WHO Country Cooperation Strategy for the Philippines 2011-2016 doc

i
WHO
Country
Cooperation
Strategy
for the
Philippines
2011-2016
ii
© World Health Organization 2011
All rights reserved
The designations employed and the presentation of the material in this publications do not imply the expression
of any opinion whatsoever on the World Health Organization concerning the legal status of any country, territory,
city or area or of authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps
represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed
or recommended by the World Health Organization in preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital
letters.
The World Health Organization does not warrant that the information contained in this publication is complete
and correct and shall not be liable for any damages incurred as a result of its use.
Publications of the World Health Organization can be obtained from Marketing and Dissemination, World
Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791
4857; email: ). Requests for permission to reproduce WHO publications, in part or in
whole, or to translate them — whether for sale or for noncommercial distribution — should be addressed to
Publications, at the above address (fax: +41 22 791 4806; email: ). For WHO Western
Pacific Regional Publications, request permission to reproduce should be addressed to Publications Office, World
Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No.
(632) 521-1036, email:

iii
TABLE OF CONTENTS
Acknowledgements
iv
Foreword
v
Acronyms
vi
Executive Summary
1
Section 1: Introduction
3
Section 2: Health and Development Challenges
4
Section 3: Development Cooperation and Partnerships
22
Section 4: Review of WHO Cooperation over the past CCS Cycle
26
Section 5: The Strategic Agenda for WHO Cooperation
31
Section 6: Implementing the Strategic Agenda
37
Annexes
43
iv
ACKNOWLEDGEMENTS
This document is the result of a highly consultative process between the World Health
Organization, the Department of Health and other government agencies, international
development partners, civil society organizations, health professional organizations, academic
institutions and relevant business organizations. It has been produced by a team of WHO staff

from all three levels of the Organization, representatives of the Department of Health, led by
the WHO Representative in the Philippines.
v
FOREWORD
The health of every Filipino is one of the primary concerns of the Government of the
Philippines. With this in mind, the Philippine Development Plan 2011–2016 focuses on the
improvement of the quality of life of all Filipinos, including the attainment of universal health
care as embodied in the Aquino Health Agenda.
This Country Cooperation Strategy (CCS) defines the broad framework for WHO’s work
with the Government of the Philippines over the period 2011–2016. It articulates a coherent
vision and priorities for WHO to support the Government in achieving universal health care
goals of better health outcomes, sustained health financing and a responsive health system.
WHO and the Department of Health of the Philippines jointly developed this CCS. It
is based on a systematic assessment of the country’s development challenges and health needs,
government policies, and existing projects and programmes of other development partners. The
process included consultations with all levels of WHO, the Department of Health, other relevant
government organizations, United Nations agencies, multilateral and bilateral partners, and
nongovernmental organizations.
Based on those assessments and consultations, the present CCS acknowledges the country’s
achievements and strengths, as well as its challenges. Furthermore, the CCS harmonizes its
priority areas with the United Nations Development Assistance Framework (UNDAF) 2012–
2018, providing the health dimension not only for basic social service outcomes but for all
UNDAF outcomes.
Thus, in the spirit of partnership and solidarity with Filipinos and the global community,
this CCS serves as a key tool to guide cooperation between WHO and the Government of
Philippines. It is anticipated that the implementation of this CCS will contribute significantly
to improvements in the health of the people of the Philippines.
Mabuhay tayong lahat!
Honourable Enrique T. Ona, MD, FPCS, FACS Shin Young-soo, MD, Ph.D.
Secretary, Department of Health

Philippines
WHO Regional Director for the
Western Pacific
vi WHO Country Cooperation Strategy for the Philippines 2011-2016
ACRONYMS
ADB Asian Development Bank
ARMM
Autonomous Region of Muslim Mindanao
APSED
Asian Pacific Strategy for Emerging Diseases
AusAID
Australian Agency for International Development
BEmONC
Basic Emergency Obstetric and Newborn Care
BnB
Botika ng Barangay
CCS
Country Cooperation Strategy
CCT
Conditional Cash Transfers
CHD
Center for Health and Development
COPD
Chronic Obstructive Pulmonary Disease
DALYs
Disability Adjusted Life Years
DaO
Delivering as One
DENR
Department of Energy and Natural Resources

DOH
Department of Health
EDs
Emerging Diseases
EHA
Emergency and Humanitarian Action
EPI
Expanded Programme on Immunization
GATS
Global Adult Tobacco Survey
GDI
Gender Development Index
HDI
Human Development Index
HPM
Health Partners Meeting
HSRA
Health Sector Reform Agenda
IPs
Indigenous Peoples
ILHZs
Inter-Local Health Zones
JAC
Joint Appraisal Committee
JAPI
Joint Assessment and Planning Initiative
JICA
Japan International Cooperation Agency
LGUs
Local Government Units

MDG
Millennium Development Goal
MIC
Middle Income Country
MNCHN
Maternal, Neonatal and Child Health and Nutrition
MMR
Maternal Mortality Ratio
MTSP
Medium –Term Strategic Plan
MTPDP
Medium Term Philippine Development Plan
NCDs
Non-Communicable Diseases
NHTS
National Household Targeting System
NMR
Neonatal Mortality Rate
ODA
Official Development Assistance
PHIC
Philippine Health Insurance Corporation
PHIN
Philippine Health Information Network
PIDSR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Philippine Integrated Disease Surveillance and Response
PIPH
Province-wide Investment Plan for Health
RHU
Rural Health Unit
RUP

Reaching the Urban Poor
SDAH
Sector Development Approach for Health
SCUHE
Short Course on Urban Health Equity
SSA
Special Service Agreement
UHC
Universal Health Care
UNDAF
United Nations Development Assistance Framework
UNDAP
UNDAF Action Plan
Urban HEART
Urban Health Equity Assessment and Response Tool
WHO
World Health Organization
WPRO
Western Pacific Region Office
YAFSS3
Young Adult Fertility and Sexuality Study
WHO Country Cooperation Strategy for the Philippines 2011-2016 1
EXECUTIVE SUMMARY
The WHO Country Cooperation Strategy for the Philippines (2011–2016) serves as the
medium-term vision of the Organization’s technical cooperation for the country responding to
its realities while contributing to the Organization-wide Medium-term Strategic Plan (MTSP
2008–2013).
The process used in developing WHO’s strategic agenda ensures that the Organization’s
support is anchored on national health priorities as well as country health challenges. Meanwhile,
in line with the United Nations’ “Delivering as One” approach, the Country Cooperation

Strategy (CCS) harmonizes with and contributes to the United Nations Development
Assistance Framework (2012–2018).
In formulating the strategic agenda, the Organization focuses its contribution on the
following cross-cutting priority areas: (1) supporting the Universal Health Care Agenda of
the Department of Health; (2) achieving the Millennium Development Goals (MDGs) by
2015 with special focus on MDGs 4, 5 and 6; (3) addressing the social and environmental
determinants of health; and (4) managing health security risks and health in emergencies.
For the next six years, the Organization’s support to the country shall focus on the following
strategic priorities:
• strengthening health systems to provide equitable access to quality health care with
special focus on the MDGs and priority non-communicable diseases;
• enabling individuals, families and communities to better manage their health and its
determinants; and
• improving the resiliency of national and local institutions against health security
risks.
In contributing to these strategic priorities, the Organization elaborates further on the
specific main focus areas and related strategic approaches.
In achieving these strategic priorities, the Organization leverages its core functions with
special emphasis on (1) articulating the research agenda, generating, managing and disseminating
knowledge; (2) providing ethical and evidence-based policy options; and (3) providing technical
support towards delivering results, with focus on catalyzing change and assisting in institutional
development.
The “systems approach” of the CCS requires the team to shift from working independently
to collaborating across programmes, especially in cross-cutting themes. It shall also assist the
Department of Health leadership in responding to the health agenda by leveraging its brokering
role to form joint partnerships in areas where critical actions are required, capitalizing on the
strong (though untapped) presence of the private sector, civil society and academe.
In implementing the CCS, the Organization will take full advantage of the in-country
capacity of the WHO Representative Office and that of the WHO Western Pacific
Regional Office.

2 WHO Country Cooperation Strategy for the Philippines 2011-2016
MULTISTAKEHOLDERS CONSULTATIVE MEETING
The CCS Team led by WHO Representative in the Philippines, Dr Soe Nyunt-U during the Multi-Stakeholder Consultative Meeting held l2 October 2010 at
the Crowne Plaza Galleria Manila. This was part of a consultations and purposeful dialogue involving national authorities, local and international partners, civil
society organizations and other stakeholders at the country level to identify and analyze key issues that need to be addressed and to strengthen WHO support in
order to contribute to national health development.
WHO Country Cooperation Strategy for the Philippines 2011-2016 3
SECTION 1: INTRODUCTION
The WHO Country Cooperation Strategy (CCS) for the Philippines (2011–2016) is the
medium-term vision of the Organization’s technical cooperation for the country, responding
to its realities while contributing to the Organization-wide Medium-term Strategic Plan
(MTSP) for 2008–2013. In line with the Paris Declaration on Aid Harmonization, the
CCS contributes to the Department of Health’s Administrative Order No.2010-036 “The
Aquino Health Agenda: Achieving Universal Health Care for All Filipinos”. It also serves
as a reference document for United Nations partners as they carry out the United Nations
Development Assistance Framework (UNDAF) for 2012–2018. Through a reiterative process
of dialogue between the Government, WHO and United Nations partners, refinements were
made to the CCS to ensure alignment with the national health priorities and harmonization
with the UNDAF.
The CCS team consists of members from all levels of the Organization and focal persons
from the Department of Health. Weekly team discussions led to the identification of an initial
set of strategic priorities that was among the themes raised during the UNDAF discussions. In
a decentralized health care system, with key players at different levels of the health sector, the
development of the CCS called for a highly consultative process, leading to the identification
of potential areas of partnership among the different stakeholders. Key informant interviews
and self-administered questionnaires served to identify WHO’s contribution to the health
sector and the Organization’s comparative advantage. Input from these various sources was
used by the team during its strategic priority exercise. Thereafter, a validation meeting was
conducted wherein Department of Health senior management and technical staff — joined
by representatives of development partners, other national Government agencies, local

government units (LGUs) and civil society — were able to review, discuss and validate the
proposed strategic agenda.
Figure 1. Road Map of the WHO CCS for the Philippines 2011-2016
CCS Team
Discussion
(May 2010)
Stakeholders
Consultaon
Strategic Priority
Exercise
CCS Validaon
Meeng
(February 2011)
CCS Signing
(June 2011)
Complementary Country Analysis Synthesis
Document Development
(April to August 2010)
Agreement on Basic Building Blocks for
UNDAF (August 2010)
Consultave Meengs, Development of the UNDAF
(September 2010 –May 2011)
UNDAF Compleon
(May/June 2011)
Development of the Philippine Development Plan, Universal Health
Care Framework, National Objectives for Health
(September - October
2010)
(October 2010)
4 WHO Country Cooperation Strategy for the Philippines 2011-2016

SECTION 2: HEALTH AND DEVELOPMENT
CHALLENGES
2.1 MACROECONOMIC, POLITICAL AND SOCIAL CONTEXT
The Philippines has a land area of 300 000 square kilometres (km
2
), encompassing more
than 7 000 islands. The country’s population was 88.6 million in 2007, with an annual growth
rate of 2.04%.
1
A majority of the Filipinos (81.04%) are Roman Catholic, while a substantial
Muslim minority are concentrated in Mindanao.
The Filipinos are governed by a presidential form of government, having a strong executive
branch headed by a President, which is balanced by a bicameral legislature and an independent
Supreme Court and judiciary system.
In 1991, the Congress enacted the Local Government Code, which transferred responsibility
for the provision of health, social and agricultural services from the national Government to the
LGUs, with significant transfers of revenue through the internal revenue allotments. For the
health sector, the devolution resulted in a fragmented health care delivery system.
2.2 OTHER MAJOR DETERMINANTS OF HEALTH
2.2.1 Poverty
The percentage of the population below the national poverty threshold declined from
45.3% in 1991 to 32.9% in 2006. However, as a result of the global financial and economic
crises of 2008, soaring food and fuel prices in 2007-2008, natural disasters caused by typhoons
Ondoy and Pepeng in September and October 2009, and the recent El Niño phenomenon
in 2009-2010, the poverty level has worsened, reversing the declining trend achieved prior to
2006. This puts the country on an uncertain track to reach the MDG target of 22.7% below
the national poverty threshold by 2015.
Among poor families, 65% of family heads have only an elementary education, 29% do
not have access to safe water, and 24% do not have sanitary toilets. In June 2010, 21.2% of the
households surveyed nationwide by Social Weather Stations reported experiencing hunger in

the past three months. That rate was higher than hunger rates reported in the same month of
each of the previous seven years. In fact, reported hunger rates increased successively in each
of those years.
2
2.2.2 Social Determinants
Population growth and spatial trends. With an annual growth rate of 2.04%, population
growth in the Philippines is one of the highest in Asia. Despite long-standing high female
education rates, population growth rates have remained relatively high in the Philippines due
to cultural and political factors.
1 2007 Census of Population. Manila, National Statistics Office, 2007.
2 Second Quarter 2010 Social Weather Survey: 21.1% of families experience hunger. Quezon City, Social Weather Station, 21 July 2010
( />WHO Country Cooperation Strategy for the Philippines 2011-2016 5
Section 2: Health and Development Challenges
As of 2010, 63% of the population were living in urban areas; this is expected to increase to
70% by 2015. The increasingly urban character of destitution increases the burden on the health
care system as problems of population pressure and environmental degradation, combined with
the urban lifestyle, put the urban poor under higher risk.
Food security
. In a recent global evaluation of food security risks,
3
the Philippines was
rated as “high-risk” in terms of food security and ranked 52nd out of 163 countries based on
criteria including cereal production, GDP per capita, risk of extreme weather events, quality
of agriculture and distribution infrastructure, conflict and effectiveness of government. As
expected, the food price shock which occurred in late 2007 to early 2008 created a significant
negative impact on the well-being of the poor, including small rice farmers, most of whom are
net buyers of rice for household consumption.
4
In its broader sense, food security exists when
all people, at all times, have physical, social and economic access to sufficient, safe and nutritious

food to meet their dietary needs and food preferences for an active and healthy life.
5
Therefore,
attention to enhancing food safety will also contribute significantly to food security in the
Philippines.
Literacy and education. The Philippines had a basic literacy rate of 93% in 2003, one
of the highest rates in the world. Literacy is higher among females (94.3%) than males
(92.6%).
6
Functional literacy (which includes not only reading and writing but also numeracy
skills) was 84% in 2003, higher among females (86.3%) than among males (81.9%).
However, the country’s chance of meeting the MDG on achieving universal primary
education is highly improbable.
7
In 2008, an estimated 3 million children in the 6-15 years age
group were out of school. Almost 53% of 6-year-olds do not enter the formal school system
at all and those who enter begin dropping out soon thereafter, especially between grades 1 and
2. Furthermore, for every 1000 children who enter public school in grade 1 and graduate in
grade 6, only seven have sufficient mastery of English, mathematics and science.
Gender. From the Human Development Report of 2009, the Philippines’ Gender
Development Index (GDI) value of 0.748 is 99.6% of its Human Development Index (HDI)
value of 0.751. Out of the 155 countries with both HDI and GDI values, only 39 countries
have a better ratio than the Philippines.
8
Despite these positive indicators of women’s status,
women continue to suffer from a lack of reproductive rights, given the legal, regulatory, political
and cultural constraints on women’s ability to exercise their reproductive rights. Other issues
include the feminization of overseas employment and its implications for the women and their
families, and women in armed conflict.
9

3 Food Security Risk Index 2010. Bath, Maplecroft, 2010.
4 Balisacan AM, Sombilla M and Dikitanan R. Rice crisis in the Philippines: Why did it occur and what are its policy implications?
In: Dawe D, ed. The Rice Crisis: Markets, Policies and Food Security. London and Washington, DC, Earthscan, 2010:123–142. Cited in
United Nations Complementary Country Analysis Synthesis, Philippines. September 2010 (unpublished).
5 World Food Summit, 2009.
6 Functional Literacy, Education and Mass Media Survey 2003. Manila, National Statistics Office, 2003.
7 United Nations Complementary Country Analysis Synthesis, Philippines. September 2010 (unpublished).
8 The GDI measures achievements in the same dimensions using the same indicators as the HDI but captures inequalities in achievement
between women and men. It is simply the HDI adjusted downward for gender inequality. The greater the gender disparity in basic
human development, the lower is a country’s GDI relative to its HDI.
9 The Philippines has developed a National Action Plan on Women, Peace and Security to implement United Nations Security Council
Resolution 1325.
6 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
2.2.3 Environmental determinants
Natural hazards and climate change. Due to its location along the Pacific Ring of Fire
and the typhoon belt, the country is prone to various natural hazards such as typhoons,
landslides, volcanic eruptions and earthquakes with their attendant consequences. In 2009,
the Philippines topped the list of countries with the most number of reported natural
disasters. It ranked third in terms of mortalities (1334 deaths) and second in terms of number
of victims (13.4 million).
10
The magnitude of some of these disasters compelled the Philippine
Government to request assistance from international organizations, including from WHO.
The Philippines ranked 10th in the Global Climate Risk Index 2009 among countries
most affected by extreme weather events from 1998 to 2007.
11
The country is one of those
that are most vulnerable to climate change and is particularly susceptible to multiple climate
change hazards (e.g. sea level rise, drought).

12
Furthermore, the Philippines reported the highest
number emergencies among countries in the Western Pacific Region from 2008-2010.
13
Pollution, water supply and sanitation. Water pollution, air pollution, poor sanitation, and
unhygienic practices contribute to an estimated 22% of all reported disease cases and nearly 6%
of all reported deaths.
14
Most regions in the Philippines identified the transport sector
15
as the
major source of air pollution, with an increased carbon monoxide load caused by the increasing
population of gasoline-fed vehicles, including cars, motorcycles and tricycles.
Achievement of total sanitation coverage is constrained by poor hygiene practices,
prohibitive costs of facilities, and availability of appropriate technology. In 2008, the country
had 76% coverage overall — 80% in urban areas and 69% in rural areas.
16
Sewerage systems
are still insufficient with only 10% coverage. Open defecation is still practised by 8% of the
population.
The quality of sources of drinking water (e.g. rivers, lakes, and groundwater) has
deteriorated with indiscriminate disposal of solid wastes and inadequate wastewater treatment
and disposal. Although there was an observed improvement in the country’s water supply
coverage, from 87% in 1990 to 91% in 2008,
17
some populations shifted their preference to water
refilling stations and bottled water despite the higher costs. This was due to the presence of
sediments and the discoloration of the water supply after heavy rains. Sources of safe drinking
water supply are limited. In 2005, of 525 bodies of water classified by the Department of
Environment and Natural Resources (DENR), only 41% were classified as being of sufficient

quality to serve as sources of drinking water.
18
10 Femke et al. Annual Disaster Statistical Review 2009: The Numbers and Trends. Brussels, Centre for Research on the Epidemiology of
Disasters, 2010.
11 Harmeling S. Global Climate Risk Index 2009: Weather-related Loss Events and Their Impacts on Countries in 2007 and in a Long-term
Comparison. Bonn, Germanwatch, 2008.
12 Polotan-dela Cruz L, Ferrer E and Pagaduan M (eds). Building Resilient Communities: Stories and Lessons from the Philippines.
ChristianAid, 2010
13
Emergencies and Humanitarian Action: Disasters in the Region. Manila, World Health Organization, 2011 ( />sites/eha/disasters/summary.htm)
14
Philippine Environment Monitor: Environmental Health, World Bank, 2006.
15 National Air Quality Status Report. Manila, Department of Environment and Natural Resources, Government of the Philippines.
16 WHO/UNICEF Joint Monitoring Programme on Water and Sanitation, 2010
17 WHO/UNICEF Joint Monitoring Programme on Water and Sanitation, 2010
18 National Water Quality Status Report. Manila, Department of Environment and Natural Resources, Government of the Philippines,
2005.
WHO Country Cooperation Strategy for the Philippines 2011-2016 7
Section 2: Health and Development Challenges
2.3 HEALTH STATUS OF THE POPULATION
The projected life expectancy of Filipinos at birth in 2010 is 73.1 years for females and 67.6
years for males,
19
up from 71.6 years for females and 66.3 years for males in 2000. These gains
in overall life expectancy, however, mask significant variations across regions. For instance, for
the period 2005-2010, females in the Ilocos Region could expect to live 14 years longer than
females in the Autonomous Region of Muslim Mindanao (ARMM) (Figure 2).
Figure 2. Gains in overall life expectancy mask significant variations across regions (2005)
NCR
S. Luzon (IV)

C. Luzon (III)
CAR
(PHILIPPINES)
Ilocos (I)
Cagayan Valley(II)
C. Visayas (VII)
SOCCSKSARGEN (XII)
Davao (XI)
W. Visayas (VI)
N. Mindanao (X)
Bicol (V)
E. Visayas (VIII)
Zamboanga (IX)
ARMM
Male
Female
Life Expectancy (Years)
80
75
70
65
60
55
50
Source: Notes: S. – Southern; C. – Central; W. – Western; N. – Northern; E. - Eastern
Regions are sequenced according to average annual family income as of 2003, with the National Capital Region (NCR) having the highest and
Autonomous Region of Muslim Mindanao (ARMM),, the lowest.
Source: Philippine Statistical Yearbook (PSY). Manila, National Statistical Coordination Board, 2008.
The country faces a double burden of disease with the majority of the 10 leading causes
of morbidity being communicable diseases and the leading causes of mortality in the country

being mainly non-communicable diseases. Over the last five decades, non-communicable
diseases steadily increased while communicable diseases diminished in scale (Figure 3).
Figure 3. Long-term mortality trends are dominated by non-communicable disease
Mortality Trend: Communicable Diseases,
Malignant Neoplasms & Diseases of the Heart
Rate/100,000 Population
Philippines, 1953-2005
0
100
200
300
400
500
600
700
1953
'54
'55
'56
'57
'58
'59
'60
'61
'62
'63
'64
'65
'66
'67

'68
'69
'70
'71
'72
'73
'74
'75
'76
'77
'78
'79
'80
'81
'82
'83
'84
'85
'86
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97

'98
'99
2000
'01
'02
'03
'05
Year
Communicable
Diseases
0
20
40
60
80
100
Malignant
Neoplasms &
Diseases of the
Heart
Communicable Diseases
Malignant Neoplasms
Diseases of the Heart
Source: Philippine Health Statistics, 2005. Manila, Department of Health, 2005.
19 Fact Sheet: Updates on Women and Men in the Philippines. Manila, National Statistical Coordination Board, 1 March 2010 (http://www.
nscb.gov.ph/factsheet/pdf10/Women_Men_March2010.pdf).
8 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
2.3.1 Burden of communicable diseases
Eight of the 10 leading causes of morbidity in 2008 were infectious in origin, namely: acute

lower respiratory tract infection and pneumonia, acute watery diarrhea, bronchitis/bronchiolitis,
influenza, tuberculosis, malaria, acute febrile illness, and dengue fever.
Tuberculosis, malaria and HIV/
AIDS
. In 2003, it was estimated
that over 500 000 disability adjusted
life years (DALYs) were lost due to
illness and premature mortality from
tuberculosis (TB) in the Philippines
annually. This was equal to 9% of all
years of life lost. Over a three-year period
(2005 – 2007), the TB prevalence rate
showed an exponential decline (1.8%
per year). Although this annual rate
of decline has decreased recently, if this
trend is maintained, the Philippines will likely be able to meet the MDG and STOP TB
partnership target of a 50% reduction in TB prevalence by 2015 relative to the 1990 level.
20
Significant improvements have been made in malaria prevention and control. As of 2008,
only five provinces out of 79 remained highly endemic while the number of provinces declared
malaria-free almost doubled to 22. In terms of morbidity and mortality, the number of cases
fell by more than half from 2005 to 2008 while the number of deaths decreased by more than
two-thirds over the same period. Given these improvements, the Department of Health is
currently repositioning its malaria programme from “control” to “pre-elimination”.
Meanwhile, the changing epidemiological profile of HIV prevalence is a concern. Based
on the UNAIDS Report on the Global AIDS Epidemic 2010, the Philippines is one of the
seven countries where new cases increased by more than 25% from 2001 to 2009. While sexual
transmission is still the predominant mode of transmission (90%), shifting was noted in 2007
from predominantly heterosexual to bisexual and homosexual transmission. Transmission
through sharing and re-using injecting drug equipment accounted for 3% of the reported cases,

while mother-to-child transmission accounted for 1%. No data was available for 6% of the
cases reported.
21
Moreover, HIV prevalence among people who inject drugs raised an alarming
concern, increasing from 0.40% in 2007 to 0.59% in 2009 then jumping to 53% in 2010.
22
Rabies. Human rabies is still a public health threat. The country is one of the top 10
rabies-affected countries globally. Control of animal rabies, specifically canine rabies, is the
major prevention approach.
20 World Health Organization. Global Tuberculosis Control 2009: Epidemiology, Strategy, Financing. Geneva, Switzerland: WHO,
2009
21 Philippine HIV and AIDS Registry. National Epidemiology Center, Department of Health.
22 Integrated HIV Behavioral and Serologic Surveillance system of the National Epidemiology Center, Department of Health.
WHO Country Cooperation Strategy for the Philippines 2011-2016 9
Section 2: Health and Development Challenges
Infectious diseases outbreaks. The Philippines continues to witness outbreaks of emerging
infectious diseases including epidemic-prone communicable diseases such as dengue, cholera,
typhoid and leptospirosis. Dengue, especially, has become a serious public health problem,
imposing a significant burden on hospitals and other health care services. The most common
disease outbreaks are food-borne and water-borne diseases like cholera, salmonellosis and
shigellosis. Meanwhile, the Philippines continues to face health security threats from newly
emerging diseases.
2.3.2 Burden of chronic and noncommunicable diseases including injury
Noncommunicable diseases and risk factors. Six of the top 10 causes of mortality are due to
noncommunicable diseases. Diseases of the heart and vascular system are the leading causes of
mortality, comprising nearly one-third (31%) of all deaths. Other leading noncommunicable
diseases include malignant neoplasms, chronic obstructive pulmonary disease (COPD), diabetes
mellitus, and kidney diseases. Meanwhile, injury (mortality rate of 39.1/100,000) is the fourth
leading cause of death, with road traffic accidents as the leading cause of injury deaths. Among
children aged 0-17 years, drowning still tops the list of the leading cause of injury deaths, with

road traffic accidents coming in second (mortality rate of 5.85/100 000).
2.3.3 Health throughout the life cycle
Pregnancy, birth (intrapartum) and postnatal (postpartum) health
. With a decline of less
than 2% per year, the current maternal mortality ratio seems to have leveled off at 162 maternal
deaths per 100 000 live births (in 2006). This translates to more than 4000 Filipino women
dying per year during or shortly after childbirth.
23
At the current rate of decline based on the
National Demographic and Health Surveys, the Philippines is highly unlikely to achieve the
MDG target of 52 maternal deaths per 100 000 live births by 2015.
24
Official estimates reveal that the vast majority of maternal deaths can be prevented by having
skilled care at birth and reducing unwanted pregnancies.
25
In 2008, 36% of deliveries were
assisted by a traditional birth attendant.
26
The top three barriers to accessing maternal delivery
services are lacking money, having to take public transport and not wanting to go alone.
27
.
Quality of care remains a problem. A nationwide observational study of obstetric practices
in hospitals revealed that current practices were still not aligned with best-practice standards.
28
A
health facility drug supply assessment showed that one-third of the hospitals were lacking
oxytocin, as well as other essential medicines.
29
23 2006 Family Planning Survey. Manila, National Statistics Office, 2007.

24 MDGWatch: Statistics at a Glance of the Philippines’ Progress based on the MDG Indicators. Manila, National Statistical Coordination
Board ( />25 Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. The Lancet, 2006, 368:1284–
1299.
26 Philippines National Demographic and Health Survey (NDHS) 2008. Manila, National Statistics Office, 2009.
27 Philippines National Demographic and Health Survey (NDHS) 2003. Manila, National Statistics Office, 2004.
28 Mantaring J et al. Obstetric practices in fifty-one large hospitals in the Philippines need to realign practices with the evidence base: an
observational study. Policy paper submitted to Department of Health Secretary (unpublished).
29 Mission report of a joint UNFPA/WHO mission in collaboration with the Department of Health to review the status of access to a
core set of critical, life-saving maternal/reproductive health medicines in the Philippines. June 2009.
10 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
Postnatal (newborn). While the country is presently “on track” to reach its MDG 4 target of
reducing under-five mortality by two-thirds, this status is threatened because neonatal mortality
has not improved in the last 15 years. Deaths in the first 28 days of life account for almost
half of all under-five deaths.
30
Almost half of the neonatal deaths occur during the first two
days of life from largely preventable causes: birth asphyxia (31%), complications of prematurity
(30%) and severe infections or sepsis (19%).
31
A nationwide study involving 51 large hospitals
in the country revealed that the medical care given to newborn babies in the Philippines
was below WHO standards, leading to high rates of neonatal sepsis and mortality.
32
In
2008, the rate of initiation of breastfeeding at the first hour was at 54%, while the exclusive
breastfeeding rate for infants below six months was at 34%, both unchanged from 2003 rates.
Infancy and childhood. Under-five mortality
decreased from 48 per 1000 births in 1993 to 34
in 2008.

33
Infant mortality rate per 1000 births
declined from 35 to 25. However, challenges
remain even in the presence of such achievements,
including persistent regional disparities and
deficiencies in the vital registration system of
registering and reporting of newborn deaths and
stillbirths.
The percentage of fully immunized children rose from 69.8% to 79.5% between 2003
and 2008,
34
but measles vaccination coverage is still not high enough to prevent outbreaks
and meet the international target. Appropriate care-seeking for pneumonia was only 50%
(2008) while antibiotic treatment for pneumonia was given to only 42% of children with
suspected pneumonia. Of children under 5 years who had diarrhea, 58.6% were given oral
rehydration therapy.
Undernutrition remains a major public health problem in the Philippines, linked
principally to high levels of poverty. One out of every four Filipino children below 5 years old
is underweight and stunted.
35
While the prevalence of underweight children declined from
34.5% in 1990 to 24.6% in 2005, a rate that had been on track to meet the MDG target of
50% by 2015,
36
the latest survey shows that this decline has reversed (since 2005). At the other
end of the malnutrition spectrum, obesity is increasingly affecting the young. The Seventh
National Nutrition Survey in 2008 indicates that 2% of children 0-5 years old and 1.6% of
children 6-10 years old are overweight.
30 Black RE et al. for the Child Health Epidemiology Reference Group of WHO and UNICEF (CHERG). Global, regional, and
national causes of child mortality in 2008: a systematic analysis. The Lancet, 2010, 375:1969–1987.

31 The Philippine Child Survival Strategy. Manila, Department of Health, 2008.
32 Sobel H et al. Immediate newborn care practices delay thermoregulation and breastfeeding. Acta Paediatrica. (accepted for publication
in February 2011).
33 NDHS 1998 and NDHS 2008.
34 NDHS 2003 and NDHS 2008.
35 Seventh National Nutrition Survey. Manila, Food and Nutrition Research Institute, Department of Science and Technology, 2008.
36 Philippines Midterm Progress Report on the Millennium Development Goals, 2007. Manila, National Economic and Development
Authority, 2007
WHO Country Cooperation Strategy for the Philippines 2011-2016 11
Section 2: Health and Development Challenges
Adolescence. Road traffic accidents, pneumonia and drowning accounted for the largest
percentage of deaths among 10-19 year olds in the Philippines in 2005.
37
The percentage of
underweight adolescents had hovered around 16% since 1993, while 4.8% are overweight.
38
The
Global School-based Student Health Survey in the Philippines revealed a high prevalence of
risky health-related behaviours that lead to chronic medical problems in adulthood, such as lack
of physical activity (29.3% or respondents), engaging in physical fight (50%), and heavy drinking
of alcohol (24.3%). In the same survey, 42% of respondents reported mental health problems
such as feelings of sadness or hopelessness, and 17% had seriously considered committing
suicide.
39
The percentage of students aged 13 to 15 who currently smoke cigarettes is 17.5%,
while 54.5% are exposed to household second-hand smoke.
40
Nationally representative self-
reported rates of “ever experiencing adverse childhood experiences” are 90% for physical abuse,
60% for psychological abuse and 12% for sexual abuse.

41
According to the 2002 Young Adult Fertility and Sexuality Study (YAFS 3), among
youth aged 15-24, the average age of sexual debut was 18 years old.
42
As per 2008 NDHS,
among females aged 15-19, 13.6% have ever had sexual intercourse, of which only 4.7% had
used a condom at first sexual intercourse. Only 1.6% were currently using a modern method
of contraception and 1.5% were currently using a traditional method, despite 96.3% having
knowledge of modern method of contraception. The percentage of adolescents who have
begun childbearing has risen to 10% from 8% in the 2003 NDHS.
Reproductive and pre-pregnancy health. Maternal deaths can be reduced by as much as 40%
by limiting the number of pregnancies and increasing birth intervals.
43
However, women’s
access to modern contraceptives is compromised by social and political factors. As such, the
contraceptive prevalence rate for modern methods among currently married women is just
34%, half of the desirable level while only one out of three women of reproductive age (15-
49) use modern methods of contraception.
44
Less than half (43%) of births in the Philippines
are planned while 20% are mistimed and 16% unwanted. Twenty-two percent of currently
married women in the Philippines have unmet need in terms of spacing (9%) and limiting
births (13%).
Abortion is illegal in all circumstances, even when a woman’s life or health is in danger or
when a pregnancy is the result of rape or incest. Despite this, many women in the Philippines
go to great lengths to end their pregnancies. Out of 3.1 million pregnancies in 2000, more
than 473 000 women unsafely terminated their pregnancy with two-thirds of them employing
37 Philippine National Health Statistics. Manila, National Epidemiology Center, Department of Health, 2005.
38 Op cit. Ref 34
39 Miguel-Baquilod M. Global School-based Student Health Survey (GSHS) in the Philippines 2003–2004. A component project of the

World Health Organization and the U.S. Centers for Disease Control and Prevention’s Global School-based Health Surveillance
System. Country Report. Manila, National Epidemiology Center, Department of Health, 2004.
40 Global Youth Tobacco Survey, Philippines Factsheet, 2007. Atlanta, GA, United States Centers for Disease Control and Prevention, 2007.
41 Festin M et al. Baseline Survey for the National Objectives for Health. Manila, Department of Health, 2000.
42 Young Adult Fertility and Sexuality Study (YAFS 3). Quezon City, University of the Philippines Population Institute and the Demographic
Research and Development Foundation, Inc., 2002 (www.yafs.com).
43 Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. The Lancet, 2006, 368:1284–
1299.
44 NDHS 2008
12 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
methods not involving a health professional. Fifty percent of these women were young women
aged 15 to 24 years.
45
Complications from such unsafe, clandestine abortions are among
the principal causes of maternal deaths. Post-abortion care is lacking and suffers serious
quality issues.
46
2.3.4 Environmental health
Water pollution and poor sanitation conditions account for almost 17% of reported disease
cases and 1.5% of the reported deaths in the Philippines, causing significant diseases such as
acute diarrhea, typhoid, cholera, and intestinal parasitism.
47
Poor air quality from outdoor air
pollution in urban areas and indoor air pollution causes respiratory diseases
48
(including acute
and chronic bronchitis, pneumonia) and cardiovascular diseases (accounting for an estimated
5% of all reported disease cases and 4% of all reported deaths in the country). The Philippines
is prone to climate-sensitive diseases such as dengue, malaria, diarrhea and cholera.

2.3.5 Health of specific vulnerable population groups
Indigenous Peoples
. Within the Philippines, some of the highest maternal mortality ratios,
neonatal mortality rates and unmet needs for contraception are found among the geographically
isolated and disadvantaged areas of Mindanao, populated mostly by indigenous peoples. These
areas suffer from a lack of access to a wide range of maternal, neonatal, child health and nutrition
services. Continued civil unrest in southern Mindanao also significantly affects the vulnerable
population groups in the area.
Populations affected by natural and human-generated disasters. Frequent typhoons and other
natural emergencies affect the health of affected populations, either directly or indirectly when
living conditions deteriorate or when delivery of basic social services is disrupted. The long-
standing armed conflict in Mindanao has been ongoing for more than four decades with periods
of relative calm alternating with intensified fighting. This has resulted in chronic displacement
of people from the affected communities, with current 20 000 families currently seeking refuge
in evacuation centers and host communities.
2.4 NATIONAL RESPONSES TO OVERCOME HEALTH CHALLENGES
2.4.1 Major developments in the health sector
A series of legislative and policy actions adopted over the past two decades have had
defining impact on the Philippine health sector. An underlying characteristic of the change has
been a shift of emphasis to systemic approaches to health sector development, with attention to
sector-wide issues of equity and efficiency, including health care financing.
45 Singh S et al. Unintended Pregnancy and Induced Abortion in the Philippines: Causes and Consequences. New York, Guttmacher Institute,
2006.
46 Philippines: Concluding Observations of the Committee on Economic, Social and Cultural Rights under Articles 16 and 17 of the Covenant.
Forty-first session, Geneva, 3–21 November 2008 (E/C.12/PHL/CO/4, 1 December 2008), United Nations Economic and Social
Council.
47 Philippine Environment Monitor: Environmental Health. Washington, DC, World Bank, 2006.
48 Ibid.
WHO Country Cooperation Strategy for the Philippines 2011-2016 13
Section 2: Health and Development Challenges

Since the late 1980s, four major laws affecting the health system have been passed,
namely: (1) Generic Drugs Act of 1988, promoting the use of generic drugs, including mandating
prescription in generic form; (2) Local Government Code of 1991, devolving public responsibility
for much of health care to local governments and transferring corresponding shares of the
national health budget to LGUs; (3) National Health Insurance Act of 1995, introducing
mandatory health insurance and universal coverage with subsidized premiums for the poor
and creating the Philippine Health Insurance Corporation (PHIC), also known as PhilHealth,
to manage the national health insurance programme; and (4) Universally Accessible Cheaper
and Quality Medicines Act of 2008, allowing for parallel importation of cheaper drugs and
medicines and granting the President power to impose price ceilings on various drugs based on
recommendations of the Health Secretary.
Concern about the slow and unsatisfactory implementation of the three earlier legislative
measures led to the adoption in 1999 by the Department of Health of the Health Sector Reform
Agenda
(HSRA), a far-reaching plan for long-term systemic reforms country-wide. Updated
in 2005 to reflect subsequent political priorities, the HSRA was renamed the FOURmula
ONE (F1) for Health but essentially retained the four major components of the HSRA: health
financing, health regulation, service delivery and good governance.
In December 2010, the Department of Health Administrative Order No. 2010-0036,
entitled “The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos,”
was signed. The agenda is seen as the Government’s continuing effort towards reform. The
overall goal of the agenda is to ensure the achievement of the health system goals of better
health outcomes, sustained health financing and a responsive health system by ensuring that all
Filipinos, especially the disadvantaged group in the spirit of solidarity, have equitable access to
affordable health care. This shall be attained by pursuing three strategic thrusts:
(1) Financial risk protection through expansion in NHIP enrolment and benefit delivery
— the poor are to be protected from the financial impacts of health care use by
improving the benefit delivery ratio of the NHIP;
(2) Improved access to quality hospitals and health care facilities — government-owned
and operated hospitals and health facilities will be upgraded to expand capacity and

provide quality services to help attain MDGs, attend to traumatic injuries and other
types of emergencies and manage noncommunicable diseases and their complications;
and
(3) Attainment of the health-related MDGs — public health programmes shall be
focused on reducing maternal and child mortality, morbidity and mortality from TB
and malaria, and the prevalence of HIV/AIDS in addition to being prepared for
emerging disease trends and prevention and control of non-communicable diseases.
2.4.2 Programme-specific policy responses
In parallel with the above macro developments, a range of programme-specific policy
actions is being pursued by the administration. One of the most prominent though controversial
policies is the Reproductive Health Bill, which mandates the national Government to promote a
full range of family planning methods based on the fully informed choice of the individual.
14 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
This bill has been pending in Congress since 2002, but has so far failed to pass on numerous
attempts as debates among interest groups have been unrelenting.
Another important development has been the adoption by the Department of Health
in 2008 of the Maternal, Neonatal and Child Health and Nutrition strategy,
49
which aims to
rapidly reduce maternal and neonatal mortality through capacity building of LGUs to deliver
Basic Emergency Obstetric and Newborn Care services.
Other programme-specific policy responses have been in the areas of (1) disease surveillance
and response; (2) the Clean Water Act of 2004, accompanied by issuance of national standards
for drinking water; and (3) the Climate Change Act of 2009, accompanied by a national
framework of action for climate change and health.
2.5 HEALTH SYSTEMS AND SERVICES
2.5.1 Health services delivery
The Philippine health sector is a public-private mixed system, with the private
sector dominating the market. In 2005, 59% of total health financing came from private

sources.
50
However, the public sector plays a significant role in the provision, financing, as well
as regulation of health services.
Private sector services are generally perceived to be of better quality, but are also more
expensive.
51
At the other extreme, traditional healers and traditional birth attendants continue
to serve as inexpensive and easily accessible private sources of health care in both urban and
rural areas, but particularly in the latter.
The public sector provides both personal care and public health services, principally
(though not exclusively) to the lower income classes. The Local Government Code of 1991
split responsibility for health services among all levels of government, with national, provincial
and larger city governments principally responsible for tertiary and secondary care and smaller
city, municipal and barangay governments providing primary care. Responsibility for public
health care services is shared between the national Government — which manages essential
programmes like maternal and child health, family planning, TB, malaria, neglected tropical
diseases, HIV/AIDS control, promotion of healthy lifestyles — and the municipal and barangay
levels, whose staff and facilities implement these programmes with substantial operational
inputs from the national government.
Utilization patterns are affected by financial barriers, negative perceptions or lack of
awareness of services. Of the Filipinos who sought medical advice or treatment in 2008, 50%
went to public health facilities, 42% went to private health facilities, and almost 7% sought
alternative or non-medical care.
52
The poor tend to use primary health facilities more than
49 Department of Health Administrative Order 2008-0029 – “Implementing Health Reforms for Rapid Reduction of Maternal and
Neonatal Mortality”.
50 />51 Philippines: Filipino Report Card on Pro-Poor Services. Washington, DC, World Bank, 2001.
52 Bridging to Future Reforms. Health Sector Reform Agenda – Monographs. Manila, Department of Health, 2010.

WHO Country Cooperation Strategy for the Philippines 2011-2016 15
Section 2: Health and Development Challenges
hospitals because services in such facilities are largely free. Further, since the majority of the
population cannot afford the co-payments and balance billing (i.e. remaining payment to be
shouldered by patient after PhilHealth payment has been deducted), which are demanded by
both government and private hospitals, government hospitals intended to serve the poor are
also being utilized by a large non-poor clientele who cannot afford private facilities. In contrast,
those who can afford to pay tend to bypass government hospitals and lower-level facilities
because of perceived issues of quality.
2.5.2 Health systems financing
Financing for health care comes from multiple sources (Figure 4), dominated by out-of-
pocket payments (54.3% share in 2007). The national Government and LGUs had almost equal
shares of 13.0% and 13.3% in 2007, respectively. Health expenditure from social insurance,
meanwhile, indicated a decreased share in health spending from 9.8% in 2005 to only 8.5%
in 2007
53
.
Figure 4. Source of funds for health care, 2007
Naonal
Government
13%
Local Government
13%
Social Health
Insurance
9%
Out-of-pocket
54%
Others
11%

Source: 2007 Philippine National Health Accounts. Manila, National Statistical Coordination Board, 2010.
Moreover, the limited scope and support levels of PHIC benefits, the difficulties in
accessing such benefits, and the lack of information on how to do so all reduce levels of
financial protection. These problems are particularly acute and magnified among the poor,
who are frequently unable to comply with the administrative requirements and to afford the
co-payments.
Resource allocation in the country is hindered by the lack of clearly defined
of the package of essential health services to be provided at each level of care. This
is true for government as well as private health facilities. In the absence of such a
formally defined, costed, and enforced package, budget allocations tend to preserve the
status quo through incremental budgeting approaches. Budget discussions can even
become quite ad hoc or dependent on the most vocal proponent of particular health
programs. Resource allocation difficulties also arise from patient referral bypass, which is
53 2007 Philippine National Health Accounts. Manila, National Statistical Coordination Board, 2010.
16 WHO Country Cooperation Strategy for the Philippines 2011-2016
Section 2: Health and Development Challenges
quite common. Some patients go directly to a higher-level health facility as a point of entry
because of the weak, or nonexistent, gatekeeper system. The problem is compounded by the
lower-level facility (e.g. rural health unit or district hospital), which the patient should have
gone to first, does not exist in the locality or lacks essential staff and material resources. Thus,
regional and referral hospitals often also act as primary care providers of their catchment areas,
with the consequent deleterious effects on budgeting and resource allocation.
Financial fragmentation also reduces PhilHealth’s influence in shaping the types of services
to be provided and in improving provider or technical efficiency since PhilHealth continues
to be a minor funder of health services, accounting for only about 11% of the total health
expenditure. PhilHealth’s potential monopsony power as a likely single buyer of health services,
and the capability of controlling costs inherent in such power, is also undermined by its low
support value and its persistent preference for hospital-based coverage over out-patient care.
Because of these problems — financing fragmentation, supply-side lack of an essential
health service package norm and enforcement, and demand-side patient referral bypass —

appropriate resource allocation embodying economic principles of both efficiency and equity is
difficult to achieve. Thus, to make economic resource allocation work, one must first address
the key problems of fragmentation, PhilHealth’s limited scope and support level and other
shortcomings, lack of a service package norm, and patient bypass.
2.5.3 Health workforce
While the overall supply of doctors and nurses is not a problem in the Philippines, there is
large scale out-migration, the country being one of the largest suppliers of trained nurses in the
world. Among the consequences of these external job opportunities are the mushrooming of
nursing schools in the country, many of which are not at par with the standards required for nursing
education. Meanwhile, doctors who are practicing in the country are largely concentrated in
urban/peri-urban areas. Furthermore, the public sector experiences a shortage of skilled health
workers, particularly in remote, unattractive locations. Achieving and maintaining a competent
and effective health workforce, particularly in far-flung areas, remains an ongoing struggle.
2.5.4 Health Information System
The national health information system is essentially a complex one and the quality of the
national data is affected by the fragmented local health system. Devolution of health services
and budgets to LGUs has made it difficult to enforce regular and quality submission of data
from the field. Irregularities in data submission from the local level limit the ability of the
health information system to adequately monitor and evaluate performance with respect to
both efficiency and equity. Data from the private sector are limited, depending on the capacity
of the local health information system. Meanwhile, within the Department of Health, there
are other stand-alone data sources at the programme level.
The Department of Health through its National Epidemiology Center is attempting to
improve health data collection, monitoring and evaluation by creating the Philippine Integrated
Disease Surveillance and Response (PIDSR) system
. PIDSR aims to get electronic-based
reports for outbreak detection and disease monitoring that will inform timely response within
a few days/weeks rather than months/years
. Later, a web-based information system providing
access to timely and improved quality data will be established. The Field Health Services

WHO Country Cooperation Strategy for the Philippines 2011-2016 17
Section 2: Health and Development Challenges
Information System (FHSIS) and all other disease-specific surveillance data will be made
available and linked for a better holistic data base and improved analysis.
Based on a recent health information assessment, the Philippine Health Information
Network developed a strategic plan to improve the country’s health information
system
. However, implementation of this plan has yet to be initiated.
2.5.5 Medical products
The cost of medicines in the Philippines continues to be among the highest in the
region
54,55,56
although competition in the pharmaceutical industry has intensified in some
segments of the market with locally manufactured generics now accounting for nearly half
of all the medicines sold. The Universally Accessible Cheaper and Quality Medicines Act of
2008 aims to improve access by promoting the use of quality and affordable generic medicines,
and by improving competition. However, with no insurance package for out-patient medicines
(which account for 89% of the market) out-of-pocket payments are very high. As such, generic
medicine prices, as well as branded medicines under the Department of Heath price control, are
still beyond the means of the poorest.
Availability of essential medicines is poor in the public system and is one of the reasons
why patients (even poor members of the PHIC Sponsored programme) resort to higher-priced
private hospitals and self-medication. The Department of Health’s “P100” initiative, as well as
the Botika ng Barangay (BnBs) program, aims to provide a limited list of low-cost medicines
in facilities and remote areas. The sustainability of both programmes, however, is challenged
by stocks replenishment and supervision issues. Their actual impact in terms of access has not
been assessed. Issues on quality assurance and rational drug use are also limiting the efficiency
of the system.
2.5.6 Leadership and governance
Passage of the Local Government Code in 1991 resulted in the fragmentation and

diminished coherence of the public health care system, with governance responsibility devolved
to multiple levels of local government (currently 79 provinces, 122 cities, 1512 municipalities
and more than 40 000 barangays), each with a separate budget for health and with independently
operated local health facilities. Though initially slow to respond to changes that affected its own
role (and budget) to an unprecedented degree, the Department of Health gradually faced up to
the challenge of leadership in the sector, mainly through implementation of its “convergence
strategy” under the HSRA. Under this strategy, it offers financing and technical assistance to
LGUs, particularly in the preparation and implementation of Province-wide Investment Plans
for Health (PIPHs). The establishment of Inter-Local Health Zones (ILHZs) in 89% of the
54 Batangan DB et al. The Prices People Have to Pay for Medicines in the Philippines. Quezon City, Institute of Philippine Culture, Ateneo
de Manila University, 2005.
55 Pabico AP. New Rx Needed for Generics Movement. Quezon City, Philippines Center for Investigative Journalism, 2006 (http://www.
pcij.org/i-report/2006/generics.html).
56 Ball D and Tisocki K. Public Procurement Price in the Philippines. Health Action International, 2009 ( />medicineprices/surveys).