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Overview of devolution of health

services in the Philippines.
J Grundy, V Healy, L Gorgolon, E Sandig Rural and remote
health 2003

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Abstract

INTRODUCTION
In 1991 the Philippines Government introduced a major devolution
of national government services, which included the first wave of
health sector reform, through the introduction of the Local
Government Code of 1991. The Code devolved basic services for
agriculture extension, forest management, health services,
barangay (township) roads and social welfare to Local
Government Units. In 1992, the Philippines Government devolved
the management and delivery of health services from the National
Department of Health to locally elected provincial, city and
municipal governments.

AIM
The aim of this review is to (i) Provide a background to the
introduction of devolution to the health system in the Philippines
and to (ii) describe the impact of devolution on the structure and
functioning of the health system in defined locations.

METHOD
International literature was reviewed on the subjects of
decentralization. Rapid appraisals of health management systems
were conducted in both provinces. Additional data were accessed
from the rural health information system and previous consultant
reports.

RESULTS
Subsequent to the introduction of devolution, quality and coverage
of health services declined in some locations, particularly in rural
and remote areas. It was found that in 1992-1997, system effects
included a breakdown in management systems between levels of
government, declining utilization particularly in the hospital sector,
poor staff morale, a decline in maintenance of infrastructure and
under financing of operational costs of services.

CONCLUSION
The aim of decentralization is to widen decision-making space of
middle level managers, enhance resource allocations from central
to peripheral areas and to improve the efficiency and effectiveness
of health services management. The findings of the historical
review of devolution in the Philippines reveals some consistencies
with the international literature, which describe some negative
effects of decentralization, and provide a rationale for the
Philippines in undertaking a second wave of reform in order to
'make devolution work'.

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