The Philippines is lagging behind in several social sector Millennium Development Goals (MDGs), and improving access to and quality of public services for the poor remains a major challenge. The achievement of the MDGs is a shared responsibility of the national and local governments, and an improved coordination of activities is essential. Strengthened transparency, coordination and cooperation, and promotion of social inclusion and empowerment can lead to improved service delivery and outcomes for the poor. Better inter-agency coordination and institutional strengthening are also needed to realize greater synergy between anti-poverty initiatives in rural and urban areas.
xiii.Deepening the reform agendas in key public services sectors
Improving health outcomes.The ratio of health spending to GDP in the Philippines is one of the lowest in the region. Maternal and reproductive health indicators are among the worst in the region, and without concerted action, achievement of this MDG is at risk. The Philippines also has large income-related inequalities in health outcomes; for example, the infant mortality rate among the poorest quintiles is more than double that among the richest. Poor households rely most heavily on public health facilities, where the quality of care needs improvement and access in rural areas remains difficult. The problems in the health sector largely stem from excessive fragmentation in health financing and delivery, and a lack of clarity in stewardship responsibilities. Quick actions are needed to (i) scale up priority health interventions and capital investments in LGU facilities through performance-based approaches, (ii) rapidly expand the sponsored program for indigent households with national government financing using well-defined targeting mechanisms particularly the National Household Targeting System for Poverty Reduction-proxy means test, (iii) expand Philippines Health Insurance Corporation coverage for all informal sector workers and implement an expanded benefits package for all members, (iv) develop and implement a needs-based facilities and health personnel master plan, including using the plan to guide future investments in the health sector by expanding capacity in underserved areas of the country, (v) support the implementation of integrated health information systems for improved monitoring and evaluation and regulation, and (vi) integrate the prevention and control of non-communicable diseases in public health and primary care programs.
Delivering better education. For the poor, education is the single most important means of escaping poverty. The quality of education in the Philippines now trails behind a number of countries with substantially lower per capita income levels, and its poor net enrolment indicators jeopardize its chances of attaining the MDG in education by 2015. Increasing access to education for poor and marginalized groups will require better targeted programs and a greater reliance on partnerships with the private sector, while improving the quality of basic education will depend on a concerted implementation of critical reforms. In both cases, additional resources for basic education will be needed. In 2005, the government introduced a sector-wide program in basic education that seeks to improve the quality of schools in a decentralized environment. This program has yielded promising results and can be further strengthened. The most strategically urgent actions in this context are to (i) allocate the necessary budget to achieve universal primary education by 2015 and to expand secondary education enrolment, particularly for children from poor families, (ii) provide complementary support for the CCT program, (iii) expand private education, (iv) build public schools in areas with no nearby private schools, (v) improve the curriculum, and (vi) revise the system of performance incentives for teachers/principals.
Expanding early childhood interventions. Young children who participate in early childhood development programs that prepare them for school and address their health needs have lower school dropout rates and higher achievements from primary grades to adulthood. Currently, only 20 percent of eligible children are enrolled in pre-schools, which are severely constrained by a lack of facilities. Moreover, the inadequate financial protection against illness of most Filipinos also affects pre-school children. Measures need to be taken quickly to (i) facilitate public-private partnerships in pre-school education, (ii) expand national government-local government cost-sharing arrangements, (iii) provide universal health insurance coverage for children by mandating enrolment/coverage of all children under the age of six and ensuring zero or minimal co-payments for inpatient and outpatient care of these children, and (iv) enlarge the expanded program of immunization by providing government-subsidized vaccines, including the new vaccines of HiB and MMR, for all children.
xiv. Expanding basic service delivery
Expanding drinking water supply and sanitation. Although the Philippines remains on track to meet the MDG for access to improved water sources (94 percent) and improved sanitation (79 percent) in 2015, significant challenges remain in broadening access to continuous piped water supply while meeting national quality norms. After the successful privatization of Metro Manila water and sanitation services in 1997, progress has been slow in implementing a second round of reforms. These need to focus on the financing of water service providers and on streamlining institutional and financial arrangements to allow investments for improvements in services and expansion by local governments, water districts, and the private sector. Short-term actions to further these goals include (i) addressing the institutional fragmentation through consolidation of sectoral responsibilities at the central and local levels (ii) improving cost recovery for the water and sanitation services, and (iii) strengthening the regulatory capacity to ensure that the service providers are providing efficient and quality services.
Improving urban services. The Philippines is among the fastest urbanizing countries in East Asia. By 2009, urban centers accounted for 75 percent of economic output and 67 percent of households reside in urban areas. In Metro Manila and other large cities, the proliferation of slums, congestion, and exposure to man-made and natural risks reinforces a low level equilibrium that will prevent sustained economic growth. At the same time, the economies of agglomeration offer important opportunities to increase incomes, improve access to services and uplift the poor. Better urban development is needed, however, before these opportunities can be exploited. Four sets of actions that could advance the urban agenda in that direction are (i) establishing a forward-looking and ambitious national urban policy framework, (ii) developing and implementing a national slum upgrading program, (iii) revamping national and local systems and tools for urban development planning, and (iv) improving the human resource management frameworks for cities and metropolitan areas.
Addressing bottlenecks in local service delivery. Community-driven development (CDD) approaches are being successfully applied in the Philippines as part of efforts to enhance decentralized service delivery and improve local-level governance and performance, especially in poorer areas. The objective now is to expand the program coverage nationally, but there are challenges such as the possible duplication of approaches, the need to harmonize institutional arrangements, as well as ensuring adequate financing. The key action areas are the development of a roadmap based on an assessment of experience to scale up the CDD program nationwide, and the consolidation and rationalization of the “CDD platform” to achieve synergy and convergence for maximum impact.
