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THE ROLE OF LGUs IN ACHIEVING GOOD GOVERNANCE
IN HEALTH SYSTEMS
SLIDE #1
Definition:
Governance is the exercise of political, economic and
administrative authority in the management of resources for
development. It comprises complex mechanisms, processes and
institutions through which citizens and groups articulate their
interests, mediate their differences and exercise their legal rights
and obligations.
SLIDE #3
Good governance on the other hand can be measured through
the following principles:
1.Legitimacy and voice;2.Direction;3.Performance;4.Accountability; and5.Fairness
These principles can be summarized through a quotation from
Andrew Lansley: The government will require accountability atall levels for results, measured in terms of patient outcomes
rather than distorting targets.(SLIDE #4)
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We need to know our target, direct ourselves to the said target,
listen to our stakeholders and direct clientele, perform with
fairness and be accountable to our every move.
As an active partner of the Department of Health in achieving
Universal Health Care or Kalusugang Pangkalahatan, our aim is to
achieve better health outcomes, sustained health financing and
more responsive health system. This aim means that our target is
the poor to have equitable access to quality health care by being
financially protected, could access to quality hospitals and health
care facilities and further to attain the Millennium DevelopmentGoals.
After identifying our target, let us now see and evaluate the
stakeholders and our direct clientele for this aimthat is our
constituents. The targets are in our locality, in our own barangays
and our aim is to let them avail of our services in our own LGUs.
From our own local settings, let us inform, perform and reform (ifpossible) towards the achievement of our goals.
SLIDE #5
Question to ponder... Are our health services in our respective
LGUs enough and responsive to the needs of our constituents?
SLIDE #6
Before answering this question, let us see the Identified Critical
Aspects of Governance that prevent us in achieving the principles
of Good Governance, namely:
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1.Mutual Accountability of all those interested in health;2.Health Legislation and Regulation; and3.Financial Constraints
Mutual Accountability of all those interested in health:
Let us not leave all health concerns and problems to the
Department of Health alone. Since health is everybodys concern,
let us all be accountable to Universal Health Care or Kalusugang
Pangkalahatan. Being mutually accountable means strengthening
our partnerships with those who are also looking forward to ahealthy community, e.g., Civil Society Organizations (CSOs), Non-
Governmental Organizations (NGOs), local & national agencies,
and other concerned agencies.
Health Legislation and Regulation:
This includes issuances not only from the national or regionallevels but most especially those which were issued by the LGUs.
This includes issuances which defined the functions, entitlements,
incentives and regulations which will serve as guide of our
constituents to address equity and ethical issues in the
implementation of health programs, projects and activities.
Financial constraints:
Many LGUs could barely afford to provide basic services, and the
limited amount of health aid provided demands to be spent in
such a way to maximize health returns to promote health
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development. Hence, local officials are challenged to look into
other considerations and options to improve delivery of health
services and facilities.
Going back to the question, Are we providing enough and
responsive health services to our constituents? Yes or No, our
inner answer will boil down to this Kalusugang Pangkalahatan and
the mobilization of our Community Health Teams (CHTs). If our
LGU is one of the poor as enumerated and identified by the
National Household Targeting System (NHTS) courtesy of our
another partner agency, the Department of Social Welfare andDevelopment (DSWD), we should not be alarmed, instead it will
serve as our light going out from the tunnel of poverty.
Since our target in achieving the Aquino Health Agenda/ Universal
Health Care or Kalusugang Pangkalahatan is the poor, let their
responses in the data/information gathering done by our CHTs be
our guide in assessing our local health system. Apparently, thefirst-hand information will be coming from our constituents, thus
they are powerful. Let us then make use of that power by making
them equipped with information. How can our constituents avail
of our local health service when in the first place, they are not
aware of the services that our LGUs offer?
Finally, some basic principles for health program interventions
need to be in place: political will and skill; strong supply
through technical programs and strong demand from citizens
and stakeholders; and integral approach to governance,
financing, operations and capacity-building.
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There is a need to raise awareness of politicians regarding the
importance of good health system governance and performance.
And what we are doing now is a perfect venue to raise ourawareness.
SLIDE #7
Health System Governance Principle
Strategic Vision: LGUs should be mindful of setting the vision firstbefore any plan of action. The historical, cultural and social
complexities in our respective locality should be considered
because this will be where our perspective is grounded.
SLIDE #8
Participation & Accountability:
Participation and consensus orientation: Such broad participation
is built on freedom of association and speech, as well as
capacities to participate constructively. Good governance of the
health system mediates differing interests to reach a broad
consensus on what it is in the best interests of the group and,
where possible, on health policies and procedures. Before any
move to mobilize our Community Health Teams, consultations
with our Local Health Board and other conventions should be
undergone so that no stakeholder and beneficiary will be left
behind.
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SLIDE #9
Responsiveness:
Rule of Law: Legal frameworks pertaining to health should bemade free and enforced impartially, particularly the laws on
human rights related to health. Sometimes, with our eagerness to
implement laws which we think are helpful to our constituents,
we set aside the possibility of violating the basic human rights.
SLIDE #10
Transparency:
Transparency: As a major virtue of which DILG is advocating, the
LGU processes, plans, programs, activities and information should
be directly accessible to those concerned with them, and enough
information is provided to understand and monitor health
concern.
SLIDE #11
As always emphasized, I would like to share with you that
Transparency allows beneficiaries and stakeholders to hold local
officials more accountable. Transparency and more information
can lead to better informed policy-makingbetter health
systemgood governance on health system.
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SLIDE #12
Legal Basis for Inter-LGU Coverage
SEC. 25, LGC of 1991. National Supervision over LocalGovernment Units. - (a) Consistent with the basic policy on localautonomy, the President shall exercise general supervision overlocal government units to ensure that their acts are within thescope of their prescribed powers and functions.
The President shall exercise supervisory authority directly overprovinces, highly urbanized cities, and independent componentcities; through the province with respect to component cities and
municipalities; and through the city and municipality with respectto barangays.
(b) National agencies and offices with project implementationfunctions shall coordinate with one another and with the localgovernment units concerned in the discharge of these functions.They shall ensure the participation of local government units both
in the planning and implementation of said national projects.
SLIDE #13
(c) The President may, upon request of the local government unitconcerned, direct the appropriate national agency to providefinancial, technical, or other forms of assistance to the localgovernment unit. Such assistance shall be extended at no extra
cost to the local government unit concerned.
(d) National agencies and offices including government-owned or
-controlled corporations with field units or branches in a province,
city, or municipality shall furnish the local chief executive
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concerned, for his information and guidance, monthly reports
including duly certified budgetary allocations and expenditures.
SLIDE #14SEC. 16, LGC of 1991. General Welfare. - Every local government
unit shall exercise the powers expressly granted, those
necessarily implied therefrom, as well as powers necessary,
appropriate, or incidental for its efficient and effective
governance, and those which are essential to the promotion of
the general welfare. Within their respective territorial jurisdictions,
local government units shall ensure and support, among otherthings, the preservation and enrichment of culture, promote
health and safety, enhance the right of the people to a balanced
ecology, encourage and support the development of appropriate
and self-reliant scientific and technological capabilities, improve
public morals, enhance economic prosperity and social justice,
promote full employment among their residents, maintain peace
and order, and preserve the comfort and convenience of theirinhabitants.
SLIDE #15
SEC. 17, LGC of 1991. Basic Services and Facilities. - (a) Local
government units shall endeavor to be self-reliant and shall
continue exercising the powers and discharging the duties and
functions currently vested upon them. They shall also discharge
the functions and responsibilities of national agencies and offices
devolved to them pursuant to this Code. Local government units
shall likewise exercise such other powers and discharge such
other functions and responsibilities as are necessary, appropriate,
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or incidental to efficient and effective provision of the basic
services and facilities enumerated herein.
(b) Such basic services and facilities include, but are not limitedto, the following:
(1)For a Barangay:
xxx
(ii) Health and social welfare services which include maintenance
of barangay health center and day-care center;
xxx
SLIDE # 16
(2) For a municipality:
xxx
(iii) Subject to the provisions of Title Five, Book I of this Code,
health services which include the implementation of programs
and projects on primary health care, maternal and child care, and
communicable and non-communicable disease control services;access to secondary and tertiary health services; purchase of
medicines, medical supplies, and equipment needed to carry out
the services herein enumerated;
xxx
(3) For a Province:
xxx
(iv) Subject to the provisions of Title Five, Book I of this Code,
health services which include hospitals and other tertiary health
services;
xxx
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(4) For a City:
All the services and facilities of the municipality and province, and
in addition thereto, the following: xxx
SLIDE #17
SEC. 34, LGC of 1991. Role of People's and Nongovernmental
Organizations. - Local government units shall promote the
establishment and operation of people's and nongovernmental
organizations to become active partners in the pursuit of local
autonomy.
SEC. 35, LGC of 1991. Linkages with People's and Non-Governmental Organizations. - Local government units may enter
into joint ventures and such other cooperative arrangements with
people's and nongovernmental organizations to engage in the
delivery of certain basic services, capability-building and livelihood
projects, and to develop local enterprises designed to improve
productivity and income, diversify agriculture, spur rural
industrialization, promote ecological balance, and enhance theeconomic and social well-being of the people.
SLIDE #18
Thank you!