Negative effects: The implementation of the local government in 1992 provided the impetus for local government units to assume greater roles and responsibilities in bringing about socio-economic development for their respective constituents. This is in view of the devolution in the provision of basic services such as health, social welfare, socialized housing, agricultural extension, tourism development, among others, from the national to local governments. The devolution of health services of the Department of Health (DOH) to the local government units was consonance with the national goals.
The national vision signals the initial step for local communities as well as an opportunity for local government units to manage their respective health services in the most effective and efficient manner. Considering these meritorious objectives to attain the national vision, the devolution process also posed problems for the DOH and the local government units, particularly on the inadequate financial resources to undertake vigorous health service delivery programs.
In Cotabato City, the constraint of insufficient budgetary resources was only one of the problems faced by the local government in the provision of effective and efficient ranged from the geographic location of its barangays, economic status of its population, inadequate health manpower and facilities, and pre-LGC (Local Government Code) situation. The location of the barangays and economic status of the population. People of various ethnic origins (T’boili, B’laan, Tagabili, Ubo and Tasaday) coming from as far as Aparri to Tawi-tawi populate the city of Cotabato.
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Majority of its population is composed of the Maguindanaoan tribe and people from the Visayan regions. Cotabato, as a participant in the Integrated Community Health Services Project (ICHSP) was included in the Local Health Accounts pilot phase as one of six provinces where local financial data was collected. About 60 percent of the population is composed of marginal farmers and fisherfolks, seasonal job workers, unskilled labourer and jobless individuals. Those belonging to this group live within the poverty threshold level as they earn an average gross family income of php6,000 and below per month.
The remaining 40 percent accounts for the middle and high-income groups. This implies that majority of the people living in Cotabato are poor and disadvantaged and, therefore, most wanting of health and other basic services from the government. Accessibility and Transportation Constraints. The city’s geographical feature makes delivery of health services a major challenge to the local government. Brooks. Rivulets and creeks of various sizes criss-cross and traverse the city in all directions. Eight barangays can only be reached by water transportation.
Three other barangays are not easily accessible by public transportation. Before it’s special project on health and sanitation, the city has been providing health care at the Main Health Center and eleven satellite stations. However, people in remote areas cannot avail of these services because of transportation difficulties. Inadequate Financial and Budgetary Resources. The Office of Health Services (OHS) had very limited financial resources. Its regular budget was just ssufficient to cover personal services and maintenance and operating expenses.
Inadequate Health Manpower and Facilities. Due to financial constraint the OHS could not put up additional health facilities and employ much needed additional health personnel. Prior to its special project on health and sanitation, the city has only 11 health stations regularly manned by midwives. In terms of manpower, the OHS had only 39 regular personnel. These consisted of 4 doctors, 6 nurses, 11 midwives, 1 dentist, 1 medical technologist, 8 sanitary inspectors and 8 non-technical and administrative personnel.
Such health facilities and manpower have been inadequate to cover the entire household in the city Adverse Pre-implementation Health Station. Until 1993, major health statistics and conditions indicate the need to give more focus in the delivery of basic preventivehealth servies to the constituent of Cotabato City, particularly to the disadvantaged groups living in the remote barangays. Based on the National Statistics Coordination Boards (NSCB) data for 1990, the city’s infant mortality rate was 44. 0 per 1,000 live births while maternal mortality rate was 182. 8 per 100,000 livebirths.
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