24 February 2013

Social accountability and public health

This is the fourth of a series of columns on the G-Watch program of the Ateneo School of Government. For this piece, I look at how we worked with the local government of Dumaguete City on how to employ social accountability to deliver health services more effectively.

Many health services have, by law, been decentralized or devolved to local government units (especially concerning basic health care). 2010 statistics by the World Health Organization show US$142 spent per Filipino for health services, while statistics for Philhealth for the same year show coverage of less than forty percent of Filipinos: deplorably poor numbers, considering that health is critical to economic productivity and development. This makes every public centavo spent on effective medical services all the more important, for its relative scarcity, to prevent and preempt sickness and death. Dumaguete City in Negros Oriental provided the Government Watch (G-Watch) team the opportunity to help the city ensure the best returns from those scarce centavos—or, perhaps, G-Watch provided Dumaguete City the opportunity to demonstrate the city’s good faith in spending those centavos, considering City Mayor Chikiting Sagarbarria’s promise to project director Joy Aceron: “I have nothing to hide.” Or how many offi
cials in participating barangays went out of their way to provide space and snacks for monitors. Or how, though civil society still expressed the usual skepticism about public officials, the local YMCA director Greg Fernandez would opine that the local government was well-intentioned.

Considering G-Watch’s admission that Dumaguete City wasn’t even on their initial shortlist for the localization pilot run, to encounter the local government unit (LGU)’s generally welcoming attitude is fortuitous as it is appreciated.

Dumaguete City’s health program distributes medical resources from city level to barangay health centers (BHC)—not just medicines: Dumaguete prides itself in being the only city to deploy one nurse each to every BHC. These nurses would oversee the city’s Safe Motherhood and Family Planning Program, the Child Care Program, and the Prevention and Control of Infectious Diseases Program. This would certainly explain why health receives a large portion of the city budget—and the LGU’s desire to ensure accountability for the significant expenditure, a concern shared by both LGU and civil society. Apart from wasteful expenditures or graft, the city’s setup of devolving health services to the barangay level also created risk openings for political patronage.

The Dumaguete LGU, civil society organizations (CSO), and G-Watch branded the partnership “Subay Kahimsog”, Visayan for “Tracking/Pursuing Health.” Though initial enthusiasm for the project was high, all stakeholders soon realized the gravity of their pursuit. G-Watch recalls how LGU and civil society stakeholders were “bemused” by the extensive details of monitoring health services delivery. Visayan Forum director Marelen Pepino noted the reluctance of some health CSOs to participate as monitors, fearing lack of sustainability (in the end, she managed to convince them to participate, though the project noted an insufficient number of CSO volunteers). Many of the volunteer monitors were young, she added, and in their inexperience, “they held the G-Watch team in awe.”

Daunting the task may have been, but the returns of Subay Kahimsog were fruitful and significant. Monitors were able to identify some lapses and insufficiencies at the BHCs—broken or insufficient medical refrigerators, physicians not prescribing the medicines made available by the city, some barangays not allocating their own money for health; lack of coordination and documentation. Such lapses can be rectified with the proper attention, and is in fact the “feedback” purpose of citizen monitoring.

Citizen monitoring isn’t just about fault-finding. Subay Kahimsog also revealed that, deficiencies aside, the Dumaguete City health program is itself fruitful and significant, generally helping barangays meet the medical needs of their constituents. Their admirable deployment of nurses, in particular, was seen to ensure proper management and quality control of BHCs. Equally admirable was the professional and friendly service offered by BHC personnel, practically health with a smile. There are lessons for other LGUs to learn from here.

Such lessons are not limited to health services delivery, either. Whatever wariness and suspicion there was between government officials and civil society volunteers, it seemed the enthusiasm for citizen monitoring on both sides managed to bridge any gaps, soothe any fears. Perhaps it helped that the volunteers themselves, or the sectors they represented, had good reason to see a working health care system: the youth, women and children’s rights advocates, and even the local kasambahay (household helper) group, SUMAPI (so enthusiastic they were, they even readily volunteered more members than G-Watch needed).

Perhaps, most of all, it’s because this is what governance is supposed to be: to formulate, adopt, execute, and adjust as necessary, policies aimed for the common good, on the basis of sound information. That this is what democracy is supposed to be: participatory, open government and an active citizenry. That this is what accountability is supposed to be: ordinary people able to understand the effectiveness and efficiency of public policy—and even help define the standards of “effective” and “efficient”, being the beneficiaries of policy. And Dumaguete City provides hope that this promise can be achieved in the rest of the country.

The writer is Dean of the Ateneo School of Government (ASoG)  and a member of the Board of Trustees of the Affiliated Network for Social Accountability in East Asia and the Pacific (ANSA-EAP).  This essay was first published in the 11 October 2011 online and print edition of the Manila Standard Today. It is featured in VOICES with the writer's permission. Dean La ViƱa can be reached through e-mail at tonylavs (at) gmail.com and twitter: tonylavs

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