Albert Francis E. Domingo, MD

my flight of ideas

Power, Pesos, and Public-Private Partnerships in the Philippine Health Sector

Posted on | October 30, 2014 | No Comments

While it is acknowledged that the free market system and its perceived advantages as regards allocative efficiency can never take hold 100 percent due to so-called “market failures” (Morris S. et al. 2012, pp.114-132), Buse K. et al. (2012, p.52) points out that the general anti-state, pro-market trend of the 1980s arose due to allegations that “the public sector provided patronage instead of service, employment rather than goods and services, and used office to secure political support.” Health reforms said to be of “neo-liberal” influence have been instituted worldwide to various extents, with resistance seen to be coming mainly from actors content with the status quo of planned approches as well as from the “disproportionate emphasis placed on the technical content of reform at the expense of understanding the politics of the reform process.” (Buse K. et al. 2012, p.55)

Buse K. et al. (2012, p.58) cites the following contributions of commercial actors to governments as reasons for their prominence in health policy: revenues, employment, and cross-border influence among other states.

By way of an example, the potential for increased fiscal space was the pitch of the Philippines’ President Noynoy Aquino for public-private partnerships (PPPs) as he started his term (2010), when he said that “[the Philippines has] so many needs: from education, infrastructure, health, military, police and more. Our funds will not be enough to meet them… Our solution: public-private partnerships. Although no contract has been signed yet, I can say that ongoing talks with interested investors will yield fruitful outcomes.”

The call for private sector participation was specifically aired within the health sector when the Secretary of Health asked for more PPPs in the implementation of the reproductive health law, claiming that “PPP in health is not privatization. PPP is more than hollow blocks and high-tech machines. As far as health is concerned, PPP offers opportunities to improve the efficiency and cost-effectiveness of providing goods and services that save and improve lives. In simpler terms, properly executed partnerships with the private sector will help the government fulfill its sworn mandate to serve the people.” (Ona E.T. 2014)

It is interesting to note though that the Secretary of Health’s call for more participation from commercial actors came at a time when the health department realised its largest budget increase for many years now, attributed mainly to increased government revenue brought about by higher excise taxes on alcohol and tobacco. (Anon 2014) Could it be due to the failures of the state/public sector cited earlier that the Philippine government has chosen to involve commercial actors more in health, notwithstanding increasing fiscal space? We can only speculate at this point in time.

[Note: This is provided purely as an example of one of the academic requirements (specifically, the online seminar) of the course “Population Health and Health Policy” offered by the Global Public Health Unit, School of Social and Political Science, University of Edinburgh. The views expressed are entirely my own, and are not necessarily offered as expert advice in this forum of the internet.]   


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