The Price of Devolution

Many municipalities and provinces have suffered financing shortfalls causing the diversion of health funds to other priorities. There was also no prior development of health staff including those retained by the DoH, or local government executives and officials for their new roles in a devolved environment.

BY AUBREY SC MAKILAN

Bulatlat

Tuberculosis (TB) is the most common major infectious disease today. Based on the Health Alliance for Democracy (HEAD) data, around 36 percent of 82 million Filipinos are affected by the disease. Of these, 75 die of TB while around 100,000 contract the disease every year.

Aside from this, TB is also a sensitive index of a nation’s poverty, the group said.

For the government, less than 28.4 percent of the population live below the poverty line.  By government standards,  a person earning less than P32 (US$.59) per day is considered poor. The World Bank, meanwhile, reported that 51 percent of the population live on less than US$2 per day. On the other hand, data from the Ibon Foundation, an independent research agency, showed that about 88 percent live below the poverty line. In May 2003, Ibon Foundation estimated that for a family of six to survive a decent living, the breadwinners of the family should earn at least P545.73 (US$10.07) daily.   

“The increase in the poverty incidence and the spread of TB,” said HEAD secretary general Dr. Gene Nisperos, “ show that the basic and chronic problems in health are not being addressed and are being allowed to worsen.”

These unattended health problems have been made worse by the devolution, sometimes referred to as decentralization, of health services from the Department of Health (DoH) to local government units (LGUs).

Under the Local Government Code of 1991, devolution “refers to the act by which the national government confers power and authority upon the various LGUs to perform specific functions and responsibilities.”

It includes the transfer to the LGUs ─ such as health, education, agriculture and social service ─ of the records, equipment, and other assets and personnel of national agencies and offices corresponding to the devolved powers, functions and responsibilities.

To implement the decentralization plan, health planning and control was transferred to LGUs in 1992. The power of the Department of Health (DoH) diminished significantly with the transfer of responsibility for primary health care to about 1,600 LGUs.

Supposedly the lead agency in health, the DoH maintains specialty hospitals, regional hospitals and medical centers. Many of these hospitals have been or are in the process of corporatization. Regional field health offices or Centers for Health Development are located in 16 regions. These offices manage provincial health teams and retained personnel. With the devolution of health services to LGUs, the provincial governments oversee provincial and district hospitals, while the municipal governments manage rural health units (RHUs) and barangay (village) health stations.

Aside from the 600 hospitals, the devolution also included the transfer of administrative authority of about 46,000 health sector personnel to the local level, based on the April 2002 “Decentralization and Health in the Philippines and Indonesia: An Interim Report” by Samuel Lieberman of the East Asia Rebounds of the World Bank.

The devolution has been beset with economic and administrative problems. LGUs lack the necessary resources to effectively deliver basic health services and expand the coverage of these services due to the mismatch between the costs of devolved functions and the corresponding internal revenue allocation (IRA).

Based on the Local Government Code, provincial and municipal governments with higher fiscal capacity (using per capita income as a measure of financial base) tend to get higher per capita IRA allocations than those with lower fiscal capacity.

Many municipalities and provinces have experienced financing shortfalls causing the diversion of health funds to other priorities. There was also no prior development of health staff including those retained by the DoH, or local government executives and officials for their new roles in a devolved environment. Even if the DoH created the Local Government Assistance and Monitoring Service (LGAMS) to assist and support DoH representatives located at the provincial level, this was only an ad hoc body with limited resources and adequately prepared staff. Bulatlat