1. JUSTICE AND HEALTH: The Ambivalence of Democracy and Justice in the Devolution of Health Services in the Philippines

2. Figure 1. Pre-devolution Structure of the Philippine Health System Regional Health Office Regional Hospital Integrated Provincial Health Office Special Hospital District Health Office Field Health Services Hospital Rural Health Unit Barangay Health Station Mayor DOH Central Office

3. Center for Health Development Provincial Heath Representative Provincial Government City Government Municipal Government Provincial Health Board Municipal Health BoardCity Health Board Provincial District Hospital Medicare Hospital City Hospital City Health Office Rural Health Unit Municipal Hospital Barangay Health Board Figure 2. Post-devolution Organizational Structure of the Philippine Health System

4. A.History and Background of Devolution B. The Devolution Problematic a. Justice b. Democracy C. Relief for Democracy

5. Decentralization is a process of delegation and dispersal of responsibility and authority either from the top down or from the center of power towards the edges or periphery. It is marked by a strong sense of trust and confidence to local leaders in the lower rung of the political strata as the delegation of responsibility entails autonomy and higher accountabilities to leaders of a certain political, demographic and geographic division.

7. Three Types of Decentralization 1.Deconcentration 2.Devolution 3.Debrureacratization

8. Deconcentration involves the transfer of functions to lower-level administrative units designated by the central office. It is essentially a management tool to decongest the central office and spare it from having to act on matters, including routine and administrative ones, that may be best addressed at the lower levels. However, final and substantive authority still rests on the central authorities

9. Devolution involves the transfer of powers and authorities to lower level political or local government units

11. Debureaucratization involves the transfer of powers and authorities to units not within the purview of government. This involves the transfer of such to non- government organizations (NGOs) and peoples organization (POs) including private sector, all of which are sometimes collectively referred to as “civil society.”

12. “ decentralization is adopted in many countries and advocated by donor agencies (World Bank, 1998) because regional government agencies, local governments or private enterprises have institutional advantages over the national government in the provision of certain public services. The supposed advantages include better information about the preferences of the local population, greater knowledge about the fiscal constraints imposed by the local economic condition, and more incentives (and at the same time, greater pressure) to respond to local needs. ” - Joseph Capuno, The Political Economy of Decentralization

14. Pre-devolution and Post-devolution Structure of the Department of Health 1.Facilities, Hospitals, Services and Personnel

18. Regional Health Office Regional HospitalIntegrated Provincial Health Office Special Hospital District Health Office Field Health ServicesHospital Rural Health Unit Barangay Health Station Mayor DOH Central Office Center for Health Development Provincial Heath Representative Provincial Government City GovernmentMunicipal Government Provincial Health BoardMunicipal Health BoardCity Health Board Provincial District Hospital Medicare Hospital City HospitalCity Health Office Rural Health Unit Municipal Hospital Barangay Health Board DOH Central Office Figure 1. Pre-devolution Structure of the Philippine Health System Figure 2. Post-devolution Organizational Structure of the Philippine Health System

19. 2.Allocation and Funding a. The Local Government Code of 1992 has the following feature: first, it transfers to local governments the responsibility for the delivery of basic services, including health, agriculture, environment and natural s\resources and social series. b. Second, it transfers certain regulatory and licensing powers to local governments. c. Third, it increases the internal revenue allotment (IRA) shares of local governments from a low of 11 percent to as high as 40 percent. d. Fourth, it lays the policy framework for the direct involvement of civil society, most especially NGOs and POs in the process of governance (debureaucratization in our paradigm)

20. DEPARTMENT OF HEALTH CY 1991-2009 BUDGET APPROPRIATION YEARPSMOOECOTOTAL 19912,970,670,0003,882,689,000319,392,0007,172,751,000 19925,089,652,0004,710,415,000427,677,00010,227,744,000 19932,227,344,0003,862,613,000824,775,0006,914,732,000 19942,274,670,0003,679,651,0001,377,870,0007,332,191,000 19952,872,405,0003,595,884,0002,065,787,0008,534,076,000 19963,370,752,0004,089,307,0001,777,494,0009,237,553,000 19973,965,000,0004,537,828,0002,435,029,00010,937,857,000 19984,967,983,0005,435,953,0002,539,281,00012,943,217,000 19995,042,874,0005,300,903,000922,061,00011,265,838,000 20005,028,963,0005,313,600,000396,342,00010,738,905,000 20015,020,223,0004,392,428,00043,612,0009,456,263,000 20025,404,739,0005,115,498,000899,000,00011,419,237,000 20035,368,302,0003,807,988,000730,000,0009,906,290,000 20045,368,302,0003,789,927,000405,575,0009,563,804,000 20055,397,944,0003,942,388,000384,986,0009,725,318,000 20065,397,944,0003,760,310,000299,031,0009,457,285,000 20075,789,064,0004,639,809,000969,898,00011,398,771,000 20085,832,513,00010,643,479,0002,436,018,00018,912,010,000 20096,727,340,00010,584,705,0006,354,610,00023,666,655,000 SOURCE: General Appropriations Act 1991-2009 DOH Budget

21. 2.Allocation and Funding e. Finally, it encourages local government units (LGUs) to be more entrepreneurial by providing them with opportunities to enter into joint ventures with the private sector, engage in build- operate-transfer arrangements, and even float bonds

22. Under the Code, the collection of the Bureau of Internal Revenue is divided 60 - 40 in favor of the national government. The 40 percent is distributed as follows: 23 percent for the provinces, another 23 percent for the cities, 34 percent for the municipalities, and 20 percent for the barangays. Among LGUs, part of their share in the IRA is determined by their respective land area and population. Another part is equally divided among them

25. DOH Central Office Center for Health Development Provincial Heath Representative Provincial Government City Government Municipal Government Provincial Health Board Municipal Health BoardCity Health Board Provincial District Hospital Medicare Hospital City Hospital City Health Office Rural Health Unit Municipal Hospital Barangay Health Board Figure 2. Post-devolution Organizational Structure of the Philippine Health System

29. Diyos Mabalos! Daghang Salamat! Thank you very much!