From Devolution to PPP: Helping

LGUs Cope with Challenges in

Health Governance

Jaime Z. Galvez Tan MD, MPH

Team Leader, Technical Assistance on Public Private Partnership

in Health

Disclaimer: The views expressed in this paper/presentation are the views of the author

and do not necessarily reflect the views or policies of the Asian Development Bank

(ADB), or its Board of Governors, or the governments they represent. ADB does not

guarantee the accuracy of the data included in this paper and accepts no responsibility for

any consequence of their use. Terminology used may not necessarily be consistent with

ADB official terms.

Outline

20 Years of Health Devolution (1993-2012)

Unfinished Agenda of Health Devolution

Current Challenges and Opportunities to Achieve Access

to Basic Health Services by LGUs

PPP in Health: A Major Strategy to Achieve Universal

Health Care and the MDGs

20 Years of Health Devolution

1993-2012

Local Government Code of 1991 signed into law

1992 – Implementation of the LG Code

January 1993 – Start of Health Devolution

it completed the transfer of 45,896 health personnel, out

of a total of 60,000 DOH personnel, along with 595

hospitals and 12,580 Rural Health Units and Barangay

Health Stations and other facilities to LGUs

Desired Objectives of Devolution

LGUs can provide services better, taking into account local

needs and preferences.

It will bring more accountability into system as people can

hold locally elected officials accountable for their actions.

It will also increase participation and reduce alienation

among population groups outside Manila.

Thus decentralization was supposed to bring efficiency, equity

and effectiveness into the system

Health Devolution Status 2012:

Winners:

Cities have ended up winners since they had been

paying for their health services before devolution in

1993; most absorbed only 7 percent of the cost of

devolved functions from DOH. They receive 23% of

the IRA.

Barangays have had a bigger windfall because they

get 20% of the IRA without any devolved function or

personnel.

Health Devolution Status 2012:

Losers:

Provinces have absorbed 47 % of the cost of devolved

functions and personnel from DOH, but they get the

same IRA as the cities (23%).

Municipalities have a smaller share of devolved

health costs as the cities with 34% of the IRA to

support them. However, the cost is shared across

over 1,400 municipalities.

Health Devolution Status 2012:

A third of LGUs across the board have had an outstanding

performance in health,

with some of the poorest LGUs doing better than expected

(Capiz, Ilocos Norte, Biliran, Ifugao, Guimaras, Bukidnon,

Negros Oriental in improving health financing for the poor;

Ilocos Sur, Davao Oriental doing well in controlling

maternal mortality;,

Ifugao, Nueva Vizcaya, Aklan, Misamis Occidental and

Kalinga keeping childhood malnutrition below national

averages).

With another third of LGUs performing at targeted levels.

A third of LGUs are performing below nationally set

targets 20 years after devolution.

The Unfinished Agenda in Health

Devolution Health Human Resources Development

Ensuring retention of qualified health workers; National locum

services; Managing migration

Health Management Information System

Nation-wide Population Based Health Surveys; Sentinel

Surveillance Sites; Maximizing use of ICT

Health Financing

Universal Social Health Insurance

Access to Essential Medicines and Essential Health Package

Health Sector Challenges and Opportunities Income inequities in health outcomes Poor health outcomes in low income quintiles

Regional disparities in health outcomes Poor health outcomes in MIMAROPA, Bicol, Eastern Visayas, Western Visayas, Eastern

Visayas, Western Mindanao, Davao Peninsula, Zamboanga Peninsula, ARMM

Low availability, accessibility and affordability of health services Geographical, structural, financial and personnel constraints

Inadequate financial protection of the poor High OPP expenditure and low insurance coverage of the poor

Poor health services organization and governance Fragmented organization, management, services, and financing of health system

PPP in Health: A Major

Strategy to Achieve

Universal Health Care and

the MDGs

“...it must first be PPP is clarified that not privatization. PPP does not aim to

delegate the responsibility of the public sector to the private sector. PPP taps the

private sector’s managerial expertise and resources and fills in gaps in services in

the public sector.”

- ADB TA 7257 PHI Brief on the Five Applications in

PPP in Health Programs (Sept. 2011)

Why Governors and Mayors

Are Tapping the PPPH

Option for Universal Health

Care?

Why Local Chief Executives

(LCEs)are Tapping PPPH

Realization that Private Sector would be able to manage

delivery of health services more efficiently

PPPHs are new sources of capital and operation

expenses for health financing

Support factors: The National Leadership supports PPP

and PPPH and the Declaration of Universal Health Care

and PhilHealth now more responsive to LGU Health

Financing.

Mandate of PPPH within the domain of the Local

Government Code encouraging LGU enterprises.

Challenges to Accelerating PPPHs

A Broader Policy Framework of PPPs covering PPP

arrangements beyond Build Operate and Transfer (BOTs)

and LGU Enterprises

Encouraging more Health Business Solutions Company

ready for partnerships with the Public Health Sector

Enhancing the Health Financing and Health Investments

milieu

Social Marketing and Knowledge Management of past

and current PPPH whether successes or failures.

Thank You Very Much !!!

Jaime Z. Galvez Tan MD, MPH

Email: jzgalveztan@gmail.com

Mobile phone: +63917 853 7798

Website: partnersforhealth.ph