1. Reconstructing the Functions of
Government:
The Case of Primary Health Care in
the Philippines
By: Victoria A. Bautista (2003)
Prepared by:
Jerry L. Roxas - Discussant
Professor: Dr. Jo B. Bitonio
DPA 102 Philippine Administrative System – Ist Semester
2011
LNU Dagupan City

2. Definition of Primary Health Care (PHC):
World Health Organization (WHO) defines
PHC as essential care made universally accessible
to individuals and families in the community by
means acceptable to them through their full
participation and at a cost that the community and
country can afford at every stage of development.

3. Background:
Primary Health Care (PHC) was declared
during the First International Conference on
Primary Health Care held in Alma Ata, Russia on
September 6-12, 1978 by the World Health
Organization (WHO). The goal was “Health for All by
the Year 2000”. This was adopted by the in the
Philippines through Letter of Instruction 949 signed
by President Marcos on October 19, 1979 and has
an underlying theme of “Health in the Hands of the
People by 2020.”

4. • This approach has influenced many countries including
the Philippines. Its innovativeness is indicated by the call for
participatory development management since community
members are expected to take an active role in managing
their own health requirements, instead of depending on
the government. PHC also gives importance to the
participation of various sectors of government and the
private sector in local health activities.

5. Periods in PHC Implementation and
Approaches to Reconstruction
Pre-devolution
Institutionalization
Devolution

6. PRE-DEVOLUTION
Pilot Testing Stage:
A.Area Selection on the Basis of Need
B.Social Preparation
C.Identification of Volunteers
D.Creation of Intersectoral Structures

7. A. Area Selection on the Basis of Need
The introduction of PHC begun in 1979 by
pilot testing the methodology in one province in
each of the 12 regions.
In 1982 the UPCPA revealed an important
approach to ensure the outreach of the
government to the underserved areas. This was
done through the selection of the 12 provinces on
the basis on “need” such as;

8. •Low health personnel ratio, absence of any province-
wide PHC activities and inaccessibility to the regional
centers;
•Receptiveness of the local government since a new
methodology was to be implemented necessiting its
support;
•Presence of functional organizations for managing
projects at the provincial and municipal levels;
•Peace and order.

9. B. Social Preparation
The DOH conducted preparatory
activities among health and other sectoral
implementers for effective utilization of
resources.
Trainers were also identified at the
provincial levels in order to echo the essence
of PHC at the municipal level.

10. C. Identification of Volunteers
An important component of preparatory
activities for PHC was the identification and
mobilization of voluntary health workers(VHW’s).

11. D. Creation of Intersectoral Structures
The government mobilizes PHC committees at the
national and local levels.
e.g.
•World Vision – conducted orientation seminars for BHW’s
•UP Institute of Health Science – served as the institutional
base for health manpower training
•Davao Medical School Foundation – involved in the
training of BHW’s in region XI

12. Institutionalization
A.Bureaucratic Innovations
B.Identification/Preparation of Volunteers
C.Validation of Indigenous Methodologies
D.NGO's as Conduits of Funds and as chief
Mobilizers for PHC
E.Incentives for Community Involvement

13. A. Bureaucratic Innovations
• 1981 – under President Marcos, nationwide
implementation of PHC took place through the vigorous
effort of the top leadership of Minister Jesus Asurin.
• 1982 – administrative innovations started to put in place
which could facilitated the implementation of PHC.
This enabled local field offices of then Ministry of
Health to have greater unity in pursuing health
activities.

14. B. Identification/Preparation of Volunteers
Three years after the nationwide orientation
programs for health workers, PHC was initiated in
99% of the barangays.
1982 - 1 BHW/70 households
1986 – 1 BHW/29 households

15. C. Validation of Indigenous
Methodologies
•Herbal gardening was encourage to solve the
existing shortage of supplies and high cost of drugs.
This program was supported through the
dissemination of manuals, seedlings and plants.
•Oral Rehydration Therapy using oral rehydration
(ORESOL) was a key innovation by the Ministry of
Health. This simple inexpensive solution was proven
effective in preventing diarrhea-related deaths.
•Strengthening the Botika sa Barangay (BSB).

16. D. NGO's as Conduits of Funds and as
Chief Mobilizers for PHC
•In 1986 President Corazon Aquino gave importance
to NGO’s in the promotion of PHC.
•The DOH experimented new approach which is the
Partnership for Community Health Development
(PCHD) which entailed financial assistance to NGO’s
which serves as conduits of funds to mobilize
partnership effects among Local Government Units
(LGU’s), NGO’s and peoples organizations to
undertake health and related development activities
in the barangays.

17. •In 1991, the government issued
Administrative Order No. 112 in the 1st
National Convention for NGO’s which
conducted by the DOH. It is a policy on
Collaboration between Public and Private
Sectors on Health Policies and Programs.
•According to studies from 1991-1995, the
impact of PCHD pointed to the reduction of
preventable diseases.
e.g. malaria - 50%
acute respiratory infection – 42%

18. E. Incentives for Community Involvement
•In the year 1994, various incentives and measures
were implemented by the DOH; this included the
provision to BHW’s such as free medical and dental
check-up, bloodtyping, supply of drugs and medicines,
laboratory examination and tetanus toxiod
immunization.
•Income generating projects were also encourage
through the provision of financial grants to BHW’s for
livelihood.

19. DEVOLUTION
Direct responsibility for PHC is now
assumed by mayors of municipalities and
cities due to the Local Government Code of
1991.

20. Implications of Devolution on PHC
•Lack of understanding and appreciation by local
chief executives of health services of PHC as an
innovative strategy.
•The government launched the Minimum Basic
Needs (MBN) approach as the management
technology for supporting the Social Reform Agenda
to improve the quality of the poorest of the poor.

21. Mechanisms for Propagating PHC
Under Devolution
A.Capability Building
B.Support to LGU's Through NGO's
C.Policy Formulation
D.Research/Documentation

22. A. Capability Building
•The UPCPA assists in the conduct of seminars
to convey the meaning of PHC.
•Under Ramos administration, the DOH had
strong commitment to enforcing the “health
in the hands of the people.” Strong advocates
of PHC among professional civil servants
urged the continuation of this motto.

23. B. Support to LGU's Through NGO's
•The DOH sustains its support to PCHD in order to
provide assistance to LGU’s not able to employ
participatory method in their area.
•Retained also by the DOH to propagate PHC was
the provision of support for innovative strategies.
e.g. The grant to cooperatives to engage in the
operation of drugstore to reduce the cost of drugs
in a locality.

24. C. Policy Formulation
•BHW’s Incentives Act or Republic Act 7883
of 1995
-directing the LGU’s to provide subsequent
allowance for BHW’s as they cater to hazardous areas.

25. D. Research/Documentation
Due to lack of information regarding the
status of PHC implementation, the government
has adopted the conduct of researches
subcontracted to private institutions to determine
the status of PHC.

26. Problems/Issues
The implementation of PHC has not been spared from
problems and difficulties.
•Lack of political will of the top leadership of the DOH for the
continued implementation of PHC.
•Passage of BHW’s Incentives Act which violated the principle of
volunteerism and could be a tool for politicking by local
executives since the volunteer workers could beholden to them
instead of the community.
•The transfer of responsibility of PHC to local executives under
devolution is not easy. PHC could not be fully achieved if the
bureaucracy itself is not empowered.

27. Reference:
Introduction to Public Administration
A Reader 2nd Edition
National College of Public Administration
& Governance
University of the Philippines
Diliman, Quezon City, 2003