Epic Fail: Devolution and the Philippine Health Care Delivery System


RA 7160 or the Local Government Code resulted in both the improvement and deterioration of the health care delivery system in our country.  In 1993, the health services were devolved or transferred from the Department of Health to the local government units that mostly were perpetually cash-strapped. All the provincial, district and municipal hospitals were turned over to the provincial governments and the rural health units and barangay health stations were given to the municipal government.

LGUs were given internal revenue allocations commensurate with their income. The poorest municipalities, therefore, receive the lowest allocations. This impacts on the provision for health and other public services for people who need them most. Some LGU’s were only interested in the purchase of supplies and medicines. There was untimely or decreased procurement of drugs, medicines and supplies by LGU officials. There was also a decline in maintenance of infrastructure and under financing of operational costs of services and hea;th facilities. There was decreased health center utilization.

Health workers morale was affected as they are often torn between the conflicting health and political objectives of the LGU. Devolution clipped their career opportunities’ as there was lack of professional advancement. There was a loss of managerial and fiscal control of hospitals by hospital administration. Their security of tenure and professional autonomy were threatened by local politicians. District hospitals then were not able to attract doctors especially surgeons.

The health referral system was weakened. If the catcment area cut across political/ administrative unit, operations are hindered by by limits of jurisdiction. This acts to restrain cooperative health activities such as technical supervision, health referral communications, sharing health information, joint health planning and cost sharing. Classic example would be, if you are from Tacloban City, hence the Romualdez’ turf, you can only go to City Hospital and not the Leyte Provincial Hospital because that is the Petilla’s territory.

Due to inadequate regulatory mechanisms for health services, there is a resulting poor quality of health care, high cost of privately provided health services, high cost of drugs and presence of low quality drugs in the market. The health care delivery system was also inapproriate. There is an inefficient and poorly targeted hospital system, ineffective mechanism for providing public health programs on top of health human resources misdistributions. These all contributed to the epic failure of the devolution of our health care system. 

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