Special Report: Philippines- The unhealthiest of poor countries

Special Report
(First of two parts )

Despite the promises of devolution, funding for health services is unable to keep up with local needs

Sidebar: Not enough doctors, and nurses, in

SECOND PART: LGUs try enterprise to cure shortage in health funding

By MARYA SALAMAT
Bulatlat.com and Maggie De Pano Fellow

Surigao del Sur was not proud of their health figures six years ago: for every dozen mothers who died of pregnancy complications or while giving birth in the country in a year, one came from this province. It was the highest maternal mortality rate among provinces—269 in every 100,000—even higher than the national average of 230.

The provincial government moved quickly. It clustered adjacent municipalities and assigned a team of woman health workers to monitor pregnant women in each area. Their duty was to make sure these mothers went to skilled health professionals for regular check-ups, and delivered in birthing clinics or hospitals. The province also allocated more funds for the improvement of these health facilities, and enrolled almost all the declared indigents in the state’s health insurance system or Philhealth.

By 2009, Surigao del Sur had brought down maternal deaths to 99 in every 100,000. The following year, Malacañang noticed and gave it the Galing Pook award, which recognizes innovative programs by local governments.

But the good news ends there. Other priorities had been competing for the limited provincial budget, that sustaining the program became difficult. Starting 2009, the yearly decline in maternal deaths stopped. This year, the province will start paying the World Bank loans it incurred for the construction of additional birthing clinics and the upgrade of hospitals, even though these didn’t turn into financially viable facilities.

Surigao del Sur is not a unique case. Since the national government devolved health services and facilities in 1992, a considerable percentage of local government units (LGUs) have failed to achieve financial sufficiency to deliver and maintain these.

In the Philippines, the number of maternal and child deaths—the most basic indicators adopted by different countries—reflects the widespread lack of affordable and accessible health care.

Good intention

As of 2009, the United Nations Population Fund estimated that 4,500 women died each year due to complications arising from childbirth, while 80,000 children died before they reach the age of 5—all of easily preventable causes. Data from various sources showed that 6 of every 10 Filipinos die without being attended to by health professionals.

Following the mandate of the Local Government Code of 1991, the Department of Health (DOH) transferred some 46,000 permanent employees or health workers (62% of its work force) to the provincial, city, and municipal governments. Government hospitals (93% of the total number) and over 10,000 health care facilities or buildings were also placed under the authority of the LGUs. The central government retained only the tertiary and specialty hospitals.

The intention was to reach and cover more citizens, especially the poor families, down to the far-flung areas, by empowering the LGUs to deliver quality health services.

However, the corresponding funding didn’t come with the responsibilities that were passed on to the LGUs. Only 40% of the national government’s internal revenue collection is given to some 1,700 provinces, cities, and municipalities to divide among themselves. This meager share is supposed to fund all the new services, not just health, that LGUs are supposed to deliver.

From 1992 to present, the IRA (internal revenue allotment), the yearly allocations for local government coming from central government, had increased nominally, but it never amounted to even a fifth of the total national budget as it peaked at just 18.29% of the national budget in 2006, at P166-billion compared to the national budget of P907.6billion.

The LGUs’ health spending, in turn, peaked at just a fifth of their IRA for two years (in 1997 and 1998) from 1994 to 2007. But after its peak in 1998 it fluctuated and went down to 16.9percent by 2007.

Declining allocations

From 1994, a couple of years after devolution was completed, the LGUs’ share in national total health spending rose from 15.8% (or P8.7 billion) to peak at 19.3% (P22.2billion) in 2000, based on revised data from the National Statistics Coordination Board (NSCB).

(Total Health Expenditure refers to the combined amounts of money shelled out by all Filipinos in a given year. In Philippine National Health Accounts, this consists of the allocations from the government (both national and local), social insurances, private sources, among other sources.)

But the LGUs failed to sustain the increasing allocations, much less keep up with increasing spending requirements on the sector. Nominally, health spending at the local level increased, from P17.8 billion in 2002 to P31.1billion in 2007. But their share of total spending has been on the decline—from 15% in 2002 to less than 13% in 2007.

The same is true with the national government’s share in health spending. In 1994, the national government contributed 21% to total health expenditures. By 2007, it was contributing only 12.9%.

Partly it is because of budgetary restrictions. While health spending requirements doubled from P117 billion in 2002 to P234.3 billion in 2007, national and local budgets failed to keep up with the pace.

Thus, even if the overall national health spending annually increases, the government’s total spending on health (P61.5billion) is now less than 1% (0.9%) of the gross domestic product (GDP).

The Philippines, therefore, falls short of the health budget of at least 5% of the GDP that’s prescribed by the World Health Organization (WHO).

Lagging behind

The Philippines, in fact, has one of the lowest health spending as a percentage of GDP, and one of the lowest allocations of financial resources to primary health care.

The government under-spending in the health sector expectedly resulted in a decline in accessible health services.