Devolving Health Care in the Philippines: The context-dependence of decentralisation and health care reform

In 1991, the Local Government Code of the Philippines devolved responsibility for public health, primary care, and selected hospital services to local administrative units. The literature reviewed demonstrates a marked tendency to assume that health care decentralisation is inherently empowering to local communities. Heretofore, no study has assessed the outcomes of this health care reform in the Philippines. This pilot study attempts to assess these assumptions through interviews with administrators and community members in 16 communities of four municipalities in the Philippines.

400 community members, including local administrative councils responsible for local health care units, were non-randomly selected through snowball and convenience sampling for semi-structured interviews and focus groups using open-ended questions. N-Vivo was employed for data analysis.

A low level of satisfaction since devolution was found in the majority of communities assessed. Community administrators generally reported significant challenges in executing their local health care responsibilities due to lack of financial and knowledge based resources. A model illustrating the context-dependence of health care reform is presented.