Sunday Essay: Should local public hospitals stay local?

If we have chosen local government officials who are competent to run these public hospitals or at least wise enough to delegate the challenge to those who can do it, then the answer is yes.

This is not a new question. It began to come up not long after many public health services were transferred to local governments in the Philippines in 1992, when the new Local Government Code took effect.

It has surfaced again these days because of a certain Mindanao senator’s attempt to return two provincial hospitals to the control of the National Government. Grilled by other senators last week, he tried to bring the debate to a halt but failed. The discussion will resume this week.

The senator has mentioned two reasons to return these devolved hospitals—one in Benguet and the other in Lanao del Norte—to the Department of Health’s (DOH) control and management. One was that the move will add 200 beds to each of these hospitals. The other was that the provinces in charge of these hospitals have asked for help.

Both changes can be pursued without returning these hospitals to national control.

In fact, the DOH has a Health Facilities Enhancement Program (HFEP) that has plenty of resources with which to assist hospitals, whether these had been devolved to the local governments or one of the tertiary or regional hospitals retained by the DOH.

In 2019, the Commission on Audit (COA) questioned HFEP contracts that were worth a combined P3.82 billion for different reasons, one of them being that the HFEP-assisted unit was idle or not fully used. Government auditors also pointed out that some P716 million worth of HFEP equipment were either undelivered or delivered yet not being used. Plan better, COA told the health department, so that what you do procure matches what the hospitals immediately need.

One of the things that bothers me about these proposals to return these two hospitals to national control is a false promise that’s being peddled. The argument goes that once the provinces of Benguet and Lanao del Norte give up control and management of their provincial hospitals, they would not only get more beds and more health workers. They would also have the chance to invest on other projects what they would otherwise have spent on running these hospitals.

But that’s not the case. The legislative bills for both hospitals clearly state that the cost of “renationalizing” these hospitals would be allocated or added to the budget of the DOH and charged against the Internal Revenue Allotment of both provinces. Both provinces would, in effect, lose part of their share in national taxes.

It takes both national and local attention to make public health services work. We are seeing this in the way the Covid-19 vaccination program has proceeded. The National Government provides the vaccines to most local governments (except for the handful that have had both the resources and the foresight to secure vaccines on their own), while the local governments do what’s needed to administer the vaccines to their communities.

Many challenges have surfaced since the national government transferred the management of most public hospitals to the provinces and cities nearly 30 years ago. Yet there are some success stories and gains. And this is clear: The DOH has never been helpless. It has always had the authority and resources to support local governments that needed help in running their hospitals and other public health services, whenever it wanted to do that.

This pandemic has tested our local government units’ ability to provide public health services, yet it would be wrong to say that all the LGUs have uniformly failed. There are some hard-earned wins and lessons. One of those lessons has to be that public health experts, not politicians, generally do a better job of setting health care policies and running health programs. Let them be heard in this debate.