BETTER coordination, synchronicity and oversight of national agencies on local governments could fix inefficiencies and boost healthcare delivery to Filipinos, an expert said.
In a presentation last Monday, Maria Eufemia C. Yap said despite the expanded fiscal space for delivering health services due to reforms such as the Universal Healthcare Law and amendments to the National Tax Allotment (NTA), local governments still reported inefficiencies.
‘You go across the different provinces and municipalities in the country and they’re always saying [their funds for the health sector are insufficient],’ Yap, senior research fellow at the School of Government of the Ateneo de Manila University, said. ‘Spending lags appear where process owners are fragmented and off-budget or extra-budgetary flows are not synchronized with planning and this is a fiscal governance issue.’
According to Yap, these inefficiencies translate into unattained healthcare targets like maternal mortality and fluctuating vaccination rates.
‘It’s hard to translate [these inefficiencies] into pesos but, to say that if the country spends, like what they said in [a] PSA [Philippine Statistics Authority] study [in] 2024, that around P12,000 is being allocated to primary health care per person,’ she said.
However, Yap said that in the areas they studied, ‘although it’s not really apples to apples, [it was] only like P400, P500 per person, which is a very far cry from what the PSA said is the spending on primary health care.’
Yap’s research focused on areas in the cities of Quezon and Isabela, Antique province and the municipalities of Odiongan and Belison. The research found that municipalities relied on the NTA for up to 95 percent of health funds.
In terms of the flow of funds, they also found that local governments pour most of their health budget, about 80 percent, to personnel services, while the Department of Health (DOH) supplied inputs like commodities and facilities.
‘When it comes to meeting expected standards of care, especially at the primary healthcare and primary care level, we cannot yet say that availability and quality have been fully achieved and from a spending perspective, this indicates poor investments in primary healthcare and primary care,’ Yap said.
She highlighted misaligned tools, templates and calendars between local government units (LGUs) and national agencies as the ‘choke points’ that hindered effective healthcare delivery, while also citing the ‘learned dependency’ of the LGUs on the DOH through the Local Government Code.
”If your LGU cannot handle the services that you’re supposed to deliver, who you gonna call? [The] national government.’ It has created the learned dependency of the LGUs. because the LGUs will say, ‘we won’t anymore budget for new personnel or fill in this post, [the] DOH will give us,’ and so they don’t anymore think about really how they will handle the delivery of the health services,’ Yap added.
To combat the issue, Yap emphasized synchronicity in timing and templates between LGUs and national agencies like the DOH, the Department of Budget and Management and the Philippine Health Insurance Corp.
‘We’re hoping when we present to Secretary [Amenah F.] Pangandaman that we can really make a play for having a program convergence budgeting approach for the health, particularly for the special health fund, so that we can synchronize and rationalize resource flows by organizing a backbone for tagging, for downloads, creating predictable flows tied to service packages, interfacing with budget tagging, allotment, downloads, performance reporting,’ the academician said.
Yap is proposing an oversight and accounting group chaired by the Coordinating Committee on Decentralization to ensure transparency and proper coordination between the government players.
‘With one clock, one set of templates and a firm oversight accounting spine, pesos are easier to track, to release and to pay, which is the heart of fiscal integrity,’ she added.