Reconstructing the Functions of Government:The Case of Primary Health Care in the Philippines By: Victoria A. Bautista (2003) Prepared by: Jerry L. Roxas - Discussant Professor: Dr. Jo B. Bitonio DPA 102 Philippine Administrative System – Ist Semester 2011 LNU Dagupan City
Definition of Primary Health Care (PHC): World Health Organization (WHO) definesPHC as essential care made universally accessibleto individuals and families in the community bymeans acceptable to them through their fullparticipation and at a cost that the community andcountry can afford at every stage of development.
Background: Primary Health Care (PHC) was declaredduring the First International Conference onPrimary Health Care held in Alma Ata, Russia onSeptember 6-12, 1978 by the World HealthOrganization (WHO). The goal was “Health for All bythe Year 2000”. This was adopted by the in thePhilippines through Letter of Instruction 949 signedby President Marcos on October 19, 1979 and hasan underlying theme of “Health in the Hands of thePeople by 2020.”
• This approach has influenced many countries includingthe Philippines. Its innovativeness is indicated by the call forparticipatory development management since communitymembers are expected to take an active role in managingtheir own health requirements, instead of depending onthe government. PHC also gives importance to theparticipation of various sectors of government and theprivate sector in local health activities.
Periods in PHC Implementation and Approaches to Reconstruction Pre-devolution Institutionalization Devolution
PRE-DEVOLUTIONPilot Testing Stage:A.Area Selection on the Basis of NeedB.Social PreparationC.Identification of VolunteersD.Creation of Intersectoral Structures
A. Area Selection on the Basis of Need The introduction of PHC begun in 1979 bypilot testing the methodology in one province ineach of the 12 regions. In 1982 the UPCPA revealed an importantapproach to ensure the outreach of thegovernment to the underserved areas. This wasdone through the selection of the 12 provinces onthe basis on “need” such as;
•Low health personnel ratio, absence of any province-wide PHC activities and inaccessibility to the regionalcenters;•Receptiveness of the local government since a newmethodology was to be implemented necessiting itssupport;•Presence of functional organizations for managingprojects at the provincial and municipal levels;•Peace and order.
B. Social Preparation The DOH conducted preparatoryactivities among health and other sectoralimplementers for effective utilization ofresources. Trainers were also identified at theprovincial levels in order to echo the essenceof PHC at the municipal level.
C. Identification of Volunteers An important component of preparatoryactivities for PHC was the identification andmobilization of voluntary health workers(VHW’s).
D. Creation of Intersectoral Structures The government mobilizes PHC committees at thenational and local levels.e.g.•World Vision – conducted orientation seminars for BHW’s•UP Institute of Health Science – served as the institutionalbase for health manpower training•Davao Medical School Foundation – involved in thetraining of BHW’s in region XI
InstitutionalizationA.Bureaucratic InnovationsB.Identification/Preparation of VolunteersC.Validation of Indigenous MethodologiesD.NGOs as Conduits of Funds and as chiefMobilizers for PHCE.Incentives for Community Involvement
A. Bureaucratic Innovations• 1981 – under President Marcos, nationwide implementation of PHC took place through the vigorous effort of the top leadership of Minister Jesus Asurin.• 1982 – administrative innovations started to put in place which could facilitated the implementation of PHC. This enabled local field offices of then Ministry of Health to have greater unity in pursuing health activities.
B. Identification/Preparation of Volunteers Three years after the nationwide orientationprograms for health workers, PHC was initiated in99% of the barangays. 1982 - 1 BHW/70 households 1986 – 1 BHW/29 households
C. Validation of IndigenousMethodologies•Herbal gardening was encourage to solve theexisting shortage of supplies and high cost of drugs.This program was supported through thedissemination of manuals, seedlings and plants.•Oral Rehydration Therapy using oral rehydration(ORESOL) was a key innovation by the Ministry ofHealth. This simple inexpensive solution was proveneffective in preventing diarrhea-related deaths.•Strengthening the Botika sa Barangay (BSB).
D. NGOs as Conduits of Funds and asChief Mobilizers for PHC•In 1986 President Corazon Aquino gave importanceto NGO’s in the promotion of PHC.•The DOH experimented new approach which is thePartnership for Community Health Development(PCHD) which entailed financial assistance to NGO’swhich serves as conduits of funds to mobilizepartnership effects among Local Government Units(LGU’s), NGO’s and peoples organizations toundertake health and related development activitiesin the barangays.
•In 1991, the government issuedAdministrative Order No. 112 in the 1stNational Convention for NGO’s whichconducted by the DOH. It is a policy onCollaboration between Public and PrivateSectors on Health Policies and Programs.•According to studies from 1991-1995, theimpact of PCHD pointed to the reduction ofpreventable diseases.e.g. malaria - 50% acute respiratory infection – 42%
E. Incentives for Community Involvement•In the year 1994, various incentives and measureswere implemented by the DOH; this included theprovision to BHW’s such as free medical and dentalcheck-up, bloodtyping, supply of drugs and medicines,laboratory examination and tetanus toxiodimmunization.•Income generating projects were also encouragethrough the provision of financial grants to BHW’s forlivelihood.
DEVOLUTION Direct responsibility for PHC is nowassumed by mayors of municipalities andcities due to the Local Government Code of1991.
Implications of Devolution on PHC•Lack of understanding and appreciation by localchief executives of health services of PHC as aninnovative strategy.•The government launched the Minimum BasicNeeds (MBN) approach as the managementtechnology for supporting the Social Reform Agendato improve the quality of the poorest of the poor.
Mechanisms for Propagating PHCUnder DevolutionA.Capability BuildingB.Support to LGUs Through NGOsC.Policy FormulationD.Research/Documentation
A. Capability Building•The UPCPA assists in the conduct of seminarsto convey the meaning of PHC.•Under Ramos administration, the DOH hadstrong commitment to enforcing the “healthin the hands of the people.” Strong advocatesof PHC among professional civil servantsurged the continuation of this motto.
B. Support to LGUs Through NGOs•The DOH sustains its support to PCHD in order toprovide assistance to LGU’s not able to employparticipatory method in their area.•Retained also by the DOH to propagate PHC wasthe provision of support for innovative strategies.e.g. The grant to cooperatives to engage in theoperation of drugstore to reduce the cost of drugsin a locality.
C. Policy Formulation•BHW’s Incentives Act or Republic Act 7883of 1995 -directing the LGU’s to provide subsequentallowance for BHW’s as they cater to hazardous areas.
D. Research/Documentation Due to lack of information regarding thestatus of PHC implementation, the governmenthas adopted the conduct of researchessubcontracted to private institutions to determinethe status of PHC.
Problems/Issues The implementation of PHC has not been spared fromproblems and difficulties.•Lack of political will of the top leadership of the DOH for thecontinued implementation of PHC.•Passage of BHW’s Incentives Act which violated the principle ofvolunteerism and could be a tool for politicking by localexecutives since the volunteer workers could beholden to theminstead of the community.•The transfer of responsibility of PHC to local executives underdevolution is not easy. PHC could not be fully achieved if thebureaucracy itself is not empowered.
Reference: Introduction to Public Administration A Reader 2nd EditionNational College of Public Administration & Governance University of the Philippines Diliman, Quezon City, 2003