Chapter 1 The Provincial Health Situation introduction




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Internal Management

Public Finance ManagementIts goal is that all LGUs to have an effective and efficient internal management through the enhancement of revenue generating capacities of health facilities and by increasing budgetary allocations for RHUs and complementation.

Procurement ManagementIts goal is to have a systematic procurement and strengthen supply management in all health facilities.

Internal AuditIts goal is the maximum utilization of resources through the operationalization of Supply of Inventory System and through regular audit.

Chapter 4
Critical Investment
The formulation of the log frame aims to guide in a more focused manner the interventions in the province so that the desired development directions chartered in the PIPH shall be attained. Priority programs and projects contained therein are deemed urgently necessary for implementation for the next five years.

Most LGUs are dependent on their Internal Revenue Allocation for the budget and operation of their health sector. The government has the responsibility to deliver an efficient and qualitative health service in every locality. Below is a summary of the health budget in the Province of Cagayan from CY 2003-2007.




Summary of Health Budget CY 2003-2007
The expenditure programming for health in the Province of Cagayan covers the cost of goods and services for the provincial health and nutrition program including medical, dental and health services. It covers expenditures for hospitals, medical and dental clinics, health centers, sanitaria and similar institutions which provide preventive health services/treatment and other services. This also includes for the public health personnel of the Provincial Health Office and all hospitals devolved to the Province and special or unit project of the department level operating in the province.


Table 22: Expenditure Program for Health Services, CY 2003 – 2007

From CY 2003 to 2007, the Provincial Government of Cagayan’s budget have continuously increased from P773,763,281.98 in CY 2003 to P910,282,323.42 in CY 2007. This could be attributed to the annual increase in the share of the Internal Revenue Allotment and increasing local revenue resources/collection. With the increasing trend the budget for health services increases on a yearly basis.



Figure: 36 Provincial Government Budget, CY 2003 - 2007

Of the five year period, from CY 2003 to CY 2007, there is an average budget amounting to P836, 148,844.31. In addition, the average allocations for health services are at P166, 738,256.62 or at 19.94% of the total budget. With this allocations and considering the wide range expenditure concerns of the province, health services is a priority program of the Provincial Government of Cagayan.



Figure 37: Health Services Appropriations Figure 38: Health Services Expenditures


Comparatively, the above pie chart shows the budget allocations and utilization for health services.
On the average, 37.22% of the Personal Services appropriations, 7.51% of the Maintenance and Other Operating Expenses appropriations, and 2.76% of the Capital Outlay appropriations was allocated for health services.

There is an average utilization of 92.65% for health services. On the other hand, the matrix shows a fluctuating trend of expenditure from 2003 to 2007. It is also noted that there is an inefficient utilization and mobilization of funds for health sector. For instance, although 96.02% on the average was spent for Personal Services, only 80.53% and 54.40% on the average was spent for Maintenance and Other Operating Expenses and Capital Outlay, respectively.



Internal Management
Human Resource System – the Province of Cagayan is not being spared of the effects of the crisis on the current trend of health workers opting to seek for greener pasture. Nurses and doctors and other heath related positions in the different districts hospitals and the Provincial Health Office became scarce. Many of them resigned and chose to go abroad. With this dilemma, it is proposed in this plan that the government has to implement measures on how to adopt or operationalize the National Health Human Resource Plan in order to attract our health workers to remain in the province.
A lump sum amount for capability building of health workers should be allocated for the training and retraining of personnel to enhance their performance and capabilities.
Procurement System – all municipalities including the province has localized and has institutionalized Republic Act No. 9184. They see to it that only qualified bidders for drugs and medicines and hospital equipment participates in the bidding process. Fly by night bidders are not entertained to ensure that procurement of goods for health use is ensured.
Internal Audit System –the Accountant’s Office in the province and in the municipalities does the internal auditing of financial transactions in accordance with the New Government Accounting system. This activity is being done in order to see to it that the money spent for PPAs is properly charged from its correct source for the said purpose and to ensure that there is no juggling of funds which will take place.
Foreign Funding Institution and other external sources – financial as well as technical assistance shall be sought through foreign funding institutions and other external sources in order to achieve the goals of this plan. The assistance of these institutions shall tapped to complement local resources particularly for the rehabilitation of hospitals and the upgrading of its facilities.
Bridging the financing gap
The plan strongly emphasizes the need to formulate and adopt policies in order to enhance and strengthen its financial aspect through the following:


  1. Equitable sharing of resources among LGUs;

  2. Improved livelihood activities at the grass root level; and

  3. Promotion of cooperation and interdependence among LGUs

During the series of workshop conducted in preparation of the PIPH situational analysis was made use in order to determine the current status of all programs, projects and activities in the health sector. As a result strength and weaknesses were identified. Gaps were zeroed in as the take off point in the planning process. Whereas the preparation of the summary for the investment portion of this plan, this was done by the different health coordinators in the province, costing together with the type of expenditures were determined by them too. (Please see Table of Assumption in Attachments)

The PIPH has an aggregate amount of 1,934,542,480.18 broken down into capital outlay, procurement of goods and services, and other administrative costs including payment and salaries of proposed positions to be filled up.

Figure 39: Summary of Project Cost by Type of Expenditure

The figure above shows the summary of project cost by type of expenditure.

Consistent with the ultimate objective of providing quality service delivery coupled with the intent of qualifying with the DOH standard for licensing and accreditation, Procurement / provision of Medical supplies and equipment has the highest allocation followed by Health Facility Development with P932,701,242.53 and P152,032,248.00 respectively.
Conduct of IEC/advocacy totaled to P167, 185,037.00 while Training and other capability building activities has an aggregate amount of P157, 740,586.00
Human Resource Requirement and Other Operating Cost account is estimated at P193, 005, 582.65. Included under this are the salaries and wages of proposed items for creation and hiring and the full implementation of the Magna Carta for health workers. Also, monitoring and evaluation, program assessment reviews, procurement of vehicle and other non-medical equipment including counterparts for the PHIC premium were made part of this account.

Table 23: Total Investments by F1 Component

Component

Estimated Cost

% Share

Service Delivery

P 1,514,695,590.53

78.30%

Financing

P 170,277,777.00

8.80%

Health Regulation

P 26,576,350.00

1.37%

Governance

P 222,992,762.65

11.53%

Total

P 1,934,542,480.18

100%

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