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 sectors 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