October 15, 2007
This morning, an Inter Local Health Zone organizational meeting was convened for LGUs in the 2nd Congressional District of Camarines Sur and the neighboring Burias island by the Metro Naga Development Council and the DOH Regional Office. In attendance were DOH Usec del Mundo, DOH R-V Director Santiago, elected local officials and municipal health officers. The meeting, although long overdue, again brought back to fore the tensions as a result of the devolution of health services to LGUs. The perennial issue of funds and mandates seem to preoccupy the minds of elected local officials. On the other hand, while not bluntly said, DOH felt that health performance, as borne out by health indicators, have deteriorated after the devolution. Unless DOH and the LGUs come to terms with the realities of the current problems, LGUs will continue to relegate health at the bottom of its priorities (with district hospitals lacking in doctors, supplies and medicines), offering devolution as an excuse for the inadequacy. DOH will continue to harp that the health delivery system was better when it was unified under the national government. Both of these are farthest from the truth. Many localities have done better under the devolved system. It is often argued that devolution only worked well in cities. But outstanding initiatives have been undertaken by small municipalities and provinces demonstrating that devolution works. On the other hand, the same problems encountered by patients in hospitals administered by provinces are felt in hospitals under the DOH. LGUs can continue to blame the national government for its shortcomings (like for instance, the unreasonable impositions of the Magna Carta for Health Workers that distort salary scales in LGUs). But clearly, if only they will channel some of the funds from their “imeldific undertakings” to basic health concerns, our health numbers would have been better.
The establishment of inter-local health zones attempts to achieve a seamless interface between the delivery programs of LGUs and DOH. While the concept is very sound, the participation of LGUs will depend on: a) how the local leadership view health as a priority of the locality, b) how much resources can be leveraged from the national government, donor partners and the local community through its participation and c) how it can improved desired health outcomes (as they perceive it).
Firstly, the priorities of most localities are determined by the elected officials, specially the local chief executive. They are influenced therefore by the political benefits that can be gained from these priorities. When health care is identified as a priority, the curative aspect of health care takes precedence over the preventive aspect — simply because this is the most direct and visible way to reach the constituency (medicines dispensed, patients taken cared of and referrals to government hospitals).
Secondly, from the point of view of local officials, they would only be willing to pool resources if this will pave the way for counterpart funding from the national government or other local governments (as in the case of the Metro Naga Development Program, where Naga City in effect subsidizes the other members by virtue of the formula by which contributions are assessed). Interest will wane if the LGUs feel that, in effect, another entity holds sway as to how its funds are to be disbursed. The most significant incentive in joining an inter-LGU health board is the capacity of the unit to multiply the resources or access to resources by the member-LGU.
Thirdly, will an inter-LGU health board provide the member LGU access to more curative care services. Simply put, will this allow the LGU better access to nationally administered hospitals (given the difficulty of dealing with them right now)?
Organizing and institutionalizing an inter-LGU local health board requires that this seemingly less important “political needs” of the elected officials be satisfied. In fact, the other way of looking at it is these can serve as the carrot to push the agenda of better coordination between the national and local health delivery systems.
Relatedly, most LGUs have organized their own local health boards. While the institution is mandated by the code, resources come from regular budgetary allocations. If health is considered a national priority, it might be good to consider creating a health fund similar to the Special Education Fund (SEF) from property tax levies on property owners. SEF is a revenue source as a result of a national legislative measure. A similar measure incorporated in the proposed amendments to the local government code will be acceptable to LGUs. This will open opportunities for better functioning inter-LGU health zones and local health boards.
To make these institutions responsive and accountable, a health score card could be established that will allow comparison between LGUs based on agreed indicators on desired health outcomes (a good model is the system of regularly measuring nutritional status conducted by the regional and national nutrition councils). When LGUs are compared with each other, it will allow their constituents to measure how good their local officials are as compared to their other counterparts. Health will now be part of the political discourse. There is now more incentive for the elected officials to put health as a priority in their development agenda.