Theory of Change in

Fiscal Management
Health Human Resource , Materials and Fiscal Resource Management

Final Report

BY:

Patricia Martires , Cherilyn Rivero, Marichelle de Castro

Contents

● Background (Brief situationer: DOH; COA reports)

● Identified problems
○ Evidences
○ S.W.O.T
○ Logical Framework
Background
2021 COA Report (Taken from the Executive Summary)

- Misstatements in Assets, Liabilities and Net Assets/Equity

- ₱ 33,094,160,346.82 (Misstatement in Assets)
- ₱ 25,852,823,095.95 (Misstatement in Liabilities)
- ₱ 58,946,983,442.77 (Misstatement in Net Assets/Equity)
- Beginning balances are unreliable and not fairly presented, while notes
accompanying the financial statements lacked adequate disclosures necessary to
provide full understanding of it’s statement and financial position , financial
performance, changes in net assets/equity and cash flows.
- Documents aggregating to ₱ 5,829,833,179.33 were not submitted for audit.
- Lapse of unutilized allotments and low utilization rates indicated inability of the DOH
to maximize the utilization of its budget
- Deficiencies in the distribution of x ray machines for the COVID-19 response
(₱55,200,000.00) - indicates lack of adequate needs assessment and weakness in
safeguarding of gov’t assets from risk of wastage and or improper disposition
- Distribution of various COVID-19 related items procured and delivered by the
PS-DBM using the funds transferred by the DOH revealed deficiencies covering
items amounting to at least ₱185,602,876.00 - indicates inefficiency in the
distribution system of said gov’t assets exposing them to risk of loss, misuse or
wastage
- Benefits and Allowances of HCW - doubt on eligibility , authority and entitlement of
concerned recipients.
- Discrepancies in quantities of vaccines per PTR issued by the DOH and the
quantities received by the LGU
- Wastage and near expiring vaccines
- Issue with Various Health Facilities Enhancement Program infrastructure projects
- Procurement and utilization of several equipment funded under the HFEP had
deficiencies
- Drugs , medicines and other inventories - expired, near expiry, overstocked, slow
moving, damaged - wastage of government funds
3 Identified problems

● Misuse of funds
● Transparency issue
● Inefficient utilization of funds
1. Misuse of Funds

- Misuse of public funds includes expenditures that are made without proper
authorization or that are unlawful or contrary to applicable legislation, regulations,
policies and procedures.

- Purchases that are wastefully unnecessary and that are not in keeping with the
business or operational needs of the organization may also constitute a misuse of
public funds.

Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/Misuse of Public Funds or

a Public Asset
 Misuse of funds: S.W.O.T
Strength Weakness
High budget given to health Weak internal control and poor monitoring leading to deficiencies,
discrepancies/ irregularities, wastage of resources

Proper wages are not given to healthcare workers

Poorly equipped medical facilities

Absent or inappropriate rules for delegating authority to the

financial managers and accountants who operate these legally
defined systems.

Opportunities Threats
Better COVID-19 response, better health outcome Insufficient health human resources

HCWs are satisfied (well compensated, not Emergence and re-emergence of other communicable
overworked, etc) diseases

Improvement of health facilities Collapse of the healthcare system

 Misuse of funds: Log Framework
Objectives Indicators of Achievement Means of Verification Assumptions

Overall Goal: Improve Health Reduction of Mortality rate Hospital Records N/A
Outcomes of Filipinos
Access to quality health services Data and Statistics acquired by the
DOH

Purpose: Improved health financial Maximize the utilization of budget Audit Report HCWs are compensated well
management system given
Comparative Report from previous Facilities are well equipped
years

Outcomes / Output: Correct Reduced loss, misuse and wastage Quantitative Audit Reports No material, equipment, medicine are
Utilization of Appropriated funds misused and wasted
within the Department of Health Verification / Confirmation of
submitted report by third party (COA)

Activities: Reduced deficiencies, Verification of Auditors Internal Control and strong monitoring
Implementation of strong internal discrepancies/irregularities in capacity is strictly carried out
control and monitoring documentation

Regular and Timely Evaluation - to

immediately address challenges
2. Transparency issues

● Fiscal transparency emphasises the need for openness on the structure and
functions of government, fiscal policy intentions, public sector accounts and
fiscal projections.
● The comprehensiveness, clarity, reliability, timeliness, and relevance of public
reporting on the past, present, and future state of public finances is critical for
effective fiscal management and accountability
Four Pillars of Fiscal Transparency

Accountability Transparency

Predictability Participation
Transparency issues: S.W.O.T
Strength
- Advanced health information platforms
(Social media platforms)
- Achieve financial and economic stability
- The results of fiscal policy, and provide oversight
bodies and the public with timely, relevant, accurate and
clear information.
- Informs citizens how government and tax revenues are
spent and is a critical element of effective public financial
management.
-Transparency provides citizens a window into
government budgets and those citizens, in turn, hold
governments accountable.
Weaknesses
- Bad operational decisions
- Reputational damage
-Economic loss, penalties
-Fines
-Legal action and even bankruptcy.
- Low staff morale, declined utilization of health facilities,
breakdown in management at two levels, maintenance.
- Lack of open and competitive public procurement,
transparent fiscal information, effective control systems,
and weak external accountability to the legislature
 Transparency issues: S.W.O.T
Opportunities
To develop national plans, technical standards, and guidelines
on health. Aside from being the regulator of all health services
and products, the DOH is the provider of special tertiary health
care services and technical assistance to health providers and
stakeholders.
- Supports the call of medical professionals and health worker
groups for a better COVID-19 response by households,
communities, local and national governments.
- The institutional steward of the nation's health system. As the
prime national health agency,
Threats
- Heighten risks that corrupt acts may take place.
- Analysis of these vulnerabilities.
-Governance vulnerabilities are often associated with another
important concept, namely fiscal risk, but the two concepts are
not identical.
- Governance vulnerabilities comprise the specific
characteristics of systems, mechanisms, and processes that
can be exploited by corrupt people/groups or that may support
or facilitate their corrupt activities.
- Shortages of human capacity.
 Transparency issues: Log Framework
Objective Verification Indicators Means of Verification
Assumptions

Bringing Industry Percentage of the audit plan
Goal Knowledge, Efficiency completed.
And Value To Clients. Count of issues found and
recommendations made.
Percentage of
recommendations implemented
on time.
Hours spent per audit.
Confirmations from third
parties, analysts' reports,
and comparable data
about competitors
(benchmarking data).
Economic Forces.
Social and Cultural Forces.
Political, Governmental and
Legal Forces.
Technological Forces.
Demographic Forces.

Purpose The four possible To form an independent Inquiry, observation, Provides credibility to a set of
outcomes of an audit opinion on the financial examination or inspection financial statements and
are an unqualified statements of the audited of evidence, gives the shareholders
opinion, a qualified entity. re-performance, and confidence that the accounts
opinion, a disclaimer of computer assisted audit are true and fair.
opinion or an adverse technique (CAAT).
opinion.
Transparency issues: Log Framework

Outputs Used to make Financial performance, Potential portfolio of Competitive activity, economic
managerial changes business management, quantitative measures conditions, social and cultural
and improvements to and client engagement. that may provide new trends, demographic changes,
internal controls. insights about how high political attitudes to business,
quality audits are and regulatory changes.
achieved.
 Transparency issues: Log Framework
Activities Reviewing client-prepared
responses to external audit
reports;
Training on fraud prevention,
internal controls, and risk
assessment processes;
Analyzing client or third-party
prepared data;
Scribing client-facilitated risk
assessment exercises.
by physical checking of
inventory to make sure that all
departments are following
documented system of
recording transactions. It is
done to ascertain the
accuracy of financial
statements provided by the
organisation.
The on-site verification The use by
activity, such as management of an
inspection or acceptable financial
examination, of a reporting framework in
process or quality the preparation of the
system, to ensure financial statements
compliance to
requirements.
3. Inefficient utilization of funds

What is fund utilization?

applying general management principles to financial resources of the

enterprise/ institution/department.
Factors to efficient utilization of funds

● Competent fiscal managers

● Strict financial management and planning
● Regular financial analysis
● Strict budget, monitoring & evaluation
Inefficient utilization of funds: S.W.O.T

Strengths Weaknesses
● Budget ● Transparency
● Established IRRs ● Implementation of policies and
● Workforce skills programs
● Poor allocation of budget
● Fiscal management and analysis
● Economic loss

Opportunities Threats
● Better implementation of existing ● Absence of DOH secretary
programs ● Insufficient number of healthcare
● New administration workers
 Inefficient utilization of funds: Log Framework
Objectives
Overall Goal: Efficient utilization of
DOH health funds
Purpose: Improve overall health of
all stakeholders
Activities:
Capacity building: Regular strat
plan meeting, training of fiscal
managers
Ensuring health for all:
Household surveys, fiscal report
analysis
Outcomes / Output:
Competent fiscal managers
Well defined budget plans
High satisfaction surveys of the
Filipinos
Transparent and clear fiscal reports
Objective verification indicators Means of Verification Assumptions
Budget = output COA report After 6 year of term ….
there will be a more efficient
utilization of national health
fund
Programs are aligned with health for all value COA report and LGU reports There will be an increased
statement number of healthy satisfied
Filipinos
Increased numbers of highly skilled fiscal managers Profiling There will be sufficient amount
of capacity building activities
Increased satisfaction rating for health managers and
Written reports personnels
Worker=work demands ratio Well defined job description There will be more equipped
and org chart and competent fiscal
Improved budgeting and allocation managers
COA report
Improved satisfaction rating
DOH report
Clear and well published report that is accessible to all
References

● https://www.coa.gov.ph/reports/annual-audit-reports/aar-ngs/#49-5456-department-of-healt
h-1658122476
● MONITORING THE BUILDING BLOCKS OF HEALTH SYSTEMS: A HANDBOOK OF INDICATORS
AND THEIR MEASUREMENT STRATEGIES . WHO 2010
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://apps.who.int/iris/bitstream/h
andle/10665/258734/9789241564052-eng.pdf
● chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ijbmi.org/papers/Vol(2)
11/Version-1/F021101042046.pdf
● https://www.who.int/health-topics/health-financing#tab=tab_3