Most Health Facilities Replaced
MOST HEALTH FACILITIES REPLACED The government’s Health Facilities Enhancement Program (HFEP) supported 831 hospitals, 3,395 rural health units (RHUs) and 2,685 barangay health stations from 2010 to 2014, the Philippine Institute for Development Studies said. A policy note titled, More than Infrastructure and Equipment: Process Evaluation of the HFEP, said most, if not all, of the investments under the program are used to replace old buildings and equipment and only a few new ones are being added. As part of the process evaluation, field surveys were conducted between December 2014 and April 2015 in the provinces of Tarlac, Quezon, Catanduanes, Capiz, Surigao del Sur, and Zamboanga del Norte covering 19 infirmaries and hospitals and 18 RHUs and birthing centers. Among the 37 health facilities surveyed, 83 percent have been completed; the rest are ongoing. Among the completed health facilities, 45 percent are fully functional, 24 percent are partially functional and 14 percent are not functional for the purpose that they were built. The challenge is to make the nonfunctional facilities functional, the policy note said. “Despite the major problems identified in HFEP implementation, none of the key informants proposed its termination. However, everyone called for a better HFEP management,” it added. The policy note also said the HFEP strategy and implementation are flawed and do not embody good practices in medical infrastructure. “When it began, the program had no national or regional health infrastructure plan, which would have informed key RHUs, infirmaries, and hospitals about priority upgrading or construction,” it said. “With such a plan, HFEP would have also embodied the notion of a service delivery network or referral services, a concept discussed in health policy circles but has not materialized into an actual infrastructure and investment plan. Moreover, individual health facilities also lack long-term plans,” it added. The report also said health facilities under HFEP were funded and contracted individually, an approach deemed unwieldy, time consuming, management intensive, and uneconomical. The policy note said instead of individual contracting, the Department of Health should have employed a “commissioned contracting” approach, where a group of projects is pooled together and contracted out as a “lot” or “tranche” to allow contractors to economize on planning and design, bulk procurement of inputs, construction, monitoring, and equipping. The policy note said the non-use of this approach meant that individual infrastructures were built one by one, with inputs purchased locally in retail suppliers, instead of procured wholesale under bulk procurement arrangements. “The commissioned contracting approach is ideal to combine construction and equipping contracts on a turn-key basis. As it was, construction was separated from equipping, resulting in sequencing and coordination problems (too early, too late, or repetitive delivery of equipment),” the policy note said. The report also said that small, incremental multi-year funding often led not only to fragmented buildings and service structures but also to highly disruptive health services.