Issues on Health and

Agriculture
Decentralization
Devolved functions: Issues and Problems on Health
 University of the Philippines
National College of Public Administration and Governance
PA-251
Presented by Mitchel Esperanza and Lawrence Malasa
 OUTLINE
Part 1: Health
 Background

 History of Decentralization of the Health Sector

 Devolution on functions

 Health Policies/ Benefits under decentralization

 Financial Decentralization: Challenges in Local Health Finance

 Health Expenditures

 Local Health Financing Initiatives

 Policies on the Health Sector
 Case Study
History of the Decentralization
 5

History of the Decentralization

 Under Marcos regime in 1970s and 1980s, Philippines was highly centralized.
 After the fall of the Marcos regime, democracy was restored in 1986 and decentralization was seen as a
method for re-democratization of society and polity.
 Local Government Code of 1991 was passed. It aimed to devolve service delivery throughout the
Philippines
 6

LGC of 1991
 After the LGC of 1991, most processes/services offered by the Department of Health were deconcentrated and
devolved.

 The process met resistance from Department of Health initially, as it anticipated loss of control, authority and
employment.

Structure of the Decentralization of Health
Before Decentralization
 Department of Health (DOH) was
responsible for centralized planning,
spending and decision-making. Local
and Regional Hospitals were still
centralized.
7
After Decentralization
 After Decentralization:
 After LGC, Fiscal Devolution took place
 Internal Revenue Allocation
 50% based on Population
 25% based on land area
 25% equal sharing
 50% of DOH budget has gone to the IRA
 Pre-Devolution Structure
Office of the Secretary of
Health

Executive Committee for

National Field Operations

Regional Hospital Medical

15 Regional Offices
Centers

Provincial Health Offices

Provincial Hospitals
District Health Offices

City Health Offices District Medicare &

Municipal Health Offices
Municipal Hospital

Source: DOH Central Barangay Health Centers

 Post-Devolution Structure
Office of the Secretary of Devolved to Provincial Government
Health
Devolved to City Government
Executive Committee for Devolved to Municipal Government
National Field Operations

Regional Hospital Medical

15 Regional Offices
Centers

Provincial Health Offices

Provincial Hospitals
District Health Offices

City Health Offices District Medicare & Municipal Health Offices

Municipal Hospital
Barangay Health Centers Barangay Health Centers
Source: DOH Central
 Post-Devolution Structure

Source: Magno, 2001

 11

Given that decentralization took place

DOH still plays as the central steward for
Healthcare
 12

Flaws on Health Devolution

 Allocation for health expenditure out
of total IRA allocation, other than
staff  wages, was entirely left to local
governments. Also, there were no
assurances that central level public
health care initiatives would be
carried out by the local governments.
 IRA allocation was independent of
capability of local government, it
created losers and winners among local
governments as some were more
capable than others to finance and
manage devolved health care services.

IRA dependency despite budget generating

capacity
 13

ISSUE no. 1: Salaries of Devolved Personnel

 Salaries from Central Government to Local Government differs

 Local Executive pressured the National Government to pass a Magna
Carta for Health Workers
 Still, LGUs can’t match up all requirements (Magna Carta and CSC Salary
requirements), resulted in National Government assistance to both DOH
and LGUs.
 14

ISSUE no. 2: Lack of Technical Capacity

 LGUs lack the financial capacity to maintain technical experts on the

field.
 15

ISSUE no. 3: Re-Nationalization of Hospitals

 48 Hospitals Retained
 Resulted in pouring DOH 50% of its budget to Hospitals
 The Bias to hospitals Vis-à-vis rural/municipal Health Centers
 16

ISSUE no. 4: Lack of Coordination

 LGUs lack coordination with each other

 Free-riding and externalities dealt
 17

ISSUE no. 5: (MOST EXPECTED) Corruption

 LGUs failed to address red tapes

 18

Dr. Rosalie M. Sto.

Domingo
City Health Officer of San Juan
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Case Study: San Juan City Health Office

 History of San Juan City Health Office

 Difficulties on Issue no. 1: Salary and Budget Maintainance
 Difficulties on Issue no. 2: Maintaining Experts in the LGU
 Difficulties on Issue no. 3: Re-Nationalization of Devolved entities
 Difficulties on Issue no. 4: Is free-riding existing from other cities to San Juan or
Vice Versa?
 20

Case Study: San Juan City Health Office

 History of San Juan City Health Office

 1991 Decentralized
 21

Difficulties on Issue no. 1: Salary and Budget Maintainance

 All employees were devolved into the LGU

 At first, it was difficult since it was new to the LGU

 Is the National Wages comparable to the LGU level wages

 CSC Salary Bracket applied
 E.g. Nurse I – SG 11 (Entry Level)
 25% - Hazard (sg 19 n below)
 22

Difficulties on Issue no.2: Maintaining Experts in the LGU

 Example of a DOH Program that was difficult for the LGU to adapt:
 IClinicSys for the Rural and City Health Care Centers
 Electronic Health Information Recording System
 Features:
1. Field Health Services Program (e.g. Maternal Care, Family Planning, Child Care,
Dental Care,
 Tuberculosis, Filariasis, Malaria, Leprosy, Environmental Health, Natality,
Morbidity, Mortality)
 2. Unified Disease Registries (Cancer, Diabetes, Stroke, COPD, Injuries and others
 3. Watching Over Mother Babies (WOMB)
 a. Pantawid Pamilyang Pilipino Program of the DSWD
 23

Case Study: San Juan City Health Office

 4. Philippine Health Information Exchange

 a. Philhealth Systems (e.g. Membership Verification, Philhealth Membership
Registration for
 New Members, Tsekap Benefits)
 b. Maternal and Neonatal Death Reporting System
 24

Case Study: San Juan City Health Office

 Difficulties on Issue no. 2: Maintaining Experts in the LGU

 San Juan City had a difficulty on adapting DOH programs that requires
experts/technical human resource (Lack of Computer Literacy)
 Not enough Manpower due to the ages of the human resource available
 Lack of Hardware required
 Lack of Budget even though with LGU Budget autonomy
 Integration of the Philhealth Accreditation
 Solution made: Ordinance for budget for IclinciSys
 25

Difficulties on Issue no. 3: Re-Nationalization of Devolved entities

 No issue on re-nationalization of hospitals

 The problem resides on the maintenance of the San Juan City Hospital
 According to the City Health Officer, There is not enough HFEP Fund(Health
Facilities Enhancement Program).
 The Hospital still needs to balance the expenses through income-generating
mechanisms (drugs and medicines, bills, etc.)
 26

Difficulties on Issue no. 4: Is free-riding existing from

other cities to San Juan or Vice Versa?

 Bordering Cities’ Residents come to San Juan’s Health Centers

 The LGU still provide healthcare even if they are not residents
 Case: Relocated Residents to Bulacan
 San Juan still provides healthcare to the former residents since
 1. They are still voters of the LGU
 2. Their medical records resides in San Juan
 27

ISSUE no. 5: DOH lack of coordination of LGU Needs

 DOH does not provide the right specifications to the needs of the LGU
 Ex. Vaccine Refrigerator that doesn’t fit in the facilities
 DOH doesn’t look into the specs of the LGU needs
 Also, the policies cascaded are difficult for some LGUs to be adapt.
 28

ISSUE no. 6: Red Tape

 No Red tape, if some, hidden.

 Transparency
 Procurement: Manpower and Isystems (no proper supply chain
management)

 DOH Supply- DOH Procurement

 29

BONUS: Federalism

 Clustering Problem
 Is the LGU Ready
 Preparation should be done for the LGU
 30

Special Thanks:
Place your screenshot here
Dr. Rosalie M. Sto. Domingo
City Health Officer
San Juan City
 31

Thanks!
Any questions?
 References
Negi, S. S. (2009). Decentralization and its effects: Health Sector in the Philippines. Retrieved From:
https://www.scribd.com/doc/29383981/Health-Decentralization-and-Its-Effects-in-Philippines

Bank, W. (2016). DECENTRALIZATION AND HEALTH IN THE PHILIPPINES AND INDONESIA: An Interim Report.
Retrieved from:
http://www1.worldbank.org/publicsector/LearningProgram/Decentralization/decenhealth.pdf
Shair-Rosenfield, S. (2016). The Causes and Effects of the Local Government Code in the Philippines: Locked in
a Status Quo of Weakly Decentralized Authority? Journal of Southeast Asian Economies, Vol. 33, No. 2, Special
Focus: (De)centralization in Southeast Asia (August 2016), pp. 157-171. Retrieved From:
https://www.jstor.org.ezproxy.upd.edu.ph/stable/pdf/44132299.pdf?refreqid=excelsior%3Aca38931adf06669a26af
f39a71b58a38

Michael R.M. Abrigo, Z. C. (2017). Decentralization and Health in the Philippines: A Systematic Review of
Evidence. DISCUSSION PAPER SERIES NO. 2017-58.
Retrieved from:
https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps1758.pdf

32
Assessment of Devolved Agricultural
Services in the Philippines

Lawrence Angelo M. Malasa

PA 251
13 March 2019
 How do LGUs deliver agricultural services to
their communities (especially to the farmers)?

What are the challenges faced by their programs

and ways moving forward?
Presentation Outline
● Introduction
○ Agricultural functions as per Local Government Code of 1991
○ State of agriculture in the country
● Case Studies
○ Redireksyon Program (Santiago City, Isabela)
○ Pluralistic Extension System (Claveria, Misamis Oriental)
● Insights from Case Studies
○ Identifying common factors that influence agricultural service delivery
● Moving Forward
Devolved functions under LGC of 1991

(Magno, 2001)
Devolved functions under LGC of 1991

Reclassification of Lands Linkages with CSOs/NGOs

(1) when the land ceases to be economically
feasible and sound for agricultural purposes
as determined by the Department of Agriculture
(2) where the land shall have substantially
greater economic value for residential,
commercial, or industrial purposes, as
determined by the Sanggunian concerned
LGUs may enter into joint venture or other
cooperative arrangement to engage in the
delivery of certain basic services, capability-
building and livelihood projects, and to develop
local enterprises

Limited reclassification of agricultural land,

depending on the type of city/municipality
State of Philippine agriculture
Taking Advantage of the Benefits of
Devolution: The Santiago City
Redireksyon Program

(Francisco and Montes, 2007)

Supply of seedlings Training, Research and Capacity-building

Markets produce

Green Thumb
Marketing
Corporation
Success Factors

• Strong supportive leadership from local government

• Receptive farmers
• Strong farmers’ associations
• Multisectoral engagement
Issues Faced

• Sustainability of the project

• Political influences
• National vs. local program implementation
Taking Advantage of the Benefits of
Devolution: The Santiago City
Redireksyon Program

(Carada, 2007)
A Need for a Harmonized Approach

• Interventions need to be coordinated and harmonized

• Who should handle?
• Tendency to duplicate interventions = not efficient
• Extension services that are community-based and participatory
Insights from Case Studies
On functions and roles
• Vague/overlapping roles between NGAs and LGUs
• Lack of coordination among LGUs
• Need to harmonize services provided by different institutions
Funding for devolved services
• Functions downloaded does not directly equate to increase of funds
transferred to LGUs
• Support services to farmers are affected
• access to credit
• farm to market roads and other infrastructure projects
• agricultural supplies
• other training programs
Sustainability of programs
• Political influence, political will over institutionalization
• Depleting agricultural lands due to conversion
• Improved monitoring and evaluation of programs
Personnel management and capacity-building
• Access (and funding) to technical training
• Knowledge transfer
• Uncertainty of position
Moving Forward
Moving Forward
• Harmonization of ongoing programs
• Sustainable, long-term goals
• Reformulate IRA to allot more funding to agricultural programs of LGUs
(Magno, 2001)
• Establishment of research institutes and breeding stations, and
construction of irrigation facilities (Magno, 2001)
• Increase access to economic opportunities (Brown et al, 2018)
• Innovative financing schemes
• Land and water resources