justice and health: the ambivalence of democracy and justice in the devolution of health services in...
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JUSTICE AND HEALTH:
The Ambivalence of Democracy and Justice in the
Devolution of Health Services in the
Philippines
Figure 1. Pre-devolution Structure of the Philippine Health System
Regional Health Office
Regional Hospital
Integrated Provincial Health
Office
Special Hospital
District Health Office
Field Health Services
Hospital
Rural Health Unit
Rural Health Unit
Barangay Health Station
Barangay Health Station
Mayor
DOH Central Office
DOH Central Office
Center for Health Development
Provincial Heath Representative
Provincial Government
City Government
Municipal Government
Provincial Health Board
Municipal Health Board
City Health Board
Provincial District Hospital
Medicare Hospital
City Hospital
City Health Office
Rural Health Unit
Municipal Hospital
Barangay Health Board
Barangay Health Board
Figure 2. Post-devolution Organizational Structure of the Philippine Health System
A.History and Background of Devolution
B. The Devolution Problematica. Justiceb. Democracy
C. Relief for Democracy
Decentralization is a process of delegation and dispersal of responsibility and authority either from the top down or from the center of power towards the edges or periphery. It is marked by a strong sense of trust and confidence to local leaders in the lower rung of the political strata as the delegation of responsibility entails autonomy and higher accountabilities to leaders of a certain political, demographic and geographic division.
Three Types of Decentralization
1.Deconcentration
2.Devolution
3.Debrureacratization
Deconcentration involves the transfer of functions to lower-level administrative units designated by the central office. It is essentially a management tool to decongest the central office and spare it from having to act on matters, including routine and administrative ones, that may be best addressed at the lower levels. However, final and substantive authority still rests on the central authorities
Devolution involves the transfer of powers and authorities to lower level political or local government units
Debureaucratization involves the transfer of powers and authorities to units not within the purview of government. This involves the transfer of such to non-government organizations (NGOs) and peoples organization (POs) including private sector, all of which are sometimes collectively referred to as “civil society.”
“decentralization is adopted in many countries and advocated by donor agencies (World Bank, 1998) because regional government agencies, local governments or private enterprises have institutional advantages over the national government in the provision of certain public services. The supposed advantages include better information about the preferences of the local population, greater knowledge about the fiscal constraints imposed by the local economic condition, and more incentives (and at the same time , greater pressure) to respond to local needs.” - Joseph Capuno, The Political Economy of Decentralization
Pre-devolution and Post-devolution Structure of the Department of
Health
1.Facilities, Hospitals, Services and Personnel
Regional Health Office
Regional Hospital Integrated Provincial Health Office
Special Hospital
District Health Office
Field Health Services
Hospital
Rural Health Unit
Rural Health Unit
Barangay Health Station
Barangay Health Station
Mayor
DOH Central Office
Center for Health Development
Provincial Heath Representative
Provincial Government
City Government
Municipal Government
Provincial Health Board
Municipal Health Board
City Health Board
Provincial District Hospital
Medicare Hospital
City Hospital
City Health Office
Rural Health Unit
Municipal Hospital
Barangay Health Board
Barangay Health Board
DOH Central Office
Figure 1. Pre-devolution Structure of the Philippine Health System
Figure 2. Post-devolution Organizational Structure of the Philippine Health System
2. Allocation and Funding
a. The Local Government Code of 1992 has the following feature: first, it transfers to local governments the responsibility for the delivery of basic services, including health, agriculture, environment and natural s\resources and social series.
b. Second, it transfers certain regulatory and licensing powers to local governments.
c. Third, it increases the internal revenue allotment (IRA) shares of local governments from a low of 11 percent to as high as 40 percent.
d. Fourth, it lays the policy framework for the direct involvement of civil society, most especially NGOs and POs in the process of governance (debureaucratization in our paradigm)
DEPARTMENT OF HEALTHCY 1991-2009 BUDGET APPROPRIATION
YEAR PS MOOE CO TOTAL
1991 2,970,670,000 3,882,689,000 319,392,000 7,172,751,000
1992 5,089,652,000 4,710,415,000 427,677,000 10,227,744,000
1993 2,227,344,000 3,862,613,000 824,775,000 6,914,732,000
1994 2,274,670,000 3,679,651,000 1,377,870,000 7,332,191,000
1995 2,872,405,000 3,595,884,000 2,065,787,000 8,534,076,000
1996 3,370,752,000 4,089,307,000 1,777,494,000 9,237,553,000
1997 3,965,000,000 4,537,828,000 2,435,029,000 10,937,857,000
1998 4,967,983,000 5,435,953,000 2,539,281,000 12,943,217,000
1999 5,042,874,000 5,300,903,000 922,061,000 11,265,838,000
2000 5,028,963,000 5,313,600,000 396,342,000 10,738,905,000
2001 5,020,223,000 4,392,428,000 43,612,000 9,456,263,000
2002 5,404,739,000 5,115,498,000 899,000,000 11,419,237,000
2003 5,368,302,000 3,807,988,000 730,000,000 9,906,290,000
2004 5,368,302,000 3,789,927,000 405,575,000 9,563,804,000
2005 5,397,944,000 3,942,388,000 384,986,000 9,725,318,000
2006 5,397,944,000 3,760,310,000 299,031,000 9,457,285,000
2007 5,789,064,000 4,639,809,000 969,898,000 11,398,771,000
2008 5,832,513,000 10,643,479,000 2,436,018,000 18,912,010,000
2009 6,727,340,000 10,584,705,000 6,354,610,000 23,666,655,000
SOURCE: General Appropriations Act 1991-2009
DOH Budget
2. Allocation and Funding
e. Finally, it encourages local government units (LGUs) to be more entrepreneurial by providing them with opportunities to enter into joint ventures with the private sector, engage in build-operate-transfer arrangements, and even float bonds
Under the Code, the collection of the
Bureau of Internal Revenue is divided 60-
40 in favor of the national government. The 40 percent is distributed as follows: 23 percent for the provinces, another 23 percent for the cities, 34 percent for the municipalities, and 20 percent for the barangays. Among LGUs, part of their share in the IRA is determined by their respective land area and population. Another part is equally divided among them
DOH Central Office
Center for Health Development
Provincial Heath Representative
Provincial Government
City Government
Municipal Government
Provincial Health Board
Municipal Health Board
City Health Board
Provincial District Hospital
Medicare Hospital
City Hospital
City Health Office
Rural Health Unit
Municipal Hospital
Barangay Health Board
Barangay Health Board
Figure 2. Post-devolution Organizational Structure of the Philippine Health System
Diyos Mabalos!Daghang Salamat!Thank you very much!