Abstract
The Philippines is statistically on track to meet most of the 2015 MDG health targets. But while it may “win the numbers,” the unanswered need is how to broaden the MDG reach to expand access and enhance quality for more Filipinos over a wider geographical area in order to cover more impoverished areas. Conventional wisdom suggests enlarging the scale of both locally based effective pilot health projects and centrally established government health operations. That implies that centrally based, top-down governance and locally driven, bottom-up governance are considered complements rather than substitutes. But pilots seldom spread geographically, and centrally directed health programs have reached bureaucratic exhaustion. The key to unlocking this dilemma is to reinvent the scaling-up process: in the process of reaching out, centrally directed health programs should be “localized” down without loss of coherence, and local initiatives should be scaled up without loss of context. While a coherent national health framework is indispensable, health is at its core contextual—the result of localized interactions and shared experiences. A successful, context-friendly expansion seems to lie in scaling up the conditions that allowed the health initiative to do well, more than the specific elements that constitute it. In the final analysis, a reinvented scaling-up process is always a negotiated arrangement on how to maintain the appropriate balance between central authority and local autonomy. This chapter attempts to draw lessons, using a critical assessment of a number of significant cases of public sector health service delivery systems in the Philippines, regarding the links between local health contexts and a reinvented scaling-up process.
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Notes
- 1.
The reasons are drawn mostly from Samoff et al. (2003); the examples are separately supplied.
References
Andrews M, Shah A (2003) Citizen-centered governance: a new approach to public sector reform. In: Shah A (ed) Bringing civility in governance, vol 3 of handbook on public sector performance reviews. The World Bank, Washington, DC
Bossert T (1998) Decentralization of health systems: decision space, innovation and performance. Soc Sci Med 47:1513–1527
Bossert T, Beauvais JC (2002) Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Policy Plan 17(1):14–31
Cortright J (2001) New growth theory, technology and learning: a practitioner’s guide. Rev Econ Dev Lit Pract 4:1–35
Dede C (2005) Scaling up: evolving innovations beyond ideal settings to challenging contexts of practice. In: Sawyer RK (ed) Cambridge handbook of the learning sciences. Cambridge University Press, Cambridge
Earls A (2011) Process governance: One concept, multiple approaches. Process governance. http://www.ebizq.net/topics/process_governance/features/13223.html?page=1. Accessed 1 Feb 2012
Fabros M-I (2010a) From 2010 and beyond: children should live past age 5. In: Winning the numbers, losing the war: the other MDG report 2010. Social Watch Philippines, Diliman, Quezon City
Fabros M (2010b) Improved maternal health: a move towards universalizing health care. In: Social Watch Philippines (ed) Winning the numbers, losing the war: the other MDG report 2010. Social Watch Philippines, Diliman, Quezon City
Gilson L, Schneider H (2010) Managing scaling up: what are the key issues? Health Policy Plan 25:97–98
Institute on Governance (2011) Governance. http://iog.ca/en/about-us/governance. Accessed 31 Jan 2012
Kirk E, Standing H (2006) Institutional issues in scaling up programmes for meeting the health-related needs of the very poor. Paper presented at the “what works for the poorest: knowledge, policies, practices” international conference, BRAC, Rajendrapur, 3–5 Dec 2006
Lais JS (2010) The Bangsamoro outlook on the millennium development goals. In: Social Watch Philippines (ed) Winning the numbers, losing the war: the other MDG report 2010, 2010th edn. Social Watch Philippines, Diliman, Quezon City
Lee O, Luykx A (2005) Dilemmas in scaling up innovations in science instruction with nonmainstream elementary students. Am Educ Res J 42(3):411–438
Lieberman SS (2002, Apr) Decentralization and health in the Philippines and Indonesia: an interim report. Special Focus, East Asia and Pacific Regional Overview, World Bank, East Asia and Pacific Region
Mediratta K, Fruchter N (2003) From governance to accountability: building relationships that make schools work. New York University Institute for Education and Social Policy (for the Drum Major Institute for Public Policy), New York
Pastrana C (2011) MDGs in the national development plan. Paper presented at Sub-Regional Workshop for LDCs in Achieving MDGs, Incheon, South Korea, 14–16
Samoff JE, Sebatane M, Dembélé S (2003) Scaling up by focusing down: creating space to expand education reform. Paper prepared at the biennial meeting of the Association for the Development of Education in Africa, Arusha, Tanzania, 7–11 Oct 2001
Schneider H, Gilson L, Ogden J, Lush L, Walt G (2006) Health systems and the implementation of disease programmes: case studies from South Africa. Glob Public Health 1:49–64
Senderowitz J (2007) Scaling up youth reproductive health and HIV prevention programs. YouthLens, Sept, No. 22. http://www.fhi360.org/NR/rdonlyres/ehkdgsyalkorpr7ukkwyeu5rdonwdol5ahclbc5dujs4kcieitvqhcvs6lxss745xf4sqnsdgd4mqp/YL22e.pdf. Accessed 14 Feb 2012
Simmons R, Shiffman J (2007) Scaling up health service innovations: a framework for action. In: Simmons R, Fajans P, Ghiron L (eds) Scaling up health service delivery: from pilot innovations to policies and programmes. World Health Organization, Geneva
Thomas G (2011) Choosing governance models. The Data Governance Institute. http://www.datagovernance.com/gbg_governance_models.html. Accessed 1 Feb 2012
United Nations Development Programme (2010) Philippines progress report on the millennium development goals 2010. UNDP, Manila
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Gonzalez, E.T. (2013). The Scaling-Up Process and Health MDGs in the Philippines. In: Singh, A., Gonzalez, E., Thomson, S. (eds) Millennium Development Goals and Community Initiatives in the Asia Pacific. Springer, India. https://doi.org/10.1007/978-81-322-0760-3_3
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