CONVERGENCE
STRATEGY
When the Health Sector Reform Agenda (HSRA)
was planned in early 1999, the DOH aimed to achieve nationwide
implementation of the health reform program by 2004.
As designed, the program would require a massive public investment
of around 111 B pesos. It
would also require sustained political commitment and support in order to
neutralize the many controversial aspects of the program. However, it was
only in early 2000 that the DOH was able to decide on an implementation
strategy and develop an overall implementation plan.
A unique implementation strategy had to be adopted because the
major assumptions that formed the bases for planning HSRA in 1999 were no
longer valid in 2000. For
example, it was no longer realistic to expect that the huge capital outlay
required to implement the program was forthcoming because of the
increasing budget deficit faced by government, the dwindling external
donor support, and the reluctance of government to resort to deficit
spending. Furthermore, the
political disturbance that began in late 1999 and which eventually led to
the downfall of the Estrada administration (which by the way, authored and
championed the reform program as part of its pro-poor strategy), made it
unlikely that the sustained political commitment and support needed for
the long-term implementation of the program would continue.
Because of these, the DOH decided that instead of aiming for a
nationwide implementation of HSRA by 2004, it would design the
implementation of the reform program in such a way as to achieve by 2004 a
momentum for health reform that will be difficult to reverse.
The strategy that was adopted is to implement the reform package in
selected strategic LGU sites, and the intention is to generate substantial
improvements in health services provision and financing which the
residents in these strategically located LGUs can readily appreciate.
It is being theorized that if the residents and political leaders
in these sites are happy and satisfied with these improvements, they will
form a strong support base that will make HSRA implementation in that
locality irreversible. Residents
of neighboring provinces and cities, after seeing the health service
improvements and financing benefits enjoyed by their neighbors, will
pressure their own local governments to grant them the same package of
benefits. Thus, through the
so-called rippling effect, it can be reasonably expected that the adoption
of the health reforms will gradually spread throughout the country.
Sixty four LGUs, or two provinces and two
cities in each of the 16 administrative regions were selected and targeted
by the DOH for HSRA implementation by the year 2004.
These LGUs are called convergence sites not only because all the
five major health reform components are being implemented in an integrated
fashion, but also because all the major stakeholders such as the DOH,
PhilHealth, the local government, civil society groups, and the
beneficiaries themselves come together and pool their efforts and
resources to make the health reforms succeed.
It
was originally planned that HSRTAP would directly assist HSRA
implementation in 16 of the 64 sites, but the number was later reduced to
eight after recognizing the enormity of the effort and resources needed to
launch a convergence site. HSRTAP developed the methodology, processes,
procedures, and tools for implementing the convergence strategy, which are
being applied in the eight LGU sites that it is directly assisting. These
are constantly refined as experiential knowledge accumulates, and are
being shared with the central and regional DOH offices, which will be
responsible for attaining the target of establishing 64 HSRA convergence
sites by 2004.
