DOH eyes federalism to cure ‘dismal’ healthcare in provinces

BAGUIO CITY—The Duterte administration is unhappy over the way some local governments have implemented health programs in towns and provinces.

The success rate of infant immunization by local governments, for instance, was only 45.6 percent in 2016, according to a status report presented at a national health assembly held here recently.

Calling this “dismal” performance by local governments, Health Secretary Paulyn Jean Ubial said the administration intends to cure ailments that were brought by a devolved healthcare system.

This could be done by giving healthcare functions to regional or state-run health agencies under a federal system of government.

While the proposal is not final, it was drawn from a review of the country’s healthcare system after the 1991 Local Government Code (Republic Act No. 7160) mandated the devolution of healthcare functions to city, town and provincial governments.

The devolution, however, did not require the national government to turn over health funds or transfer skilled health workers to local government units (LGUs).

Many LGUs failed to hire enough doctors and build health centers for constituents, according to health reports.

Ubial led a three-day meeting with top health officials at the Baguio Country Club recently to assess the country’s healthcare system, including an initiative to create a national data bank on medical status of patients.

Bigger issues

The government’s electronic medical records allow efficient treatment of patients regardless of where they fall ill and help hasten health insurance processing.

But the government has bigger issues over the “fragmentation” of the healthcare system.

Ubial said research is ongoing on the devolution of healthcare functions with the help of the United States Agency for International Development, which is coming out with a review of the healthcare system after the devolution in 1992.

She said the Department of Health (DOH) and other agencies are studying the problems that blocked efficient delivery of health services following the devolution.

Different problems

The administration, however, is not inclined to bring back centralized healthcare delivery by the national government.

She said under federalism, devolution would be done at regional levels.

“All health facilities and health professionals in one region will be under a state health department,” Ubial said.

She said centralization would defeat the purpose of federalism.

For instance, she said, while HIV-AIDS is a health issue in highly urbanized areas like Metro Manila, Metro Davao and Metro Cebu, “in the rural areas you hardly have any HIV problems.”

“So why provide the same program in those areas?” she said.

The national government is pushing a program to encourage women to give birth in health facilities since home births have increased the risks of maternal deaths, Ubial said.

She said healthcare has improved despite defects brought by devolution, though.

In 2016, births attended by doctors, nurses or midwives rose to 91 percent, exceeding the government target of 90 percent, said Ubial.

“That would have been an impossible target five years ago,” she said.

The rate of infant mortality last year also declined, she said, adding that the DOH has reduced deaths to 20 per 1,000 live births. —VINCENT CABREZA