies, organizational and policy changes, and public
investments needed to improve the delivery, regulation and financing of health care. The HSRA guides
XII S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
EXECUTIVE SUMMARY
the health sector and more importantly, the LGUs, in improving their capacity and capability to
implement health delivery services in five (5) areas:
Local Health Systems Development: Promote the development of local health systems and
ensure its effective performance.
Public Health Reforms: Secure funding for priority public health programs.
Hospital Reforms: Provide fiscal autonomy to government hospitals.
Health Regulation Reforms: Strengthen the capacity of health regulatory agencies.
Health Care Financing: Expand the coverage of the National Health Insurance Program (NHIP).
WHAT THE LGUs CAN DO
The Philippines faces these tremendous challenges in the health sector: making devolution work;
ensuring community participation in the delivery of health services; recruiting, retaining, and building
the capability of health personnel; and financing and implementing health service programs. The
country can surmount these challenges only through the enactment and implementation of
comprehensive reforms. LGUs, standing at the frontline of the health delivery system, play a critical role
in realizing the goals of the HSRA and improving health services in general.
Some of the issues confronting LGUs and the corresponding reforms include establishing and
strengthening inter-local health systems and their subsystems, implementing the Barangay Health
Workers’Incentives Act, increasing the Internal Revenue Allotment (IRA) for health to a fixed percentage
and the budget for health to five (5) percent of the local and national budgets, increasing enrollment
in the Philippine Health Insurance Corporation’s (PHIC) Social Health Insurance Program, and advocating
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T XIII
EXECUTIVE SUMMARY
and encouraging national government and devolved hospitals to become fiscally autonomous through
the charging of user fees, income retention schemes, and other revenue enhancing methods.
WHAT SOME LGUs HAVE DONE
In the effort to deliver health care services, LGUs need various kinds of assistance. The need for financial
resources remains an obvious and perennial concern. Equally important is the need for information on
good practices that LGUs can study, emulate, and adapt to their situation. This resource book provides
nineteen (19) cases of LGUs from across the country that responded effectively to problems in health
service delivery. The cases show how LGUs have dealt with the challenges of planning, financing, and
delivering health services and the innovative practices that have developed along the way. Among such
practices are mobilizing popular support; generating participation in health care projects; and instilling
a culture of quality service among health workers.
XIV S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
INTRODUCTION
A
modest objective of this resource book is to provide a handy reference for local governments
from all over the country—from the local chief executive to the rank and file employees of the
local bureaucracy. This reference will help in making decisions, preparing budgets, and
implementing projects related to health service delivery. This book also contains basic information on
health service delivery that will be useful to the rank and file employees of the Department of Health,
non-government organizations, and agencies that provide assistance to LGUs.
On a grander scale, this resource book seeks to make local governments—and anyone who cares
deeply about health— begin thinking systematically about the problems of the sector. More importantly,
the book aims to prod concerned agencies and individuals to act on these problems, or advocate reforms
with the proper authorities.
The resource book dares local governments to make good on the often-heard motto, “A healthy
citizenry is the catalyst for economic and social development.” It further challenges local governments
to achieve this goal by:
Entering into partnerships to promote effective local health systems

Prioritizing public health programs
Improving the efficiency and effectiveness of hospital services and facilities
Ensuring the safety, quality, and accessibility of health products and services
Extending health protection to the poor through social health insurance
This book casts a wide net over many health sector areas, from the planning to actual delivery of
services, from policies to implementation tools. Some readers may feel that certain topics have not been
discussed with a level of detail that does justice to the subject. This is a valid expectation for a
monograph, but not for a resource book. A resource book’s primary audience are practitioners who need
S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T 1
INTRODUCTION
to know the issues quickly and concisely, be informed of their options and available resources, and see
how things turned out for those who faced similar situations. Details that may be of specific interest to
health researchers and academics are therefore not included.
The resource book also focuses on the public health sector, specifically those areas where local
governments play an important role. Except for a few recommendations affecting them, this resource
book does not deal with the private health sector. Even with the public health sector, the book does not
attempt to be exhaustive or extensive. It focuses only on areas most relevant to LGUs and on issues where
LGU efforts can have the most impact.
This resource book is divided into five (5) chapters:
Overview of the Health Sector

Mandates of the Local Government Units
Implementation & Policy Issues and Recommendations
Case Studies on Good Practices in Health Service Delivery
Tools and References
The first chapter provides a general picture about the health situation in the country, touching on topics
such as mortality rates, financing, health facilities, human resources, and the Health Sector Reform Agenda.
The second chapter highlights the role of LGUs in delivering health services under a devolved set-up.
It compares the mandates of LGUs under the Local Government Code with the following roles of the
DOH: (1) personnel management and human resource management, (2) facilities management, (3)
planning and decision-making, (4) procurement of drugs and other health products, and (5) financing
2 S E R V I C E D E L I V E R Y W I T H I M P A C T: R E S O U R C E B O O K s F O R L O C A L G O V E R N M E N T
INTRODUCTION
and implementing health projects. This chapter also enumerates the various laws and policies
(Constitutional provisions, Republic Acts, Department Orders, etc.) that govern health service delivery
by LGUs.
The third chapter discusses issues regarding service delivery and advances several recommendations.
These issues were raised during the Round Table Discussion on Health Service Delivery on August 2002
in Davao City, sponsored by the Philippine-Canada Local Government Support Program (LGSP). This
section also identifies reforms that the LGUs can undertake on their own, through their various Leagues
(Municipalities, Cities, and Provinces), and with the executive and legislative branches of the national
government.
The fourth chapter presents 19 case studies on these various issues and are classified according to the
functions undertaken by LGUs: Planning Health Service Delivery, Financing Health Service Delivery, and
Delivering Quality Health Services.
The two (2) cases on Planning Service Delivery emphasize the need for adequate information on the
health needs of the population and the sicknesses ailing them. These cases also show how this
information can be gathered, collated, stored, analyzed, and used for deciding on the appropriate
intervention; how these interventions can be monitored; and, finally how this data can be used for impact
evaluation.
The section on Financing Health Service Delivery has ten (10) cases. Each of them illustrate one or several
strategies that LGUs have used to address the constant lack of funding: socialized user fees, matching
grant schemes, setting up trust funds for hospitals, pooling hospital drug procurement, bulk and
parallel procurement and distribution of drugs, joint ventures, fund raising among overseas Filipino
workers and overseas Filipino communities, tracking and allocating costs among different hospital units.
INTRODUCTION
The third (and last) section on Delivering Quality Health Services presents seven (7) cases. These cases
demonstrate the importance of popular support and participation, a responsive project design, and a
culture of quality in effective health service delivery.
The fifth chapter contains tools and references that readers may consult and find useful to deepen their
understanding of the issues presented here.
Some of topics discussed in the five chapters may already be familiar to LGU readers, and they may feel
justified to skip or skim over those portions. Nevertheless, it is recommended that this resource book
be read in full, perhaps not in one sitting but in several, choosing portions that are relevant and
important for the challenge of the day.
For direction-setting and programming purposes, local chief executives and elected officials may find
most useful these sections on the LGUs’mandates, laws and policies governing health service delivery,
and the issues and policy recommendations. On the other hand, the case studies section illustrates how
policies work out in actual practice and what their implementers undergo.
Local health workers may spend some time looking at the case studies for approaches and practices
they can adopt in their own programs and projects. The question and answer portion that immediately
follows is meant to clarify the adopted approaches, their advantages and disadvantages, their
applicability in other situations, the resources used by this particular approach, and the resulting
benefits.
The case studies chosen for this book were designed to meet specific challenges at a particular time and
context. They may or may not be applicable to those who are situated differently. They are presented
here to inform, inspire and trigger the thinking process.
INTRODUCTION
This resource book is also for civil society partners, people’s organizations, and non-government
organizations engaged in policy advocacy and health service delivery, especially in collaboration with
LGUs and agencies providing various kinds of assistance (e.g., capability building to LGUs) The resource
book can help to better understand local government partners—where they are coming from and what
constrains them from delivering the kind of services that people need.
Compared to the scope and burden of the challenges facing the sector, the successes cited in this resource
book might appear modest. Hopefully these small accomplishments will encourage people to start
projects, however small and humble they may be. It is hoped that local government leaders will be
motivated to see the big picture and the possibilities in health service delivery yet to be realized. LGU
leaders are thus prodded to “Start Small, Think Big, Scale Up Fast.”
1
OVERVIEW OF
THE HEALTH
SECTOR
T
OVERVIEW OF THE HEALTH SECTOR CHAPTER
his chapter provides a bird’s eye view of the Philippine health sector. The performance of
the sector has been mixed, to say the least. While gains have been made over the last 50
years in maternal and child mortality rate, the country continues to lag behind its neighbors
1
in these key indicators. Preventable communicable diseases like diarrhea, pneumonia, and
bronchitis remain as the leading causes of illness. A disturbing trend is the re-emergence and
increasing prevalence of tuberculosis in the general population. Lifestyle diseases like diseases of
the heart and the vascular system and malignant neoplasms are the leading causes of death.
Access to health care and health-seeking behavior remain poor, constrained as they are by the
location of health facilities, the low levels of education and the limited income of many Filipinos,
and the high prices of medicines and hospital care. Overall public spending in health remains below
international standards. In the absence of universal health insurance coverage, health expenditures
continue to be financed largely from the pockets of patients and their families. Spending is still
heavily biased in favor of hospital or curative care to the detriment of preventive and promotive
health services. Health human resources are poorly distributed across regions. Most of the doctors
are in the National Capital Region and in urban metropolitan centers. Four out of 10 doctors in the
whole country are in Metro Manila.
Ten years after devolution, the number of DOH-retained hospitals is increasing, as provincial and
district hospitals are reclassified as regional and national centers. As a result, the DOH is spending
more on a relatively small number of hospitals than it was doing before devolution. On the other
hand, provincial and district hospitals perform poorly due to the financial constraints of the LGUs,
among other factors.
1 HEALTH
To address these problems, the DOH crafted a Health Sector Reform Agenda (HSRA) in 1999. The
HSRA describes the major strategies, organizational and policy changes, and public investments
needed to improve the way health care is delivered, regulated, and financed. The HSRA guides the
health sector, especially the LGUs, in improving their capability to implement health delivery
services in five (5) areas, to wit:
Local Health Systems Development: Promote the development of local health systems and
ensure its effective performance.
Health Regulation Reforms: Strengthen the capacity of health regulatory agencies.
Health Care Financing: Expand the coverage of the National Health Insurance Program (NHIP)
❙ HEALTH STATUS OF FILIPINOS

◗ MATERNAL AND INFANT MORTALITY (DEATH) RATES
Over the last 50 years, the health of Filipinos has improved significantly. From 1990 to 1995, infant
mortality declined from 56.7 per 1,000 live births to 48.9 per 1,000 live births in 1995. Child
mortality went down from 79.4 per 1,000 children (under five years of age) in 1990 to 66.8 in 1995.
Maternal mortality rate also went down from 209 per 100,000 live births in 1990 to 180 in 1995.
The overall improvement in child and maternal mortality has not been uniform across all the
regions and provinces of the country. Large differences separate the five lowest mortality provinces
from the top five high mortality provinces, as shown by Table 1.
OVERVIEW OF THE HEALTH SECTOR 1
Table 1. High and Low Infant Mortality and Maternal Mortality Provinces, 1995
HIGH MORTALITY PROVINCES IN 1995 LOW MORTALITY PROVINCES IN 1995
Province Rate Province Rate
Infant Mortality
Ifugao 64.6 Bulacan 34.8

Eastern Samar 65.8 Cavite 35.8
Northern Samar 66.4 Pampanga 36.7
Samar 67.1 Laguna 37.2
Lanao Del Sur 69.1 Rizal 38.2
Maternal Mortality
Sultan Kudarat 267.0 Cavite 116.0

Maguindanao 296.4 Batangas 139.1
Tawi-Tawi 299.1 Rizal 140.1
Aurora 311.6 Davao Del Sur 148.6
Sulu 333.7 Pangasinan 147.0
Source: NSCB (1995)
◗ LEADING CAUSES OF ILLNESS AND DEATH
Most of the leading causes of illness or morbidity are communicable diseases, but non-
communicable diseases like hypertension and other diseases of the heart are fast rising as the leading
cause. The leading causes of illness are:
1. Diarrhea
2. Pneumonia
3. Bronchitis
1 HEALTH
4. Influenza
5. Tuberculosis, respiratory
6. Hypertension
7. Malaria
8. Chicken pox
9. Diseases of the heart
10. Measles
The leading causes of death or mortality are mostly non-communicable diseases. Yet fast rising
causes of deaths are diabetes mellitus and accidents and injuries. The 10 leading causes of
death/mortality are:
1. Diseases of the heart

2. Diseases of the vascular system
3. Pneumonias
4. Malignant neoplasms or different kinds of cancers
5. Tuberculosis, all forms
6. Accidents
7. Chronic obstructive pulmonary diseases and allied conditions
8. Other disease of the respiratory system
9. Diabetes mellitus
10. Diarrheal diseases
◗ ACCESS TO HEALTH SERVICES AND HEALTH-SEEKING BEHAVIORS
Physical barriers, such as the location of health centers and hospitals, hamper many Filipinos’access
to health services. Education and location are important factors that determine whether mothers
bring their sick children to a health facility or a health provider, for instance. Another example is
the higher prevalence of acute respiratory infection in the rural areas than in urban areas, and among
Table 2. Health-Seeking Patterns by Income Group, 1993 (In Percent)
Response to Health Complaint Poorest Quartile 2 Quartile 3 Richest

Quartile Quartile
Consulted doctor 25 36 37 48
Consulted other health professional 5 3 1 1
Consulted traditional healer 6 2 2 1
Self-care 64 59 60 50
Total number of respondents 100 100 100 100
Source: DOH-PIDS Household Survey (1993)
children of less educated mothers. In contrast, the percentage of children taken to a health facility
or provider is higher in urban areas and among children of more educated mothers.
Income is another factor that determines whether the services of a health provider or a health facility
will be used. The poorest members of the population resort to self-care more than the richest quartile.
More often, they go to other health professionals and traditional healers and consult the doctor
less frequently than the richer quartiles.
◗ CAPACITY TO FINANCE HEALTH CARE
Many Filipinos cannot afford medical care because of limited incomes and high costs. The prices
charged to charity patients in a private hospital far exceed those charged to an insured patient in
a public hospital. Neither does health insurance help bring down prices. Both private and public
hospitals charge insured patients more than they do uninsured patients, as Table 3 shows. Many
who cannot avoid hospital-based care bring the sick to public hospitals where facilities, equipment,
and services cannot compare with private hospitals.
1 HEALTH
❙ FINANCING: SOURCES AND USES
In 1998, the Philippines had a total budget of P540.783 billion. Of this amount, only an estimated
three centavos for every peso budgeted went to health.
Table 3. Predicted Bills and Costs for a Standard Package Compared to the country’s Gross National
of Services (In Pesos)
Product (GNP), combined public and private
sector spending on health was only P88.4 or
Predicted Price Private Public Difference
about 3.5 percent of GNP. This figure was below
Charged to Hospital Hospital
the minimum standard for health spending of
five (5) percent of GNP prescribed by the World
Charity patient 4,590 838 3,752
Health Organization (WHO) for developing
Uninsured patient 6,663 1,539 5,124
countries.
Insured patient 8,359 2,777 5,582
Breaking down the 1997 health spending, 72
Source: Solon, et al. centavos for every peso spent went to personal
health care services like the purchase of medicines, consultation fees, and diagnostic tests. Only
13 centavos for every peso spent went to public health services. The rest (15 centavos) went to the
cost of running the health system, like salaries of doctors, nurses, hospital administrators, etc.
By source, about 46 centavos for every peso spent came from the pockets of individuals. Government
contributed only 39 centavos for every peso spent—21 centavos from the national government
and 18 centavos from the local government. The National Health Insurance Program (NHIP)
contributed only 7 centavos for every peso spent. Private health insurance and community-based
health financing schemes shared the remaining 8 centavos. Most of the spending heavily favored
curative, rather than preventive and promotive health services.
The large government hospitals in Metro Manila got the biggest share while an insufficient budget
was given to primary care facilities at the local level.
❙ HEALTH HUMAN
RESOURCES AND THEIR DISTRIBUTION
From 1990 to 1995, the World Health Organization (WHO) estimated that there
were 82,494 doctors, 259,629 nurses, and 102,878 midwives. Majority of these,
however, worked in the private sector and engaged in private practice. Ratio of
government
In 1997, the LGUs employed 3,123 doctors, 1,782 dentists, 4,882 nurses, and health workers to
15,647 midwives.
the population
The Department of Health employed 4,232 doctors, 179 dentists, 4,837 nurses,
and 241 midwives. 1 doctor per
9,727 people
Comparing government health workers to the population, the ratios were: 1 dentist per
1 doctor per 9,727 people 36,481 people
1 dentist per 36,481 people 1 nurse per
1 nurse per 7,361 people 7,361 people
1 midwife per 4,503 people
1 midwife per
However, the distribution of health workers tells another story. Most of the 4,503 people
doctors are based in the National Capital Region and in urban metropolitan
centers. Four out of 10 doctors in the whole country are in Metro Manila.
❙ HEALTH FACILITIES
More than ten years after the devolution of health services and facilities from the DOH to LGUs, 48
hospitals still remain under the DOH as retained hospitals. The number of DOH-retained hospitals
1 HEALTH
has been slowly increasing because of the reclassification of some provincial and district hospitals
into regional or national centers. Concerns have been raised about the lack of resources and the
need to expand capacity to accommodate patients who now bypass poorly equipped provincial
and district hospitals and instead proceed to regional and national centers.
As a result, the share of the DOH budget spent on retained hospitals has substantially increased.
In fact, the DOH now spends more on a much smaller number of hospitals than the period before
devolution.
The reclassification of hospitals into regional or national centers and their retention by the DOH
is an inefficient strategy to address the problems of health service devolution. Thus regional
hospitals spend more in dealing with cases that can best be handled by provincial and district
facilities.
Thus far, the provincial and district hospitals have poorly performed under devolution. This stems
from the LGUs’ unwillingness and inability to spend for these hospitals at levels prior to their
devolution. Reduced spending affects mostly the maintenance and other operating expenses
(MOOE) of hospitals. This situation leads to a lack of supplies, drugs, and allowances for repair and
maintenance of medical equipment. In the end, service delivery and the poor patients of these
hospitals suffer.
❙ HEALTH SECTOR REFORM AGENDA
To address problems of the health sector, the DOH drafted a Health Sector Reform Agenda (HSRA)
in 1999 to describe the major strategies, organizational and policy changes, and required public
investments to improve the way health care is delivered, regulated, and financed. The HSRA
guides the health sector and more importantly, the LGUs, in improving their capacity and capability
to implement health delivery services in five areas:
Local Health Systems Development: Promote the development of local

health systems and ensure its effective performance. Five Areas for
Improvement in
Health Regulation Reforms: Strengthen the capacity of health regulatory Health Service
agencies. Delivery
Health Care Financing: Expand the coverage of the National Health
Insurance Program (NHIP). 1. Local Health
Systems
1. Promote the development of local health systems and ensure its
effective performance. Development
2. Public Health
Local health systems development seeks to institutionalize local health Reforms
systems within the context of local autonomy and to develop mechanisms
for inter-LGU cooperation. It also aims to (a) upgrade health care 3. Hospital Reforms
management and service capabilities of local health facilities; (b) promote 4. Health Regulation
inter-LGU linkages and cost-sharing schemes including local health care Reforms
financing systems for better use of local health resources; (c) foster the
participation of the private sector, non-government organizations (NGOs), 5. Health Care
and communities in local health systems development; and (d) ensure the Financing
quality of health service delivery at the local level.
2. Secure funding for priority public health programs.
Public health reforms seek to significantly reduce the burden from infectious and degenerative
diseases through the adoption of multi-year budgets, and by increasing investments to address
emerging health concerns and to advance health promotion and prevention programs. In order
to ensure the effective use of such investments, the management capacity and infrastructure
of public health programs must be improved. Capability building is also necessary for these
programs to provide technical leadership over local health systems.
1 HEALTH
3. Provide fiscal autonomy to government hospitals.
The reform of hospital systems aims to convert government hospitals into financially independent
entities and to develop the Philippine hospital system with the private sector. More specifically,
hospital reform attempts to upgrade provincial and district hospitals to strengthen the delivery
of promotive and preventive health services, and the primary, secondary, and in selected
provincial hospitals, even tertiary curative services.
Parallel to the expansion of health insurance coverage, hospital reform seeks to convert regional
and national hospitals into fiscally autonomous facilities, and eventually, into financially viable
government corporations. Financial autonomy can be achieved if government hospitals are
allowed to collect socialized user fees to reduce the dependence on direct subsidies from the
government. Hospitals’ critical capacities like diagnostic equipment, laboratory facilities, and
medical staff capability must be upgraded to effectively exercise fiscal autonomy. Such
investment must recognize the complimentary capacity provided by public-private networks.
Moreover, such capacities allow government hospitals to supplement priority public health
programs. Appropriate institutional arrangements must be introduced, such as allowing
government hospitals autonomy in view of converting them into government corporations
without compromising their social responsibilities. Thus the goal is to make government
hospitals become more competitive and responsive to health needs.
4. Strengthen the capacity of health regulatory agencies.
Reforms in this area seek to ensure the quality, accessibility, and safety of health care products,
facilities and services through stronger health regulatory agencies. Weaknesses in regulatory
mandates and enforcement mechanisms must be effectively addressed. Appropriate legislation
must be enacted to fill regulatory gaps. Public investments must be made to upgrade facilities
and human resource capabilities in standards development, technology assessment, and
enforcement.
5. Expand the coverage of the National Health Insurance Program (NHIP).
Health care financing reforms focus on making the National Health Insurance Program (NHIP)
a major payor of health services by expanding the National Health Insurance Program toward
universal coverage. A priority is extending protection to the poor. To achieve this, health
insurance benefits must be improved to make the program more attractive. Improved benefits
and services will be used to aggressively enrol members. Adequate funding must be secured
for premium subsidies that are needed to enrol indigents. Effective mechanisms must be
developed to cover and provide service to individually paying members. As membership
expands and benefit spending increases, appropriate mechanisms to ensure quality and cost
effective services must be developed and introduced. Capacities and new administrative
structures must be developed to allow the Philippine Health Insurance Corporation (PHIC) to
effectively service more members and manage increased benefit spending.
2
LGU MANDATES
ON HEALTH
SERVICE DELIVERY
LGU MANDATES ON HEALTH SERVICE DELIVERY
T
CHAPTER
his chapter discusses the mandates of the LGU in relation to the delivery of health services
and the operation and maintenance of local health facilities. By virtue of the Local
Government Code of 1991, each local government unit is responsible for the performance
2
of functions that were previously vested in the Department of Health (DOH). These functions are:
(a) general control and supervision over devolved personnel and facilities, (b) the operation and
maintenance of local health facilities like provincial hospitals and health centers, (c) service delivery
such as the implementation of promotive, preventive, curative, and rehabilitative health programs
and services, and (d) regulatory functions such as the formulation and enforcement of local
ordinances related to health, nutrition, sanitation, and other health-related concerns.
In a devolved setup, the DOH, on the other hand, exercises oversight and regulatory functions;
provides technical assistance; formulates standards and guidelines; and, manages the operation
of retained hospitals, regional medical centers, regional training and/or teaching hospitals,
specialized health facilities, and national government hospitals.
Besides the Local Government Code, there is a whole gamut of laws and policies that govern various
aspects of health service delivery by LGUs. These laws are categorized here under six (6) headings:
1. Local Health System Development

2. Public Health Reform
3. Hospital Reform
4. Drug Management System
5. Health Care Financing/Social Health Insurance
6. Specific Concerns
2 HEALTH
❙ THE LOCAL GOVERNMENT CODE
The Local Government Code of 1991 devolved the delivery of basic services
and the operation and maintenance of local health facilities from the
Challenges to LGUs
DOH to provinces, cities, and municipalities. This means that each local
government unit is now responsible for the performance of functions
1. Enter into that were previously vested in the national government, specifically the
partnership to DOH. These are:
promote effective
Formulation and enforcement of local ordinances related to health,
local health systems nutrition, sanitation, and other health-related concerns
2. Prioritize public Implementation of health programs in accordance with national policies,
health programs standards and regulations
Provision of promotive, preventive, curative and rehabilitative health
3. Improve efficiency programs and services
and effectiveness of Operation and maintenance of local health facilities (e.g., district and
hospital services and provincial hospitals under the provincial government, rural health
units, health centers and barangay health stations under the municipal
facilities or city government)
4. Ensure safety, quality Capability building of health personnel
and accessibility of Establishment of a functional local health information system
Monitoring and evaluation of the implementation of various health
health products and services
services Establishment of partnership with all sectors including inter-local
5. Extend health government unit collaboration in health promotion
Provision of funds for health at local levels
protection to the
poor Table 4 summarizes the functions of the LGUs vis-à-vis the DOH under a
devolved set-up.
LGU MANDATES ON HEALTH SERVICE DELIVERY 2
Table 4. Health Functions Devolved to LGUs, and Functions, Services, Facilities, Programs, Personnel
and Assets Retained by the DOH
Local Government Units Department of Health
General control and supervision Remaining powers and functions

Service delivery functions Oversight (general supervision, monitoring and
Regulatory functions (e.g., sanitation) evaluation functions)
Formulation of standards and guidelines
Technical and other forms of assistance
Examples Examples:
Components of national programs that are funded from
Working with the health officers and other foreign sources.
members of the local health board to ensure that Nationally funded programs that are in the process of
health services planned and implemented being pilot-tested or are in the process of being
respond to the health needs of the community. developed.
Working with the local Sanggunian, the local chief Health services and disease control programs that are
executive ensures that health plans integrated in covered by international agreements such as illnesses
the local development plans are given financial that require their carriers to be quarantined and disease
support. eradication programs.
Ensuring equity, quality and access to health Regulatory, licensing and accreditation functions in
services for all people in the community. accordance with existing laws such as the Food, Drugs,
and Cosmetic law, the Traditional and Alternative
Medicine law, and hospital licensing.
Regional hospitals, medical centers, and specialized
health facilities.
Figure 1 describes the facilities devolved to LGUs and their links to the DOH national and regional
offices. As the figure shows, the DOH retains control over regional medical centers, regional
training and/or teaching hospitals, specialized health facilities like the Philippine Heart Center,
leprosaria, and sanitaria, national government hospitals, and other retained hospitals. Independent
and highly urbanized cities control the city hospitals and city health offices. In turn, the city health
2 HEALTH
PROVINCE
INTER-LOCAL Provincial Health Office INTER-LOCAL

COOPERATION OR COOPERATION OR
PARTNERSHIP PARTNERSHIP
Hospitals of Provincial District and

Component Cities Hospital Municipal Hospitals
CITY INTER-LOCAL COOPERATION

MUNICIPALITY
OR PARTNERSHIP
City Health City Hospital Municipal

Office (independent) and Health Office
highly urbanized)
Rural Health
Diagnostic Lying-in Health Units
Facilities e.g., Clinics Centers
TB Clinic, STD Barangay
Clinic, etc. Health
Stations
DOH - CENTER FOR HEALTH DEVELOPMENT
(Formerly DOH-Regional Health Office or DOH- Regional Field Office)
DOH Attached Agencies - Regional Medical Centers

- (BFAD DOH CENTRAL - Regional Training and/or
- PhilHealth OFFICE Teaching Hospitals
- PITAHC) - Specialized Health Facilities
(e.g., Phil. Heart Center,
leprosaria, sanitaria)
Figure 1. Health Facilities Devolved to Local Government Units and - National Government Hospitals
Retained by the Department of Health - Retained Hospitals
office supervises the health centers, the lying-in clinics, and diagnostic facilities. The municipal health
office manages the rural health units and the barangay health stations. At the provincial level, the
provincial health office controls the provincial hospital, the hospitals of component cities, and the
district and municipal hospitals. The province, cities, and municipalities have inter-local cooperation
or partnership. The DOH’s Center for Health Development provides support to the inter-local
cooperation.
❙ LAWS AND POLICIES GOVERNING

LOCAL HEALTH SERVICE DELIVERY
The following are laws and policies governing local health service delivery. They are grouped
according to the priority areas of the Health Sector Reform Agenda:
◗ LOCAL HEALTH SYSTEM DEVELOPMENT
The table below provides the relevant constitutional provisions, policy mandates, as well as legal
documents supporting the institutionalization of partnership and cooperation among local
government units, specifically in the organization of a local health system.
The basic role of LGUs in local health system development lies in building mechanisms and
partnerships for the effective delivery of quality preventive, promotive, and curative health
services. These partnerships are done at different levels:
1. Intra-LGU, e.g., strong local health boards, partnership with civil society organizations and the
private sector
2. Inter-LGU, e.g., inter-local health zones, health district approach, cooperative LGU schemes
3. Supra-LGU, e.g., partnerships between the LGU and the national government
2 HEALTH
LGU MANDATES UNDER THE LOCAL HEALTH SYSTEM

Laws / Policies Specific Provision Remarks
Section 2, Article X of “The territorial and political Provides the basis for the creation of
the 1987 Constitution subdivisions shall enjoy local public quasi-municipal corporations
autonomy.” for the administration of some State
or public, but not self-governing
functions. Local or specific legislations
are usually provided to support such
administrative bodies.
Section 11, Article X of “The Congress may, by law, create Basis for the creation of a special
the 1987 Constitution special metropolitan political metropolitan political subdivision, an
subdivisions…. The jurisdiction of the inter-local government cooperative
metropolitan authority…shall be arrangement for coordinating the
limited to basic services requiring delivery of basic services.
coordination.”
Section 13, Article X of “Local governments may group A most direct mandate in the creation
the 1987 Constitution themselves, consolidate or coordinate of an inter-local health system by
their efforts, services and resources for clustering municipalities into inter-
purposes commonly beneficial to local health zones.
them.”
Section 14, Article X of “The President shall provide for Basis for the creation of regional
the 1987 Constitution regional development councils or development councils or inter-local
other similar bodies composed of local development councils for
government officials, regional heads administrative decentralization to
of departments and other government strengthen autonomy and accelerate
offices and representatives of development.
nongovernment organizations.”
Section 17 of the 1991 “Local government units shall A mandate to local government units
Local Government endeavor to be self-reliant and shall at various levels to be self-reliant and
Code continue exercising the powers and exercise their functions and duties
discharging the duties and functions including those formerly dispensed by
currently vested upon them…. and the national government agencies
the functions and responsibilities of prior to the devolution. This covers,
national agencies and offices devolved among others, programs and projects
to them.…” necessary for the effective and
efficient delivery of health services.
Section 33 of the 1991 “Local government units may, through A constitutional provision to enter
Local Government appropriate ordinances, group into inter-local government
Code themselves, consolidate, or coordinate cooperative arrangements for the
their efforts, services and resources for mutual benefits of cooperating LGUs.
purposes commonly beneficial to
them.”
Section 34 to 35 of the “Local government units shall Basis for mutually beneficial
1991 Local Government promote the establishment and partnership between the local
Code operation of people’s and government and civil society
nongovernmental organizations…. organizations. It makes enormous
(they) may enter into joint ventures sense to foster partnership as a strategy
and such other cooperative of complementation and
arrangements…in the delivery of supplementation when addressing the
certain basic services, capability various health concerns of a
building and livelihood projects….” community.
Section 102 of the 1991 “There shall be established a local Basis for the creation and composition
Local Government health board in every province, city or of the local health boards. The
Code municipality.” provision recognizes the significance of
the contribution of civil society, the
private sector, and the DOH toward
the crafting of better health policies
for LGUs.
2 HEALTH
Section 106 to 115 of “Each local government unit shall have Bases for the creation of intra-local
the 1991 Local a comprehensive multisectoral development councils for
Government Code development plan to be initiated by its multisectoral development including
development council and approved by public investment programs to
its sanggunian…. the development promote health.
council at the provincial, city,
municipal, or barangay level, shall
assist the corresponding sanggunian
in setting the direction of economic
and social development, and
coordinating development efforts….”
1999 Health Covenant A covenant by the League of Provinces Made during a convention entitled
signed in March 1999 together with “Governors’Workshop on Health:
the Secretaries of the Department of Partnership for Devolution.” This
Health and the Department of the articulates the commitment for the
Interior and Local Government. implementation of the district health
system.
Executive Order (EO) An order providing for the creation of Basis for the creation of a national
No. 205 a national health planning committee health planning committee and the
and the establishment of inter-local establishment of inter-local health
health zones throughout the country. zones. The EO is in support of
devolution and the decentralization of
health services.
◗ PUBLIC HEALTH REFORM
This section presents the policies and laws governing the necessary reforms in the area of public
health. The laws and policies mandate investments in public health programs, improvements in
physical infrastructure and management structure at all levels of the health system, and capability
building.
The basic role of LGUs in this area comprise the following: (a) to prioritize public health programs;
(b) reward, boost the morale, and raise the quality of health personnel under their wing; (c) to
encourage more people to become barangay health workers; and (d) recruit more nurses and
doctors.
LGU MANDATES UNDER PUBLIC HEALTH REFORM
Republic Act 7305 Magna Carta of Public Health Workers Provides the mandate for the
of 1992. recruitment and selection, tenure,
duties and obligations, rights and
privileges, benefits, incentives,
development and capacity building of
public health workers.
Republic Act 7883 “The Primary Health Care Approach is The Barangay Health Workers’ (BHWs)
recognized as the major strategy Benefits and Incentives Act of 1995 is
towards health empowerment, a law that grants benefits and
emphasizing the need to provide incentives to accredited BHWs. It aims
accessible and acceptable health to set up a system for them to gain
services through participatory access to a package of resources and
strategies…” (Section 2 of RA 7883) opportunities that would lead to their
personal and professional
development.
2 HEALTH
Administrative Order Establishing primary health care as the DOH, 31 March 1993
No. 11, s. 1993 core strategy in program thrusts of
government at all levels and creating
the various structures to oversee its
implementation.
Administrative Order Guidelines for the payment of laundry DOH, 29 June 1994
No. 31e, s. 1994 and subsistence allowance of public
health workers under RA 7305.
Administrative Order Validation and update of Barangay DOH, 15 January 1996

No. 2, s. 1996 Health Workers master list.
Administrative Order Operational guidelines in the DOH, 2 October 1997

No. 22b, s. 1997 implementation of the Doctor to the
Barrios Program.
Administrative Order Guidelines in the implementation of DOH, 17 April 1998

No. 15a, s. 1998 Barangay Health Workers’ Scholarship
under the Integrated Community
Health Services Project.
Administrative Order DOH guidelines for Board of Investments DOH, 12 July 2000
No. 81, s. 2000 registration of health care projects.
Administrative Order Amendment to the revised implementing DOH, 4 June 2001

No. 22, s. 2001 rules and regulations of the Magna Carta
of Public Health Workers.
Administrative Order Revised operational guidelines for the DOH, 8 February 2001
No. 181a, s. 2001 implementation of the Doctor To The
Barrios Program.
◗ HOSPITAL REFORM
The specific policies listed below are relevant to the improvement of hospital systems in the
country.
The basic role of LGUs in hospital reform is to improve the facilities and services of devolved
hospitals, and integrate the services of these hospitals with the LGUs’primary health care programs.
LGU MANDATES UNDER HOSPITAL REFORM
Administrative Order Amendment of AO 68a, s. 1989 DOH, 7 July 1994

No. 32h, s. 1994 regarding the Registration, Licensure
and Operation of Hospitals in the
Philippines.
Administrative Order Rules and regulations on the DOH, 29 July 1994

No. 34, s. 1994 supervision of Health Maintenance
Organizations.
Administrative Order Revised guidelines for the DOH, 4 June 1996

No. 21, s. 1996 procurement of equipment for
hospitals.
Administrative Order Guidelines for the bed subsidy DOH, 11 November 1997
No. 27a, s. 1997 program for private hospitals.
Republic Act 8344 An act penalizing the refusal of An amendment to Batas Pambansa
hospitals and medical clinics to Bilang 702
administer appropriate initial medical
treatment and support in emergency
and serious cases.
2 HEALTH
Administrative Order Implementing rules and regulations of DOH, 18 February 1998

No. 5b, s. 1998 RA 8344.
Administrative Order Implementing guidelines for the DOH, 14 December 2001

No. 67a, s. 2001 provision of assistance in the
upgrading of devolved local health
hospitals and RHUs based on Sentrong
Sigla Standards, PHIC Accreditation
and DOH Licensing Standards.
◗ DRUG MANAGEMENT SYSTEM
The laws and policies listed below govern the procurement of drugs, other drug products, health
supplies, and equipment of LGUs. They also provide guidelines on making medicines more
accessible and affordable.
The basic role of LGUs in the drug management system is the procurement, marketing, distribution,
and sale of safe, cheap but good-quality drugs needed by the majority of citizens.
LGU MANDATES UNDER THE DRUG MANAGEMENT SYSTEM

Administrative Order Authority of DIRFO directors to DOH, 26 May 1995

No. 10, s. 1995 purchase drugs, medical, and dental
supplies for vertical public health
programs implemented by their units
and as assistance to LGUs and NGOs as
partners in national health
development.
Administrative Order Addendum to the implementing DOH, 10 October 1997

No. 23, s. 1997 guidelines on the purchase of drugs
and medicines by LGUs.
Administrative Order Guidelines and procedures on the DOH, 22 December 1998

No. 27, s. 1998 accreditation of government suppliers
for pharmaceutical products.
Administrative Order Procurement guidelines for drugs and DOH, 29 April 1999
No. 13c, s. 1999 medicines.
Administrative Order Amendment to AO 2a, s. 1999 regarding DOH, 30 June 1999

No. 22, s. 1999 the accreditation of suppliers.
Administrative Order Guidelines for the DOH, 3 November 1999

No. 47, s. 1999 implementation/operations of the
expansion of the Gamot sa Presyong
DOH (Medicine at DOH Prices).
Administrative Order Creation of Joint DOH-DTI AO 23a, s. DOH, 7 April 2000

No. 23a, s. 2000 2000 regarding the creation of a Joint
DOH-DTI Task Force on Pharmaceutical
Concerns.
2 HEALTH
Administrative Order Policies and guidelines on over-the- DOH, 9 March 2000

No. 23c, s. 2000 counter drugs and drug products.
Administrative Order Amendment of Joint DOH-DTI Task DOH, 2 March 2000

No. 32-1, s. 2000 Force on Pharmaceutical Concerns.
Administrative Order Procurement benchmarks. DOH, 10 May 2000

No. 50-1, s. 2000
Administrative Order Policies and guidelines governing the DOH, 13 July 2000
No. 82, s. 2000 sale by drug outlets of generic
alternatives at discounted prices.
Administrative Order Registration requirements for a DOH, 14 July 2000

No. 85, s. 2000 government agency importing a
pharmaceutical product with a
registered counterpart brand in the
Philippines.
Administrative Order Additional guidelines on the DOH, 25 September 2000

No. 119, s. 2000 promotion of OTC drugs to the public.
Administrative Order Rules and regulations on generic-

No. 130, s. 2000 prescribing by government physicians. DOH, 10 October 2000
Administrative Order Granting of provisional accreditation DOH, 26 February 2001

No. 1, s. 2001 to pharmaceuticals suppliers.
Administrative Order Guidelines and procedures in the use DOH, 20 December 2001
No. 69, s. 2001 of funds for drug importation and
distribution for the Pharma 50 Project
implementation/operations of the
expansion of the Gamot sa Presyong
DOH.
Administrative Order Licensing of Botika ng Barangay in DOH, 3 January 2002

No. 70, s. 2001 various LGUs.
Administrative Order Amendment to AO 117, s. 2000 DOH, 24 January 2001

No. 177, s. 2001 relative to the guidelines on the
accreditation of suppliers of medical
equipment, parts, accessories, and
medical equipment repair shops.
Administrative Order Policy guidelines and procedures in DOH, 29 May 2002

No. 122, s. 2002 implementation of the P60,000,000
financial assistance from the PCSO for
the purchase of drugs and medicines
by the DTI through the Philippine
International Trade Corporation to be
sold in government hospitals.
2 HEALTH
◗ HEALTH FINANCING/SOCIAL HEALTH INSURANCE
The mandates below provide policy support for the financial sustainability of the health service
delivery system. This support is particularly relevant to the viability of inter-local health zones.
The basic role of LGUs in health financing and social health insurance is to extend health protection
to as many of their constituents as possible, especially the poor who can ill-afford to get sick.
LGU MANDATES UNDER HEALTH FINANCING
Republic Act 7875 An act instituting a National Health Also known as the National Health
Insurance Program for all Filipinos and Insurance Law. This mandates the
establishing the Philippine Health PHIC or PhilHealth to provide
Insurance Corporation for the purpose. universal coverage of social health
insurance to all, especially the poor.
Republic Act 8291 An act expanding and increasing the PD 1140 as amended
coverage and benefits of the GSIS,
instituting performance therein, and
for other purposes.
Administrative Order Management of the indigency fund at DOH, 14 August 2000

No. 101a, s. 2000 the DOH specialty hospitals.
◗ SPECIFIC HEALTH CONCERNS
The LGUs also have specific mandates related to their participation in national health programs like
the Sentrong Sigla, the Anti-Polio Drive, and the Philippine Quality Award.
LGU MANDATES UNDER SPECIFIC HEALTH CONCERNS
Republic Act 9013 An act establishing the Philippine RA 9013 encourages organizations in
Quality Award. the private and public sectors to attain
excellence in the production and/or
delivery of their goods and services.
Administrative Order Guidelines on routine immunization of DOH, 15 January 1996

No. 1a, s. 1996 infants during Knock Out Polio Days.
Administrative Order Guidelines to operationalize the DOH, 26 March 1999

No. 12, s. 1999 voluntary redeployment of CO
personnel.
Administrative Order Policies and guidelines in the conduct DOH, 30 January 2001
No. 22, s. 1999 of local and foreign medical and
surgical missions.
Administrative Order Voluntary redeployment of CO DOH, 6 July 1999

No. 24, s. 1999 personnel to RHO/retained hospitals.
Administrative Order Adolescent and youth health policy. DOH, 10 April 2000
No. 34a, s. 2000
Administrative Order Reproductive health policy. DOH, 24 April 2000

No. 43a, s. 2000
2 HEALTH
Administrative Order Guidelines on the handling and DOH, 30 October 2000

No. 144, s. 2000 treatment of children involved in
armed conflict.
Administrative Order Implementing guidelines for the DOH, 15 March 2001

No. 7, s. 2001 provision of grants and technical
assistance in support of the
implementation of the Sentrong Sigla
Movement 2002 (Center of Health
Movement 2002).
Administrative Order Guidelines for the implementation of DOH, 26 June 2001

No. 30, s. 2001 the LGU Performance Program for
2001-2002.
3
IMPLEMENTATION & POLICY ISSUES
AND RECOMMENDATIONS
T
IMPLEMENTATION & POLICY ISSUES AND RECOMMENDATIONS
CHAPTER
he Philippines faces tremendous challenges in the health sector: making devolution work;
ensuring community participation in the delivery of health services; recruiting, retaining, and
building the capability of health personnel; and financing and implementing health service
programs. The country can surmount these challenges only through the enactment and implementation
3
of comprehensive reforms. Local government units (LGUs) have a major role to play in pursuing
and undertaking these reforms. In carrying out their role, LGUs have encountered implementation
and policy issues, to which recommendations have been identified. The issues are grouped into
functions normally carried out by a health service organization or LGU. The categories are:
Institutional Development
Devolution and Community Participation
Human Resource Development
Support Functions: Health Research, Education, and Information
Health Care Financing

Public spending for health
Making quality health services accessible and affordable for all

Delivery of Public Health Programs and Services
Management of Health Facilities
Procurement of Medicines and Other Health Products by the Government and Citizens
The reforms are classified into two. First, reforms that can be undertaken by the LGU and secondly
Reforms that LGUs can advocate to the national executive and legislative bodies. The Leagues
(municipalities, cities, and provinces) are LGU mechanisms through which policy advocacy and
development are pursued at the national level.
3 HEALTH
❙ INSTITUTIONAL DEVELOPMENT
◗ DEVOLUTION AND COMMUNITY PARTICIPATION
The years immediately following devolution saw the fragmentation of the health system. Planning
was done inconsistently and individually by LGUs without regard for the larger picture. Priorities
changed depending on the local chief executive. One positive result of devolution, however, was
the opportunities it presented for the participation of people’s and non-government organizations
in local special bodies like the Local Health Board and the Local Development Councils. These
opportunities have injected energy and creativity into the local health sector. To continue the gains
made by devolution and to remedy its ill effects, the following reforms are recommended:
ON DEVOLUTION AND COMMUNITY PARTICIPATION
Issues and Concerns Recommendations
Cooperation and integration of Can be undertaken by the LGUs:

LGUs and other stakeholders Empowering the local health board— policies, implementation of
Operationalization of local health health programs, budget, and BHW membership approval
boards Institutionalizing NGO-PO-GO cooperation at all levels (barangay,
Determining priority health municipal, provincial and national levels)*
programs and activities Establishing and strengthening inter-local health systems and their subsystems
Integration of health services (integrated health planning, referral system, health information system, drug
management with long-term management, human resource development, and financial management)*
development plan of LGUs Ensuring continuity of relevant health programs regardless of who the
Partnerships and alternative secretary of health or the local chief executive is*
strategies for health services
delivery Can be advocated by the LGUs:
Redefining the functional relationship between regional offices and LGUs
especially as provider of technical assistance and setting standards
Developing and strengthening health programs and policies in the DILG
*Can be undertaken by the LGU in collaboration with the national government
IMPLEMENTATION & POLICY ISSUES AND RECOMMENDATIONS 3
◗ HUMAN RESOURCE DEVELOPMENT
The Philippine public health system suffers from the inadequate number and competence of health
workers. Poor salaries and the lack of opportunities for continuing development make the public sector
unattractive as a lasting career option. More rewarding opportunities abroad and in the private sector
have reduced the ranks of doctors and nurses working in the public sector. Inconsistencies in the
compensation and rewards systems at the local level have led many resident doctors in district
hospitals to leave their posts and seek employment as municipal doctors because the latter position
paid more. The distribution of health professionals, like doctors and nurses, remains lopsided in favor
of Metro Manila and the country's urban metropolitan centers-to the neglect of rural municipalities
and villages. To address these problems, the following reforms are recommended:
ON HEALTH HUMAN RESOURCES
Inadequate number and Can be undertaken by the LGUs:

competence of health workers Implement RA 7883 Barangay Health Workers incentives and
Recruitment, selection, continuing education, non-monetary benefits
performance evaluation and Develop career path for health officials and employees at the local level
merit promotion plan Implement the benefits under the Magna Carta for Health Workers*
Career path, continuing Promote Code of Ethics for the health workers*
education and development Increase the number and availability of midwives, nurses and doctors*
Tenure, compensation, benefits, Encourage public recognition of outstanding health workers*
incentives, and rewards system Develop a system to compensate capable and competent health
workers with integrity*
Can be advocated by the LGUs:

Develop a system to encourage doctors, midwives, and nurses to work
outside Metro Manila and other urban metropolitan centers
* Can be undertaken by the LGU in collaboration with the national government
3 HEALTH
◗ SUPPORT FUNCTIONS: HEALTH RESEARCH, EDUCATION AND INFORMATION
The timeliness, quality, and efficiency of health services delivery depend on the quality of the
supporting services or functions. To improve the quality of support services and functions, the
following reforms are recommended:
ON HEALTH RESEARCH, EDUCATION, AND INFORMATION
No common agenda and Can be undertaken by the LGUs:

coordination regarding health Can be undertaken by the LGUs:
research Encourage or even require medical and paramedical
Western-oriented, curative- students/graduates to render rural or urban poor service*
oriented health education Institutionalize information/public information units up to the
Lack of qualified medical barangay level to improve health intelligence/statistics*
personnel in poor and rural Develop the Patient’s Rights Code*
communities Raise consciousness of people’s/patient’s/consumer’s rights in
Lack of awareness among people relation to malpractice*
about patients’ rights
Strengthen inter-agency cooperation on various aspects of health
research (Health Intelligence Service, PCHRD, Department of Science
and Technology)
Develop common research agenda that would be implemented
extensively
Change curricula of all health workers to include traditional and
alternative/complementary medicine, gender sensitivity, preventive
health care, primary health care, and cultural sensitivity
Continue stepladder health education program
❙ HEALTH CARE FINANCING
◗ PUBLIC SPENDING FOR HEALTH
The World Health Organization (WHO) recommends that governments spend a minimum of five
(5) percent of GNP for health. However, the Philippines has yet to reach that standard. Moreover,
public expenditure is erratic and is often at the mercy of changing priorities, budget cutbacks, reserve
requirements, and budget deficits. To address the problems of sufficiency and security in funding,
the following reforms/steps are recommended:
ON PUBLIC SPENDING FOR HEALTH
Inadequate funding Can be undertaken by the LGUs:

Inefficient sourcing Increase the Internal Revenue Allotment (IRA) for health to a fixed
Ineffective allocation percentage
Sustainable local budgetary Increase budget for health to five (5) percent of national and local budget*
provisions Provide fiscal government autonomy to hospitals to reduce their
dependence on direct subsidies from government. The resources freed
up could be channeled to priority health programs.*
Set up trust funds for health programs and health facilities like hospitals*
Adopt multi-year budgets*

Augment the health budget of poor municipalities
Establish and develop the National Health Finance Program to define
sources of funds for various public health programs
Review the indemnity insurance in relation to the quality and cost of
services in hospitals
3 HEALTH
◗ MAKING QUALITY HEALTH SERVICES ACCESSIBLE AND

AFFORDABLE TO THE POOR
People cover the cost of medicines, consultation, diagnostic tests, and hospitalization largely
from their savings. Many of the poor forego seeking medical attention because of the high cost
of health care. While there are many Health Maintenance Organizations (HMOs), the cost of
enrollment or membership is beyond the reach of many. Strict admission standards also disqualify
many who have chronic illnesses like diabetes, hypertension, etc. Some of these HMOs have so poorly
managed their finances and operations that they fail to deliver the promised package of benefits
to their members. Moreover, health insurance benefits are biased toward hospital-based care
when most Filipinos require outpatient care. To ease the financial burden of the poor and provide
them to quality health services, the following reforms are recommended:
ON MAKING QUALITY HEALTH SERVICES ACCESSIBLE AND AFFORDABLE TO THE POOR
Access to and financing of Can be undertaken by the LGUs:

quality health care, especially by Increase enrollment into the PHIC’s social health insurance program
the poor and the marginalized Institute means test for indigents*
Develop and strengthen community-based health financing schemes
and seek ways to link them up to the national health insurance
program*

Address gaps, put safeguards, and review the National Health
Insurance Act
Regulate Health Maintenance Organizations (HMOs)
* Can be undertaken by the LGU in collaboration with the national government
❙ DELIVERING QUALITY HEALTH SERVICES
◗ DELIVERY OF PUBLIC HEALTH PROGRAMS AND SERVICES
To make public health programs and services more responsive to the needs of citizens and to improve
quality, the following reforms are recommended:
ON PUBLIC HEALTH SERVICES
Effective health services delivery Can be undertaken by the LGUs:

by LGUs Prioritize public health and preventive services*
Prioritization of relevant health Establish a National Preventive Health Program*
programs Set up the National Public Health Standards for major public health
Sustainability of community- programs
based health programs Institutionalize community-based health programs*
Health-seeking behavior of Integrate public health and hospital services in health facilities*
communities Integrate traditional/indigenous and alternative/complementary
health care into the mainstream of health care delivery system while
taking into account rich cultural nuances*
Develop a policy and program to consolidate all emergency medical
services in the country with regard to disaster preparedness to
establish the necessary protocol in giving adequate, timely,
appropriate medical care to emergency cases, and giving adequate
hospital care (Pinoy 911)*
Develop and strengthen policies on anti-smoking with sanctions for
smoking practices in public places*
Develop and strengthen other legislation and policies on lifestyle-
related diseases and environmental health*
3 HEALTH

Develop the National Policy on Mental Health
(Mental Health Code)
Develop the National Nutrition Code to include
fortification of other basic food commodities and
address other types of micronutrient
malnutrition
Develop the National Commission on
Occupational Health, Safety and Compensation
to address the needs of health workers in a
rapidly industrializing society
Establish a health environment and protection
agency that addresses health and environment
hazards/risks
Advocate the Civil Protection Act, to rationalize
and demilitarize disaster mitigation efforts and
transfer them to the health and civilian sectors·
Develop a national land use plan to show the
cities/urban areas, agricultural lands, forest lands,
sources of water and the site of various industries
*Can be undertaken by the LGU in collaboration with the

national government
◗ MANAGEMENT OF HEALTH FACILITIES
Physical facilities, equipment, and services of devolved hospitals deteriorated after the Local
Government Code was passed in 1991. The morale of health workers dropped as budgets decreased.
There are several reasons for diminished funding of devolved hospitals:
Insufficiency of the IRA given to provinces to meet the cost of the devolved hospitals.
The number and size of devolved hospitals exceeded the needs of the localities. Before
devolution, construction of hospitals proceeded without any sound basis regarding size,
coverage, and number. Legislation to construct provincial and district facilities did not meet local
resistance since the facilities were to be funded with national sources.
Bureaucratic Procedures. After devolution, local executives had to confront bureaucratic
procedures to get funds for salaries and MOOE items. It was noted that a devolved set-up required
at least 17 signatures (compared to two to three signatures before devolution) needed for
purchases to be made, and involved a delay of at least two months before medicines and
other supplies were delivered.
Delays in the repair and maintenance of hospital facilities and equipment further aggravate the
lack of funding and slow disbursement of funds for hospital operations. During the years prior to
devolution, no capital outlays were budgeted for the renovation or repair of facilities of devolved
hospitals.
To restore the morale of hospital personnel, rehabilitate facilities, and purchase new equipment
for hospitals, the following reforms are recommended:
3 HEALTH
ON HEALTH FACILITIES
Adequacy and resources of Can be undertaken by the LGUs:

health facilities Expansion of the fund allotment system for the hospitals. This would
Management of LGU health assure hospitals of funding without experiencing undue delays.·
facilities Upgrade of regional, provincial, district and municipal hospitals*
Increase of the number of hospitals at local levels
Advocacy and encouragement of hospital income retention and
other revenue enhancing methods*

Conversion of all leprosaria to general hospitals, health training
centers, or turn them over to LGUs
Legislation covering national health facilities development
Comprehensive national health facilities enhancement program to
rationalize hospital development, infrastructure, and equipment
support throughout the country
Involvement of health NGOs in hearings on privatization of specialty
hospitals
Review of monitoring systems that check on compliance with
standards of hospital accreditation
◗ PROCUREMENT OF MEDICINES AND OTHER HEALTH PRODUCTS BY

GOVERNMENT AND CITIZENS
The purchase of medicines, supplies, and other health products constitute the bulk of the
procurement of government hospitals. Most of the citizens' out-of-pocket expenses for health go
to medicines, especially maintenance medicines. A comparative study of involved ASEAN nations
shows that prices of medicine in the Philippines are significantly higher compared to its neighbors.
To bring down the cost of medicines, the following reforms are recommended:
ON DRUGS AND OTHER HEALTH PRODUCTS
Access to reasonably-priced but Can be undertaken by the LGUs:

safe and effective drugs Procurement of drugs in bulk*
Safety and efficacy of other Encouragement of local production of drugs and other health
health products products*
Strict implementation of the Generics Law, with amendments to
include stiffer penalties*
Rationalization of drug procurement in government hospitals by
adopting scientific tools like ABC and VEN analyses**

Continuation and expansion of parallel drug importation
Creation of the Philippine Pharmaceutical Institute to address
research problems, especially in the pharmaceutical field, and to take
care of medicine importation
Streamlining the bureaucracy to facilitate the procurement of health
products and make the process more transparent
Implementation of PhilHealth’s policy of limiting its drug
reimbursements
3 HEALTH
Regulation of the price of drugs, organic foods, food supplements,

and herbal medicines
Development and implementation of national guidelines on Botika
sa Barangay
Creation of a Bureau of Health Technology to expand the mandate of
DOH over products and processes to include foreign health equipment
and technology that will increase with globalization of trade
Advocacy to urge the President to exercise presidential powers as
mandated in Section 4 on the Tariffs and Customs law to reduce
protective measures and duties on essential drugs
Updating the Philippine National Drug Formulary

**For an explanation of what ABC and VEN analyses were, please refer to Chapter 4,
specifically the case study on Pangasinan Province's Pooling Hospital Drug
Procurement.
4
GOOD PRACTICES IN HEALTH
SERVICE DELIVERY
GOOD PRACTICES in health service delivery CHAPTER
The 19 cases presented in this chapter illustrate effective responses of LGUs to specific issues and
problems in delivering health services. The 19 cases are clustered into three general headings:
4
Planning Health Service Delivery
Financing Health Service Delivery
The two cases under the Planning section show how two cities responded to the problem of
inadequate information that was hampering effective planning, response, and assessment. The
city of Malaybalay in Bukidnon was the prototype for the Community Based Monitoring and
Information System that identified the needs of vulnerable groups in the community. The system
has since been adopted by many other LGUs. The City of Bago in Negros Occidental pioneered the
installation of a Community Disease Surveillance System (CDSS), the elements of which became
the basis for a training program that has been rolled out to other LGUs.
Financing Service Delivery is a perennial challenge for many LGUs. The ten (10) cases show different
ways by which LGUs confronted the problem of insufficient funding.
One way is by raising funds. Funds can be raised from various sources. Bucking opposition, the
Municipality of Malalag in Davao del Sur charged socialized fees from the users of its health
services. Sagay City in Negros Occidental and the Municipality of Bindoy in Negros Oriental both
availed of the matching grant scheme to provide health insurance coverage to their indigents. In
setting up a Community Clinic and related facilities, the Municipality of Sebaste in Antique entered
into joint ventures with private practitioners and companies and mobilized the funds of overseas
Filipino workers and Filipino communities abroad.
4 HEALTH
A second way of ensuring the viability of health service delivery is by increasing efficiency. There
are many ways of doing this. Provincial and city hospitals in Negros Oriental, Misamis Occidental,
Bulacan, and Pasay and Roxas Cities are using computers to better track and allocate costs among
different units. The Province of Capiz availed of the Parallel Drug Importation Scheme to purchase
affordable but quality drugs. The Province of Pangasinan pooled the procurement of its hospitals,
resulting in savings and greater availability of drugs and medical supplies.
A third way of ensuring continuous funding for health facilities and services is by introducing sound
financial management policies and mechanisms. Quezon Province established a trust fund for its
provincial hospital, a portion of which came from the hospital’s own earnings. With this scheme,
hospital administrators could no longer blame the budget office for lack of funds. It also served as
an incentive for these same administrators to use resources more efficiently and to increase revenues
from operations, knowing full well that the surplus and savings would be ploughed back to the
hospital. The Province of Negros Occidental instituted a performance-based sub-granting scheme
for its municipalities to prod them to improve the delivery of health services. In neighboring Negros
Oriental, Bayawan City, and the Municipalities of Basay and Sta. Catalina, they organized themselves
into an interlocal health zone to implement a district-approach matching grant program.
The third section contains seven cases on delivering services. Often, many well-intentioned
programs and projects fail because they are unable to gain the support of the community. The
Municipality of Sampaloc in Quezon Province illustrates how people’s organizations (POs) can be
mobilized to recruit members for a social health insurance scheme. The case of Surigao City shows
the benefits of mobilizing and organizing women to address the poor health-seeking behavior of
the community and to promote primary health care programs. In Irosin, Sorsogon, the municipal
government organized and utilized the expertise of traditional healers to serve as frontline health
workers.
GOOD PRACTICES IN HEALTH SERVICE DELIVERY 4
Another reason for the failure of projects lies in the mismatch between the design and needs of
the target group. Talisay City in Cebu Province managed the problem of finances and poor health-
seeking behavior of the community by giving personalized call slips to delinquent clients. The
personalized call slips made the people feel that they were important to the local government.
Another critical element in project design is the incentives for proper behavior. San Jose del
Monte in Bulacan rewarded mothers who availed of the municipality’s feeding and immunization
services and whose babies showed signs of improvement after a prescribed period.
The last two cases emphasize the importance of not only doing things right, but also delivering
services with the highest quality. The Pangasinan Provincial Hospital in San Carlos City introduced
the Japanese 5S quality system to address poor hospital management and to instill a culture of
service excellence within the organization. A culture of excellence and quality can only be
achieved if employees are experiencing high morale. The Municipal Mayor of San Luis in Aurora
Province knew this and sought to motivate health workers by ensuring that their salaries were paid
on time and that they had the requisite resources. The mayor also tapped volunteers to assist in
the municipality’s health projects.
❙ PLANNING health SERVICE DELIVERY
Excellent service delivery begins with a sound plan. A sound plan fits the service-its features and
delivery system-to the needs of citizens, and stretches the capacity of the service organization. A
sound plan is realistically idealistic; it reaches up to achieve a vision or goal while remaining
grounded in the realities of both the service organization and the citizen-clients.
A sound service plan is backed up by relevant, timely, accurate and reliable information, and
systems to collect that information, analyze, store, and periodically update them. Two cities,
Malaybalay in Bukidnon and Bago City in Negros Occidental, established such systems.
4 HEALTH
Planning HEALTH Service Delivery

USING A COMMUNITY-BASED MONITORING AND INFORMATION SYSTEM
(CBMIS) TO REDUCE UNMET NEEDS: MALAYBALAY CITY, BUKIDNON
Project Description
Contact Information:
The City of Malaybalay established and maintained a CBMIS to identify and
City Health Officer
Malaybalay City prioritize women who have unmet needs for family planning and, along with their
Health Office children, are in need of health services.
Bukidnon
Tel. No.: (088) 813-
What is CBMIS?
2750, (088) 221-2242
CBMIS is a system of gathering information and giving feedback, operated and
maintained by the community itself. CBMIS aims to provide decision-makers and
service providers relevant, timely, accurate, and reliable information on the nutritional and
health status of a specific barangay or purok, especially the unmet needs of its more
vulnerable members like children, women, and elderly so that the appropriate programs
and projects can be planned and designed.
How was CBMIS set up?
Mobilization of households and data collection team

In Malaybalay, the City Health Office mobilized approximately 500 households to collect
household data. The data collection team was composed of barangay health workers (BHWs),
barangay nutrition scholars, barangay kagawads on health, and other community volunteers.
Conduct of a household survey

The team conducted a survey and completed family profiles for permanent residents or
those who had lived in the barangay for at least six months.
PLANNING HEALTH SERVICE DELIVERY Malaybalay City
Establishment of a color-coded master list for target clients.

The target clients were children between zero to four (0-4) years old in need of vaccinations included
in the Expanded Program on Immunization (EPI) and Vitamin A supplementation, and pregnant and non-
pregnant women of reproductive age in need of tetanus toxoid vaccinations and family planning
services. At the end of the survey, the midwife checked the individual family profiles under her
jurisdiction. With the BHWs, they established a color-coded master list of individuals for each barangay.
This facilitated the tracking of unmet needs and the updating of family profiles.
How was the CBMIS sustained or updated?

The color-coded master list made it easier for the BHWs to pinpoint the people or families who had unmet
needs and identify what these unmet needs were. The BHWs prioritized these families. The BHWs’ visit
served as an occasion to update the master list, which was done every month. To sustain the CBMIS,
Malaybalay invested in:
The capability building of BHWs
The production of an information and education kit
A handbook written in Cebuano covering topics such as maternal and childcare, breastfeeding,
nutrition, family planning, infectious diseases and the management of diarrhea
What are the benefits of having a CBMIS?

Focusing services on priority clients
The monthly updating of the family profiles allowed the City Health Office to focus its services on
priority clients.
Improvement in acceptance of family planning, immunization rates for women and children
The CBMIS led to improvements in family planning, the vaccination of children less than 12 years old
against six diseases, tetanus toxoid immunization for women, and the provision of vitamin A
supplements for children between 12 to 59 months old.
Source: Department of Health. List of Sentrong Sigla Awardees
4 HEALTH
Planning HEALTH Service Delivery

MONITORING THE OUTBREAK OF DISEASES:
BAGO CITY, NEGROS OCCIDENTAL
Project Description
City Health Officer
In 2000, the City of Bago established a community-based surveillance
Bago City Health Office
Negros Occidental system (CDSS) that was intended to:
Tel. No.: (034) 461-0196, Provide early warning about disease outbreaks
(034) 461-0118 Formulate and carry out appropriate and timely interventions
Determine trends of diseases under surveillance
Describe the demographic characteristics of identified cases
Assess the effectiveness of health interventions using the CBMIS that Bago City has
implemented as a complementary data-gathering system
Generate information that can be used to lobby for more support for health
How is a CDSS installed?
The Bago City Health Office received technical assistance from the Management Sciences
for Health (MSH), a consulting firm for USAID-funded health projects in the Philippines. The
system entails the following:
Study tour
Staff of the health office went on a study tour at the Epidemiology and Disease Surveillance
Unit of Parañaque City, the only LGU in the country with a computerized CDSS, to observe
and learn about its system.
PLANNING HEALTH SERVICE DELIVERY Bago City
Training course
The Bago City Health Office then held a five-day training course on the CDSS for its health staff. The course
included training in the use of epidemiological information for database management and an analysis.
Adoption of existing worksheets

To speed up the installation of the CDSS, the group agreed to adopt the worksheets developed by
Parañaque City.
What are the important considerations in setting up the system?
Involvement of epidemiologists
During the planning stage, it is important to involve national and regional epidemiologists (specialists
who track diseases in the population) to ensure support for implementation.
Complementation among local health surveillance systems and support for the national level
surveillance system
Complementation means the use of common information systems, common reporting formats and
disease naming, and consensus on a common set of diseases that the whole Philippine surveillance system
will track over and above those that would be specifically monitored by a local surveillance system. Local
level surveillance systems must complement each other and provide support for a national level
surveillance system.
What are the diseases that the CDSS monitored?

The CDSS of Bago City was designed to monitor 13 diseases, among them, animal bites, dengue
hemorrhagic fever, diarrheal disease, measles, typhoid fever, cholera, and viral hepatitis.
4 HEALTH
Bago City PLANNING HEALTH SERVICE DELIVERY
Who are involved in the Community-Based Disease Surveillance System?
The important actors in the CDSS are:

the barangay health workers (BHWs)
the surveillance officers
City Health Office staff of nurses, doctors, and midwives
How does it work?
The CDSS follows a six-step process:

1. The midwife or the BHW identifies the cases.
2. The midwife completes the individual treatment record (ITR) and CDSS worksheet.
3. The midwife submits the CDSS worksheet to the surveillance officer at the end of the week.
4. The surveillance officers enter the clinical data gathered, using the EPI information.
5. The surveillance officers prepare reports for dissemination.
6. The City Health Office takes appropriate actions based on recommendations.
What are the benefits from a CDSS?
Faster response to outbreaks

In Bago City, the installation of the CDSS enabled local health managers to respond to outbreaks
immediately.
Aid to assessing the adequacy of preventive measures

CDSS complemented the operations of the CBMIS. The system helped local health workers assess the
adequacy of preventive measures such as immunization and micronutrient supplementation.
PLANNING HEALTH SERVICE DELIVERY Bago City
Better information for decision-makers

The CDSS informed local politicians about the city’s health problems, encouraging them to provide support
to health programs and services.
Provides a basis for LGU training course

On a wider scale, Bago City’s experience became the basis for a training course to prepare other LGUs
for setting up a basic disease surveillance system and conducting outbreak investigations. Several LGUs
in Negros Island and Iloilo Province have availed of this training course.
Source: Department of Health. Sentrong Sigla, 1999
❙ FINANCING HEALTH SERVICE DELIVERY
The quality of services and the timeliness and cost-efficiency of their delivery depend upon a sound
financial base and the steady flow of funds. There are three strategies that can achieve financial
stability:
Raising Funds
Increasing Efficiency
Sound Financial Management Policies and Mechanisms
◗ RAISING FUNDS
Funds can be raised from internal and external sources. One way is by charging fees from the users
of health services and facilities.
4 HEALTH
FINANCING HEALTH SERVICE DELIVERY

CHARGING USER FEES FOR BASIC HEALTH SERVICES:
MUNICIPALITY OF MALALAG, DAVAO DEL SUR
Project Description:
Municipal Health
Officer In 1993, the municipal government of Malalag passed the Malalag Revenue
Municipality of Malalag Code that, among others, charged fees for basic health services using a
Malalag, Davao del Sur socialized scheme. Like many changes, the Code met resistance from the
Telefax: 109-082-1987114
people, which the opposition party exploited. Some of the municipal
or 109-082-1987116
councilors who voted for the Code lost their seats in the next election. In
time and through consultations, information and education campaigns, the
people came around to paying the fees, and more importantly, developed a sense of
responsibility that were numbed by dole-outs for many years.
What is a socialized payment scheme?
A socialized payment scheme charges fees for services on the basis of the customer’s
capacity to pay. The wealthier members of the community pay more than the poorer
members.
What are its advantages and disadvantages?

The scheme makes it possible for the poor to access basic services without unduly
burdening them. The difficulty lies in determining whether the person is really poor.
People tend to understate their income to pay less.
FINANCING HEALTH SERVICE DELIVERY Malalag, Davao del Sur
Under what circumstances is a socialized payment scheme most likely to work?

A socialized payment scheme works best in a small setting like Malalag, where everyone knows almost
everybody, and where information about a person’s economic status is easy to gather or verify. For a
socialized payment scheme to work, there must be significant differences in the income or economic
situation of users. Otherwise, a flat rate might be best. In areas where there are many providers of the
same service, it is important to know how much “competitors” are charging. Making richer clients pay
more than what competitors charge may push richer clients to shift to rival health providers, making
it less likely for the socialized scheme to work.
How does charging socialized user fees affect the behavior of clients and of health personnel?
Now that the people of Malalag are paying to maintain their health, they have become more conscious
of the quality of services. This motivates the staff of the rural health units and the municipal health office
to perform better. If raising revenues from users are difficult despite a socialized payment scheme, the
LGUs can try raising the money from external sources like:
National government funds consisting of grants and subsidies lodged in national programs like Anti-
TB and “Garantisadong Pambata”
Official Development Assistance (ODA) in the form of grants and loans
Private donations both within and outside the LGU—in cash or health commodities or services
from individuals, philanthropic organizations, corporate foundations, nongovernment organizations,
i.e., “Kapwa Ko, Mahal Ko”
Loans provided by government and private financing institutions
Bond issuances
Joint ventures with the private sector
Social health insurance schemes implemented by the Philippine Health Insurance Corporation and
by cooperatives, self-help groups, people’s organizations and locally- based associations
Source: Galing Pook, 1996.
4 HEALTH
PROVIDING SOCIAL HEALTH INSURANCE COVERAGE THROUGH A

MATCHING GRANT SCHEME: SAGAY CITY, NEGROS OCCIDENTAL
Project Description
Contact Information
City Health Officer
City Health Office of Sagay City in the Province of Negros Occidental was one of the first LGUs
Sagay, Negros Occidental to enroll in the Matching Grant Program of the Department of Health
Tel No.: 034-4880114 (DOH). Under this program, an LGU set aside a portion of its health budget
Fax No.: 034-4880187
for social health insurance, which was matched by PhilHealth giving a
proportionate amount. The program had two phases:
Phase 1 consisted largely of hospital benefits.

Phase 2 included a capitation fund that provided for out-patient or out-patient care.
How can an LGU provide social health insurance through a matching grant
program?
Social health insurance aims to provide coverage to poor, non-formally employed members
of the community by having an LGU and the National Government share the cost of the
premium through the Philippine Health Insurance Corporation.
An LGU or a group of LGUs enters into a Memorandum of Agreement with PhilHealth to

enroll a number of indigent or poor residents. The LGU pays a set portion of the premium,
while PhilHealth covers the rest. The enrollees receive an ID that identifies them as a
member and entitles them and their qualified family members to a package of benefits.
FINANCING HEALTH SERVICE DELIVERY Sagay City, Negros Occidental
LGU partnerships are the best set-up because they maximize leverage. Leverage occurs when partners
make small individual contributions and are able to access and use a pool of funds larger than the amount
they could access individually. For an annual contribution or premium of P118.80 per enrollee, a
member is entitled to a package of benefits 10 to 20 times larger than that amount.
What are the benefits of being a PhilHealth member?
PhilHealth extends to its members the following benefit package:
“Unified” Regular In-Patient and Out-Patient Program

room and board
services of health care professionals
diagnostic, laboratory, and other medical examination services
prescription drugs and biologicals
in-patient education packages
out-patient services, e.g., chemotherapy, radiotherapy, hemodialysis, cataract extraction, minor
surgical procedures performed in an operating room complex
Special Programs (through LGU-managed Rural Health Units)

out-patient diagnostic package
other programs as may be determined by PhilHealth board
Who benefited from the social health insurance of Sagay?
Phase 1 of the Social Health Insurance for Indigents of Sagay served monthly an average of 50 clients
who stayed in the hospital for an average of three days. Sagay’s main health center also served 90
PhilHealth members. The center gave first priority to these clients.
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Sagay City, Negros Occidental FINANCING HEALTH SERVICE DELIVERY
What is a capitation fund and how does it work?
A capitation fund is a means of guaranteeing the LGUs a return for their premium. PhilHealth paid the
LGUs for the services rendered by RHUs and devolved hospitals to PhilHealth members.
A capitation fund released money to the LGU on a regular basis. To avail of the fund, Sagay had to obtain
accreditation for its main health center. Use of the fund was governed by guidelines, among them, limiting
spending for administrative purposes to only 20 percent of the released amount.
What were the benefits under Phase 2 of the capitation fund?
Under the capitation fund, the members in Sagay enjoyed free chest X-rays. The City Health Office provided
the X-ray films to the district hospital for the use of the referred PhilHealth clients.
What are some of the issues/challenges in social health insurance?
Identifying the Poor

Programs targeted for the poor like Social Health Insurance often face problems in separating the
poor and non-poor and making sure that only the poor get the benefits. Preventing “political enrollees”
is another problem. One way to prevent this from happening is to institute means testing. Means
testing involves the development and administration of an instrument (usually a questionnaire) to
determine a person’s poverty and hence, his eligibility to join the program. An example of a means test
is the Community-Based Information System-Minimum Basic Needs survey done by local social welfare
offices.
FINANCING HEALTH SERVICE DELIVERY Sagay City, Negros Occidental
Access
Another issue faced by a social health insurance program is access. While the program can enroll many,
membership is useless if necessary facilities like hospitals and pharmacies are either: absent in the locality;
costly to access; or, in the case of hospitals, are not accredited by PhilHealth. The lack of access and the
means to gain access are one of the main reasons why utilization levels among the poor, especially those
in the rural areas, remain low.
Limitations in the Benefit Package

Limitations in the benefit package also discouraged many LGUs to enroll. The package consisted largely
of hospital-provided benefits. Most people had illnesses that did not require hospitalization. This is one
reason why PhilHealth devised the capitation fund.
How would this affect LGU-initiated social health insurance schemes and other LGU programs?
Existing LGU-initiated social health insurance schemes can complement the Matching Grant Scheme by
increasing the benefits provided by PhilHealth, or by addressing gaps or needs not addressed by the
partnership (for example, maintenance medicine for chronic illnesses). Social health insurance can
free resources that otherwise would have been used for programs such as Aid to Individuals in Crisis
Situations and charity patients.
In the neighboring province of Negros Oriental, the municipality of Bindoy also started its own Social
Health Insurance and PhilHealth Capitation Fund.
Source: Management Sciences for Health and Johns Hopkins University. Tulong-Sulong sa Kalusugan (Health Sector Reform Agenda)
Kit. Manila: Management Sciences for Health and Johns Hopkins University, 2002.
4 HEALTH
MEDICARE PARA SA MASA:

MUNICIPALITY OF BINDOY, NEGROS ORIENTAL
Project Description
Contact information:
Office of the Mayor
Bindoy, Negros Oriental Bindoy is the first LGU in Region 7 to have its Rural Health Unit accredited
Tel. No.: (0912) 890-3616 in the Out-Patient Consultation Benefit Package. A PhilHealth representative
introduced the Out-Patient Consultation Benefit Package (OPCBP) in
August 2001. The municipality signed a Memorandum of Agreement (MOA) with PhilHealth
in October 2001.
Bindoy’s Sangguniang Bayan passed a resolution in January 2002 committing P100,000.00

as PhilHealth premium subsidy. The PhilHealth Capitation Fund was created. The Association
of Barangay Captains (ABC) of Bindoy also passed a resolution committing one percent of
their Internal Revenue Allotment (IRA) as counterpart funding.
Distribution of identification cards (IDs) followed the CBIS-MBN (Community-Based

Information System and Minimum Basic Needs) survey in January. In February 2002, IDs
were distributed to 784 initial enrollees. In April, another batch consisting of 898 people
were enrolled. In May 2002, Bindoy received P107,000 as Capitation Fund for the first
784 enrollees. In June 2002, another 2,076 people from 394 households were enrolled.
All told, Bindoy’s “Medicare para sa Masa” had a total fund of P563,700.00 , in 2002 from
the Barangay Internal Revenue Allotment, the municipal counterpart, the provincial
FINANCING HEALTH SERVICE DELIVERY Bindoy, Negros Oriental
counterpart, and the BINATA-Inter-Local Health Zone LGU counterpart. This amount was expected to
enroll about 4,744 households at a premium contribution of P118.80 per household.
Funds are available for health insurance and for the delivery of certain services. But money for health
infrastructure is not as easy to obtain. Infrastructure projects require a bigger budget that would have
to be raised from a variety of sources. They also require a variety of financing schemes.
Source: Tulong-Sulong sa Kalusugan, 2001.
4 HEALTH

MOBILIZING OVERSEAS FILIPINOS’ SAVINGS AND USING JOINT VENTURES
TO BUILD A COMMUNITY CLINIC: MUNICIPALITY OF SEBASTE, ANTIQUE
Project Description
Contact Information
Officer-in-Charge
Sebaste Lying-In Clinic Like many municipalities in the country, Sebaste had a Rural Health Center
Sebaste, Antique manned by a government physician, a public health nurse, six midwives,
and a sanitary inspector. The Center operated on a standard office schedule,
opening at 8:00 a.m. and closing shop at 5:00 p.m. Beyond these hours, residents had no place
to bring their sick.
Moreover, the lone government physician was not always present, being away at various times
on official travel to the Provincial Health Office in San Jose or to the Regional Health Office
in Iloilo City. Also, the Health Center could not accommodate patients who required
prolonged hospitalization and surgery. Even simple laboratory tests could not be done in
the Health Center.
To address this problem, Mayor Juanita de la Cruz worked to set up a community clinic in
the municipality. She allotted funds for the community clinic from the Development Fund
of the IRA. Knowing these efforts were inadequate, the Sebaste Municipal government
sought the help of residents who had migrated to Germany and Austria. Throughout the
whole province, Sebaste was known as the dollar capital of Antique because of the significant
number of its populace (mostly nurses) working abroad. Mayor de la Cruz herself went to
Europe to drum up support for the project.
FINANCING HEALTH SERVICE DELIVERY Sebaste, Antique
Her visit and proddings led to the formation of the Eugene Daberto Memorial Foundation (EDABEM) in
Austria and the Capiznon, Ilonggo, Aklanon, Antiquenhon Association (CIAA) in Austria. These two
associations raised funds among themselves and from other funding agencies in Europe that enabled
the municipality to purchase medicines, supplies, and medical equipment, including an ambulance.
To deal with the problem of funding the establishment of an in-house pharmacy, laboratory, and
dental facilities, the municipal government entered into a joint venture with Gerden, a private business
firm supplying pharmaceutical products and services. For the dental clinic, it entered into a partnership
with a local dentist.
What were the terms of the joint ventures?
The private pharmaceutical supply firm set up a pharmacy and laboratory and brought in its own
employees to operate the facilities. The Sebaste municipal government received 10 percent of the
income and exercised regulatory functions over Gerden’s pricing. The municipal government also
entered into a joint venture agreement with a local dentist. The dentist himself provided the equipment
and services, while the LGU provided the building for a clinic and children’s ward, funded through the
Countryside Development Fund (CDF) of the local congressman.
What were the services available in the community clinic?
The Sebaste community clinic had the following facilities:

Pharmacy
Laboratory
Dental Clinic
Ambulance
Five beds (initially)
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Sebaste, Antique FINANCING HEALTH SERVICE DELIVERY
It had two physicians, four nurses, three nursing attendants, two utility workers, one security guard,
and four volunteers.
It was open 24 hours a day and provided the following services:

Primary health care
Early detection and intervention
Dental care
Laboratory
In-House pharmacy
Minor surgery
Longer stay-in hours
What were the benefits of setting up a community clinic?
Savings in Time and Money

Before the clinic was established, the nearest government hospital was four kilometers away in the town
of Pandan. But Sebaste residents preferred to bring their sick to a secondary hospital 20 kilometers away
because it had better facilities and better trained personnel. Transportation to and from Sebaste was limited
and expensive. Whenever there were emergencies, residents had to spend from P500.00 to P1,000.00
for transportation alone.
Accessible Source of Reasonably-Priced Medicines

Since the clinic also had a pharmacy, the residents of Sebaste had an accessible source of medicines at
regulated and reasonable prices.
Source: Galing Pook, 1998.
◗ INCREASING EFFICIENCY
Increasing efficiency is the second strategy for achieving a sound financial position. The cost
drivers of a particular service should first be identified. Cost drivers are the 20 percent of cost items
that eat up 80 percent of the total cost. This is easier said than done, for often, many health units,
especially hospitals, have no system for monitoring and allocating expenditures among their
different service units.
Expenses are primarily recorded according to the budgetary line items prescribed by the Department
of Budget and Management (DBM) and in conformity with the government’s accounting manual.
There is no monitoring of expenses per hospital unit, much less relating these expenses to the quality
and quantity of the services delivered. Expenses are allowed as long as they are done within
approved or accepted guidelines; their necessity is not questioned. But all of these are changing.
Among government policy makers, health practitioners, public hospital staff, and the general
public, there is a growing awareness and acceptance of the need to monitor public expenditures.
4 HEALTH
MONITORING AND ALLOCATING COSTS IN GOVERNMENT HOSPITALS:

PROVINCIAL HOSPITALS OF MISAMIS OCCIDENTAL AND NEGROS
ORIENTAL; PASAY CITY GENERAL HOSPITAL, ROXAS MEMORIAL
HOSPITAL, AND BULACAN PROVINCIAL HOSPITAL
Contact Information
Provincial Health Officer
Oroqueta, Misamis HOSPICAL or the Hospital Cost Allocation tool was developed by the
Occidental Management Sciences for Health (MSH) during a project with the Kenyan
Telefax: 088-5311529 Health Ministry. HOSPICAL is a spreadsheet-based software that is relatively
simple and easy to use. It had been pre-tested in three local hospitals, and is
Dumaguete City, Negros in various phases of being rolled out in the provincial hospitals of Misamis
Oriental Occidental and Negros Oriental, and in the Pasay City General Hospital, Roxas
Tel # 0352550950/2252615 Memorial Provincial Hospital, and Bulacan Provincial Hospital.
City Health Officer
Pasay City Hall What are the resources and preparations needed for installing and
FB Harrison, Pasay City operating a HOSPICAL system?
Telefax: 02-8318201
The experiences of the five pilot hospitals showed that the successful
Bulacan Provincial Hospitalinstallation of the system required the following:
Mojan, Malolos, Bulacan Enough time given to hospital staff to participate in data collection
Telefax # 044-7910630 Records of actual budget expenditures being within easy reach of those
participating in the costing exercise
Enough computer units
Training to build the confidence of hospital staff who do not have enough experience
with spreadsheet operations and who prefer manual encoding
FINANCING HEALTH SERVICE DELIVERY Monitoring and Allocating Costs in Government Hospitals
How does one choose a monitoring and evaluation systems software?
Nowadays, monitoring and evaluation systems come in software packages. One can opt to purchase off-
the-shelf software or commission the development of customized software. The choice would depend
on the following considerations:
Budget
The needs of the hospital vis-à-vis the features of off-the-shelf software available in the market
The need to interface with other critical players in the information environment
The ease and cost of upgrading
The possibility of sharing costs with other hospitals and LGU units
What steps were followed in instituting and rolling out HOSPICAL?
The first step was pre-testing. HOSPICAL was pre-tested in at least three hospitals. A team then reviewed
the software and the manual, discussing approaches and potential problems in adopting the tool in LGU
hospitals. Based on their feedback, HOSPICAL was adopted in LGU hospitals.
Rolling out the cost allocation tool followed four phases:

1. Formation of a costing core group in each of the hospitals, a general orientation on the HOSPICAL
cost allocation tool, and orientation on building the HOSPICAL database
2. Actual data collection and encoding
3. Analysis of results and presentation to hospital officials and core group
3. Training selected hospital staff in managing the HOSPICAL tool
Who were involved in instituting the tool?
An important step in instituting the tool was the formation of a costing core group whose task was to
4 HEALTH
Monitoring and Allocating Costs in Government Hospitals FINANCING HEALTH SERVICE DELIVERY
supervise the costing exercise. The members of this core group were either knowledgeable about the
financial operations of the hospital or were familiar with the activities of the hospital’s major divisions/units.
The following could be members of the costing core group:

Administrative Officer
Chief of Clinics or Hospital Chief
Pharmacist
Supply Officer (CSR)
Bookkeeper
Maintenance/engineer/building administrator
Personnel Officer
Chief Nurse
Billing and Collections Clerk
Records Officer
Medical Social Worker (optional)
What were the common problems or issues encountered in the costing exercise?
Padded procurement costs of drugs and medicines which made it difficult to estimate the real cost
Difficulty in estimating the actual level of effort needed by the different service divisions of the hospital
due to the detailing of hospital personnel in the provincial capitol, and inconsistency between the
job description of some hospital personnel and the actual tasks they were performing.
HOSPICAL data requirements were not consistent with the data recording and reporting system in
most of the hospitals
Too much political interference hindered the appropriate classification of patients
FINANCING HEALTH SERVICE DELIVERY Monitoring and Allocating Costs in Government Hospitals
What are the benefits of doing a good cost allocation exercise?
Accurate Estimation of Cost

The hospital can easily determine how much it actually takes to deliver a particular service. How much
does a caesarian delivery cost? How much is the room and board? How much is the anesthesiologist’s
fee? This will make financial planning easier. It will also allow the hospital to estimate how much it needs
to charge patients to recover cost and generate a surplus.
Identification of Revenue and Cost Centers

Revenue centers and cost centers can be determined. From there, transforming cost centers into
revenue centers can be planned, or if that is not possible, reducing their cost or allocating them
accordingly across the whole organization.
Performance Measurement
The cost information can be related to the quality and quantity of the services delivered to come up with
a comprehensive picture of the performance of a unit or whole organization.
Benchmarking with Similar Hospitals and the Industry’s Standard

With this information, the hospital can compare itself with its competitors or with the so-called industry
standard to find out how it stands. From there, it can develop the appropriate strategies and plans to
strengthen and improve performance. Once the cost drivers are identified, the second step is to find ways
of reducing them. Drugs are a common expense of patients, whether inside or outside the hospital. They
also eat up a large portion of the Maintenance and Operating Expenses (MOOE) of government hospitals.
A patient’s health insurance coverage or a provincial trust fund will not go a long way unless the prices of
drugs are brought down to more affordable levels. Two provinces—Capiz and Pangasinan—succeeded in
this effort. The former tapped alternative and cheaper sources; the latter re-engineered its procurement process.
Source: Management Sciences for Health (MSH) for the Department of Health
4 HEALTH
MAKING HIGH-QUALITY DRUGS AFFORDABLE THROUGH

PARALLEL DRUG IMPORTATION: PROVINCE OF CAPIZ
Project Description
Contact Information
Provincial Health Office The province of Capiz in the island of Panay, Western Visayas is a pilot
Roxas City, Capiz area for PhilHealth’s Health Passport Program that aims to achieve universal
Tel. No.: (036) 621-0320 health coverage. The program’s success, however, was threatened by the
lack of high quality affordable medicines in pharmacies that were located
in the vicinity. In 2000, the provincial government purchased medicines
under the Parallel Drug Importation (PDI) scheme implemented by the Philippine International
Trading Corporation (PITC) of the Department of Trade and Industry (DTI).
What is parallel drug importation?
Parallel drug importation is a program undertaken by the government aimed at lowering

the prices of drugs in the country. Under the program, the government—through the
Philippine International Trading Corporation (PITC)—imports drugs from cheaper sources
(e.g., manufacturers in India) and distributes them to pharmacies in government hospitals.
What and how much resources were used by Capiz for PDI?
Capiz’s parallel drug importation had an initial budget of P1 million—P500,000 from the
Operationalization of the Inter-local Health Zones (ILHZ) and P500,000 in counterpart
funding from the 20 percent Development Fund of the province.
FINANCING HEALTH SERVICE DELIVERY Province of Capiz
What kinds of drugs are best purchased through PDI?
The best drugs that could be imported through PDI are expensive and maintenance drugs for chronic
illnesses like hypertension, asthma, and diabetes, as well as expensive drugs to treat tuberculosis.
Because these are maintenance medicines, the demand for them is steady, and government pharmacies
are sure to have regular customers. Making them accessible and affordable improves the patients’
compliance with the treatment regimen, which is crucial in curing TB and managing chronic illnesses.
The first and second deliveries of PDI drugs to Capiz consisted of four drugs:
Nifedipine (Adalat) for hypertension
Gibenclamide (Daonil) for diabetes
Cotrimoxazole (Bactrim) for infections
Salbutamol (Ventolin) for asthma
What systems/mechanisms or resources are required for PDI to work?
Affordable drugs are useless unless they are also credible and accessible. Critical to the success of PDI
is a good marketing system.
Effective Marketing
The job of a marketing strategy is to prove that although drugs are cheap and its brands are not well
known, these are as effective as expensive and branded drugs. A marketing program has to prove and
communicate this fact to doctors whose cooperation is crucial since the law declares that drugs could
not be sold without prescription. Thus doctors are the point of contact between the product and the
buyer. In Capiz, the first delivery sold out in just a month. News traveled fast through the radio, by word
of mouth, and a few key idealistic doctors who told their fellow doctors about the effectiveness of the
medicines.
4 HEALTH
Province of Capiz FINANCING HEALTH SERVICE DELIVERY
A Good Distribution Network

After proving the drugs’ effectiveness, the next task is to make them accessible to people. The Capiz
provincial government distributed the drugs to government hospital pharmacies located at the center
of the province’s five Inter-Local Health Zones.
Equitable Purchase Policies

Meanwhile, policies were crafted to ensure that as many people as possible benefited from the drugs.
The provincial government set the maximum quantity that could be bought at one month’s supply for
maintenance medicines and a week’s full course for antibiotics.
What are the benefits of PDI?
Based on the Capiz experience, the following were the benefits of PDI:
Improved Patient Compliance with Treatment Guidelines

With lower prices, patients could afford to buy the drugs, thereby improving their compliance with
treatment.
Greater Variety of Drugs

With poor people being able to pay for affordable drugs, the trust fund for medicines did not run out
and even grew, allowing the provincial government to import four more kinds of drugs.
Enhanced Reputation of Government Hospitals

With PDI, government hospitals acquired a good reputation. People patronized the pharmacies as a source
of affordable and good quality medicines.
FINANCING HEALTH SERVICE DELIVERY Province of Capiz
Reduced Prices of Drugs Procured by Other Means

Finally, the provincial government used the success of the program as leverage in its negotiations with
a multinational pharmaceutical firm. It succeeded in getting the firm to lower its selling price for a drug
from P390.00 to P150.00 per vial, resulting in a discount of more than 50 percent.
How could the program be sustained and expanded?
The provincial government imposed a mark-up of 30 percent of the acquisition cost. The provincial
accountant created a separate book for recording the sales of medicines. The sales were deposited in
a trust fund from which subsequent purchases were charged. For wider distribution, the provincial
government thought of tapping private pharmacies and encouraged municipalities to make PDI an
economic enterprise.
Source: Tulong-Sulong sa Kalusugan, 2001.
4 HEALTH
POOLING HOSPITAL DRUG PROCUREMENT: PROVINCE OF PANGASINAN
Project Description
Contact Information
Provincial Population
Officer In 1998, Pangasinan Governor Victor Agbayani embarked on a program to
Provincial Population Office improve the quality of hospital operations including drug procurement.
Lingayen, Pangasinan The program covered all 14 hospitals managed by the province. With the
Te. No.: (075) 542-6349,
help of Management Sciences for Health (MSH), the governor ordered the
(075) 542-3981
pooling of the drug procurement of all 14 hospitals.
What are required for pooling drug procurement?
Preparatory Meetings
Setting up the system started with a series of meetings with hospital chiefs, General Services
Office (GSO) staff, hospital staff, and suppliers. MSH conducted interviews with key LGU officials
and personnel concerning the LGU’s standard operating procedures in procurement.
Training
The hospital staff was trained in the use of VEN analysis and ABC analysis to help them prepare
the annual procurement plan.
Familiarity with and Use of Critical Information

The staff had to be familiar with the leading causes of illnesses and deaths in the locality, the
treatment protocols, and the Philippine National Drug Formulary (PNDF). These served as
the bases for the preparation of the annual procurement plan.
FINANCING HEALTH SERVICE DELIVERY Province of Pangasinan
An Active Hospital Therapeutic Committee

Procurement regulations required that the hospital’s annual procurement plan should be reviewed by
a Hospital Therapeutic Committee before it is finalized. Pooling forced the hospitals to revive their Hospital
Therapeutic Committees.
What is a procurement plan?
An annual procurement plan contains the items that the organization will purchase for the year—including
price, specifications, and quantity.
What is the Philippine National Drug Formulary?
The Philippine National Drug Formulary (PNDF) is a list of drugs that are most essential for common local
diseases and conditions. It also describes the appropriate use of these essential drugs. The use of the
PNDF as a basis for the government’s drug procurement was made mandatory by Executive Order No.
49 issued in 1993 by then President Fidel Ramos.
What is VEN analysis?
VEN stands for Vital, Essential, and Non-Essential. Drugs can be classified according to these categories
depending on different sets of criteria. One set of criteria is the locality’s profile of causes of death and
illnesses. Drugs that are vital are those needed to address the Top 10 leading causes of illness in the locality.
Another set of criteria is found in the Philippine National Drug Formulary (PNDF). The drugs are
considered Vital, Essential, and Non-Essential based on the frequency of occurrence of the illness, the
number of persons affected, the severity of the conditions, and the action of the drug.
4 HEALTH
Province of Pangasinan FINANCING HEALTH SERVICE DELIVERY
What is ABC analysis?
A-B-C analysis is one way of organizing purchases and inventory according to degrees of importance,
usually measured in pesos used or bought. Belonging to the A category are items that are very
important. Those in Category B are items that are moderately important; and those in Category C are
least important. Items under Category A generally account for about 15 to 20 percent of the number
of items that are purchased or kept in inventory but they constitute 60 to 70 percent of the total cost
of purchases. At the opposite end, Category C items may account for about 60 percent of the number
of items purchased, but only about 10 percent of the total purchase cost.
How do ABC and VEN analyses help in rationalizing drug procurement and reducing drug
expenditures?
Relating ABC to VEN analysis, a hospital’s procurement plan is rational if all items in Categories A and B
are drugs listed as vital and essential. Non-essential drugs should never be in Category A. Money is saved
if the hospital concentrates on purchasing the right kind of drugs (vital and essential) and buys them
at the most reasonable prices.
What are the benefits of pooling the procurement of drugs?
Sizeable savings are made due to the ability to purchase in bulk, the avoidance of expensive and
frequent emergency purchases, and improved and more competitive bidding procedures
Better quality products are more available because of the quality inspection measures instituted at
the hospital. If the products delivered are unacceptable, the end-user completes a Product Problem
Report submitted to the Hospital Therapeutic Committee. The Hospital Therapeutic Committee
sends drug preparations suspected of being of poor quality to the Bureau of Food and Drug for analysis.
FINANCING HEALTH SERVICE DELIVERY Province of Pangasinan
Procurement is processed faster because of lesser paperwork involved in both hospitals and the
provincial General Services Office that handles procurement.
Stocks are available in hospitals every quarter; purchase requests are prepared by the hospital every quarter.
The inventory system is better controlled because of the introduction of a common inventory
control system in all 14 hospitals.
Hospital Therapeutic Committees are revitalized.
Source: Sentrong Sigla, 1998
◗ SOUND FINANCIAL MANAGEMENT POLICIES AND MECHANISMS
Before 1992, hospitals were permitted by the Department of Health to set up their own trust funds.
With devolution, most LGUs prohibited hospitals from maintaining these trust funds. Instead,
hospitals were required to give all receipts or incomes derived from the operation and provision
of services to the Provincial Treasury, where these funds became part of the general fund. This system
led to a general deterioration in the quality of services, shortages in medicine and supplies, and
overall financial distress for the hospitals. These were caused by:
The removal of any incentive for the hospitals to earn more from their operations, since there
was no certainty that the funds would be returned to them
Changing priorities in allocation every year
Delays in procurement, as purchase requests had to pass through the budget officer
The provincial government of Quezon realized the ill effects of this practice early on and included
hospitals in its provincial Trust Fund account.
4 HEALTH
ENSURING FINANCIAL STABILITY OF HOSPITALS

THROUGH PROVINCIAL TRUST FUNDS: PROVINCE OF QUEZON
Contact Information
Integrated Provincial In 1993, Quezon province received a considerable increase in its IRA. The
Health Office increase was intended to cover the costs of devolution like salaries and
QMH Compound, benefits of devolved personnel. Departing from the usual practice of many
Quezon Ave.
LGUs, the provincial government included hospitals in the provincial Trust
Lucena City
Tel # 042-7102440 Fund account.
Fax # 042-7103444
The inclusion allowed them to remit to the fund income from medical and
operating room supplies, X-ray, laboratory, ambulance, and other kinds of fees. Income from
hospital services such as accommodation and subsistence allowance, and physicians’ and
anesthesiologists’fees were remitted to the provincial government as part of the general fund.
What is the General Fund?
The general fund is used to account for monies and resources that may be received by and
disbursed from the local treasury. The general fund is available for the payment of
expenditures, obligations or purposes that are not specifically declared by law as accruing
and chargeable to, or payable from any other fund. (RA 7160, section 308)
FINANCING HEALTH SERVICE DELIVERY Province of Quezon
What is a Trust Fund?
A trust fund consists of private and public monies that have officially come into the possession of the
local government or a local government official as a trustee, agent, or administrator. A trust fund can
only be used for the specific purpose for which it was created.
What are the advantages of a Trust Fund?
Earmarked for Specific Purposes

Funds held in trust are earmarked or set aside for specific purposes. Earmarking assures funding for items
that hospitals need on a continuous and regular basis like medicines and supplies like cotton, syringes,
etc. It also protects these items from changing priorities in allocation.
Faster Processing Time

Processing time is also faster, since purchase requests for items to be charged to the trust fund need not
pass through the LGU’s budget office. The reduction in processing time is crucial during emergencies.
How does a Trust Fund work?
In the 14 hospitals, trust funds were used for medicines, hospital supplies, emergency materials, and
equipment. The Provincial Health Officer and the Chief of Hospitals made a request to the Sanggunian
Chair for Health, who, as a member of the Local Health Board, then sponsored a resolution for the request.
The Sanggunian approved the request.
What is required to make a Trust Fund work?
The success of the trust fund in Quezon was made possible by a hospital cashiering system that
4 HEALTH
Province of Quezon FINANCING HEALTH SERVICE DELIVERY
accounted, classified, and segregated the hospital receipts and remitted the fees and charges to the
appropriate fund. The module was part of the HAMIS Information System for Hospitals piloted in
Quezon Memorial Hospital, and later expanded to all hospitals within the province.
What were the benefits of a Trust Fund?
Faster Access to Funds

The trust fund allowed greater and faster access to funds, a large part of which the hospitals themselves
generated.
Purchase of New Equipment

With greater access to funds, the Quezon Memorial Hospital succeeded in purchasing new equipment
like an X-ray machine, an electrocardiogram unit, air conditioner, and an ionic enzyme analyzer.
Who benefited from the Trust Fund?
Hospital staff
Hospital management, nurses, and doctors immediately felt the benefits in the form of better working
conditions and better equipment for training and use. Staff morale rose with these improvements.
Hospital patients, especially the poor

In the end, the patients of the hospital, many of whom were poor, benefited from better equipment and
availability of emergency supplies. Sound financial management involves the development of mechanisms
to maximize the often-limited funds available to LGUs. Tying together financing with performance
provides incentives to deliver quality services.
Source: Gems and Jewels, 1996.

MAXIMIZING THE USE OF FUNDS THROUGH
SUB-GRANTING: PROVINCE OF NEGROS OCCIDENTAL
Project Description
Contact Information
Negros Occidental was among the first group of grantees under the LGU Provicial Health Officer
Performance Program (LPP) of the DOH. The province was expected to Provincial Administration
Center
achieve the project’s benchmarks for child immunization, tetanus toxoid Capitol, Bacolod City,
immunization, vitamin A supplementation, and contraceptive prevalence Negros Occidental
rate by the year 2000. As an incentive, all grantees that achieved the Tel.# 034-4340671
benchmarks before 2000 received premiums. Negros Occidental was one Telefax # 034-4323362
of the LPP Top Performers.
To maximize the use of its premium grant, Negros Occidental decided to subgrant 70 percent
of the amount to select municipalities and component cities, enabling them to expand and
improve the delivery of their health services.
How did sub-granting work?
Soliciting Proposals
During the initial phase, the province solicited proposals from municipalities and component
cities that did not qualify under the Matching Grant Program (MGP) of the DOH. The
selection of sub-grantees was based primarily on the quality of their proposal, which
means that the activities should generate demand, expand the delivery of sustainable and
high-quality health services, and demonstrate a measurable impact on service coverage
within 12 months.
4 HEALTH
Negros Occidental FINANCING HEALTH SERVICE DELIVERY
Providing Counterparts
The LGUs should also commit counterpart funds equal to at least 25 percent of the maximum sub-grant
of P100,000 per LGU.
Ensuring Accountability
To ensure accountability, each sub-grantee was required to designate a coordinator, open a separate
trust fund account, and submit a quarterly progress and financial report. They were also required to
establish a community-based monitoring and information system (CBMIS).
What are the advantages of sub-granting compared to other modes of providing assistance?
Greater Flexibility
Compared to in-kind assistance, sub-granting gave the recipients more power to decide on and
implement specific projects needed by their citizens. In-kind assistance normally did not distinguish
between the different municipalities, and unlike cash, could not easily be shifted to urgent concerns.
Stronger Partnerships and Ownership of the Projects

Sub-granting also fostered partnerships between the province and the municipalities. The partnership
and ownership of the projects would not have been as strong if the grant were managed from a central
office.
More Efficient Fund Allocation

Asking for proposals and setting criteria for choosing the recipients allowed the province to direct the
use of available resources on priority localities and activities. If the funds were divided equally among
all municipalities, significant impact would not have been attained.
FINANCING HEALTH SERVICE DELIVERY Negros Occidental
Greater Commitment
The requirement for counterpart funds ensured commitment from the recipients. It communicated the
message that the funds were not a dole-out.
Performance-Driven
Setting performance standards and accountability measures ensured that the funds would be used
properly and poured into activities that would have an immediate impact.
A different way of implementing the Matching Grant Program (MGP) happened in the neighboring
province of Negros Oriental. Instead of proceeding vertically from province to municipalities, the
scheme adopted a district approach.
Source: Sentrong Sigla, 1999.
4 HEALTH

A DISTRICT APPROACH TO IMPLEMENTING THE MATCHING GRANT
PROGRAM: BAYAWAN CITY, BASAY AND STA. CATALINA, PROVINCE OF
NEGROS ORIENTAL
Project Description
Contact Information
Chief of Hospital and
District Health Officer The Santa Bayabas (acronym for Bayawan City, Basay, and Sta. Catalina) is
Bayawan District Hospital the only district or formal inter-LGU system currently participating in the
Bayawan City, Negros Matching Grant Program (MGP). District Health Officer Dr. Fidencio Aurelia
Oriental
enrolled the district in the MGP.
Tel. No.: (035) 531-0169;
(035) 531-0485
How does the district approach work in implementing the MGP?
The District Health Board serves as the overall policy and decision-making body for MGP
Implementation. The District Health Officer is the overall MGP Coordinator while the Bayawan
Treasurer’s Office manages the grant. The LGU counterpart comes from the district’s common
fund. The LGUs contributed to this fund based on their financial capability while the provincial
government contributed half a million pesos.
The district has an MGP Plan that serves as a roadmap for the implementation of projects. This
plan was formulated with the participation of the district office staff, the city/municipal
health officers, the nurses and midwives, and representatives from the Provincial Health
Office and Center for Health Development of Region 7. This plan was later presented to the
governor and the mayors during a workshop.
❙ DELIVERING Quality Health SERVICES
To ensure that the appropriate services are delivered when and where people want it, or offer quality
and timely service, a service organization must consider the following:
Participation of those who stand to benefit from the services and those who can influence its
delivery
Responsiveness of the delivery design and mechanisms
Commitment and culture of the service provider
◗ MOBILIZING POPULAR SUPPORT AND

GENERATING PARTICIPATION IN DELIVERING SERVICES
The participation of affected groups enhances the chances of project success and makes the
delivery of health services easier and cheaper. Ownership by the stakeholders (those affected and
those who can affect project success) increases the probability that the project will continue
even in the absence of the pioneering local official. The three cases below illustrate how organized
groups, women, and traditional healers were mobilized to participate in the delivery of vital
health services.
4 HEALTH
DELIVERING QUALITY HEALTH SERVICES
VIGOROUS RECRUITMENT IN PARTNERSHIP WITH PEOPLE’S

ORGANIZATIONS: MUNICIPALITY OF SAMPALOC, PROVINCE OF QUEZON
Project Description
Contact Information
Municipal Health Officer
Rural Health Office In 1992, the Municipality of Sampaloc, Quezon started Medicare II, a
Sampaloc, Quezon program meant to provide health insurance coverage for most of its
Tel # (109) 042-1981605 population who were not formally employed such as farmers and market
vendors.
How did the Mayor mobilize people’s organizations to recruit people into the
program?
Active Recruitment
To recruit more members, the program tapped people’s organizations and self-help groups
like the Senior Citizens’ Group, the Quezon Women’s League, the purok leaders and the
Farmers’ Association of Sampaloc to promote the program and to recruit more members.
Community-based Payment Scheme

The Farmers’ Association used its “turnuhan,” a rotating credit and savings scheme, to
alternately pay for the premium of its members.
Monitoring
The purok leaders installed purok tally boards to monitor the recruitment campaign. In the
Activities Center of the municipality, a listing of all enrolled citizens was posted in blue, while
those not enrolled were posted in red.
DELIVERING QUALITY HEALTH SERVICES Sampaloc, Quezon
What were the benefits of the program?
Better and Greater Benefits

Sampaloc’s Medicare II Program covered patient and in-patient services. With more members, the
Program provided greater and better benefits.
Protection in Times of Illness

With insurance coverage, members did not have to use up their savings, get into debt, or sell property
to have a sick member of the family treated.
More Savings for the LGU and the Hospital

As a result, there were fewer people who availed of the “Bigay Kalinga”or the Aid to Individuals in Crisis
Situations (AICS) program of the local Department of Social Welfare and Development (DSWD). The
municipality had more savings as it subsidized less of the expenses of indigents hospitalized in the
Sampaloc Medicare Hospital.
The hospital also had less charity cases. With more savings, the Sampaloc Medicare Hospital could hire
more people and purchase better equipment.
Source: Gems and Jewels, 1996
4 HEALTH
MOBILIZING WOMEN FOR PRIMARY HEALTH CARE: CITY OF SURIGAO,

PROVINCE OF SURIGAO DEL NORTE
Project Description
Contact Information
Office of the Mayor
Surigao City, Surigao del Surigao City successfully mobilized women to address the community’s lack
Norte of awareness of health programs and to promote primary health care
Tel #: (086) 8260299; programs in the different barangays. The program commenced in January
8264131
1997, equipped with a budget of P1.2 million from the local government.
The women initially started as a group of volunteer health workers
supporting the implementation of the DOH programs. They eventually formalized their
association into the Primary Health Care Federated Women’s Club. The club conducted
purok level health education activities and participated in the implementation of DOH
programs. The club also promoted income-generating projects.
What is primary health care?
Primary health care should be distinguished from primary care. Primary care covers services
like health education, maternal and child health, family planning, nutrition, supply of
essential drugs, treatment of common diseases, immunization, and control of locally
endemic diseases like malaria and dengue.
On the other hand, primary health care is a strategy—not a program or service—for

improving the health and the related needs of an individual, family, and community so that
they can enjoy life. Primary health care entails the management of all the elements involved
in meeting those needs.
DELIVERING QUALITY HEALTH SERVICES City of Surigao,Surigao del Norte
How important is the participation of women in primary health care?
In general, women look after the daily needs of family members—from planning the family’s meals,
budgeting the money, marketing, preparing food, to caring for sick children and relatives, bringing them
to the doctor, and supervising their medication. With these tasks and responsibilities already providing
family care, it is much easier to get women to volunteer for health-related activities.
Involving women in community development activities leads to the following benefits for the community:
Women’s self-esteem is enhanced
Increased participation expands the pool of leaders within the community.
Children and families consequently enjoy better health and nutrition.
What are the effects of the project?
Socio-Economic. Because of the project, the earning capacity of the members improved. Moreover, the
problem of sanitation has been addressed by the intensified environmental sanitation campaign,
especially through the construction of sanitary toilets at the purok level.
People Empowerment. The project led to the formation of a voluntary women’s organization that
provided the needed human resources for the implementation of health programs in the city. The
partnership between the City Health Office and the women’s organization tapped indigenous capacities
and strengthened community structures.
Efficiency of Delivery. Service delivery became more efficient because of the use of indigenous
capacities.
Source: Galing Pook, 1995
4 HEALTH
MOBILIZING TRADITIONAL HEALERS TO PROVIDE PRIMARY HEALTH

CARE: MUNICIPALITY OF IROSIN, PROVINCE OF SORSOGON
Project Description
Contact Information
Executive Director
LIKAS, Inc. Irosin is famous for its pioneering efforts to promote traditional medicines,
LIKAS – RIDGE Complex with its barangay herbal gardens and the accreditation of the arbularyos
Maharlika Highway, San or traditional medicine men and women. The traditional medicine men and
Pedro, Irosin, Sorsogon
women serve at the frontlines, complementing the work of barangay
Tel. No.: (109) 1984922 –
5553250; (0920) 408-8374 health workers and providing on-the-spot treatment for certain illnesses.
This freed up the barangay health centers to concentrate on other tasks.
Why mobilize traditional healers?
Despite advances in public health services, many poor people still seek remedies for all kinds
of illness from traditional healers. Traditional healers are accessible, well known, and trusted
in the community. They can also be paid in kind for their services and do not charge as much
as the doctors who reside in the poblacion or town center.
The treatments they prescribe are inexpensive and they use resources available in the
community. The former Irosin mayor, Eddie Dorotan, saw the potential of tapping these
traditional healers to support the health objectives of the municipal government.
DELIVERING QUALITY HEALTH SERVICES Irosin, Sorsogon
How were they mobilized?
The traditional healers were oriented on the basics of primary health care at the municipal health
office. During the orientation, the traditional healers also described their practices and remedies for the
benefit of the health office staff. The municipal health office staff examined these practices and remedies
in the light of basic hygiene and good health practices. After undergoing the orientation, the traditional
healers were accredited.
What duties were entrusted to traditional healers?
The traditional healers became the frontline of the municipality’s barangay health system, working
alongside barangay health workers. Traditional healers were allowed to continue prescribing remedies
proven to be safe and effective. Certain practices were discontinued such as the way they treat snake
and dog bites. Traditional healers usually sucked the blood from the wound of the bite victim, a method
found to be unsafe because infection was highly probable and facilitated the spread of other diseases
like hepatitis.
What were the benefits of mobilizing traditional healers?
Savings for the LGU

Mobilizing traditional healers saved the LGU money that would have otherwise gone into the hiring,
training, and honoraria of barangay health workers.
Savings for the Poor

The project saved the poor money that would have otherwise gone to doctors’ fees and synthetic
drugs.
4 HEALTH
Irosin, Sorsogon DELIVERING QUALITY HEALTH SERVICES
Promotion of Herbal Medicine

The project promoted the use of inexpensive, easy to grow medicinal plants and herbs. It encouraged
people to preserve and cultivate these plants.
Enhancement of Western Medicine and Preservation of Indigenous Medical Knowledge

Western medical knowledge was enriched while traditional or indigenous knowledge and practices were
preserved and enhanced.
Source: Gems and Jewels, 1996
◗ DESIGNING THE DELIVERY SYSTEM

TO MATCH THE NEEDS AND SITUATION OF THE CLIENTS
Many projects begin with good intentions and end in failure because of poor design that is not
responsive to the needs and situation of clients. Some projects fail to take into account the culture
of people, their patterns of living, capacities, location, interests and motivations. The two cases below
are models for getting the incentives right and matching the delivery system with the needs of clients.

PERSONALIZED FOLLOW-UP OF CLIENTS
THROUGH CALL SLIPS: TALISAY CITY, PROVINCE OF CEBU
Project Description
Contact Information
A Commission of Audit regulation states that incentives cannot be provided City Health Officer
to government workers for traveling within a 50-kilometer radius in the Talisay, Cebu
Tel.: (032) 2735599
fulfillment of their duties. This meant that health workers had to use their
own funds when visiting their areas. As a result, health workers stayed in the
health centers and waited for clients to come to them.
To deliver services, the health centers carried out a monthly Panagtambayayong or

outreach. In preparation for the Panagtambayayong, the barangay health workers
distributed call slips to program delinquents advising them to come to the health center
during the scheduled dates of the Panagtambayayong.
How did the Panagtambayayong work?
Panagtambayayong or outreach ran for three days, usually starting on Wednesday. An

outreach team consisted of a doctor or nurse, two or three midwives, and the volunteer health
worker of the barangay. Every member of the team received P250.00 per day as incentive.
What are personalized call slips?
Personalized call slips are sheets of paper distributed to those not diligently participating
in their program, advising them to come to the health center and indicating what services
4 HEALTH
Talisay, Cebu DELIVERING QUALITY HEALTH SERVICES
they should access. Three types of call slips were given out: one for child immunization, another for tetanus
toxoid immunization, and the third for Family Planning (FP). During the Panagtambayayong, the people
presented these call slips to health center personnel.
What makes personalized call slips effective?
The personalized call slips added a personal touch to the delivery of routine services. It indicated to the
recipients that they were important, and that health workers were concerned with their welfare. The
personalized call slips aim not merely to satisfy but to please the clients as well.
What systems/mechanisms were required to make personalized call slips effective?
Personalized call slips work only if there is an operative community-based monitoring and information system
(CBMIS), such as the one described earlier in the section on Planning Service Delivery (section A of this
chapter). This system keeps track of people in the community who have incomplete immunization or who
have not received micronutrient supplementation. Yet even if the services are already delivered at people’s
doorstep, the problem sometimes lies with the beneficiaries—their mindset, attitudes, and health practices.
What were the benefits of the personalized call slips?
The personalized call slips led to:

Improved coverage rates in immunization
Increased demand for routine health services
Stronger partnerships between health workers and barangay leaders
Allocation of medical supplies based on priorities

MOTHER–BABY WATCH: MUNICIPALITY
OF SAN JOSE DEL MONTE, PROVINCE OF BULACAN
Project Description
Contact Information
San Jose del Monte was a 1999 recipient of the LGU Performance Program- City Health Officer
Matching Grant Program (LPP). Through the Community-Based Monitoring City Health Center
City of San Jose del
and Information System (CBMIS), the municipal health office identified Monte, Bulacan
problems of poor health-seeking behavior and poor health practices among Telefax # 044-6912584
mothers. Specifically, these were in the areas of pre-natal and post-natal care,
family planning, immunization, and growth monitoring for infants and
pre-schoolers.
To address these problems, the “Mother-Baby Watch”(MBW) concept under the “Sustansya
para sa Masa”(SPM) or “Nutrition for the People”banner of the government was implemented.
How did the Mother-Baby Watch concept work?
Enrollment. The Mother-Baby Watch concept started with enrollment of high-risk pregnant
women who were screened and then monitored regularly throughout the course of their
pregnancies. At birth, their babies were likewise enrolled, and each mother-and-child
pair was followed up until the baby turned 24 months.
Issuance of MBW Cards. These cards were issued to all enrollees to keep track of the services
they used. Three types of incentive points were awarded depending on the type of service
obtained: must-points, extra points, and star points.
4 HEALTH
San Jose del Monte, Bulacan DELIVERING QUALITY HEALTH SERVICES
For Mothers:
Must points for mothers: These were issued when they had regular pre-natal check-ups or received
a tetanus toxoid shot.
Extra points for mothers: If the mothers used iodized salt and attended a health/nutrition class.
Star points for mothers: These were issued to fully immunized mothers, mothers who breastfed up
to six months, and those whose babies were fully immunized at nine months of age.
For Babies
Must points for babies: These were issued when mothers plotted monthly weights on the growth-
monitoring chart and when they introduced complementary food at the proper time.
Extra points for babies: These were issued when the mother maintained the growth chart and its trend
indicated an upward growth curve.
Star points for babies: These were issued when the baby sustained an upward growth curve during
a 12-month period.
Redemption of Points. The Municipal Health Office estimated that a mother-child pair could earn a
total of 25 points in a month. Each point was equal to one peso. Attending health personnel gave
a coupon to the mother for every 25 points earned. The mothers redeemed the coupons at designated
redemption centers, such as the main health center.
How did the LGU sustain the funding for the program?
The municipal health office mobilized and organized a group of SPM (Sustansya para sa Masa)
benefactors. Each SPM benefactor could opt to support several mother-baby pairs. Among themselves,
the SPM benefactors organized a movement to help health center personnel manage the program.
Source: Sentrong Sigla, 1999.
◗ INSTILLING QUALITY CONSCIOUSNESS AMONG SERVICE PROVIDERS
Because of devolution, the local public hospital system did not receive the attention and support
it duly deserved. This led to a mismanaged public hospital system and the delivery of unresponsive
and poor services. In the Health Sector Reform Agenda (HSRA), hospital reform was one of the key
areas because public health facilities were vital elements of the health care delivery system. The
hospital reform program under the HSRA hopes to re-establish linkages among both devolved and
retained hospitals, and to strengthen the capabilities of these hospitals to work within a decentralized
set-up and respond to the needs of the community. A critical component of the hospital reform
program is building a culture of quality among hospital staff.
4 HEALTH
QUALITY IMPROVEMENT PROGRAM

IN THE PROVINCIAL HOSPITAL: PROVINCE OF PANGASINAN
Project Description
Contact Information
Provincial Population
Officer With the help of the DOH and the United States Agency for International
Provincial Population Office Development (USAID), the Provincial Government of Pangasinan introduced
Lingayen, Pangasinan the 5S Quality Improvement Program in the Pangasinan Provincial Hospital
Tel. No.: (075) 542-6349,
in San Carlos City.
(075) 542-3981
Provincial Health Officer What is 5S?

Provincial Health Office
2/F Calantiao Bldg.,
The 5S quality improvement program was originally conceived by the
Lingayen, Pangasinan
Telefax: (075) 542-3997 Japanese to improve work standards in the industrial sector. The 5S stands
Email: for: Seiri (Sort), Shiketsu (Systematize), Seiso (Sweep), Seiton (Standardize),
pangpho2@yahoo.com and Shitsuke (Self Discipline).
Adopting the 5S program seeks to inculcate positive values in the hospital staff to make them
more organized and more responsive to the needs of hospital clients. It also seeks to make
them internalize the virtues of self-discipline, and initiate and implement improvements
without having to be told to do so.
How does it work?
5S is a method of providing fast, efficient, and appropriate services to an organization’s internal

customers. Internal customers are persons and units within the organization that use
DELIVERING QUALITY HEALTH SERVICES Province of Pangasinan
another unit’s outputs. The method satisfies internal customers by eliminating waste due to unnecessary
movement, searching, work repetition, and workplace clutter.
The first S, Seiri, means Sort Out. The organization or its units must decide which items are to be disposed.
Disposing these items saves valuable space and reduces the time wasted on searching and unnecessary
movement and travel.
The second S, Shiketsu, means Systematize. The unit must arrange the necessary items in good order
so that they can easily be retrieved when needed. The people in the organization must think where things
should be placed or stored, consider how often things are used, decide on the proper place for things
to be stored or kept, and label all cabinets/shelves and their contents.
The third S, Seiso, means Sweep. The unit must clean its workplace to avoid dust and dirt anywhere.
The unit is directed not to wait until things get dirty, set aside three minutes everyday to clean the
workplace, be responsible for the surrounding areas, never throw anything around, and staff must do
the cleaning themselves.
The fourth S, Seiton, means Standardize. The unit must always maintain a high standard of
housekeeping. The unit must continue implementing not only the first 3Ss, but instead create a
maintenance system for housekeeping. The unit must make a schedule for regular cleaning and sorting.
An inter-departmental 5S competition is also seen to help maintain this method or system.
The fifth S, Shitsuke, means Self-Discipline. This also means spontaneously doing things, without having
to be told or ordered.
4 HEALTH
Province of Pangasianan DELIVERING QUALITY HEALTH SERVICES
What were the results of the 5S program?
The 5S program was one of the major reasons behind the four-fold jump in the income of the Pangasinan
Provincial Hospital—from P2.4 million in 1998 to P10.5 million in 2000.
Hence, it is difficult for health workers to treat citizens as customers if their own organization fails to treat
them in similar fashion. Health workers serve in the frontline; yet also make up the internal customers
of the finance, procurement, and administration units of their service organizations.
Source: Management Sciences for Health (MSH) for the Department of Health.

BOOSTING MORALE AND TAPPING INTO
THE SPIRIT OF VOLUNTEERISM: MUNICIPALITY OF SAN LUIS, AURORA
Project Description
Contact Information
Immediately after devolution, Mayor Annabelle Tangson launched a Municipal Health
campaign to improve the delivery of social services in her municipality. Along Officer
San Luis, Aurora
with the Municipal Health Officer, Dr. Maria Pura Valenzuela, the mayor: (a)
rationalized the health budget; (b) minimized duplication of functions by
having one nutrition program; (c) launched health education, sanitation, and environmental
programs; (d) encouraged each barangay health center to have its own herbal garden and
every family in the municipality to grow medicinal plants; and (e) started a social health
insurance scheme.
What were the Mayor’s strategies for improving the delivery of social services?
Improving Discipline
At the start of devolution, poor discipline among the health workers was a problem.
Mayor Tangson sought to boost morale, and instill and improve discipline by making
sure health workers’ salaries were paid on time and by speeding up the procurement of
supplies. The health workers had no more reason to complain and were motivated to
perform better.
Rationalizing the Budget

A certified public accountant, the mayor introduced order into the budget. She allotted
15 percent of the municipal budget for health.
4 HEALTH
San Luis, Aurora DELIVERING QUALITY HEALTH SERVICES
Prioritizing Purchases and Promoting Preventive Medicine

Due to limited funds, the Municipal Health Office became selective about the kind of medicines they
bought. Instead of encouraging people to become dependent on dole-outs, the health workers
emphasized preventive medicine.
Encouraging Volunteerism
The mayor actively promoted volunteerism in the different projects of the municipality. The Volunteers
Club sustained the enthusiasm of the volunteers by holding parties and picnics.
Networking
Because of the limited equipment of its lying-in clinic, the municipality entered into partnerships with
hospitals in many areas. Residents in coastal barangays were consulted about which municipalities they
would find easier to go to for medical consultations.
Who benefited from the strategies?
These groups in the municipality benefited from the changes:
Health Workers. The health workers received their salaries on time and they received their supplies faster.
The Poor. Sanitation and nutrition projects benefited the poor who could not afford to get sick.
Residents of Remote Areas. Those living in the remote areas of the municipality benefited from the
partnerships created with other hospitals and municipalities.
Source: Gems and Jewels, 1996.
5
REFERENCES AND
TOOLS
❙ REFERENCES
◗ BOOKS, MANUALS AND MONOGRAPHS

REFERENCES AND TOOLS CHAPTER
5
Berman, Peter (Ed.). Health Sector Reform in Developing Countries: Making Health Development
Sustainable. Boston: Harvard University Press, 1995.
Bishops-Businessmen's Conference Livelihood Foundation, Inc. Directory of Foreign and Local

Development Assistance Agencies. 3rd Edition. Makati City: Society of St. Paul Printing Press,
1998.
Department of Health. Health Sector Reform Agenda, Philippines (1999-2004), Monograph Series
No. 2, Manila, 1999
Department of Health. National Objectives for Health, Philippines (1999-2004), Manila, 1999.
Department of Health-Environmental Health Service. Implementing Rules and Regulations of

Chapters 2, 3 and 17 of the Code on Sanitation of the Philippines (P.D. 856). Manila: Department
of Health-Environmental Health Service, 1995.
Department of Health-Environmental Health Service. Implementing Rules and Regulations of

Chapters 9, 14, 16 and 21 of the Code on Sanitation of the Philippines (P.D. 856). Manila: Department
5 HEALTH
Department of Health, Environmental Health Service. Implementing Rules and Regulations of

Chapters 5, 8, 10 and 15 of the Code on Sanitation of the Philippines (P.D. 856). Manila: Department
Department of Health, Environmental Health Service. Implementing Rules and Regulations of

Chapter 7 "Industrial Hygiene" of the Code on Sanitation of the Philippines (P.D. 856) Amending
Administrative Order No. 111 s. 1991. Manila: Department of Health-Environmental Health Service,
1999.
Department of Health-Environmental Health Service, et. al.. Environmental Health Risk Perception
Survey, Philippines. Manila: Department of Health-Environmental Health Service, College of
Public Health University of the Philippines-Manila, International Development Research Centre (IDRC),
Canada, 1998.
Department of Health Environmental Health Service, et. al. Environmental Health Risk Perception
Survey, Philippines: Executive Summary. Manila: Department of Health Environmental Health Service,
College of Public Health University of the Philippines-Manila, International Development Research
Centre (IDRC), Canada, 1998.
Department of Health-Environmental Health Service. Philippines: Environmental Health Assessment

Volumes 1,2 and 3. Manila: Department of Health-Environmental Health Service, 1996.
Department of Health-Environmental Health Service. Philippines: Environmental Health and the

Environment. Manila Department of Health-Environmental Health Service, 1996.
Department of Health Environmental Health Service, et. al. Philippines - Health and Environment:
The Vital Link. Manila: Department of Health Environmental Health Service, College of Public Health
University of the Philippines-Manila, International Development Research Centre (IDRC), Canada,
1998.
REFERENCES AND TOOLS 5
Department of Health - Environmental Health Service et.al. Philippines - Health and Environment:
The Vital Link (Executive Summary). Manila: Department of Health Environmental Health Service,
College of Public Health University of the Philippines - Manila, International Development Research
Centre (IDRC), Canada, 1998.
Department of Health Environmental Health Service, et. al. Health and Environment Intersectoral
Consultations: A Component of the Health and Environment Policy Impact Project. Manila:
Department of Health Environmental Health Service, College of Public Health University of the
Philippines - Manila, International Development Research Centre (IDRC), Canada, 1998.
Department of Health, Environmental Health Service. Philippine National Framework and Guidelines
for Environmental Health Impact Assessment. Manila: Department of Health-Environmental
Health Service, 1997.
Department of Health - Local Government Assistance and Monitoring Service (LGAMS). Health
Services and Local Autonomy. Manila: Department of Health - Local Government Assistance and
Monitoring Service (LGAMS).
Department of Health - Local Government Assistance and Monitoring Service (LGAMS). Responding
to Questions on Devolution of Health Services (Guidebook for Governors, Mayors and Members
of the Local Health Board). Part 1: Health and Development. Manila: Department of Health -
Local Government Assistance and Monitoring Service (LGAMS), 1993 (First Edition).
of the Local Health Board). Part 1: Health Planning. Manila: Department of Health - Local
Government Assistance and Monitoring Service (LGAMS), 1993 (First Edition).
5 HEALTH
of the Local Health Board). Part 1: Health Services Management. Manila: Department of Health -
Local Government Assistance and Monitoring Service (LGAMS), 1993 (First Edition).
of the Local Health Board). Part 1: The Local Health Boards. Manila: Department of Health - Local
Government Assistance and Monitoring Service (LGAMS), 1993 (First Edition).
of the Local Health Board). Annexes to Guidebooks. Manila: Department of Health - Local
Government Assistance and Monitoring Service (LGAMS). 1993 (First Edition).
Department of Health and Management Sciences for Health - Health Sector Reform Technical
Assistance Program (HSRTAP). A Handbook on Inter-Local Health Zones: District Health System in
a Devolved Setting. Manila, 2002.
Department of the Interior and Local Governments. Rules and Regulations Implementing the Local
Government Code of 1991. 1992.
Kaban Galing: The Philippine Case Bank on Innovation and Exemplary Practices in Local Governance.
Ford Foundation, United Nations Development Program (UNDP), UNICEF, Galing Pook Foundation,
Local Government Academy. 2001 Edition.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. Lifestyle-Related Diseases in the Philippines:
Areas for Health Policy and Systems Research. HPSR Monograph No 2. Manila: Department of Health
Essential National Health Research, 1998.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. Nutrition in the Philippines: Areas for
Policy and Systems Research. HPSR Monograph No 2. Manila: Department of Health Essential
National Health Research, 1998.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. The Expanded Program of Immunization
in the Philippines: Areas for Health Policy and Systems Research. HPSR Monograph No 2. Manila:
Department of Health Essential National Health Research, 1998.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. The Health of Filipino Women: Areas for Health
Policy and Systems Research. HPSR Monograph No 2. Manila: Department of Health Essential
National Health Research, 1998.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. Sexually Transmitted Diseases and HIV/AIDS
in the Philippines: Areas for Health Policy and Systems Research. HPSR Monograph No 2. Manila:
Department of Health Essential National Health Research., 1998.
Lansang, Mary Ann and Rebullida, Ma. Lourdes O., eds. Tuberculosis: Areas for Health Policy and
Systems Research. HPSR Monograph No 2. Manila: Department of Health Essential National
Health Research., 1998.
Pons, Melahi and Schwefel, Detlef, eds. Health and Management Information Systems (HAMIS) Good
Health Care Management: The Winners of the First HAMIS Contest. Manila: Department of Health
and Deutsche Gesellschaft fur Technische Zusammenarbeit, 1993.
Quimpo, Bernadette A., ed. Devolution Matters: A Documentation of Post-Devolution Experiences

in the Delivery of Health Services. Manila: Department of Health- Local Government Assistance and
Monitoring Service.
5 HEALTH
Rebullida, Ma. Lourdes G., and Elma B. Torres. Training Needs Assessment of Sanitation Officers for
Capability Building in Integrated Health and Environment in Local Government Units. Manila:
Department of Health - Health Policy Development and Planning Bureau, Foundation for Integrative
and Development Studies, University of the Philippines Center for Integrative and Development
Studies, 2002.
The Association of Foundations Philippines, Inc. Philippine NGOs: A Resource Book of Social
Development NGOs. Quezon City: The Association of Foundations Philippines, Inc., 2001.
Veneracion, Cynthia C. Community Health Development: Experiences from Rural Philippines.

Quezon City: Institute of Philippine Culture, Ateneo de Manila University, 1994.
Women's Health and Safe Motherhood Project - Partnership Component RPMU CARAGA.
Community Development Field Guide. July 2001.
Veneracion, Cynthia C. Implementing Projects and Activities for Community Health Development:
Partnership in Community Health Development Experiences, 1991-1993. Quezon City: Institute
of Philippine Culture, Ateneo de Manila University, 1994.
Veneracion, Cynthia C. Initiatives and Strategies for Community Health Development. Quezon City:
Institute of Philippine Culture, Ateneo de Manila University, 1993.
Veneracion, Cynthia C. NGOs in Primary Health Care: The Philippine Experience 1978-1998.
Quezon City: Institute of Philippine Culture, Ateneo de Manila University, 1999.
Veneracion, Cynthia C. Partnership Building and Planning for Community Health Development:
PCHD Experiences, 1990-1993. Quezon City: Institute of Philippine Culture, Ateneo de Manila
University, 1993.
Veneracion, Cynthia C. PCHD Community Project Implementation 1991-1993. Quezon City,:

Institute of Philippine Culture, Ateneo de Manila University, 1993.
◗ REPORTS AND OTHER UNPUBLISHED MATERIALS
Department of Health. List of Sentrong Sigla Awardees.
Department of Health - Matching Grant Program. MGP LGUs as of June 30, 2002.
Department of Health. National Health Planning Committee Annual Meeting. December 19,
2001. Holiday Inn, Manila.
Department of Health. Setting the Agenda for Reform, Annual Report 1999. Manila.
Department of Health - Bureau of International Health Cooperation. Pipeline Projects as of June

20, 2002.
Department of Health - Bureau of International Health Cooperation. Profile of Ongoing Foreign

Assisted Projects in the Department of Health, for CY 2002.
Department of Health - Health Policy Development and Planning Service. Governors Workshop
for Health: Partnership for Devolution. March 9-10, 1999. Westin Philippines Plaza Hotel, Manila.
HEALTHDEV Institute. Development of a Genuine People Initiated Legislative Agenda on Health.

Quezon City: HEALTHDEV Institute, 1996.
The National College of Public Administration and Governance, University of the Philippines, for
the Department of Health - Community Health Service. Primary Health Care Resource Center Project:
Profile of Institutions and PHC Practitioners - Region IX. 1998.
5 HEALTH
Profile of Institutions and PHC Practitioners - Region X. 1998.
Profile of Institutions and PHC Practitioners - Region XI. 1998.
Abstract of PHC Researches, Regions IX - XII and ARMM. 1998.
Social Development Research Center, De La Salle University, Manila for the Department of Health
- Community Health Service. Research Abstracts: NCR, Regions VI, VII, VIII, XII. 1998.
Social Development Research Center, De La Salle University, Manila. Exaltacion E. Lamberte, Alice
Manlangit and Mark Miranda. Research Abstracts: A Report Submitted to Department of Health
- Community Health Service. 1999.
Women's Health and Safe Motherhood Project - Partnerships Component. Extension Mission
Report, July 2001, Manila: Department of Health.
◗ GOVERNMENT DOCUMENTS
La Vina, Antonio GM and Aguirre, Vyva Victoria M., eds. Health Laws and Administrative Issuances,
Volume V, Department orders Part II. Quezon City: Department of Health - Health Policy Development
Program, 1994.
Department of Health - Health Policy Development and Planning Service. Listing of Administrative
Orders.
Medical Laws: Republic Act Nos. 70, 349, 1056, 2382, and 4224.
National Health Planning Committee (NHPC). LGU Health Planning Guidelines for CY 2002. A Joint
Administrative Order by DOH and DILG.
National Health Planning Committee (NHPC). LGU Health Planning Guidelines for CY 2003. Joint
Administrative Order No. 1 s 2002.
◗ JOURNALS AND PERIODICALS
"A District Approach to Implementing the Matching Grant Program." Updates from the Field:
Best Practices, No. 1 Series of 2002.
"A Health Insurance Program for Indigents." Updates from the Field: Technical Notes, No. 2 Series
2002.
Alon, Alvic P. "An ICHSP Journey to the Last Frontier." Health Beat, Issue No. 21 (November-
December 1999), 19-22.
"AusAID grants P12.75M to Bukidnon health projects." Today, August 31, 2002, 4.
"Basilan, Sulu hospitals receive support from RP-Canadian governments." Bulletin Today. August
8, 2002.
"Bringing Sterilization Services to the Main Health Center." Updates from the Field: Best Practices,
No. 2 Series of 2001.
5 HEALTH
Challenges of Providing Health Services to the Urban Poor." Updates from the Field: Best Practices,
No. 6 Series of 2001.
"Collaboration Between Local Government Units and NGOs for Bilateral Tubal Ligation in North
Cotabato." Updates from the Field: Best Practices, No. 5 Series of 2002.
"Collaborating with Population Services PILIPINAS to Provide Bilateral Tubal Ligation." Updates from
the Field: Best Practices, No. 4 Series of 2002.
"EPI Plus." Updates from the Field: Best Practices, No. 1 Series of 2000.
"Expanding the Delivery of Health Services Through a Community-Based Monitoring and Information
System." Updates from the Field: Technical Notes, No. 1 Series 2001.
"Importation of Parallel Drugs: Making High-Quality Drugs More Affordable." Updates from the Field:
Technical Notes, No. 1 Series 2002.
"Integrated Community Health Services Project. Guimaras Health Insurance Program: A Model in
Health Care Financing." Health Beat, Issue No.35 (March-April 2002), 25-28.
"Mother-Baby Watch." Updates from the Field: Best Practices, No. 2 Series of 2000.
"Personalized Client Follow-Up through Call Slips." Updates from the Field: Best Practices, No. 1 Series
of 2001.
"Pooled Pharmaceutical Procurement in Pangasinan." Updates from the Field: Technical Notes, No.
2 Series 2001.
"Promoting No-Scalpel Vasectomy: The Bago City Experience." Updates from the Field: Best
Practices, No. 2 Series of 2002.
"Responding to the Health Needs of Aetas in Lupang Pangako." Updates from the Field: Best
Practices, No. 3 Series of 2001.
"The Importance of Local Leaders in Promoting Health." Updates from the Field: Best Practices, No.
5 Series of 2001.
"Using the Community-Based Monitoring and Information System to Help Reduce Unmet Needs."
Updates from the Field: Best Practices, No. 4 Series of 2001.
"Mobilizing Resources for the Matching Grant Program." Updates from the Field: Best Practices, No.
3 Series of 2002.
"Setting Up a Community-Based Disease Surveillance System." Updates from the Field: Technical
Notes, No. 4 Series 2001.
"Strengthening Provincial-Municipal Partnerships Through Subgranting." Updates from the Field:

Technical Notes, No. 5 Series 2001.
"The Matching Grant Program: A Strategy to Expand Local Health Service Delivery." Updates from
the Field: Technical Notes, No. 6 Series 2001.
"The 2000 Family Planning Survey: Variation in Use of Modern Contraceptives." Updates from the
Field: Technical Notes, No. 3 Series 2001.
5 HEALTH
◗ BROCHURES AND FLYERS
Department of Health. A Primer on Sentrong Sigla (Philippine Quality Assurance Program).
Department of Health. Integrated Community Health Services Project: A DOH Response to the
Challenges of Devolution. Manila: Department of Health.
Department of Health - Matching Grant Program. Frequently Asked Questions. Manila: Department
of Health - Matching Grant Program.
Department of Health. German Support to the Philippine Health Sector (2001-2004). Manila:
Department of Health.
Management Sciences for Health and Johns Hopkins University. Tulong-Sulong sa Kalusugan
(Health Sector Reform Agenda) Kit. Manila: Management Sciences for Health and Johns Hopkins
University, 2002.
◗ WEBSITES
<www.msh.org> (Date of visit: July 2002)
<www.doh.gov.ph> (Date of visit: August 9 and 26, 2002.)
❙ RESOURCES FOR HEALTH SERVICE DELIVERY
◗ BILATERAL AND MULTILATERAL FOREIGN ASSISTED PROJECTS
ONGOING FOREIGN ASSISTED PROJECTS, DOH, CY 2002

Fund Source / Type Area of
Contact Title/Description
and Duration Coverage
Dr. Ma. Virginia Ala Women’s Health and Safe WB – Loan Nationwide
Head, Unified Project Motherhood Project – focus on ADB – Loan
Management Division, BIHC women of reproductive age, reduce KFW – Grant
(02) 7438301 local 1304 female morbidity and maternal EU – Grant
mortality, promote safe motherhood; AusAID – Grant
1) service delivery 2) institutional 95 – 01 Extended to
strengthening 3) community June 02
partnership 4) policy operations and
research
Ms. Cherrylyn Daus Early Childhood Development (10 yrs) ADB – Loan 6, 7, 12
Chief Health Pro-gram – ensure survival and promote WB – Loan
Officer, BIHC physical and mental development of 98 – 04
(02) 7438301local 1306, 07 young children in the worst
vulnerable and disadvantaged
segments of the population
Southern Phil Irrigation Sector Project ADB – Loan 7, 13, ARMM

(SPISP) – construct and develop 99 – 05
small/ medium scale irrigation
system, drainage facilities, intensive
cultivation of rice and other crops;
NIA, Schistosomiasis Control
Infectious Disease Surveillance and USAID – Grant CAR, 7, 12

Control Project (IDSCP) – DOH and LGUs 99 – 02
5 HEALTH

Fund Source / Typeand Area of
Duration Coverage
Dr. Criselda Abesamis Upgrading of Zamboanga City Spanish gov’t – Loan Zamboanga
National Center for Health Medical Center and Zamboanga del 02 City,
Facilities Sur Provincial Hospital 9
(02) 7438301local 1400,
1401
Construction and Equipping of the JICA – Grant 11

Outpatient and Preventive Care 99 – 02
Center of the Davao Medical Center
Project
Ms. Cecilia Pangilinan Integrated Family Planning and USAID – Grant Nationwide
(02) 7438301local 1333 Maternal Health Program – (7 yrs) Aug 99 – Sep 02
reduce unmet need for FP and
selected child health services
1) private sector/NGO
2) LGU performance program
3) National Services
Dr. Rosalinda Majarais Support to DOH Reproductive Health UNFPA – Grant 2, 6, 12, ARMM
(02) 7438301local 1305 00 – 04
Dr. Claude Bodart German Support to the Health Sector KFW – Grant Nationwide
(02) 7438301local 1340 - FP and HIV/AIDS Prevention Project- 99 – 03
Social Marketing (DKT II) condoms
and OCP· GTZ – Grant Nationwide
- Philippine – German Technical 99 – 01
Cooperation Project on Health Care
Equipment

Dr. Leo Reyntjens Belgian Integrated Agrarian Reform Belgian gov’t – Grant 7 – 46 ARCs
Dumaguete City Support Program 2 – alleviate Sep 00 – Aug 03 9 – 28 ARCs
(035) 2258680,422-9272 poverty, improve agricultural
production, uplift well-being of low-
income communities (ARCs)
Engr Bonifacio Magtibay Integrated Community Health ADB – Loan Kalinga,

781-8843781-5890 Services Project 97 – Jun 02 Apayao,
Guimaras,
AusAID – Grant Palawan,
97 – Sep 03 So. Cotabato,
Surigao del
GOP Norte
Dr. Loreto Roquero Director Family Health International/IMPACT USAID – Grant Metro Manila,
Center for Family and Jun 98 – Sep 02 Cebu City,
Environmental Health Davao City,
(02) 7438301 local 1728, Angeles City
2254, 2256
Dr. Ma. Virginia Ala 2nd Social Expenditure Project – WB – Loan

Head, Unified Proj Mgt Div, Health Component (SEMP II) – 02
BIHC accelerate HSRA implementation 1)
(02) 7438301loc 1304 improve access and quality of health
care for the poor 2) introduce
financing, regulatory and
organizational changes – for purchase
of drugs
Engr. Rolly Mercado Rural Water Supply and Sanitation ADB – Loan
(02) 7438301loc 1307 Sector Project (RW3SP) – LGUs Nov 97 – Aug 01
Extended to 02
5 HEALTH

Dr. Criselda Abesamis Hospital Development Project – Austria – Loan
National Center for Health medical/non-medical equipment of 4 01 – 03
Facilities medical centers/regional hospitals, 12
(02) 7438301local 1400, provincial hospitals, 7 district
1401 hospitals
Dr. Consorcia Lim Quizon AIDS Surveillance and Education USAID – Grant
Dir., National Epidemiology Project (ASEP) WHO – Grant
Center 92 –00 Extended to 02
(02) 7438301local 1907
Dr. Claude Bodart German Support to the Health Sector GTZ – Grant
(02) 7438301local 1340 · Social Health Insurance Networking 96 – Mar 03
Empowerment (SHINE)
· Family Health by and for Poor GTZ – Grant 4, 6, 7, 8,9, 10,
Settlers (FAMUS) – LGUs through Feb 99 – Dec 01 13,NCR
NGOs Extension proposed
Dr. Esperanza Espino Implementation and Evaluation of a AusAID – Grant

RITM Self Sustaining Community-Based 95 –00 Extended to 03
809-7599 Malaria Control – community
volunteer system health insurance
scheme, health education and
surveillance system
Dr. Loreto Roquero 5th Country Program for Children – UNICEF – Grant
Director, Center for Family Maternal and Child Friendly 99 – Dec 03
and Environmental Health Movement
(02) 7438301local 1728,
2254, 2256 Family Planning/Maternal and Child JICA – Grant
Health Project Phase II
PIPELINE PROJECTS UNDER HOSPITAL REFORM, DOH

Construction and Equipping NVBSP PHP 709M5 yrs (03-07) JICA – Grant
of the Phil Blood
Transfusion Center and 2
Regional Blood Centers
(Cebu and Davao)
Upgrading of Zamboanga CHD 9 PHP 463M Spanish

City Medical Center and government
Zamboanga del Sur
Provincial Hospital
Development of CHD 1, 5, 6, 7, 9, 10 PHP 803M JICA – Grant

Subspecialty Capabilities for Netherlands –
Heart, Lung and Kidney Loan
Patients in the Philippines
Construction of OPD Bldg CARAGA Regional Hosp (13) PHP 326M JICA – Grant
and Upgrading of Med
Equipment CARAGA
Regional Hospital
Upgrading of Medical Amai Pakpak Medical Center PHP 110M Austrian – Loan
Equip-ment and Facilities of
Amai Pakpak Medical
Center
Establishment of Women CHD – CAR PHP 2.6M British

and Children Protection CHD 7 PHP 2.49M government
Unit in BGHMC, VSMMC and CHD 11 PHP 1.76M
DMC
5 HEALTH
PIPELINE PROJECTS UNDER PUBLIC HEALTH REFORM, DOH

Japan Aid to Phil Fight Against NCDPC PHP 200M JICA

Infectious Diseases – upgrade 03 – 07
national center and sub national
centers, diagnostic, management
and surveillance system, research,
community-based prevention and
control program for parasitic
diseases
Quality TB Control Program – NCDPC PHP 117M JICA

network of TB laboratories (1 03 – 07
national, 2 regional), DOTS,
operational researches
Japan Special Aid for Children for NCDPC US$ 3.17M JICA
follow-up measles campaign Apr-Aug 03
PIPELINE PROJECTS UNDER LOCAL HEALTH SYSTEM, DOH

Hospital Equipment Assistance LGU – DILG PHP 797.67M Spanish

Project (HEAP) (Spanish loan: P 76.28M, government –
Dona Gregoria Memorial Hospital DILG: PHP 121.39M) Loan
Quirino Provincial Hospital
Masbate Provincial Hospital
Biliran Provincial Hospital
Alfredo Maranon Sr. Memorial
Hospital
Kalinga Provincial Hospital
Abra Provincial Hospital
Ifugao Provincial Hospital
San Jose City General Hospital
Rizal Provincial Hospital
Laguna Provincial Hospita
Iloilo Provincial Hospital
Dr. Locsin Memorial Hospital
Mariano J. Cuenco Provincial
Hospital
Leyte Provincial Hospital
Aurora General Hospital
Cotabato Provincial Hospital
Quezon City General Hospital
Samar Provincial Hospital
Siquijor Provincial Hospital
Upgrading of Medical Equipment Regions 9, 10, 12, ARMM No figure Finland

for Selected Government
Hospitals (Mindanao Area
Mindanao Area-Based Hospital
Development Plan)
5 HEALTH
PIPELINE PROJECTS UNDER LOCAL HEALTH SYSTEM, DOH

Upgrading of Essential Medical CHD 11 PHP 881M JICA – G

Equipment for Strategic
Government Referral Hospitals in
Southern Mindanao Region
Davao Medical Center
Davao Regional Hospital – Tagum
Montevista District Hospital
Davao Oriental Provincial Hospital
Davao del Sur Provincial Hospital
South Cotabato Provincial Hospital
General Santos City Hospital
Samal District Hospital
Lupon District Hospital
Gregorio Matas District Hospital in
Davao del Sur
Kiamba District Hospital in
Saranggani Province
PIPELINE PROJECTS - OFFICE OF THE REGIONAL GOVERNOR, ARMM

Fund Source / Type
and Duration
Upgrading of Hospitals in the Office of the Regional Governor of the Canadian International
Provinces of Sulu and Basilan Autonomous Region of Muslim Mindanao Development Agency
(UHPSB) – (ORG-ARMM) through the Department of (CIDA) and National
Sulu Provincial Hospital, Health of ARMM (DOH-ARMM) Economic Development
Luuk District Hospital, Authority (NEDA) through
Pangutaran District Hospital, the Philippines-Canada
Parang District Hospital, Development Fund (PCDF)
Siasi District Hospital,
and Lamitan District Hospital
OTHER PIPELINE PROJECT IN MINDANAO
Creating Child-Friendly Bukidnon, Agusan del Sur, AusAID and UNICEF

Families and Communities in Davao City,
Mindanao Sarangani,
(Projects in health, children in Sultan Kudarat,
need of special protection, Sulu and Zamboanga del Sur
education, communication, and
gender and development)
5 HEALTH
❙ RESOURCES FOR INTER-LOCAL HEALTH ZONES
◗ MAIN SOURCES OF FUNDS
Regular budget of the LGUs for hospitals and RHUs - through Internal Revenue Allotment
(IRA)
20% development funds of LGUs
Augmentation and subsidies for Department of Health (DOH) and Centers for Health
Development (CHD)
Congressional funds
Health insurance scheme through PhilHealth
◗ OTHER SOURCES OF FUNDS
Cost-sharing
Revenue enhancement
Utilization of income
Community-base health insurance
Bulk or pooled procurement system of drugs and supplies
Grants
Establishment of cooperatives
Fund raising
Source:
Department of Health and Management Sciences for Health - Health Sector Reform Technical Assistance Program (HSRTAP).
A Handbook on Inter-Local Health Zones: District Health System in a Devolved Setting. Manila, 2002.

Facing Up To The Health Challenge: Resource Books For LGUs

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HEALTH

Copyright @2003 Philippines-Canada Local Government Support Program

All rights reserved

The Philippines-Canada Local Government Support Program encourages the

Printed and bound in Manila, Philippines

Philippines-Canada Local Government Support Program (LGSP)

Ateneo Center for Social Policy and Public Affairs (ACSPPA)

Department of the Interior National Economic and Canadian International

Agriteam Canada Federation of Canadian

CHAPTER 1: OVERVIEW OF THE HEALTH SECTOR

CHAPTER 2: LGU MANDATES ON HEALTH SERVICE DELIVERY

CHAPTER 3: IMPLEMENTATION & POLICY ISSUES AND RECOMMENDATIONS

CHAPTER 4: GOOD PRACTICES IN HEALTH SERVICE DELIVERY

CHAPTER 5: REFERENCES AND TOOLS

HON. JOSE D. LINA, JR.

Philippines-Canada Local Government Support Program (LGSP)

HSRA Health Sector Reform Agenda

PITAHC Philippine Institute for Traditional and Alternative Health Care

THE HEALTH SECTOR

WHAT THE LGUs CAN DO

WHAT SOME LGUs HAVE DONE

 Entering into partnerships to promote effective local health systems

This resource book is divided into five (5) chapters:

 Overview of the Health Sector

❙ HEALTH STATUS OF FILIPINOS

HIGH MORTALITY PROVINCES IN 1995 LOW MORTALITY PROVINCES IN 1995

Province Rate Province Rate

Ifugao 64.6 Bulacan 34.8

Sultan Kudarat 267.0 Cavite 116.0

Source: NSCB (1995)

◗ LEADING CAUSES OF ILLNESS AND DEATH

1. Diseases of the heart

◗ ACCESS TO HEALTH SERVICES AND HEALTH-SEEKING BEHAVIORS

Table 2. Health-Seeking Patterns by Income Group, 1993 (In Percent)

Response to Health Complaint Poorest Quartile 2 Quartile 3 Richest

Consulted other health professional 5 3 1 1

Consulted traditional healer 6 2 2 1

Total number of respondents 100 100 100 100

Source: DOH-PIDS Household Survey (1993)

◗ CAPACITY TO FINANCE HEALTH CARE

❙ FINANCING: SOURCES AND USES

❙ HEALTH SECTOR REFORM AGENDA

 Local Health Systems Development: Promote the development of local

2. Secure funding for priority public health programs.

3. Provide fiscal autonomy to government hospitals.

4. Strengthen the capacity of health regulatory agencies.

5. Expand the coverage of the National Health Insurance Program (NHIP).

1. Local Health System Development

❙ THE LOCAL GOVERNMENT CODE

Local Government Units Department of Health

 General control and supervision Remaining powers and functions

INTER-LOCAL Provincial Health Office INTER-LOCAL

Hospitals of Provincial District and

CITY INTER-LOCAL COOPERATION

City Health City Hospital Municipal

DOH Attached Agencies - Regional Medical Centers

❙ LAWS AND POLICIES GOVERNING

◗ LOCAL HEALTH SYSTEM DEVELOPMENT

LGU MANDATES UNDER THE LOCAL HEALTH SYSTEM

Laws / Policies Specific Provision Remarks

Laws / Policies Specific Provision Remarks

◗ PUBLIC HEALTH REFORM

LGU MANDATES UNDER PUBLIC HEALTH REFORM

Entering into partnerships to promote effective local health systems

Overview of the Health Sector

Local Health Systems Development: Promote the development of local

General control and supervision Remaining powers and functions

Cooperation and integration of Can be undertaken by the LGUs:

Inadequate number and Can be undertaken by the LGUs:

No common agenda and Can be undertaken by the LGUs: