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Decentralisation and its implications for reproductive health: the Philippines experience

Decentralisation of health care in the Philippines poses a threat to reproductive health services

Authors: Lakshminarayanan, R.
Publisher: Reproductive Health Matters

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This paper, from Reproductive Health Matters (RHM), examines the decentralisation of the Philippines health sector that took place in the 1990s. The paper looks at the impact of decentralisation on the financing and delivery of services, institutional capacity, health personnel, quality of care, and local representation. It finds that the decentralisation process in the Philippines has exacerbated inequities, weakened local commitment to priority health issues and decreased the efficiency and effectiveness of service delivery. Such effects have posed a particularly serious threat to reproductive health services.

The paper concludes that these problems derive from a range of both non-health and health sector factors that impacted on the decentralisation process, including attitudes toward gender relationships, fluctuating political commitment to reproductive health goals, health sector capacity constraints and geographical variations in financial resources. The author argues that better preparation for the devolution process could have reduced the impact of such factors. This should have included measures such as a core package of reproductive health services to prevent local governments from overlooking such services. In addition to remedial measures, sustained political commitment and systematic strengthening of institutional capacity at all levels are now needed to translate reform measures into actual health sector improvements.

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