Tutor presents her side re CCH 

Third district Rep. Kristine Alexie Tutor explains her side as she pushes for the re-nationalization of the Candijay Community Hospital (CCH).

Yesterday, Dec. 12, 2020, Tutor provided The Bohol Tribune a copy of her statement detailing her position on reverting the CCH to the Department of Health (DOH)..

The Bohol Tribune is publishing in toto her statement.

“As author of House Bill (HB) No. 4723 which seeks to convert the Candijay Community Hospital (CCH) in the 3rd District of Bohol into a district hospital, increasing its bed capacity to 50 beds from the current 10 beds, I appeared before the Sangguniang Panlalawigan upon their invitation to update them on HB No. 4723,” the solon opened her statement.

She continued, “I explained to the Sangguniang Panlalawigan (SP) that the upgrade of the Candijay Community Hospital will mean better health services for Boholanos in the town of Candijay and neighboring towns. “

“The (Department of Health) DOH Regional Office and the hospital chief of the Candijay Community Hospital both support the passage of HB No. 4723 into law,” Tutor revealed.

Moreover, the congresswoman bared, “The House Committee on Health approved HB No. 4723 last November 17, 2020. It is my hope the bill will advance to second reading and then third and final reading in the first months of 2021.”

She emphasized: “As regards the matter of the reverting local hospitals to the Department of Health, I believe Congress will continue to be guided by precedents. There are several recent laws which can serve and have been [used] as templates for this 18th Congress as regards all the pending bills on conversion or upgrading of local hospitals. I cite five recent examples:

1. Republic Act 11473 which upgraded the Talisay District Hospital into the Cebu South Medical Center. This was approved into law on June 19, 2020. 

2. Republic Act 11107 which upgraded the Bataan Provincial Hospital to the Level III Bataan General Hospital and Medical Center (approved into law on October 30, 2018)

3. Republic Act 11324 upgrading the Governor Celestino Gallares Memorial Hospital in Tagbilaran City, Bohol.

4. Bacoor District Hospital owned by the provincial government of Cavite and now a DOH Hospital, now known as Southern Tagalog Regional Hospital by virtue of RA 11233 signed by (President Rodrigo Roa Duterte) PRRD dated Feb 20, 2019. It got an upgrade from being 10-bed capacity hospital to 50 bed capacity and was placed under DOH with an annual budget from the national government.

5. Siargao District Hospital owned by the Provincial Government of Surigao del Norte was  recently  converted into a level II national hospital by virtue of RA 11500 signed by President Duterte on November 13, 2020. The hospital was named Siargao Island Medical Center with an increase bed capacity to 100 beds from 50 beds and placed under the supervision of DOH, also with an annual budget from the national government.”

The solon continued, “I am not aware of any legal challenges in court against these laws on the basis of the devolution of hospitals and health services to the local governments under the Local Government Code of 1991. I hope there will be none.”

In the same statement, Tutor said, “Common in these laws is that there is respect accorded the DOH in terms of adherence to DOH standards on medical centers devoted to a wider service area and in accordance with the status upgrade.  I agree that DOH standards on regional medical centers, tertiary level hospitals and specialty hospitals must be part of all pending hospital upgrading and conversion bills.”

“Here are some of the reasons these pieces of legislation were successfully enacted into law:

1. Devolution of health services has resulted in a highly fragmented health system as the DOH has no control over the LGUs who are the implementers of the health program;

2. The expertise for implementing health programs, construction, operation and management of health facilities still remain with the national government agencies.

3. The reversion unburdens the (local government unit) LGU of additional resources which it may use for the implementation of its programs.

4. Improved access to medical and financial assistance for health services. As RA 11463, The Malasakit Centers Act mandates the establishment of a malasakit center in all DOH Hospitals.

5. The distribution of (Internal Revenue Allotment) IRA makes it difficult for most LGUs to improve health services due to limited funding, thus many LGUs have been unable to afford the salaries of health care workers.

6. Depending on the needs of each locality, local chief executives may prioritize other programs such as education or social work, leaving limited funding for other programs. “

Furthermore, the solon says, “However, to prevent the opening of the flood gates, so to speak, on a wave of upgrading and conversion bills, it is but proper that Congress also upgrade the authority and powers of the Department of Health (DOH) on maintaining and enforcing hospital standards so that the Filipino people will not be shortchanged as regards the quality of hospital services.”

“The House already did its work on this matter by approving last January 2020 on third and final reading House Bill 5673 (AN ACT AUTHORIZING THE DEPARTMENT OF HEALTH (DOH) TO SET AND APPROVE THE BED CAPACITY AND SERVICE CAPABILITY OF ALL DOH-RETAINED HOSPITALS). The Senate has a counterpart bill,” she said.

Likewise, the third district solon in the same statement said, “In the same way that Congress respects the authority of the Commission on Higher Education to set and enforce standards on state universities and colleges, so too must we respect the authority of the DOH to set and enforce standards on government hospitals, especially so for hospitals not devolved to local governments and no longer under the local governments.”

BACKGROUND

In a report, Tutor was quoted to have said she that se will be able to “guarantee” a budget of P 100 million for the CCH once it is reverted to DOH control by way of re-nationalization.

Hours after the report was released, Gov. Arthur Yap released his own statement about the CCH. He said he will support the re-nationalization of the CCH only if there is a guarantee that P100 million will be given to the said hospital, as the DOH will be willing to absorb the employees of the hospital, as the national health agency will take the cudgels of operating and maintaining the CCH. (Editor’s Note: The statement of the governor can be found in page 6 of this paper.)

On Dec. 9, 2020, Tutor attended the committee hearing of the SP Committee on Health discussing the plan to re-nationalize the CCH.

Tutor gave a statement during her appearance in the said committee hearing, which is published en toto on page 6 of this paper.

Yap supports CCH revert to DOH if. . .

(Editor’s Note: The following article unfurls the stand of the governor on the re-nationalization of the Candijay Community Hospital – CCH, as written by Executive Assistant III and information cluster chief Kevin Damalerio. This article is published here in its entirety with minor edits and this is a material exclusively provided to The Bohol Tribune.)

Gov. Art Yap has expressed his support in upgrading Candijay Community Hospital. In an official statement posted at the Governor’s official Facebook page on Thursday, December 10, 2020, Gov. Yap welcomed the Third District Representative’s guarantee to be able to funnel 100 Million Pesos from the National Government to fund the day to day administrative and operational expenses of Candijay Community Hospital (CCH).

Prior to the release of the statement of the Governor, the Third District Solon appeared before the Sangguniang Panlalawigan Committee on Health to give an update on her bill filed at the lower house which aims to upgrade the Candijay Community Hospital from the current 10-bed capacity to 50-bed capacity and to let DOH run the said health care facility. Cong. Tutor said on the record, “While we applaud what the provincial government can do, with the 35 million, it is not enough. Without being boastful, for the third district, I can request for 100 Million. I can guarantee that.”

MORE THAN A VERBAL GUARANTEE

Gov. Yap’s support to re-nationalize the Candijay Community Hospital comes with a condition. The Governor pointed out that while a verbal guarantee seems to be pleasing to one’s ears, he wanted to be assured. Assurance for him would mean a written guarantee and certification from Sec. Francisco Duque III of the Department of Health that would support to the verbal guarantee of Cong. Tutor. 

As the Local Chief Executive of the Bohol, he wants to ensure that re-nationalization would mean, better health care facility for all Boholanos and not just a mere action for the sake of one’s good and image. 

As regards re-nationalization, Gov. Yap requests that the certification from the DOH would mention the following:

1.) Willingness to support the re-nationalization of the Candijay Community Hospital; 

2.) Commitment to upgrade and modernize the Candijay Community Hospital in the amount of 100 Million Pesos as mentioned by the Cong. Tutor; 

3.) Absorb all employees of the hospital; and, 

4.) Fund the day to day administrative and operational needs of the hospital and its personnel.

When these conditions are met, the Governor said, “I will immediately and favorably endorse her [Rep. Tutor] request to the Sangguniang Panlalawigan to support the re-nationalization of the Candijay Community Hospital. If DOH is willing to re-nationalize our hospitals, we can re-allocate Provincial Government funds to other critical medical expenditures.”

DEVOLUTION OF HOSPITALS

Devolution is a form of “administrative decentralization” wherein functions such as planning, decision-making, financing, and delivery of most health services are transferred from the central government to local government units (LGUs).

In 1991, the Philippine Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. 

The passage of RA 7160 also known as the Local Government Code of the Philippines, transferred the control and responsibility of delivering basic services to the hands of local government units (LGU). It aimed to enhance provision of services in the grassroots level as well as improve the efficiency in resource allocation. The Local Government Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. 

In 1992, the Philippine Government devolved the management and delivery of health services from the national Department of Health to provincial, city and municipal governments.

Public health service was one of the national functions devolved to local government units. The Department of Health (DOH), the sole provider of health-related services, was transformed into a technical authority providing technical support and assistance to local health units. 

The Department maintains national health centers in support of their local counterparts.

RE-NATIONALIZATION NOT A LEGAL ISSUE

The move to re-nationalize a devolved hospital is not an issue of legality. In fact, there are precedents which were signed into law that revert devolved hospitals to DOH. Some of the most recent laws that were signed by (President Rodrigo Roa Duterte) PRRD are: RA 11233 which converts Bacoor District Hospital to DOH Hospital and RA 11500 which converts Siargao District Hospital into a Level II National Hospital.

These laws were not questioned before the Supreme Court on its legality and constitutionality. 

Every member of Congress has the right to craft bills which will later on become laws of our land if signed by the President. That is true, and is protected under the constitution.

Thus, for Congresswoman Tutor to file a bill which aims to re-nationalize the Candijay Community Hospital, is not an ultra vires act relative to her post. 

And, for Governor Yap to ask an assurance prior to his endorsement and support, is sine qua non and absolutely necessary he, being the Father of Bohol

EXTERNAL FACTOR 1: UNIVERSAL HEALTH CARE LAW

Foresight is an efficient tool of leadership and public service.

In the conduct of a public officials’ duty, there is a need to look forward beyond the blind curve. What is beneficial today might not be as important tomorrow.

 Therefore, when action is needed especially if it pertains to institutional changes, it is quite important to consider external factors that either will help solve the problem or will run-against the real solution. 

Case in point is the Candijay Community Hospital. The facility is one of the ten devolved hospitals that is owned and managed by the Provincial Government of Bohol. Suffice it to say, that the Provincial Government is funding the administrative and operational expenses of the hospital from the time it was transferred under the care of the Provincial Government of Bohol until today.

Although, in recent years, the provincial government has allocated funds for the improvement of the delivery of health services. Considering its budgetary constraints due to other co-equal priorities that need to be funded, the funds may not be as big as needed. The same predicament is being faced the National Government. 

In the past weeks, it was announced that Bohol is one of the pioneering province for the roll-out of the Universal Health Care Law. The landmark law expands access to health services by automatically enrolling all Filipinos in PhilHealth’s National Health Insurance Program (NHIP). It seeks to ensure that all Filipino citizens have access to a comprehensive set of health services without financial hardship. The law aims to address a number of recurring problems in the health system. It also addresses the fragmented and overlapping roles and responsibilities of various health agencies. So, Bohol being one of the pioneering provinces for the roll-out of the UHC, Boholanos are assured to have a better health care system by next year. 

Health care facilities like Candijay Community Hospital will also be given its due share in the implementation as the UHC aims to address the fragmented implementation and solution to the needs of the facility. 

EXTERNAL FACTOR 2: MANDANAS RULING

In April 2019, the Supreme Court ruled that the share of local government units (LGUs) in the computation of the internal revenue allotment (IRA) is not only limited to the national internal revenue taxes but also includes customs duties and other taxes collected by the national government. As a result of the Court decision, which is also known as the Mandanas ruling, the IRA share of local governments is expected to increase in 2022.

The Philippine Institute for Development Studies(PIDS) study proposed that the IRA increase be sourced by defunding programs, activities, and projects (PAPs) in the budget of some national government agencies that are actually intended to deliver functions of LGUs under the Local Government Code of 1991. It also assessed the impact of the manner of financing the increase in the IRA, particularly on the vertical fiscal balance across different levels of and horizontal fiscal balance across individual LGUs within each level of local government.

At present, LGU’s IRA comes from 40 percent of national internal revenue taxes collected by the Bureau of Internal Revenue (BIR).

However, the Supreme Court ruling in 2018, which it reaffirmed last year, on the petitions of Batangas Gov. Hermilando Mandanas and former Bataan Gov. Enrique Garcia Jr. stated that the IRA must come from two-fifths of collections of “all” national taxes—including collections from import duties and other levies by the Bureau of Customs on top of the BIR tax take

With the implementation of the Mandanas ruling set on 2022, will the National Government have the funds to sustain operations small health care facilities like Candijay Community Hospital, if approved for its re-nationalization? 

If the National Government defunds programs and projects in order to implement the Mandanas ruling, will the guarantee of 100 Million pesos for the Candijay Community Hospital’s improvement, upgrade and modernization be realized?

That remains to be answered. 

CARE FOR THE WEAK: GOVERNOR’S PLEDGE

One of the Government Pillars of the Yap-Relampagos administration is care for the weak. It aims to address the basic needs of the poor, weak and vulnerable sector of our society. Hence, in recent months, we are able to see the Governor turning over checks at 1 Million pesos each to every LGU and 100 thousand each to every barangay to address the need for water in their respective localities. 

Aside from addressing the lack of potable water of our Province, as one of the sub-pillars of the Care for the Weak, is the improvement and modernization of the ten devolved hospitals which are owned and managed by the Provincial Government of Bohol. 

In fact, for Candijay Community Hospital, the Provincial Government has allocated the amount of 35 Million for the Phase 1 Improvement of the Hospital which includes improvement of the building and acquiring modern hospital and laboratory equipment. 

Long before the good Congresswoman of the Third District planned to re-nationalize the said health care facility, the provincial government through the visionary and able leadership of Gov. Art Yap and Vice-Governor Rene Relampagos has already seen the need for the improvement of the hospital and has allocated funds thereof. 

Will it be beneficial to the Boholanos to halt the implementation of the improvement and modernization of Candijay Community Hospital due to a mere verbal guarantee? The 100 Million might sound great, but when will the Boholanos get a taste of it? With the 35 Million ready for its implementation, not long enough clients and patients of Candijay Community Hospital will soon experience a better delivery of health services in the hospital. 

Nevertheless, as Gov. Yap said, the tipping point to finally let it go is the certification from Sec. Francisco Duque III of DOH for its commitment and support for the re-nationalization of Candijay Community Hospital. If and only if the Governor can get a hand of that certification, he said, “I will more than happily endorse and support the re-nationalization of Candijay Community Hospital.”