A recent study by the Philippine Institute for Development Studies (PIDS) said that local government units spend only P850 per capita on average on health and nutrition programs, falling well short of the estimated P1,827.8 per person annually needed to deliver essential primary health care (PHC) services.
Spending gaps are more pronounced in poorer and geographically isolated provinces, where health outlays can fall below P300 per capita. However higher-income LGUs rarely exceed P800.
Nearly all local governments, or 109 out of 120, fall short of the funding required to provide basic PHC, which PIDS said highlights a systemic underinvestment.
“This gap is widespread and systemic: In nearly all provinces and highly urbanized cities, estimated PHC costs exceed current expenditures, suggesting that most LGUs would need two to three fold increases in health spending to meet mandated service levels,” PIDS said.
Should LGUs fully fund PHC, it would require 15 to 30 percent of their annual operating income. However, actual spending is far lower.
According to PIDS, this shows that the shortfall is not due to the lack of funds, but because health competes with other priorities such as infrastructure, administration, and local projects.
“We found substantial variation in per capita health spending across LGUs that is weakly associated with fiscal capacity, despite the presence of operating surpluses, indicating that PHC is consistently underprioritized relative to other local expenditures,” the think tank added.
The gap persists despite the landmark Mandanas-Garcia ruling, which expanded LGUs’ just share in national taxes by requiring that their allotment be computed from all national tax collections, not just internal revenue.
The ruling resulted in fiscal deregulation, where LGUs have greater discretion in deciding how to allocate and spend their funds. For many LGUs, however, the additional resources have not translated to greater investment in basic health services.
The PIDS studies establish that despite the availability of funds and resources, public health is simply not yet a priority for LGUs. Changing that will require our leaders to have a different paradigm when it comes to allocating the precious resources of the local government, in order to have a deeper impact on the lives of their constituents.*
