Are communities being considered in health care decentralization: The case of the Philippines

The Philippines provides an interesting case example of the impacts of health care decentralization to community levels. In the Philippines health care has been decentralized to community levels. The goal of decentralization in the Philippines was to delegate powers, functions and responsibilities to the local authorities in light of better service delivery, allowing communities and municipalities to more or less govern themselves. However, in qualitative research conducted over 22 months in rural communities of the Philippines, inequitable distribution of knowledge and material resources in communities that were already receiving unequal government funding resulted in major challenges in local health care from decentralization processes. In the communities observed we identified that health care decentralization did not foster greater physical and financial access to local health care. Furthermore, decentralization magnified existing inequities between communities and did not necessarily result in more horizontal control of health care due to the hierarchies of elites at local levels. But more importantly, we found that decentralization was neither desired nor sought by the communities examined; problematizing the community participation discourse that assumes communities will inherently welcome the responsibilities of decentralization. We conclude that in order for health care decentralization to community levels to be more feasible, proper knowledge and material resources need to be distributed equitably amongst communities to better equip successful decentralization in those communities that, in fact, do seek the responsibilities of health care decentralization.