The lack or ineffective social marketing strategy (supply side barrier) and lack of information on benefits and availment process (demand side barrier) are a few of the identified restrictions to the use of health services in complex decentralised health systems such as the Philippines.
The Department of Health (DOH) is the lead agency responsible for the regulation and supervision of the country’s health system. It manages national policies, develops national plans and establishes health technical standards and guidelines to regulate the country’s health sector.
The Local Government Code of 1991 devolved the provision of health services, particularly at the primary and secondary levels, through the local government units (LGUs). Hence, health service in the Philippines is managed through provincial, municipal and barangay local government offices. Provincial and district hospitals are the responsibility of provincial governments while the Rural Health Units (RHUs) and Barangay Health Stations (BHS) are managed by municipal government units.
Complex internal developmental differences among geopolitical regions hamper provisions of health two decades after the implementation of the local government code. Less developed regions usually suffers most of the negative effects of institutional fragmentation. These least developed regions also is the least likely to recover or lags behind because it lack or poorly manages resources and is usually inefficient in allocating health resources.
Cetrángolo et al identified supply and demand side barriers that restrict the use of health provisions in the Philippines. The lack or ineffective social marketing strategy and lack of information on benefits availment process are included in these restrictions. Grundy et al echoed the same observations in a local study.
This author has practiced for more than ten years in areas with health units ran by local governments and in an urban center with health institutions ran by DOH. While there are LGUs with efficient and effective local health councils who clearly benefitted from the devolution of health, other regions aren’t as fortunate. Case in point, the WHO Safe Surgical Checklist.
The WHO Safe Surgical Checklist is the single most cost effective way of minimising post operative complications reducing death and morbidity by at least 36% on the average. No other cheap, readily and sustainably implementable guideline (except maybe the handwashing guide) had so much impact on health as this checklist. It has been incorporated into standard DOH standards operating room “toolset”, requiring every hospitals with operating rooms to incorporate such checklist in their standard operating room manuals. Yet many hospitals who have operating rooms rarely take advantage of this readily available and cheap guideline. Why is that?
Cognisant of these complex problems, efforts has been made in the past two decades to either strengthen or amend the local government code that devolved health provisions to LGUs. Bills calling for returning provisions of health back to the national lead agency (DOH) are now pending in the House of Representatives. It is not the purpose of this article to weigh the complex pros and cons of such amendments. Until such amendments or repeals are enacted into law, we have to deal with effectively delivering health down to grassroots level in the context of a decentralised health system.
An effective social media campaign may narrow regional differences in the provisions of health and address the two barriers I mentioned at the start of this article.
Join #HealthXPh this Saturday August 26, 2017 9pm Manila time as we discuss how a social media campaign may improve provisions of health in the context of a devolved health and regional developmental differences.
- T1. Is there a role for social media as social marketing strategy for effective provisions of health in a decentralised health system?
- T2. If you are the chief social media strategist what will your primary strategy be?Targeted? Regional? National?
- T3. How would you measure the effectiveness of such healthcare social media strategy? Indicators?
Please give your final thoughts on ways by which social media could be a part (or not) of the social marketing strategy for health units or agencies in a decentralised health system like the Philippines.
- Cetrángolo,O., Mesa-Lago,C., Lazaro,G., Carisma,S. Health Care in the Philippines: Challenges and Ways Forward. 2013
- Grundy J1, Healy V, Gorgolon L, Sandig E. Overview of devolution of health services in the Philippines. Rural Remote Health. 2003 Jul-Sep;3(2):220. Epub 2003 Jul 1.
- Haynes, A.B., Weiser, T.G., Berry, W.R., Lipsitz, S.R., Breizat, A.H.S., Dellinger, E.P., Herbosa, T., Joseph, S., Kibatala, P.L., Lapitan, M.C.M., Merry, A.F.: A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 360(5), 491–499 (2009)
- Atienza, Maria Ela L. 2004. “The Politics of Health Devolution in the Philippines: Experiences of Municipalities in a Devolved Set-up.” Philippine Political Science Journal 25 (48): 25–54.10.1080/01154451.2004.9754256