Decentralization 1

Decentralization and National Health

AccountsMa. Paz G. De Sagun

Office of Population, Health & Nutrition

USAID/Philippines

October 9, 2002

Decentralization 2

LGU

Local planning

HealthSocial welfare services

Environmental Management

Agricultural extension

Tourism

Housing

Investment support

Decentralization 3

By 1993:

595 hospitals

12,859 rural health units

46,080 personnel

78 provinces

1,543 municipalities

41,924 barangays

LGUs

Decentralization 4

Selected Indicators

1993 1998 1999 2000Fully Immunized Child 72% (1) 65% (2) 65% (3) 66% (4)

Mothers having 3 or more Prenatal Care Visits

81% (5) 77% (2) 81% (3) 81% (4)

Children receiving Vitamin A capsule Supplementation

90% (7) 78% (7) 74% (7) 82% (7)

Contraceptive Prevalence Rate 40% (1) 47% (2) 49% (6) 47% (6)

1 National Demographic Survey 1993

2 National Demographic and Health Survey 1998

3 Maternal and Child Health Survey 1999

4 Maternal and Child Health Survey 1999

5 Philippine National Safe Motherhood Survey 1993

6 Family Planning Survey

7 FETP-DOH Cluster Survey

Decentralization 5

DEVOLUTION OF HEALTH SERVICES

Department of Health

Regional Health OfficesDOH Retained Hospital

Provincial Hospitals

Provincial Health Offices

City Health Offices

City Hospital

District Hospitals

District Health Offices

Barangay Health Stations

Municipal Health Offices

Rural Health Units

Barangay Health Stations

Municipal LGU

DOH

Province/City LGUs

Decentralization 6

Average Total Cost of Devolved Functions, 1993

(Million Pesos)

LGU

Cost of Devolved Health Functions (CHDF)

Total Cost of

Devolved Functions

(CDF)

Share of CHDF to

Total CDF (%)Personal

Services

Maintenance and

Operating Expenses

Total

Overall Average 4.75 3.39 8.14 10.83 56.18

Province 20.32 13.59 33.9 41.64 81.49

City 1.07 2.11 3.18 6.11 52.05

Municipality 0.66 0.52 1.18 2.3 49.21

Decentralization 7

Decentralization 8

Workbook and Manual: Management and Organizational Options for Devolved Hospitals

A Manual for Regional Health Coordination

National Health Accounts

Provincial Health Accounts: Selected LGUs

National Health Insurance Act

Provincial Health Insurance Program: A Manual of Operation

Operational Health Planning under a Decentralized Set Up (Training Modules)

Health Budgeting and Financial Management under a Decentralized Set Up (Training Modules)

Decentralization 9

Share of Health Expenditure to GNP

2.86 2.88

3.16 3.14

3.33 3.37 3.44 3.4 3.43

3.25

0

0.5

1

1.5

2

2.5

3

3.5

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

P

e

r

c

e

n

t

Year

Decentralization 10

SOURCE OF FUNDS

PERCENT SHARE

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

GOVERNMENT 38.51 35.17 36.60 37.24 35.32 36.31 38.30 38.65 37.91 41.08

National 34.66 30.80 24.07 21.26 19.33 19.93 20.52 20.53 20.04 21.51

Local 3.85 4.37 12.53 15.98 16.00 16.37 17.78 18.13 17.87 19.57

                     

SOCIAL INSURANCE 5.44 5.97 6.36 5.70 4.54 5.06 5.13 3.74 4.86 7.10

Medicare 5.17 5.71 6.07 5.37 4.25 4.79 4.87 3.46 4.61 6.87

Employees' Compensation

0.27 0.26 0.30 0.34 0.28 0.27 0.26 0.27 0.25 0.22

                     

PRIVATE SOURCES 56.05 58.86 57.03 57.06 60.14 58.63 56.58 57.61 57.23 51.81

Out-of-Pocket 47.69 49.58 47.75 47.47 50.43 48.71 46.88 47.96 46.26 41.01

Private Insurance 2.88 2.83 2.41 2.09 1.77 1.68 1.94 1.98 2.14 2.03

HMOs 1.25 1.31 1.42 1.64 1.98 2.28 2.50 2.88 3.84 3.86

Employer-based Plans

3.41 4.18 4.53 4.89 4.98 5.06 4.42 3.95 4.01 3.76

Private Schools 0.82 0.95 0.92 0.97 0.97 0.91 0.84 0.85 0.99 1.13

ALL SOURCES 100 100 100 100 100 100 100 100 100 100

DISTRIBUTION OF HEALTH EXPENDITURE BY SOURCE OF FUND

Decentralization 11

Personal 79.95%

Others 12.00%Public 8.05%

1991 Distribution of Health Expenditure by Use

2000 Distribution of Health Expenditure by Use

Personal 73.85%

Others 12.18%Public

13.98%

Decentralization 12

Decentralization 13

And so …..Devolution is complex and challenging but it is desirable.

NHA is a useful tool and framework for health sector reform.

Remaining key challenges:

Financing of essential public health services including FP/RH

Covering poverty groups via risk sharing and social health insurance