The Unfinished Agenda in Health Devolution

Manila Bulletin, August 31, 2003 | Go to article overview

The Unfinished Agenda in Health Devolution


Byline: Dr. Jaime T. Galvez Tan

It has been 10 years now since the devolution of health services was put into motion in 1993. The Local Government Code of 1991 signaled the legal basis for the decentralization of central political and economic powers to local chief executives. While this development was most welcome by everyone, the decentralization of health services sparked endless debates that have lasted up to the present.

Should health services be decentralized? Or should they all be recentralized to the Department of Health (DoH)?

When then Secretary of Health Juan M. Flavier and I, as his Chief of Staff and Undersecretary, entered the DoH in July 1992, we were faced with a hostile environment wherein nearly all of the government health sector personnel were against devolution. But then President Fidel V. Ramos stated that the Local Government Code be fully implemented. We, however, requested the President that we be allowed to defer its implementation for six months since we needed time to formulate a well thought out strategic plan.

Secretary Flavier and our team designed a 10-year strategic plan for the devolution of health services. It consisted of three phases: The Change over phase (1993); followed by the Transition phase (1994-95) and the Stabilization phase (1996-2002). We had to create a totally new unit, the Local Government Advisory and Monitoring Services (LGAMS) headed by a manager and chief of health devolution, Dr. Juan Antonio Perez.

The Change over phase consisted of the following: (1) transfer of 42,000 national DoH personnel (out of 60,000) to the all local governments in the country; this meant ensuring that the personnel plantilla were accurate, up-to-date and their salary grade level intact and that they would be properly absorbed by their respective municipalities, cities and provinces without hitches; (2) transfer of all assets of health facilities and hospitals, i.e., land titles, buildings, vehicles, equipment etc., to provinces, cities and municipal governments; and (3) formal turnover ceremonies to every mayor and governor, ensuring that all these were done in a manner as smooth as possible with the least burden on both sides. Left behind in the DoH were the 52 specialty, national and regional hospitals and medical centers, the 16 regional health offices and personnel of the central office in Manila. This process took one year.

The Transition phase focused on the transfer of softwares, operational guidelines, programs and projects, capacity building of key personnel on both sides. An example of this was the establishment of a Comprehensive Health Care Agreement (CHICA) with each mayor and governor. This was meant for more than 1,600 local government executives to commit to health goals and objectives as well as the necessary support services and budget for health programs and projects.

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