1. Decentralization1 Decentralization and National Health Accounts Ma. Paz G. De Sagun Office of Population, Health & Nutrition USAID/Philippines October 9, 2002

2. Decentralization2 LGU Local planning Health Social welfare services Environmental Management Agricultural extension Tourism Housing Investment support

3. Decentralization3 By 1993: 595 hospitals 12,859 rural health units 46,080 personnel 78 provinces 1,543 municipalities 41,924 barangays LGUs

4. Decentralization4 Selected Indicators 1993199819992000 Fully 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

5. Decentralization5 DEVOLUTION OF HEALTH SERVICES Department of Health Regional Health Offices DOH 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

6. Decentralization6 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 Average4.753.398.1410.8356.18 Province20.3213.5933.941.6481.49 City1.072.113.186.1152.05 Municipality0.660.521.182.349.21

7. Decentralization7

8. 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)

9. Decentralization9 Share of Health Expenditure to GNP PercentPercent Year

10. Decentralization10 SOURCE OF FUNDS PERCENT SHARE 1991199219931994199519961997199819992000 GOVERNMENT38.5135.1736.6037.2435.3236.3138.3038.6537.9141.08 National34.6630.8024.0721.2619.3319.9320.5220.5320.0421.51 Local3.854.3712.5315.9816.0016.3717.7818.1317.8719.57 SOCIAL INSURANCE5.445.976.365.704.545.065.133.744.867.10 Medicare5.175.716.075.374.254.794.873.464.616.87 Employees' Compensation 0.270.260.300.340.280.270.260.270.250.22 PRIVATE SOURCES56.0558.8657.0357.0660.1458.6356.5857.6157.2351.81 Out-of-Pocket47.6949.5847.7547.4750.4348.7146.8847.9646.2641.01 Private Insurance2.882.832.412.091.771.681.941.982.142.03 HMOs1.251.311.421.641.982.282.502.883.843.86 Employer-based Plans 3.414.184.534.894.985.064.423.954.013.76 Private Schools0.820.950.920.97 0.910.840.850.991.13 ALL SOURCES100 DISTRIBUTION OF HEALTH EXPENDITURE BY SOURCE OF FUND

11. Decentralization11 1991 Distribution of Health Expenditure by Use 2000 Distribution of Health Expenditure by Use

12. Decentralization12

13. Decentralization13 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