THE ROLE OF LGUs IN ACHIEVING GOOD GOVERNANCE IN HEALTH SYSTEMS SLIDE #1 Definition: Governance is the exercise of political, economic

and administrative authority in the management of resources for development. It comprises complex mechanisms, processes and institutions through which citizens and groups articulate their interests, mediate their differences and exercise their legal rights and obligations. SLIDE #3 Good governance on the other hand can be measured through the following principles: 1. Legitimacy and voice; 2. Direction; 3. Performance; 4. Accountability; and 5. Fairness These principles can be summarized through a quotation from Andrew Lansley: The government will require accountability at all levels for results, measured in terms of patient outcomes rather than distorting targets. (SLIDE #4)

We need to know our target, direct ourselves to the said target, listen to our stakeholders and direct clientele, perform with fairness and be accountable to our every move. As an active partner of the Department of Health in achieving Universal Health Care or Kalusugang Pangkalahatan, our aim is to achieve better health outcomes, sustained health financing and more responsive health system. This aim means that our target is the poor to have equitable access to quality health care by being financially protected, could access to quality hospitals and health care facilities and further to attain the Millennium Development Goals. After identifying our target, let us now see and evaluate the stakeholders and our direct clientele for this aimthat is our constituents. The targets are in our locality, in our own barangays and our aim is to let them avail of our services in our own LGUs. From our own local settings, let us inform, perform and reform (if possible) towards the achievement of our goals. SLIDE #5 Question to ponder... Are our health services in our respective LGUs enough and responsive to the needs of our constituents? SLIDE #6 Before answering this question, let us see the Identified Critical Aspects of Governance that prevent us in achieving the principles of Good Governance, namely:

1. Mutual Accountability of all those interested in health; 2. Health Legislation and Regulation; and 3. Financial Constraints Mutual Accountability of all those interested in health: Let us not leave all health concerns and problems to the Department of Health alone. Since health is everybodys concern, let us all be accountable to Universal Health Care or Kalusugang Pangkalahatan. Being mutually accountable means strengthening our partnerships with those who are also looking forward to a healthy community, e.g., Civil Society Organizations (CSOs), NonGovernmental Organizations (NGOs), local & national agencies, and other concerned agencies. Health Legislation and Regulation: This includes issuances not only from the national or regional levels but most especially those which were issued by the LGUs. This includes issuances which defined the functions, entitlements, incentives and regulations which will serve as guide of our constituents to address equity and ethical issues in the implementation of health programs, projects and activities. Financial constraints: Many LGUs could barely afford to provide basic services, and the limited amount of health aid provided demands to be spent in such a way to maximize health returns to promote health

development. Hence, local officials are challenged to look into other considerations and options to improve delivery of health services and facilities. Going back to the question, Are we providing enough and responsive health services to our constituents? Yes or No, our inner answer will boil down to this Kalusugang Pangkalahatan and the mobilization of our Community Health Teams (CHTs). If our LGU is one of the poor as enumerated and identified by the National Household Targeting System (NHTS) courtesy of our another partner agency, the Department of Social Welfare and Development (DSWD), we should not be alarmed, instead it will serve as our light going out from the tunnel of poverty. Since our target in achieving the Aquino Health Agenda/ Universal Health Care or Kalusugang Pangkalahatan is the poor, let their responses in the data/information gathering done by our CHTs be our guide in assessing our local health system. Apparently, the first-hand information will be coming from our constituents, thus they are powerful. Let us then make use of that power by making them equipped with information. How can our constituents avail of our local health service when in the first place, they are not aware of the services that our LGUs offer? Finally, some basic principles for health program interventions need to be in place: political will and skill; strong supply through technical programs and strong demand from citizens and stakeholders; and integral approach to governance, financing, operations and capacity-building.

There is a need to raise awareness of politicians regarding the importance of good health system governance and performance. And what we are doing now is a perfect venue to raise our awareness. SLIDE #7 Health System Governance Principle Strategic Vision: LGUs should be mindful of setting the vision first before any plan of action. The historical, cultural and social complexities in our respective locality should be considered because this will be where our perspective is grounded. SLIDE #8 Participation & Accountability: Participation and consensus orientation: Such broad participation is built on freedom of association and speech, as well as capacities to participate constructively. Good governance of the health system mediates differing interests to reach a broad consensus on what it is in the best interests of the group and, where possible, on health policies and procedures. Before any move to mobilize our Community Health Teams, consultations with our Local Health Board and other conventions should be undergone so that no stakeholder and beneficiary will be left behind.

SLIDE #9 Responsiveness: Rule of Law: Legal frameworks pertaining to health should be made free and enforced impartially, particularly the laws on human rights related to health. Sometimes, with our eagerness to implement laws which we think are helpful to our constituents, we set aside the possibility of violating the basic human rights. SLIDE #10 Transparency: Transparency: As a major virtue of which DILG is advocating, the LGU processes, plans, programs, activities and information should be directly accessible to those concerned with them, and enough information is provided to understand and monitor health concern. SLIDE #11 As always emphasized, I would like to share with you that Transparency allows beneficiaries and stakeholders to hold local officials more accountable. Transparency and more information can lead to better informed policy-makingbetter health systemgood governance on health system.

SLIDE #12 Legal Basis for Inter-LGU Coverage SEC. 25, LGC of 1991. National Supervision over Local Government Units. - (a) Consistent with the basic policy on local autonomy, the President shall exercise general supervision over local government units to ensure that their acts are within the scope of their prescribed powers and functions. The President shall exercise supervisory authority directly over provinces, highly urbanized cities, and independent component cities; through the province with respect to component cities and municipalities; and through the city and municipality with respect to barangays. (b) National agencies and offices with project implementation functions shall coordinate with one another and with the local government units concerned in the discharge of these functions. They shall ensure the participation of local government units both in the planning and implementation of said national projects. SLIDE #13 (c) The President may, upon request of the local government unit concerned, direct the appropriate national agency to provide financial, technical, or other forms of assistance to the local government unit. Such assistance shall be extended at no extra cost to the local government unit concerned. (d) National agencies and offices including government-owned or -controlled corporations with field units or branches in a province, city, or municipality shall furnish the local chief executive

concerned, for his information and guidance, monthly reports including duly certified budgetary allocations and expenditures. SLIDE #14 SEC. 16, LGC of 1991. General Welfare. - Every local government unit shall exercise the powers expressly granted, those necessarily implied therefrom, as well as powers necessary, appropriate, or incidental for its efficient and effective governance, and those which are essential to the promotion of the general welfare. Within their respective territorial jurisdictions, local government units shall ensure and support, among other things, the preservation and enrichment of culture, promote health and safety, enhance the right of the people to a balanced ecology, encourage and support the development of appropriate and self-reliant scientific and technological capabilities, improve public morals, enhance economic prosperity and social justice, promote full employment among their residents, maintain peace and order, and preserve the comfort and convenience of their inhabitants. SLIDE #15 SEC. 17, LGC of 1991. Basic Services and Facilities. - (a) Local government units shall endeavor to be self-reliant and shall continue exercising the powers and discharging the duties and functions currently vested upon them. They shall also discharge the functions and responsibilities of national agencies and offices devolved to them pursuant to this Code. Local government units shall likewise exercise such other powers and discharge such other functions and responsibilities as are necessary, appropriate,

or incidental to efficient and effective provision of the basic services and facilities enumerated herein. (b) Such basic services and facilities include, but are not limited to, the following: (1)For a Barangay: xxx (ii) Health and social welfare services which include maintenance of barangay health center and day-care center; xxx SLIDE # 16 (2) For a municipality: xxx (iii) Subject to the provisions of Title Five, Book I of this Code, health services which include the implementation of programs and projects on primary health care, maternal and child care, and communicable and non-communicable disease control services; access to secondary and tertiary health services; purchase of medicines, medical supplies, and equipment needed to carry out the services herein enumerated; xxx (3) For a Province: xxx (iv) Subject to the provisions of Title Five, Book I of this Code, health services which include hospitals and other tertiary health services; xxx

(4) For a City: All the services and facilities of the municipality and province, and in addition thereto, the following: xxx SLIDE #17 SEC. 34, LGC of 1991. Role of People's and Nongovernmental Organizations. - Local government units shall promote the establishment and operation of people's and nongovernmental organizations to become active partners in the pursuit of local autonomy. SEC. 35, LGC of 1991. Linkages with People's and NonGovernmental Organizations. - Local government units may enter into joint ventures and such other cooperative arrangements with people's and nongovernmental organizations to engage in the delivery of certain basic services, capability-building and livelihood projects, and to develop local enterprises designed to improve productivity and income, diversify agriculture, spur rural industrialization, promote ecological balance, and enhance the economic and social well-being of the people. SLIDE #18 Thank you!