Beyond the mandates, requirements, powers and prerogatives granted to local government units (LGUs) by the universal health coverage law or act (UHCL or UHCA), it is hoped that LGUs, through their Sanggunians and Local Chief Executives will look beyond what the law provides and find innovative and creative ways to achieve the objectives of the law. In building partnerships with other health stakeholders in their given jurisdictions, LGUs will need look beyond being facility ‘owners’ towards a more critical role of being the primary enablers of the UHCA’s success.
The UHCL has added to the mandate of the Local Health Boards (LHB) of each LGU. Under the Local Government Code, the Local Health Board functions are mandated to: 1. Propose to the Sanggunian (local legislative council) annual budgetary allocations for the operation and maintenance of health facilities and services; 2. Serve as an advisory committee to the Sanggunian concerned on health matters; and 3. Create advisory committees which shall advise local health agencies on health administration matters and similar functions. To these functions have been added the roles of: 1. The oversight and coordination of the integration of health services into province-wide and city-wide health systems to be composed of municipal and city health systems; and 2. The management of the special health fund as established in Section 20 of the UHC law. The Special Health Fund (SHF) shall be used to finance population- and individual — based health services, health system operating costs, capital investments and remuneration of additional health workers and incentives for all health workers. In effect, Local Health Boards, under the supervision the Sanggunian and the Local Chief Executive have the authority to determine how the fund shall be employed and allocated, pretty much determining how well, or badly, the new law will proceed. These serve to highlight the central and crucial role that LGUs play in the implementation of the UHCA. Presumably this SHF will be allocated from central authorities over and beyond internal revenue allocations of LGUs. How central authorities, i.e. Department of Health and PhilHealth, will allocate funds remains to be clarified and will need a rigorous and transparent funding allocation model. When ‘special’ funds are issued, accountability mechanisms will need to be in place.
Local Chief Executives and policy makers must understand that building a health system is not simply about curing sick people. A genuinely responsive and pro-active Local Health System plans for and implements projects from people who are well, to those that are nearly ill and finally those who are, unfortunately, ill. The perspective then is to see the system as addressing needs of all those in the spectrum so that fewer people move from well, to nearly ill, to ill and more people move back to being well from being nearly ill and ill. This view also emphasizes, as the UHCA has recognized, the importance of prevention, health promotion and primary care as pillars of any local health system.
The broad mandates that LGUs have with respect to health systems, primary care providers and health care networks, will need to harness existing or create new avenues for people’s participation in local governance. A more democratized process for selecting members of the local health boards will improve decision making processes of the local health boards and will enhance accountability in the health sector. In New Zealand for example, district health board membership will have some members elected during the local council elections, and the Chief Executive of the health board, along with the rest of the board are appointed by the central authority, their department of health. Genuine representation in the local health boards leads to free and active exchange of information — the lifeblood of the entire UHCA — between the central authorities, LGUs and the communities.
Moreover, in determining programs and investment plans for health, LGUs should effectively utilize the local development planning process from a bottom-up approach so that local health systems are attenuated to the legitimate health needs of the people. This requires encouraging participation by grassroots organizations such as Non-Government Organizations or People’s Organizations. Such participation and partnerships have long been recognized and prescribed to by the Local Government Code but have been sparingly used when it comes to the local development planning process. It is hoped that by broadening and deepening participation, the health policies developed to implement the UHCA will be truly responsive and effective.
Finally, the UHCA requires local leaders who recognize that health is not just one of their concerns but is in fact a strategic concern that has wide-reaching impact on stubborn societal issues. By understanding that the UHCA seeks to realize better health outcomes not only through health interventions but also to other social determinants of health. Those who appreciate health systems from this perspective will not just roll up their sleeves and get to work. They will think of new ways to fully harness the opportunities under the UHCA and will hopefully transform the way we think, feel and behave about health.
Lawyer Vincent E.R. Festin is Assistant Professor at the Ateneo Graduate School of Business. He was former Director for Academics of the school’s Leaders for Health Program and is the current academic coordinator of the Master of Business Administration-Health (MBA-H) program in the Ateneo School of Medicine and Public Health.