1977 2002

PHILIPPINE INSTITUTE FOR25 DEVELOPMENT STUDIES Surian sa mga Pag-aaral Pangkaunlaran ng Pilipinas

Vol. XX No. 4 July - August 2002 ISSN 0115-9097

ill the formulation of more laws provide solutions to the Is there still a need to legislate? looming water crisis in the Wcountry? This was one of the major points of discus- sion made during a recent Policy Forum on A water policy agenda Water Resource Management held in Makati City. Said forum was sponsored and orga- nized under the auspices of a joint research project on water management conducted by the Sustainable Agriculture and Natural Re- for the Philippines source Management Collaborative Research Support Program for Southeast Asia by Antonio P. Contreras, Ph.D. (SANREM-CRSP/SEA), University of the Associate Professor, Political Science Department Philippines at Los Baños (UPLB), Philippine De la Salle University-Manila Institute for Development Studies (PIDS) and the Philippine Council for Agriculture, For- estry and Natural Resources Research and Development (PCARRD). Two, the water crisis, which is caused by work within the parameters of an eco- a conjuncture of natural and anthropo- systems approach wherein the planning This paper outlines the recommended policy genic events and rooted on destructive unit is landscape-based, or more specifi- agenda for water governance in the Philip- land-use practices, is aggravated by a cally, focused on the watershed. Further- pines based on the various papers written flawed governance system characterized more, resource valuation does not take under the project. by a soft state.1 While none of the au- into account market-based mechanisms thors actually mentioned the term, it can that will truly reflect the scarcity value Three main themes emerged from the be safely deduced that the Philippines of water resources. papers despite differences in their ap- is unable to fully implement its laws in proaches and focus. water governance, which is a key char- And three, while there is a need to acteristic of a soft state. The flawed gov- strengthen national laws in order to ad- One, the papers are unanimous in de- ernance system is further aggravated by dress the water crisis, the need to em- claring that there is a water crisis. This a flawed science-governance interface. power local government * page 3 is already a given and has been amply This is particularly seen in the failure of supported by empirical data both at the the present legal and policy environ- national and local levels. ment relevant to water governance to 1 According to Gunnar Myrdal, a soft state is character- ized by a situation wherein laws are formulated in im- precise terms. This leads to a situation wherein a con- siderable degree of discretionary power is given to gov- What's Inside ernment officials who often cooperate or connive with powerful individuals and interest groups whom they are supposed to supervise and control in the first place. 4 A model for water resource governance for the Philippines Thus, the government easily yields to powerful lobbies 5 Health Sector Reform Agenda: The key to a healthy Philippines and interests and becomes incapable of implementing appropriate laws and policies. Interests may even go 5 Together again: DOH and PIDS beyond powerful groups external to government and 8 HSRA: Setting the momentum for health reforms may also include bureaucratic organizations with large stakes on certain matters (Asian Drama: An Inquiry into the Poverty of Nations. Harmondsworth: Penguin, 1968). DEVELOPMENT RESEARCH NEWS 2 July - August 2002

DEVELOPMENT RESEARCH NEWS is a bimonthly publication of the PHILIPPINE DEVELOPMENT RESEARCH NEWS INSTITUTE FOR DEVELOPMENT STUDIES (PIDS) Vol. XX No. 4 . It highlights the findings and July - August 2002 recommendations of PIDS research projects and important policy issues discussed during ISSN 0115-9097 PIDS seminars. PIDS is a nonstock, nonprofit government research institution engaged in long- term, policy-oriented research. This publication is part of the Institute's program to Editorial Board: Dr. Mario B. Lamberte, President; Dr. Gilberto M. Llanto, Vice- disseminate information to promote the use of research findings. President (on secondment); Mr. Mario C. The views and opinions expressed here are those of the authors and do not Feranil, Director for Project Services and necessarily reflect those of the Institute. Inquiries regarding any of the studies contained Development; Ms. Jennifer P.T. Liguton, in this publication, or any of the PIDS papers, as well as suggestions or comments are Director for Research Information; Ms. Andrea welcome. Please address all correspondence and inquiries to: S. Agcaoili, Director for Operations and Finance; Atty. Roque A. Sorioso, Legal Research Information Staff Consultant. Philippine Institute for Development Studies Room 304, NEDA sa Makati Building, Staff: Jennifer P.T. Liguton, Editor-in-Chief; 106 Amorsolo Street, Legaspi Village, 1229 Makati City, Philippines Genna J. Estrabon, Issue Editor; Sheila V. Telephone numbers 892-4059 and 893-5705 Siar, Ma. Gizelle R. Gutierrez, Jane C. Telefax numbers (632) 893-9589 and 816-1091 Alcantara, and Edwin S. Martin, Contributing E-mail address: [email protected] Editors; Valentina V. Tolentino and Rossana P. Cleofas, Exchange; Delia S. Romero, Galicano A. Godes, Necita Z. Aquino and Reentered as second class mail at the Makati Central Post Office on April 27, 1987. Alejandro P. Manalili, Circulation and Annual subscription rates are: P200.00 for local subscribers; and US$20.00 for foreign Subscription; Genna J. Estrabon, Layout and subscribers. All rates are inclusive of mailing and handling costs. Prices may change Design. without prior notice.

Editor's Notes

Two issues ago, three articles on water management from can do much to respond to the issue by creating a sup- a joint research project among four major institutions portive environment among local government units were featured. This issue continues to give updates and (LGUs) that share certain water resources. Empowerment relevant information on the topic by featuring, as main plays an important role at the local level. story, one of the project papers that discusses whether there is a need to legislate a specific policy agenda for At the national level, however, he cautions that the cre- water governance in the country. ation of another body will only add confusion and bur- den to a bureaucratic set-up that is already saddled with The author, Dr. Antonio Contreras of the De la Salle Uni- an endless flow of problems. versity-Manila, assesses the present set-up of water gov- ernance in the country as well as the existing environ- Accompanying Contreras' article is a shortened version ment at the local and national levels that will either of Dr. Ben Malayang III's model for water resource gov- facilitate or slow down development in water manage- ernance that emphasizes the inclusion of legitimacy, trust ment. and credibility as key elements. Such abstract concepts may be supported by a very concrete environment made Contreras recommends at the end that given the exist- possible by interactions between public and private in- ing water crisis, both the local and national governments stitutions. DRN DEVELOPMENT RESEARCH NEWS 3 July - August 2002

Water policy...from page 1 tively implementing laws is a problem, approach in water resources gover- adding new laws will not strengthen the nance. implementing capacity of the state. A units (LGUs) and communities is clearly soft state is not a legal problem but a In this regard, it may be argued that it is recognized. structural problem. Adding new laws necessary to establish a science-based that might not be effectively imple- governance mechanism and support the One of the forum papers proposes a mented at all could even compound the institutionalization and statutory recog- model for water governance in the coun- problem. nition in any form of both a watershed try based on certain criteria that call for approach and a market-based valuation wide participation of various parties, in- Moreover, a critical analysis of lawmak- system in water resource governance. cluding communities (see related article ing would lead one to fairly conclude However, legislating for a watershed or on page 4). that most laws, with the exception of a market-based approach will only be ef- few, are heavily biased toward control fective if it is supported by capacity-build- The key problematic mechanisms. Most of the provisions in ing programs inasmuch as the issues in- The main problems in water governance the laws are either expressed as regula- volved here are of technical rather than are (a) the failure to implement the laws tory in nature or as centralized, singu- of legal nature. and the presence of corruption—the lar-unitary systems of command and con- problem of a soft state—and (b) the trol, both of which are inherent in state It is important to point out that there is absence of mechanisms to operation- simplification processes. In view of nothing in the existing legal and policy alize an ecosystems approach and a mar- these, the laws usually fall short in pro- environment that prevents governance ket-based valuation technique in water viding a developmental or advocacy mechanisms to take up an ecosystems resource governance.

In outlining the legislative and policy im- plications of the major findings of the ...While it is recognized that state failure in effectively policy forum papers mentioned earlier, some questions need to be asked: Are implementing laws is a problem, adding new laws will the present laws adequate? Do we need to legislate new laws? If yes, what should be their focus? not strengthen the implementing capacity of the state.

Furthermore, will the formulation of more laws provide solutions? Is the mechanism to support local initiatives approach or operationalize market- present legal and policy environment in governance. based resource valuation systems. In fact, already sufficient? there is a whole range of laws and poli- The intention to empower local commu- cies that focus on watershed manage- At present, the following laws provide nities is a pervasive message in most of ment, such as: the legal framework for water gover- the forum papers. As such, the formula- nance in the country: tion of new laws to strengthen and ra- j PD 705 as amended by PD 1559 tionalize the governance structures and - Revised Forestry Code, which pro- j The 1987 Constitution which mechanisms for water governance in the vided for mechanisms in managing mandates that all water resources Philippines should be guarded against critical watersheds in relation to belong to the State, compromising local initiatives. This is downstream infrastructure develop- j Presidential Decree (PD) 1067 because the complexity of governance ment; in 1976 or The Water Code of the arrangements at the local level, which is j Letter of Instruction (LOI) 917 Philippines, compounded by the varying bio- and in 1979, which declared critical wa- j Republic Act (RA) 8041 in 1995 geophysical limitations of the archi- tershed and watershed reservations or The Water Crisis Act, and pelago, requires a legal framework that as wilderness areas; j Executive Order (EO) 364 in is less centralized and singular. j EO 192 in 1987, which man- 1996, which created the Presiden- dated the Department of Environ- tial Task Force on Water Resources Meanwhile, the absence of mechanisms ment and Natural Resources Development and Management. to operationalize market-based instru- (DENR) as the primary agency re- ments as well as an ecosystems approach sponsible for forest and watershed In response to the questions earlier in resource valuation, as noted in the management; raised, this paper argues that while it is project papers, is evident in the Water j RA 7586 in 1992, which ex- recognized that state failure in effec- Code’s failure to consider a watershed tended the coverage * next page DEVELOPMENT RESEARCH NEWS 4 July - August 2002

of the National Integrated Pro- tected Areas Systems (NIPAS) to in- clude watershed forest reserves; and A model for water resource j RA 8041 in 1995, which recog- nized the importance of watershed governance for the Philippines management in relation to address- by Ben S. Malayang III1 ing the water crisis.

In addition, Article 83 of the Water Code his is an attempt to apply a model of for- through consensus or compromises, by water Act (PD 1067) authorized the National est governance on water resource gov- institutions that have the most power in a par- Water Resources Board (NWRB) to col- Ternance based on a previous work on ticular landscape to sway human conduct to- lect charges for water development. This adaptive collaborative management (ACM) and ward a certain behavior. has provided an opening for a more mar- forest governance of the Centre for Interna- ket-based valuation system, something tional Forestry Research (CIFOR). Power is presented in this model as being a that has actually not been adopted construction of a water institution’s public le- though not prohibited. Furthermore, The model draws from three assumptions on gitimacy, trust and credibility. Water institutions RA 7160 or the Local Government Code resource governance: (a) it is a complex body gain power when they have widespread public of decisions and actions; (2) these decisions confidence on (a) their mandates (whether re- has already provided a legal basis for and actions are multisectoral, multilevel, and sulting from law or from customs) to address LGUs, either acting on their own or in multithematic; and (3) those that become poli- or be concerned with water resources, (b) their partnership with other LGUs, to initiate cies and define the scope, substance and di- ability to promote public rather than individual and institutionalize their own resource rection of governance, are those which result or elite interests on water, and (c) their techni- governance arrangements. from agreements and compromises among the cal and organizational capabilities to address most powerful institutions addressing or being water issues and problems. In fact, the case of the Maasin Watershed concerned with the resource. in Iloilo is a good example of an LGU Thus, water policies are creations of power; the that took advantage of the policy climate Water resource governance is no more than the water institutions that have the more power will enabled by RA 7160 to operationalize a body of decisions and actions directed at, or dominate water policies. In turn, water poli- watershed-based management system. which affect, the conditions and uses of water. cies will tend to be more stable and precise if The establishment of the Davao River These are formed or undertaken by groups and they are composed of water decisions and ac- Authority spearheaded by the legislative institutions from either the public (i.e., govern- tions adapted by a wide array of institutions. council of Davao City is another. mental) or nonpublic (i.e., civil society, private That is, the probability that water policies will businesses, research and academic institutions, change is lower if these are the product of the The major point here is that the imple- or local communities) sectors that are con- agreements of a large number of water institu- mentation of an ecosystems approach as cerned with or mandated to address water is- tions. Furthermore, there will be a lesser chance well as a market-based valuation mecha- sues. of any water institution moving to a dominant nism is dependent on the technical ca- position of being able to control decisions and pacity and political will of local govern- There are at least four levels of water gover- actions over water. ment agencies. Hence, while national nance: global, national, subnational and local. bodies would be important, there should They cover various concerns (or themes) of Based on other studies, this model posits that be a strong mechanism to empower lo- water resources such as development, protec- legitimacy, trust and credibility are perhaps de- cal bodies and a strong advocacy and tion, utilization, commerce and trade, and regu- pendent on how water institutions conduct capacity-building component that would lations. The decisions and actions that tend to themselves. support their initiatives. dictate how water resources are developed, protected, managed or used across a social or Mainly, legitimacy may be either boosted or di- Recommendations for a policy agenda political landscape are likely to be those pre- minished by transparency or by how a water Bearing in mind the previously men- ferred, or which have been agreed upon, institution makes its efforts to pursue its man- tioned caveats regarding the need for date clear to its publics and constituency. The additional legislation, this paper here- more the constituency is regularly and fully in- upon recommends a policy agenda that 1 Professor of Environmental Science and Management, formed of the water institution’s activities, the focuses on certain legislative actions, School of Environmental Science and Management more likely that they will put their confidence (SESAM), University of the Philippines at Los Baños (UPLB); on the water agency for what it seeks to do for which may be considered at both the na- Policy and Institutions Specialist, USAID-DENR Philippine tional and local levels. Environmental Governance Project (EcoGov). Note: this them. paper contains the views of the author and does not nec- essarily reflect the official views and positions of either Trust, on the other hand, is a function of ac- Legislative action at the national level SESAM, UPLB, USAID, DENR, PIDS or EcoGov. It was writ- countability. A water institution is more likely Legislative action at the national level is ten for the SANREM CRSP/SEA-UPLB-PCARRD-PIDS project on Water Resource Management. to be deemed trustworthy if it * page 6 needed only insofar as the * page 7 DEVELOPMENT RESEARCH NEWS 5 July - August 2002

Specifically, the HSRA seeks to Health Sector Reform Agenda: undertake the following: j Provide fiscal autonomy to government hospitals. The con- The key to a healthy Philippines version of government hospi- tals into corporate entities will promote fiscal autonomy as it will allow them to collect social- ized user fees. This move will he health of Filipinos has signifi- classes and geographic areas. Those who take a great chunk off the DOH’s yearly cantly improved over the last 50 live in rural and isolated communities appropriation for hospital operations. years. Yet, there still remain many receive less and lower quality health ser- Thereupon, the DOH could use these T vices. Even in places where medical fa- savings to finance preventive public challenges that the health sector needs to address so that the citizens could re- cilities are present, people are still un- health programs. However, there is a alize more health gains. able to receive appropriate care because need to enhance the capacities of gov- services are unaffordable. Undoubtedly, ernment hospitals such as their diagnos- For instance, infant and maternal mor- rising medical costs are putting appro- tic equipment, and laboratory and medi- tality rates in the Philippines has re- priate care beyond the reach of ordinary cal staff to effectively exercise fiscal au- mained high in the last decade com- people. For the poorest of the poor, this tonomy. Such investment must be cog- pared to those of other ASEAN coun- means dying without even seeing a doc- nizant of the complimentary capacity tries. The threat from infectious diseases tor. provided by public-private networks. and the burden of degenerative condi- Most importantly, safety measures tions have also been rising. On top of To address these problems, the Depart- should be carefully put into place to pro- these, emerging health problems ment of Health (DOH) developed the tect the interest of the indigents such as brought about by environmental and Health Sector Reform Agenda (HSRA). by enrolling them in the National work-related factors also remain unat- The agenda describes the policies, pub- Health Insurance Program. tended. lic investments, and organizational changes needed to improve the way j Secure funding for priority public There is also the large variation in health health care is delivered, regulated and health programs. Budget on a multiyear status across population groups, income financed in the country. basis must be provided to * next page

he Department of Health (DOH) and the Philippine Institute for De Tvelopment Studies (PIDS) embarked on yet another joint undertak- Together again: ing in 2002. This time, it is on the DOH Legislative Agenda Advocacy Project, which aims to present and advocate the Health Department’s DOH and PIDS Legislative Agenda to the new set of legislators of the 12th Congress. As the government agency responsible for the formulation, planning, imple- (ERBL), a joint project with the Congressional Planning and Budget mentation and coordination of health policies and programs, the DOH Office (CPBO) and linked with the Institute's SocioEconomic Research developed the Legislative Agenda based on the Health Sector Reform Portal for the Philippines (SERP-P) webpage. Both the HSRA and the Agenda (HSRA). The advocacy project is crucial in providing the appro- Legislative Agenda are also being proposed to be presented before the priate venues or outlets for the discussions on the Health Department’s Legislative-Executive Development Advisory Council (LEDAC). legislative agenda and the passage of various bills in both Houses of Congress necessary to implement the HSRA (see separate article). The joint undertaking further strengthens the professional bond be- tween the two institutions as it builds upon previous projects where In calling for the prioritization of the Agenda, the advocacy project will the PIDS has lent its assistance and expertise to the Health Depart- utilize existing PIDS dissemination mechanisms such as the PIDS Sen- ment in conducting research and advocacy on key and critical health ate Economic Forum and Legislators Workshop Series. The conduct of areas. These included the Baseline Studies for Health Care Financing fora/briefings will specifically target legislators from both Houses’ Com- Reforms, which produced 24 studies in 1995, followed in 1999 by the mittees on Health and Demography, Finance/Appropriations, and Ways Institute's help in drafting the Department’s health care policy reform and Means. The project will also make use of numerous PIDS publica- agenda under then Health Secretary Alberto Romualdez’s administra- tions. It will also conduct web discussions or moderated group discus- tion. Said paper provided the foundation for the present health reform sions through the Institute’s Economic Resource Base for Legislation agenda.DRN DEVELOPMENT RESEARCH NEWS 6 July - August 2002 eliminate or significantly reduce the in- j Strengthen the capacities of health package. Health financing reforms cidence of infectious diseases. The gov- regulatory agencies. The capacities of through NHIP expansion will make hos- ernment should also allocate funds to the Bureau of Food and Drug (BFAD), pital autonomy viable and will ensure effectively address emerging health con- Bureau of Health Devices and Technol- that the poor remains protected. Hos- cerns and to advance health promotion ogy (BHDT), Bureau of Health Facili- pital reforms in turn will free up re- and prevention programs. At the same ties and Services (BHFS), and Bureau sources for investments in public health time, the management capacity and in- of Quarantine and International Health program and health regulation at the frastructure of public health programs Surveillance (BQIHS) must be strength- national and local levels. Effective pub- must be upgraded to ensure that these ened to ensure the safety, quality, acces- lic health programs and local health sys- investments are effectively utilized. Ca- sibility and affordability of health ser- tems will relieve the NHIP from paying pacity-building is likewise required for vices and products. Public investments for hospitalizations that should other- these programs to provide technical must be made to upgrade the facilities wise have been prevented or better leadership over local health systems. and manpower capability of these agen- handled at primary care facilities. cies, particularly in standards develop- j Promote the development of local ment, technology assessment and en- Implementation of the HSRA demands health systems and ensure their effec- forcement. To achieve all these, amend- public investments as well as policy and tive performance. Local government ments to the laws governing the man- organizational changes. The HSRA will units (LGUs) must enter into coopera- dates of these agencies are called for. require public investments estimated to tive and cost-sharing arrangements with amount to P112 billion within a five-year one another to improve local health ser- j Expand the coverage of the Na- period. It will also require effective vices. Funds must be secured to upgrade tional Health Insurance Program implementation of existing laws and local health facilities and build local hu- (NHIP). Social health insurance must be policies like the National Health Insur- man resource capacities. For a more ef- expanded to widen its reach. Health in- ance Act, the National Drug Policy and fective performance, participation of the surance benefits must be improved to the Local Government Code. The orga- private sector and volunteer groups make the program more attractive to nizational changes needed include the must also be tapped. Lastly, appropriate members. As membership expands and continuing reengineering of the DOH mechanisms for sustainability and the benefit spending increases, appropriate and PhilHealth and the formation of continued delivery of quality care must mechanisms to ensure quality and cost interlocal health zones. be developed and institutionalized. effective services must be developed and introduced. Capacities and new admin- Ultimately, therefore, the HSRA aims to: istrative structures must also be (a) improve the health status of the Model...from page 4 developed to allow the Philippine people through greater and more effec- Health Insurance Corporation tive coverage of national and local pub- has mechanisms in place that will ensure im- (PhilHealth) to effectively service more lic health programs; (b) increase access mediate response to explain itself and its ac- members and manage increased benefit to health services especially by the poor; tions anytime and that protect public interest spending. and (c) reduce financial burden on in- (by not being corrupt or by having mecha- dividual families. It shall be the catalyst nisms that thwart corruption). These five reform areas are highly in- that will bring the country toward the terdependent, complementary and realization of a shared vision of health Credibility, meanwhile, is a function of par- therefore should be implemented as a for all Filipinos. DRN ticipatory decisionmaking. The likelihood is bacco Control through the initiative of Senator higher that a water institution’s decisions and Momentum...from page 8 actions are technically sounder and more edu- Juan Flavier. cated if these are products of the pooling of minds of its own staff and publics. The array the certification and recognition program that Finally, to boost the Bureau of Food and Drug’s of competence is expanded if the internal ca- develops and promotes standards for health fa- (BFAD) capacity to regulate food and drugs in pability of the institution is boosted by the ex- cilities. This has provided the impetus for local the market, the Gawad Botika ng Sentrong Sigla perience and wisdom of its constituency. government executives to continue appropriat- was developed. This program aims to showcase ing financial and logistical support for the up- the BFAD Quality Seal for drug retail outlets. In sum, this short note proposes that trans- grade of health facilities and manpower to meet parency, accountability and participation—or the required high standards needed for Sentrong So far, 466 drug retail outlets have been evalu- their improvement among water institutions— Sigla certification. ated for the award. In addition, the DOH has be further strengthened and enhanced to en- appropriated additional investments for the mod- sure the stability of water resource governance In terms of public health program reforms, the ernization of the BFAD and is reviewing the and policy in the Philippines.DRN DOH has constructed one vaccine facility in bureau’s policies and procedures in order to Alabang as well as filed Senate Bill No. 1 on To- streamline its services.DRN DEVELOPMENT RESEARCH NEWS 7 July - August 2002

Water policy...from page 4 strong involvement of civil society actors In support of this local action, the task in water governance. of the national water body should in- clude advocacy and capacity-building. provision of a national-level body to over- It is worthy to note that there have al- This is to create awareness among other see the integration of all efforts based ready been bills filed at the Philippine local players on the possibility for local on existing laws is concerned. This may legislature regarding some of these con- institution-building and empower them entail the revision of the Water Code Act cerns. For instance, an earlier bill filed for water governance. It is also to expose to strengthen the integration of the roles by Siquijor Representative Orlando Fua them to the technical aspects of the wa- of national agencies such as the NWRB provides for an education and informa- tershed approach. The national water and the Presidential Task Force on Wa- tion function to a proposed National Wa- body should also be tasked to monitor ter Resources Development. ter Resources Authority and engages a and evaluate these local water bodies. strong commitment from local stake- There are two options available regard- holders and marginalized sectors, in- At the same time, local actors should ing this action. One is to create a water cluding women. It is, however, most un- continue to collectively act to encour- body either in the form of a Water Com- fortunate that this bill has not gained age Congress to strengthen local struc- mission similar to the National Commis- significant progress in the legislative pro- tures through legislative recognition. sion on Indigenous Peoples (NCIP) or cess. This collective action may include lob- the National Commission on the Role bying for the passage into law of sepa- of Filipino Women (NCRFW) or in the Another bill pending in Congress is the rate creations of the Palawan Council for form of a National Water Resources Au- Clean Water Act authored by Bukidnon Sustainable Development and the Davao thority. And the other option is to lodge Representative J.R. Nereus Acosta in the River Authority or supporting present the function of overseeing all matters Lower House and by Senator Juan initiatives in Congress to establish a na- related to water governance in the De- Flavier in the Senate. This bill recognizes tional water body or legislate a Clean partment of Environment and Natural the participation of LGUs in the man- Water Act. Resources (DENR). agement and improvement of water quality in their jurisdictions. It also pro- Conclusion These options present an issue that vides for citizen action in pursuing suits The whole point of this paper is to re- needs to be resolved in the context of against violators of the Act’s provisions mind decisionmakers that there should institutional economy and capacity. Cre- as well as the conduct of information be legislative restraint as well as legisla- ating another agency, if not properly and education campaign. This bill, how- tive activism in the form of legislative done, would just add to the already ever, does not propose for the creation economy and reform. This entails shift- bloated bureaucracy. On the other of a new water body and instead assigns ing the focus from regulation to advo- hand, the DENR is already saddled with the lead function to DENR. And while cacy, taking stock of existing laws, and too many functions. it is noteworthy that the bill already re- establishing a lean but mean legal envi- fers to market-based instruments, still, ronment that allows for initiatives at the Either way, there has to be a balance be- the proposal of one of the forum papers local level. tween the regulatory and advocacy func- to include a provision of the bill empha- tions. The latter should enhance the sizing the importance and need to use a Uniformity and the presence of a super strong capacity-building program of watershed-based approach in water man- water body may be convenient but the LGUs and other local players to be able agement will provide legal support to a existence of a pluralism of modes of wa- to operationalize an ecosystems ap- scientific basis for water resource man- ter governance in the country will en- proach and a market-based mechanism. agement. able local stakeholders (LGUs, civil so- Moreover, it is important to allow the ciety) to evolve appropriate mechanisms Action at the local level that conform with local social, political, There is a need for LGUs to establish economic and ecological realities. Thus, regional/local bodies such as water any legislation should contain a progres- councils or river basin authorities. These sive element of furthering the spirit of bodies do not necessarily require legis- devolution by providing for the imple- lation at the national level but only in- mentation of the principle of ter-LGU legislative action, particularly subsidiarity in water governance. This years when watersheds cover different munici- calls for a deliberate transfer of power 25 palities/cities of different provinces. from national to local water bodies and of service through These bodies may vary in character, char- certainly necessitates the creation of an policy research ter or nature. In fact, some of them may enabling legal and policy environment even be in the nature of cooperatives, that would capacitate and support local NGO networks or parastatals. initiatives.DRN DEVELOPMENT RESEARCH NEWS 8 July - August 2002

n pursuit of health reform and in line with management systems and quality of services. ganized and trained therapeutics committees the Arroyo government’s thrust to improve They are also pursuing measures to increase gen- (TCs), which have considerably improved the se- Iaccess to and delivery of social services to erated revenues so as to augment their budgets. lection of drugs to be procured by LGU conver- the poor and marginalized sector, the Depart- gence sites. Some of the sites have even devel- ment of Health (DOH) has pursued the imple- In terms of local health systems development, oped their own local drug formularies. mentation of the Health Sector Reform Agenda interlocal health zones (ILHZs) covering all mu- (HSRA). nicipalities in the provinces involved were orga- Moreover, almost all sites are now implementing nized. The vitality observed in the 13 conver- innovative drug procurement methods such as The HSRA is the Department’s framework of its gence sites demonstrates the advantages from bulk or pooled procurement, including that of major strategies, organization and policy inter-LGU collaboration and cost-sharing. parallel drug imports. Because of the improved changes, and public investments to improve the drug selection and procurement systems, some country’s hospital systems, public health pro- To date, 23 ILHZs have already been organized, sites have significantly reduced the procurement grams, local health systems, health regulatory of which seven are already functional (five in cost of drugs. systems and health financing systems. Negros Occidental and two in Iloilo). To acceler- ate the propagation of this reform component, a To improve health care financing in convergence Under this framework, two major initiatives are manual on organizing ILHZ was developed as sites, the enrolment of the poor under the indi- already being implemented, namely, Pharma 50 the main tool by the Department’s Bureau of gent program of the National Health Insurance and Plan 500. Pharma 50, a collaborative effort Local Health Development. Program (NHIP) was also actively pursued. of the DOH and the Department of Trade and Industry (DTI), resulted in the reduction of prices For the public health program reforms, the con- Reforms outside of the convergence sites of drugs commonly used by the poor by half. vergence sites integrated the five high impact The implementation of the health sector reform Plan 500, meanwhile, which was implemented public health programs in the health benefit is selective outside of the 13 identified conver- through the Philippine Health Insurance Corp. package of health passport holders. These are gence sites. Institutional reforms are focused (PhilHealth), has expanded the coverage of the National Tuberculosis Control Program, Con- only on critical activities that are sufficient to health insurance to 500,000 urban poor families. generate the momentum toward the completion of the HSRA. Individual reforms in specific ar- The overall reform process, however, which cov- eas are being implemented through the initia- ers a comprehensive agenda such as the HSRA, HSRA UPDATE tives of the Centers for Health Development will take some time to be fully implemented at a (CHD). national scale. Recognizing this, the DOH set up convergence sites where the five reform areas under the HSRA would be initially implemented as a package (see separate article on the HSRA). The convergence sites were chosen on the basis HSRA: Setting the momentum of the following criteria: (a) strong interest and commitments from the local executives and (b) for health reforms local initiatives on health that are reflective of responsive and dynamic health systems. The number of sites was defined by the capacity of trol of Vector-borne Diseases Program, Vaccine Institutional activities for the basic elements of the DOH and PhilHealth to provide enabling re- Preventable Disease Control Program, Women’s the reform include pilot hospital fiscal/manage- sources. Health Program and Child Health Program. In rial autonomy programs for some DOH hospi- this regard, PhilHealth has accredited 65 rural tals, sustained financing and technical leader- The first batch of convergence sites are located health units (RHUs) in convergence sites and set ship for public health, inter-LGU cooperation and in Pangasinan, Nueva Vizcaya, Bulacan, Pasay up Plan 500 areas in Pasay City, Makati, cost-sharing schemes, strengthened regulatory City, Capiz, Negros Oriental, South Cotabato, Valenzuela , San Juan, Capiz , Laguna, Batangas, activities and social health insurance. Misamis Occidental, Palawan, Southern Leyte, South Cotabato and Ilocos Norte. The accredi- Agusan del Sur, Baguio City and Ifugao. Sixty- tation of RHUs, which are the traditional provid- Frameworks for other health systems such as four more convergence sites were identified for ers of public health service, marks PhilHealth’s the small island health system are also currently later implementation. initiative to expand its provider base. It also al- being developed. The Sentrong Sigla Movement, lows RHUs to avail of capitation arrangement for for example, has been successful in promoting Reforms in Convergence Sites outpatient services, especially for maternal and improved and quality health services. This pro- The reforms being implemented in the selected reproductive health. gram, which is a joint effort of the DOH and the convergence sites cover various aspects of the LGUs, aims to promote the availability of quality five key areas identified in the HSRA. For in- Meanwhile, the convergence sites have shown health services in health centers and hospitals stance, the hospitals in the convergence sites significant levels of progress in the area of drug and to make these services accessible to every are now implementing programs to improve management systems reform. All sites have or- Filipino. Its main component is * page 6