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As the rest of the Philippines suffered from the sweltering summer heat, Baguio remained relatively cool at 20 degrees Celsius. That day early March, 12 leaders of the Samahan ng mga Nagkakaisang Pamilyang Pantawid (SNPP) were huddled in a modest-sized hall, listening intently as Faith Santos and Victoria Maglanque of Government Watch (G-Watch) presented the situation of health governance in the Philippines.
Citing the 2023 national budget, the pair pointed out that considerable sums had allocated to improve the country’s reproductive, maternal, newborn, child and adolescent health (RMNCAH). The government, for example, has Php7.4 billion (US$148 million) for its national immunization program. At the same time, Php5.6 billion (US$112 million) had been allotted to address stunting and wasting of school-aged children.
SNPP’s President Angela Tubello sat quietly on her seat, occasionally nodding her head as Santos and Maglanque spoke. When the speakers ended their presentation, Tubello raised her hand and exclaimed, “Ganyan pala kalaki ‘yung budget sa health! Hindi po naming alam ‘yan.” (So that’s how big the health budget is! We didn’t know that.)
This prompted Jai Catacio, also of SNPP, to stand up and address her fellow beneficiaries.
“Kasama sa conditionalities ng programa yung regular nating pagdalaw sa mga barangay health units,” she said. “Kung ganyan kalaki yung nakalaan na budget, dapat lang alam natin kung tama ba o dekalidad yung mga serbisyong nakukuha natin.” (Part of the conditionalities of the program include regular visits to village or barangay health units. If that’s how big the budget is, then we should know if we are receiving proper and quality services.)
Formed in November 2016, the Samahan ng mga Nagkakaisang Pamilyang Pantawid is composed of beneficiaries of the Pantawid Pamilyang Pilipino Program (4Ps), known internationally as the conditional cash transfer scheme (CCT).
In the learning exchange that they had with G-Watch, SNPP pointed out that beneficiaries had to avail the health services if they are to remain in the program. Though they see the importance of this measure, SNPP has experienced first-hand understaffed barangay health units, as well as cases of preferential care, wherein those with political ties are prioritized by health workers. Unfortunately, the evidence that they have are still anecdotal, and they have yet to develop a strategy to address these concerns.
But after the learning exchange, SNPP leaders expressed excitement over the prospect of monitoring the different health services under 4Ps. This will be the first in the world once this pushes through—of CCT beneficiaries holding government to account for the services that they are supposed to receive as part of the program’s conditionalities. And with 153,000 members across the country, SNPP can deploy monitors wherever they are needed.
G-Watch’s Health Initiative
The planned monitoring effort is part of G-Watch’s new health initiative that began early this year. Dubbed as Promoting Rights Organizing for Health (PRO-Health), the project will monitor different health programs and services that are being implemented by the national and local governments.
According to Joy Aceron, convenor-director of G-Watch, monitoring will enable the project to identity strategic issues and gaps in health governance. The data that will be collected will then be used to craft a health reform agenda to improve the delivery of services and other related citizen entitlements. She further added that particular attention will focus on reproductive, maternal, newborn, child and adolescent health (RMNCAH).
Apart from SNPP, five G-Watch local sites have already been tapped to implement the project. These are Dumaguete, Agusan del Sur, Puerto Princesa, Lanao del Sur and Cebu. There are also engagement with the Pasig City government and the Student Council Alliance of the Philippines (SCAP).
Track Record
G-Watch is no stranger to health monitoring.
From 2010 to 2012, for example, a joint-monitoring effort was undertaken in Dumaguete called Subay Kahimsog. Derived from the Visayan words “subay” (to follow or trace) and “kahimsog” (health), the initiative monitored the delivery of essential drugs and medicines from the city government.
According to standard procedure, the medicines are bought in bulk by the City Health Office though public bidding. These are then delivered to the different barangay health stations, which are all manned by a midwife and a fulltime nurse. The medicines are provided for free to all patients, though residents of the barangay where the BHS is located are given priority.
Prior to Subay Kahimsog, Dumaguete’s health service had a low satisfaction rating. To address this challenge, G-Watch undertook a monitoring initiative—training several volunteers to check drug procurement and storage. The city government was then informed of the monitoring results, prompting the former to systematize the delivery of medicines to barangay health stations.
Despite its experience, this will be the first time that G-Watch Dumaguete will undertake monitoring to craft a comprehensive health agenda.
Reenergizing the Base
For Aceron, PRO-Health’s ultimate purpose is to “reactivate, broaden and reinventing the social base for reform and good governance.” It is for this reason why the initiative has two interrelated goals. First, it is an opportunity for G-Watch, its sites and its partners, not only to gather information regarding the existing health policies and programs, but to also address the problems and gaps that they might uncover in the course of the monitoring. But more importantly, PRO-Health can enable the sites to activate their untapped volunteers.
In a series of discussions with local G-Watch leaders, it was established that the network had successfully recruited a lot of new G-Watchers, but they remain inactive or untapped since they have no opportunity to take part in a larger monitoring effort. PRO-Health provides that opportunity.
G-Watch Sibagat, for example, successfully undertook a municipal-wide monitoring of water services from 2012 to 2014. But since then, it has yet to undertake a similar effort at such a level of scale.
G-Watch Lanao del Sur, on the other hand, already has a large base of volunteer-monitors, mostly composed of Bangsamoro youth. Isni Binumbaran, the G-Watch local coordinator in the province, shared that the volunteers are already excited to join PRO-Health. Last year, for example, when G-Watch-Lanao posted an invite to a briefing-orientation on G-Watch, the 70 slots were immediately filled in half a day. Many of these volunteers have yet to be tapped for any monitoring effort, but they will soon be mobilized for PRO-Health.
In Dumaguete, all the chairs of the different barangay health committees have already expressed interest in taking part in G-Watch’s health monitoring. In their recent Ako, Ikaw Tayo May Pnanagutan (AIM-P) activity, Jerome dela Cruz of G-Watch Dumaguete pledged to mobilize, involve and capacitate these barangay committee heads for PRO-Health.
And in Puerto Princesa, the different community-based sustainable tourism sites (CBSTs) have also already conveyed their willingness to take part in G-Watch’s new health initiative. These CBSTs have benefitted from previous G-Watch monitoring, resulting in the passage of the CBST Ordinance.
Mobilizing the Youth
G-Watch has also began partnering with youth organizations, believing that they are important stakeholders in the RMNCAH agenda. As an initial activity, a roundtable discussion was held on March 25 with leaders of Student Council Alliance of the Philippines (SCAP) and Youth for Mental Health Coalition (Y4MH). In the course of the conversation, it became apparent that today’s youth activists had a deep interest in mental health.
However, G-Watch was surprised to learn that none of the participants were aware that the government has allocated Php2.1 billion (US$42 million) for mental health services in its 2023 budget. This was a significant increase from last year’s budget of Php568 million (US$11.4 million).
Through their partnership with G-Watch, young mental health advocates can monitor how the allocation is being spent. Specifically, youth leaders can determine if mental health policies are being carried out and if citizens are able to access the services stipulated in the Mental Health Law. Doing so will train youth leaders to engage in strategic accountability which, according to American scholar Jonathan Fox, is characterized by the coordination of “citizen voice initiatives with governmental reforms that bolster public sector responsiveness.” Synergizing monitoring with their advocacy efforts, SCAP can be more effective in making government improve mental health services in the country.
Filling the Gap
The strong interest in PRO-Health indicates that the initiative is already filling critical gaps in health governance, even though the groundwork has just begun.
In a meeting, for instance, with the Department of Health (DOH) on 20 April, officials saw the importance of verifying the actual conditions on the ground and the need to monitor the delivery of health services and engagement with local governments. Expressing interest PRO-Health, DOH requested to be briefed once the project is done with the monitoring.
In a roundtable discussion held in March, it was revealed that civil society organizations (CSOs) in Pasig were not aware of the government’s health programs. It was only through G-Watch’s orientation that they came to know of the services available to them. They pointed out a huge gap in the awareness level of citizens on health services and governance, which they believe a joint CSO-LGU initiative on health can address.
Though PRO-Health has yet to be formally launched, it is already making an impact on the ground and creating interests among G-Watch bases and partners. The challenge now is sustaining that momentum.
PRO-Health will be launched on April 28 in Pasig as it kicks off its briefing-orientation seminars for its volunteer-monitors.
Photos
1 - Group picture with leaders of Samahan ng Nagkakaisang Pamilyang Pantawid (SNPP) who attended the learning exchange with G-Watch in Baguio City last March 10, where the prospects of health monitoring by 4Ps beneficiaries, a potential groundbreaking initiative, was discussed
2 - Roundtable discussion with civil society leaders of Pasig City on the state of public health last March 16 at an office that used to be inaccessible to ordinary citizens but is now a common meeting place of CSOs in Pasig City
3 - Group picture after the Department of Health (DOH) officials handling the programs and services on reproductive, maternal, neonatal, children and adolescent health briefed G-Watch Center last May 20
4 - Student Council of the Philippines (SCAP) from Bulacan, Isabela and NCR mapping stakeholders of social accountability and rights organizing initiatives on mental health last March 25 in Quezon City
5 - G-Watch Lanao core group planning while on fast during Ramadhan last March 30 in Cagayan de Oro
6 - Group picture after a substantive discussion last March 21 in Butuan City on the situation of health programs and services in Agusan del Sur and how IWAG can expand its accountability work