NU Paper 1 by BV

Dear Prof Jorge,

Sorry, I won’t be able to come to class tomorrow.
It’s Family Day at my son’s school, and he asked me to be there.
Below is my first NU paper.
Anyway, I’ll keep tabs on materials and assignments I will miss tomorrow.
See you next year, Prof, and enjoy the holidays!


Bong Villamor



NU Paper: JUAN A. VILLAMOR, MBAH Section 10B

Convincing Local Government Units to Improve Health Leadership and Governance

(New Attitudes, New Paradigms)



The devolution of health programs and services to LGUs as mandated by the Local Government Code of 1991 did little to improve health conditions in many rural areas of the country. On the contrary, the lack of resources, competing priorities of LGU officials, and quite simply, the dearth of leadership and governance on the part of local leaders have resulted to deteriorating health indicators, especially among the poor, in the countryside.


Among many serious reasons why health has taken a backseat is the lack of appreciation among local leaders of health’s immediate and strategic value. Among politicians, what counts most is what will bring in votes come election time, and these priorities take the form of infrastructure projects like basketball courts or farm-to-market roads, where billboards with their names can be erected alongside to claim credit for the progress that these concrete improvements in the community represent. On the other hand, who wants to bother with increasing the budget for health services (“health is a bottomless pit”), hiring more health workers (“they will eventually vote for my opponents”), or building better-equipped health facilities particularly in far-flung areas (“there is simply not enough funds”)? Oftentimes, this mindset is framed by the next election in mind, constrained by the three-year runway within which local officials should produce the most tangible manifestations of their terms of office.


When leaders are confronted with the question of leaving a legacy, however, the more circumspect begin to see a new reality: that of mothers and children dying under their watch. Given this scenario, or more forcefully, confronted with actual numbers, the horrible fact that mothers die of severe bleeding and other complications arising from difficult deliveries, especially if unsupervised by skilled health professionals, often shock local chief executives out of their comfort zones. The jolt often separates politicians from true leaders: the former often look away or defend their negligence, while the former inevitably asks, “what do I need to do?”

Those who are interested in what needs to be done are forced into a new way of thinking about and doing public health. While their “usual” health programs took the form of medicines donated from the mayor’s office, or cash donations to help pay for hospital bills, local chief executives are now asked to look at their health system as a whole, preferably under the lens of the World Health Organization’s six building blocks of health systems development. They are thus introduced to systems thinking, multi-stakeholder processes, and creativity and innovation to try and address enduring challenges in their local health systems, specifically in the areas of maternal and child care.


It is indeed surprising to find out what local leaders do not know about their public health system. A significant number do not even know that they have municipal health officers, and that their health budgets pay for so little, or that they have a small army of midwives and barangay health workers waiting to be organized and directed into meaningful action. To begin with, many are unaware of numbers that matter, such as their maternal mortality ratios, infant mortality rates, prevalence of malnutrition, TB and other infectious diseases, and many other health indicators among their constituents.


At the same time, it is heartwarming to realize how many of them can be mobilized into action – with heightened commitment and a renewed passion – given the slightest incentive, and that is to justify their purpose as public servants. Indeed, we can never underestimate the mandate of local chief executives, their influence among stakeholders, and the resources they can mobilize IF they put their hearts and minds to addressing serious yet surmountable gaps in their local health systems. In as little as two years, immediate and critical improvements can be seen in key areas of public health, with the promise of more strategic health gains made more realistic by sweeping enhancements in primary and basic health care programs and services.[1] <#_ftn1> At the end of the day, leadership is what matters most, and changing the paradigm and mindsets of local leaders indeed goes a long way in promoting the right of our people, especially the poor, for responsive, equitable, affordable and quality healthcare programs and services. 4

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[1] <#_ftnref> Lifted from the ZFF website: http://www.zuelligfoundation.org/

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