BUDGETING IN A DECENTRALIZED ENVIRONMENT

Blesilda A. Gutierrez

Department of Health

Republic of the Philippines

What is Universal Health Care?

Universal Health Care (UHC)* is the Aquino administration’s health agenda to ensure that Filipinos, beginning with the poor, have :

1) ACCESS to preventive and promotive care

2) AFFORDABLE health services; and

3) QUALITY care in modern clinics and hospitals

*Also known as Kalusugan Pangkalahatan per DOH Department Order 2011-0188

Office of Secretary of Health

Attached Agencies

DOH Regional Offices

Provincial Health Offices

City Health Offices (Component Cities)

Inter-local Health Zones

City Hospitals

Health Centers

Barangay Health

Stations

District hospitals

Municipal health offices/ Rural Health

Unit

Barangay Health Stations

Provincial Hospitals

DOH Regional hospital Medical Centers

Sanitaria

City Health Offices (Chartered Cities)

City Hospitals

Health Centers

Barangay Health

Stations

Local Code in 1991 Decentralization of Services

Decentralization

Advantages • Provides a Framework which

facilitates & stimulates local sustainable development

• Offers more ability to recognise & respond to specific needs

• Ability to target localised areas of needs & issues

• Brings government closer to the people

• Increase efficiency in determining service provision

Disadvantages

• Poor capacity of the LCEs

• Inter-regional inequity may increase

• Lack of commitment from LCEs

• Discontinuity in the policy & service implementation

• Misuse of authority due to inadequate supervision/weak accountability mechanism

CHALLENGE : MAKE DEVOLUTION WORK!

Achieving health Goals through Local Health System

Performing Local Health Systems

Goals

Better health Outcomes

Fair Health Financing

Responsive Health Systems

Support

Policy Directions

Technical Assistance

Financial Assistance

Commodity Assistance

Health Facilities Enhancement

Health Insurance

Heath Human Resource

Health Information

Effective, Efficient, Equitable and Em

powering

Instruments 1. Health

Financing,2. Service

Delivery3. Policy

,Standards and Regulation

4. Health Human Resource

5. Health Information

6. Health Governance

Functions1. Provision

of services

2. Financing3. Resource

Generation

4. Stewardship

Technical Clusters Operations cluster

DOH Central Office

Engaging Partnership: Province-Wide Investment Plan for Health

Translates national health goals into specific concrete actions at the local levels and vise-versa

National

PROVINCE-WIDE INVESTMENT PLAN

FOR HEALTH

Health Sector Reform Goals

Medium Term Development Goals ,

Medium Term Philippine Development Plan &

National Objectives for Health

Programs/Projects Activities

Key instrument in forging DOH & LGU partnership to achieve the health sector goals

Forging Commitments: SLA

the Service Level Agreement is the legal basis of the Annual Operation Plan that defines specific agreements between DOH and Province/City/DOH ARMM for: output and performance milestones amount of funds to be provided (ODA, DOH and

LGU) conditions and requirements pertaining to the

release of said funds.

LGU Report Card

Outside Panel

Improved the Information System • Developed & Implemented Expenditure Tracking System NEXT STEPS: • Link ETS with other IT systems to develop a synchronized

and unified system for the DOH – Hospital Operation Management Information System – Procurement Operation & Management Information

System – National Online Stock Inventory Reporting System – Electronic New Government Accounting System – Health Facilities Enhancement Program Tracking System – Field Health Service Information System