Health Care Service Provision under the Universal

Health Care Act and Re-devolution by Virtue of

E.O. no. 138

Based on the Approved Joint Department of Health - National Nutrition Council

Devolution Transition Plan CY 2022-2024
(Updated as of January 20, 2022 based on DBM’s In-depth Evaluation)
 Philippine Health System
● Devolved or fragmented set-up

● Department of Health’s Role:

Leader in Health
Enabler and Capacity Builder
Regulator and Administrator of Specific Health Services
Financier of Population-based Health Services
 Health Service Delivery
vis-a-vis Universal Health Care
● Population-based health services
○ Received by population groups
○ Health promotion, disaster risk reduction and management, disease surveillance,
vector control etc.
○ DOH to contract province-wide and city-wide health systems
● Individual-based health services
○ Received by an individual
○ Ambulatory and inpatient care, medicines, laboratory tests and procedures, etc.
○ PhilHealth to contract public, private, or mixed health care provider networks
 DOH Devolution
Transition Plan vis-a-vis UHC Act

Respects the autonomy and
varying capacities of LGUs,
hence DTP to be transitioned
in phases
Capacitate LGUs during the Encourage LGUs to invest Higher budget will empower
transition period for more on health through LGUs and fast track the
redevolved functions & UHC stronger M&E systems, managerial, financial and
related activities matching grants and incentives technical integration of LGUs’
P/CWHS
Principles for Redevolving Functions to LGUs
RA 7160 “Local Government Code of 1991", RA 11223 “UHC Act”

Delivery of basic services Local autonomy

Streamline health Strengthen province- and

financing mechanisms city-wide health systems
 Overview of the DOH Devolution
Transition Plan CY 2022-2024
Considerations:
● Income Class
● National Allocation Framework
Health System has a
● Local Capacity
Devolved Set-up
● Availability of Services & Commodities in
the Local Market
● UHC Act & Pertinent Laws

Not Affected by Re-devolution:

Re-devolution of
functions, not necessarily
downloading of funds
● DOH Hospitals & Other National
Health Facilities
● Attached Agencies & Corporations,
except for the National Nutrition
Council
 Expenditure Assignment on Health
Based on the Local Government Code

Province Health services which include hospitals and other tertiary health services

Municipality ● Health services which include the implementation of programs and projects on:
○ Primary Health Care,
○ Maternal and Child Care, and
○ Communicable and Non-communicable Disease Control Services
● Access to secondary and tertiary health services;
● Purchase of medicines, medical supplies, and equipment
● Rehabilitation programs for victims of drug abuse;
● Nutrition services and family planning services
● Clinics, health centers, and other health facilities necessary to carry out health services

City All the services and facilities of the municipality and province, and in addition thereto, adequate communication
and transportation facilities

Barangay Health services which include the maintenance of barangay health facilities
 Definition of Terms
Retained with DOH Implementation of inherent DOH-retained functions

Partially Devolved Shared responsibility between NG and LGUs (e.g. NG to retain

buffer / augmentation for GIDA, etc.)

Fully Devolved Entire function / responsibility re-devolved to LGUs

 Summary of DOH P/A/Ps for Re-Devolution
DOH Budget Line Items (P/A/Ps) DOH Recommendation LGU Role Basis for Re-Devolution
1. Health Facilities Enhancement Gradually and Partially Procurement of National Allocation Framework in the
Program (HFEP) Devolved by CY 2022 Capital Outlay PHFDP 2020-2040
2. Epidemiology and Surveillance Gradually and Partially Hiring of DSOs* RA 11332: At least 1 trained DSO per
Devolved by CY 2022 ESU
3. Human Resources for Health (HRH) Gradually and Partially Hiring of nurses Low possibility of market failure
Deployment Devolved by CY 2023 and midwives
4. Public Health Commodities:
❏ Family Health, Immunization, Gradually and Partially Procurement, With PHIC package, Individual-
Nutrition, & Responsible Parenting Devolved by CY 2022 warehousing, based health services (best
❏ Prevention & Control of storage, and
optimized by public and private
Communicable Diseases distribution of
commodities to service delivery) for PHIC benefit
❏ Prevention & Control of Non- target recipients development & financing, Available in
Communicable Diseases the local market, Low cost,
Population- based services which
LGUs have the capacity to implement

* Due to the approval of funding in the 2022 GAA, DOH shall continue to support the hiring of DSOs to
all LGUs until 2023 only. However, by 2024, it will be fully devolved to LGUs only but retained in DOH,
RESUs and PDOHOs.
 National Allocation Framework* Phasing of Gradual & Partial Devolution Province City Municipality
1 Health Facilities Enhancement Program
BASIS
Category 4 (High Capacity, Low Gap) FOR RE-DEVOLUTION OF HFEP: National Allocation
Devolved beginning 2022 14 Framework
11 327

HFEP
Category 3 (High is mandated
Capacity, High Gap)to support UHC
Devolved through
beginning 10 and procurement
2024allocation of capital outlay 21 of 139
health
infrastructure, equipment, and medical transport 32 - 727
Category 2 (Low Capacity, Low Gap) Devolved beginning 2023

*National Allocation Framework in the Philippine Health Facility Development Plan 2020-2040. The parameters in the developed allocation framework include poverty incidence, resources of local
government, presence of GIDA, and the current gap in health facilities to establish their Health Care Provider Networks

To view the complete list of provinces, cities, & municipalities

and the corresponding year of devolution, visit https://tinyurl.com/LGUcategoriesNAF
1 Health Facilities Enhancement Program
BASIS FOR RE-DEVOLUTION OF HFEP: National Allocation Framework

National Allocation Phasing of Gradual and

Province City Municipality
Framework Partial Devolution

Category 4 - - - Devolved beginning 2022

Category 3
(Biliran, Tacloban City, South 2 2 26 Devolved beginning 2024
Leyte)

Category 2
3 4 88 Devolved beginning 2023
(Leyte, North Samar, Samar)

Category 1
1 1 22 Retained with DOH
(East Samar)

To view the complete list of provinces, cities, & municipalities

and the corresponding year of devolution, visit https://tinyurl.com/LGUcategoriesNAF
2
Disease Surveillance Officers (DSO)*
BASIS FOR RE-DEVOLUTION: RA No. 11332
Mandatory Reporting of Notifiable Diseases & Health Events
of Public Health Concern Act
● As a minimum requirement, each Epidemiology and Surveillance Unit (ESU) shall have at least 1 DSO duly trained on
applied/field epidemiology, surveillance, and response; and 1 epidemiology assistant of an allied health profession.
● The budget requirements for the operations of ESUs shall be drawn from the annual budget of their respective mother offices
(RESU, PESU, CESU, MESU).
● Devolution of hiring of DSOs to all LGUs by CY 2024. DOH shall only continue to provide funding support for the hiring of
DSOs to all LGUs until 2023.
● DOH commits to provide TA and capacity building to LGUs on the minimum training requirements for ESU functionality.

● Funding for the hiring of DSOs in Central Office, CHDs, and PDOHOs will continue to be funded.

*formerly known as Public Health Associates

 3
National Health Workforce Support System
(formerly as Human Resources for Health Deployment)
BASIS FOR RE-DEVOLUTION OF HIRING HRH
● No HRH Re-devolution in CY 2022
● Sec. 24 of UHC Act - To augment health workforce and secure positions to hire health workforce for deployment under the
National Health Workforce Support System (NHWSS)
Retained with DOH Devolved to LGUs by CY 2023

● Cadres: Doctors, Nurses, Midwives, Dentists, Medical Techs, ● Cadres:

Pharmacist, Nutritionist Dietitian, Physical Therapist in GIDAs, target Nurses and Midwives in 1st to 4th income
areas for peace-building efforts, areas for poverty reduction, and with class municipalities
critical HRH gap
● Pre-service Scholarship for Priority Cadre of Health Professionals & In- ● Rationale: Low possibility of market failure
Service Scholarships
● Policy Development, Technical Assistance, Training, Advocacy
3
National Health Workforce Support System
(formerly as Human Resources for Health Deployment)

PROVINCES 5TH CLASS MUNICIPALITIES 6TH CLASS MUNICIPALITIES

Hindang, Julita, La Paz, MacArthur,

Leyte Mayorga, Merida, Pastrana, Santa Fe, Tunga
Tabontabon, Tolosa

Allen, Biri, Capul, Lapinig, Mapanas,

Northern Samar San Vicente
Rosario, San Antonio, San Jose, Victoria

Source: Income Classification per DOF Order No. 23-08, dated July 29, 2008
https://blgf.gov.ph/wp-content/uploads/2016/10/updated-reclass-CY-2008-4-27-16.pdf
 4 Procurement of Public Health Commodities
BASIS FOR DELINEATION OF FUNCTIONS
Re-devolved functions to the LGUs include
procurement, storage, distribution and monitoring.
Retained with DOH Devolved to LGUs (Fund Source: NTA or PHIC)
● Internationally procured or with limited local market ● Services or commodities that are readily available in
● Commodities with economies of scale the local market
● Population-based services that need to be ● Services with existing PhilHealth benefit packages
consistently implemented ● Population-based services which LGUs have the
● Individual-based services but without PhilHealth capacity to implement
package in the interim
 Summary of Retained and Re-devolved Functions

PARTIALLY
RETAINED FULLY DEVOLVED
DEVOLVED
■ Environmental & Occupational Health ■ HRH Deployment ■ Hypertension
■ National Immunization ■ Health Facilities Enhancement Program ■ Hypercholesterolemia
■ Tuberculosis Control ■ Family Health, Nutrition & Responsible ■ Diabetes (beginning CY 2023)
■ Mental Health Parenting ■ Leprosy*
■ Cancer ■ Disease Surveillance Officers** ■ Integrated Management of
■ HIV ■ Oral Health Childhood Illness (IMCI)
■ Schistosomiasis ■ Food & Water-borne Diseases ■ Soil-Transmitted Helminthiasis
■ Vector Control ■ Filariasis
■ Rabies Control
■ ■ Dengue
Assistance for Indigent Patients
■ Emergency & Re-emerging Infectious
Diseases
■ Sexually Transmitted Infections

Note: These are some examples of key programs and not an exhaustive list. Subject for
further discussion and may be subject to changes.
*WHO-donated multidrug therapy for Leprosy will still be provided.
**Due to the approval of funding in the 2022 GAA, DOH shall continue to support the
hiring of DSOs to all LGUs until 2023 only. However, by 2024, it will be fully devolved to
LGUs only but retained in DOH, RESUs and PDOHOs.
 Key Issues and Recommendations

ISSUES RECOMMENDATIONS

● Legislate the relaxation of PS cap through

Difficulty in hiring HRH amendments to Local Government Code
● DOH to continue support of hiring DSOs in
LGUs needing the support during the initial
transition years
 Waiving of LGU PS Cap Limitations

This is reflected in the

General Provision of 2022 GAA
Volume IB, Section 93,
Specific items v-viii
(pp. 802)
Maraming Salamat po!