22 October 2008

Under-5 Programs Need More Boost

Photo courtesy of canon.freak
The Philippine Government is making headway in reducing infant and child mortality rates. Data show that infant mortality rate in the past 10 years has shown a decreasing trend, from 34 death per 1,000 live births in 1993 to 29 deaths per 1,000 live births 2003. There has also been a steady decline in the under-five mortality, from 54 deaths per 1,000 live births in 1993 to 40 deaths per 1,000 live births ten years later (NDHS, 2003).

The 2002 Maternal and Child Health Survey reported a decrease in the number of children fully immunized before they turn a year old. In 2002, 62.9 percent of all children aged 12-23 months were fully immunized, a decrease of almost 3 percentage points from 65 percent in 2000.

The percentage of fully immunized children in the urban areas was higher (66.6 percent) than those in the rural areas (59.8 percent), a slight decrease from the 2000 figures of 68 percent and 63 percent respectively. The seemingly decreasing trend in the number of immunized children was attributed to the following reasons: (a) devolution of health services to the local governments; and (b) shortages in vaccines in 2000-2001 due to untimely deliveries brought about by changes in procurement system.

One of the largest factors responsible for the poor performance of the Philippine health sector is the low and ineffective public spending for health. Even though there have been increases in the DOH and LGU budgets, these have been insufficient to offset inflationary pressure during the period.

In addition, 60 percent of the DOH budget is used for subsidies to 50 retained hospitals. Currently, about 48 percent of total health spending comes from out-of-pocket, further illustrating the inefficient and inequitable pattern of health financing. The contribution of social insurance is a mere 5 percent. Positive changes in the public spending for health would greatly improve the chances for the success of under-five health programs.

Other challenges that should be addressed include the following:

Strengthening of Maternal Child Health (MCH) Services

The Local Government Code of 1991 (RA 7160) decentralized many central government functions, making the LGU the primary provider of basic health care services, including management and control of maternal and child health programs. However, without pre-existing capacity to fulfill their new role, LGU managed health care systems have broken down, hence, compromising much of the basic services needed by the population.

In order to address this challenge, local government units must be strengthened by improving (1) key management systems to sustain service delivery, (2) financing for key community-based health programs, and (3) performance among service providers. Currently, there are few informed and active community interest groups that motivate and assist local officials in finding solutions to the systemic problems that have developed. This is especially the case when looking at the need to provide health services to the poor and indigent population. To ensure that LGUs maintain a greater focus on the need to strengthen health care management in their localities, advocacy groups must be formed and trained in policy dialogue. Addressing this issue will lead to LGU capability and accountability, both of which are pre-requisites for long term sustainability of maternal and child health programs and other services.

Increasing Advocacy for Financing

Both the Government and the NGOs need to get the public involved in improving health services by being informed and giving feedback to providers. Active monitoring from civil society organizations can be effective in raising important issues with LGUs such as the equitable and sustained financing of under-five health programs. Equally important is pressure on local political leaders to follow through on public commitments to push local initiatives in support of the program. Domestic financing policies must become better geared to support service provision and use to avoid leaving people without critical services. Illustrative activities include assistance in the establishment of community-based health committees and mechanisms to inform local chief executives and LGU legislative bodies, the Sangguniang, on under-five health issues.

Increasing the Supply of Affordable and Fortified Foods

The Food Fortification Law was passed in 2000 its Implementing Rules and Regulations was signed. This provides an opportunity to greatly expand the number and quality of fortified foods on the market. Technical assistance and incentives will enable producers of the basic staples and consumer goods to fortify foods to address widespread micronutrient malnutrition in the Philippines. National Government technical assistance to the LGUs should be directed toward enhancing the continuing efforts to enforce and promote the fortification of more products in the market, e.g., salt, sugar, oil and flour and making these fortified products widely available.

Improving Policy Environment for Financing and Provision of Services

The Government, donors and other stakeholders have recognized that the expanded delivery of child health interventions has been hampered either by unrealistic or outdated legal and regulatory barriers and the absence of appropriate supportive policies or guidelines both at the national and local levels. There is a need to carefully analyze these policy gaps and institute measures that will address them. The most important, and those that will be the focus of this issue, are policies that will (1) ensure long term vaccine security, (2) improve service provision, and (3) ensure sustainable financing for information, services and products that will facilitate the delivery of MCH services. Once policies are established, the program emphasis will shift to support development of mechanisms and tools to effectively implement the policies.