LOCAL HEALTH ACCOUNTS IN THE PHILIPPINES Understanding the Sources and Uses of Funds in a Decentralized Health System

Philippine National Health Accounts  Developed in 1991 to provide basis for health reforms  Provides information for evidence-based decision-making - setting targets and goals - monitoring the progress and outcomes of policy interventions

Office of Secretary of Health Executive Committee for National Field Operations Regional Offices Provincial Health Offices City Health OfficesDistrict Health Offices City HospitalsRural Health Units Barangay Health Stations District HospitalsMunicipal Health Offices Barangay Health Stations Provincial Hospitals Regional Hospitals Medical Centers Sanitaria Devolved to provincial government Devolved to city government Devolved to municipal government

Aquino Health Agenda to achieve Universal Health Care (2010 onwards) Fourmula One for Health (2005 – 2010) Health Sector Reform Agenda ( ) Health Reform in the Philippines National Health Insurance Program Law 1995 Local Government Code 1991

Despite these reform initiatives.. Questions remain unanswered how much is being spent on health care who pays for health care what health care services are being spent on

Lack of sector-specific expenditure data at the local level made it difficult to analyze local spending for health Local Health Accounts

Mid 1990s: LHAs in selected provinces not sustained Lack of capacity to do estimation Inadequate appreciation and use of LHA information in local policy-making 2008: - Local purpose felt with the PIPH Data needed for use for setting targets and goals, monitoring progress, and evidence-based decision-making - DOH spearheading building capacities and institutionalization

INSTITUTIONALIZING LHA ESTIMATION National LHA team/TWG overseeing the institutionalization of LHA estimation in the provinces LHA estimation methodology developed, based on international methods of estimating health accounts. Manuals and other guide materials developed. - Methodology is simple, doable - Uses secondary data

Local Health Accounts: Local Use Province of Capiz Known for successful health reforms: e.g. implementation of pooled procurement and revolving drug funds 2006 LHA became the basis to triple enrollment of indigent population in the National Health Insurance Program

Source: Province of Capiz, 2010 Capiz Budget for PhilHealth Enrollment of Indigent Families

Source: Preliminary Capiz Local Health Accounts, Capiz Health Expenditures by Financing Agent,

Local Health Accounts: Local Use Province of Bukidnon All indigents enrolled by Province in PhilHealth. Facilities are equipped to deliver curative services. Province to use LHA results to discuss and leverage with municipalities the delivery and financing of preventive and public health services.

Source: Preliminary Results of Bukidnon Local Health Accounts, Health Expenditures by Financing Agent, Bukidnon, (in Percentage)

Source: Preliminary Results of Bukidnon Local Health Accounts, Health Expenditures by Health Care Function, Bukidnon, (in PhP)

Source: Annual Health Report, Bukidnon, 2010

Local Health Accounts: Local Use Makati City Makati Health Program (MHP)/Yellow Card Program: City subsidizes hospitalization expenses of constituents in the city hospital LHA results flag areas to make the MHP more sustainable by minimizing unnecessary subsidies : - need to properly identify services due for reimbursement from the National Health Insurance Program - need to cost hospital service properly, to be able to charge the paying patients correctly

Source: Preliminary Results of Makati City Local Health Accounts, PhilHealth Claims in Makati City and in Ospital ng Makati, (in PhP)

CHALLENGES Data Collection Mainstreaming in the functions of the local personnel: planning, budgeting

LHA: WAY FORWARD At the local level  Mainstreaming in the planning and budgeting processes  PIPH and LGU Scorecard At the national level  Mainstreaming in the monitoring systems - LGU Scorecard  More responsive financing support to LGUs  Partnering with a training institution to offer LHA training courses