In essence, SAPs are based on neo-liberal philosophy, which emphasizes the role of the free market while de-emphasizing government intervention in the economy. It was granted in two installments, with the release of the first installment conditional on. 2. Assumption by the national government for the external debt obligations of the government and private entities/corporations and the Central Bank (CB).
Privatization has consistently been included in the medium-term development plans of the past three administrations (NEDA and 1999). This time, however, the plan expanded the role of the private sector in health care delivery, financing and human resource development, and called for the rationalization of the health bureaucracy. In addition, the streamlining of the bureaucracy under the Estrada government was carried out through the government's Rationalization and Streamlining Plan (RSP).
Evidence of the low priority given to health are the sector's low annual budgets and expenditures. The health budget was at its lowest level in 1997 as a result of the Asian financial crisis. In addition to the decline in real terms of the health budget due to public spending cuts, as well as the devaluation of the peso and inflation and the deregulation of the prices of goods and services, the low priority given to health by the government can be inferred from the low level. percentage of percentage of total health expenditure to GNP.
At 12.4 percent, the United States has the highest share of health care expenditures in relation to GNP, while the rest of the world has an average of about 7.5 percent on health care (PIDS, 1998). The irrational use of health funds contributes to the dismal state of the population's health as a result of budget cuts to an already low allocation. The irrational use of the limited health budget can be seen in the distribution of the health budget per functions/programs - or between "hospital and regional operations and services or hospital facilities maintenance and operations" on the one hand and "public health services and primary health programs," on the other.
From 1986 to 2000, at least 20 to 73 percent of the total health budget was spent on hospital and regional operations and services. See Tables 2 and 6. The uneven distribution of the health budget is not only in stark contrast to the national government's policy of prioritizing basic health services, but also inconsistent with the overall disease pattern in the country. Before and after the transfer, the concentration of health spending was for hospitals in Metro Manila, which hosts 13 DOH specialty hospitals.
Of the total programmed expenditures for health during the period, the budget for special hospitals varied from 8 to nearly 23 percent. In fact, the prices of drugs and medicine in the Philippines are among the highest in Asia. Most health professionals and workers are concentrated in the cities and urban centers, especially Metro Manila, Southern Tagalog (region 4) and Central Luzon (region 3), accounting for almost two-thirds of the country's total number of doctors. .
Executive Order 102 reassigned more than 90 percent of the DOH Central Office staff to new positions, leading to a significant reduction in the number of DOH.
However, devolution did
Meanwhile, the decentralization of DOH hospitals and field health services to local units, together with the transfer of provincial and district hospital operations to provincial governors and RHUs to city and municipal mayors, also resulted in about 45,000 health personnel being transferred to local governments. These decentralized health functions roughly translate into costs of P4.2 billion based on the 1992 health budget (PIDS, 1998). At first glance, there is a rationale for transferring management and financial responsibilities to various levels of health services, including institutions and.
Thus, health services became inadequate and inaccessible to many rural residents, especially the poor. Decentralization has also made the health care system more vulnerable to the whims and whims of local government executives, many of whom do not view health as a priority. This privilege, which is often dictated by political and other expediency, as well as corruption, often results in unequal provision and delivery of health care services and, as a result, poor health care in communities.
This authority has also led to the transfer of public health responsibilities to the private sector – all in the name of efficiency and equity. Indeed, decentralization has made the flow of local health services dependent on the ability of LG Us to mobilize and use resources efficiently, and on the prices of health products and services for which these resources are spent (World Bank, 1994). ). The inability to generate revenue and the low allocation of IRA by the national government give the LG Us all the more reason to transfer responsibility for healthcare to the private sector.
While there is a growing need to increase the health budget for local units, health expenditure has decreased since deconcentration, as shown in the comparative consolidated list of actual local government expenditure. This also means that, at the discretion of the LGU, funds that may have been intended for health services can be diverted to other purposes. The devolution of health functions to local units has resulted in the demoralization of health personnel due to the violation of the employment contract between the DOH and the decentralized health workers.
According to the Health, Nutrition and Population Survey Notice of June 1998, the transfer of devolved health workers to local units has resulted in the following: job insecurity; The paper showed the adverse effects of SAPs on the health budget and on the provision of health services, stating how SAPs and their conditions undermined the state's obligation to promote and protect people's right to health by providing accessible, affordable and quality health. goods and services. In addition, health budget cuts and the elimination of government subsidies for social services have exacerbated people's inability to meet their health needs and improve their well-being.
Thus, health is fast becoming
The initiative" launched in 1994 by UN agencies, specifically the UNDP, UNESCO, UNICEF and WHO, to encourage governments and international aid agencies to allocate 20 percent of their budgets to basic social services to fill the huge gaps to fill in funding and to provide universal access should be supported and possibly expanded Based on the country's disease pattern and health needs, a review of the composition of health expenditure should be done so that the distribution of sickness funds between preventive/public health programs such as the National TB Control Programme, Nutrition Programme, Health Education Program and the National Malaria Control Program and curative/hospital services are more rational.Furthermore, the distribution of funds for public health programs and curative services must be equitable to ensure that the regions or areas of the country most in need are given priority.
The introduction of capacity building programs to strengthen the planning and management capacity of local authorities is a requirement to assist LG U officials to undertake devolved health functions more effectively. Data for the paper was based on a 2000 Citizens' Assessment of Structural Adjustment (CASA) study conducted in the Philippines by the Freedom From Debt Coalition (FDC), a Philippines-based non-governmental organization (NGO), which also provided funding for the study. The data for the study is based on the review and content analysis of public records, documents and other materials collected from various government offices such as the Departments of Budget and Management (DBM), Finance and Health, National Economic and Development Authority (NEDA), National Statistical Coordination Board (NSCB) and the Bangko Sentral ng Pilipinas (BSP).
Data analysis focused on identifying patterns or trends in the annual health budget and comparisons between the health budget and the budgets of other national program items, particularly national defense and debt service. 34;Structural and Other Adjustments.” In Walden Bello et al., Development Debacle: The World Bank in the Philippines. Investing in health equity: a ten-year public investment plan for the health sector.
