Wednesday, June 24, 2009

Hospital Mess: Part 2

In a previous blog post, I reported on the details of cases of alleged financial misconduct committed by some officials of the Lianga District Hospital. The said fiscal anomalies are now the subject of separate official investigations by both the provincial government of Surigao del Sur which has direct authority over local district hospitals and the regional office of the Ombudsman in Davao City.

However, as a result of the formal investigations, Dr. Dionisio Tayko, LDH's erstwhile chief of hospital who has borne the brunt of the accusations of misappropriating hospital funds, has been relieved of his position and reassigned to Tandag, the provincial capital, pending the final outcome of the twin official inquiries. As to whether other currently serving hospital officials will follow in his footsteps remains to be seen at this point in time.

The unfortunate events at Lianga's local government hospital may seem to point out to the negative consequences to what can be considered the failure of local governments, particularly those at the provincial level, to exercise proper monitoring and supervision of the operations of government hospitals under their jurisdiction. There are, however, also many local observers who say that proper monitoring is not actually the problem but the "politicalization" of the rural health service in the provinces.

They say that the incident at the LDH would have been resolved earlier and prevented from blowing up into a scandal if local politicians have not interfered and muddied up the controversy for the purpose of protecting persons and personnel within the hospital with political links to them. The fact that the perpetrators of the supposed financial anomalies had been allowed to continue with their illicit work for some time already without being unmasked and punished by their superiors in the provincial government, they add, is ample proof of this.



When provincial governments assumed supervisory and funding responsibilities over district hospitals within their area in the early 1990's as a consequence of the passage of the Local Government Code of 1991, this devolution of responsibility from the national government to local government units was a traumatic process for many small government funded health institutions like the Lianga District Hospital. Like most tertiary level hospitals all over the country on the front lines of the rural health service, it was ill-prepared and inadequately positioned to cope with the increased demands for modern health services in their catchment areas while provincial governments like the one in Tandag were also struggling with financial and budgetary constraints.

To a large extent even today, the LDH, like most district hospitals in poverty stricken provinces like Surigao del Sur, is under-budgeted and forced to function with limited material and manpower resources. Rural folks desperate for hospital care are often forced to purchase medicines and hospital supplies which otherwise could have been provided for free or minimal cost under more ideal circumstances.

But what makes the situation worse is the fact that district hospitals have, to a great degree , become virtual pawns in the never ending political chess games local politicians play as they struggle to control the levers of power all over their political fiefdoms. Since local hospitals like the LDH provide essential medical care and a whole range of much needed health services to the local folk, it becomes strategically and tactically necessary for politicians in power to ensure that they have their own people inside controlling hospital operations. And for those with a more nefarious agenda, district hospitals can provide opportunities for outright graft or the occasional illegal diversion of government funds.

To prevent, therefore, the repetition of what has happened at LDH (something that obviously has happened a lot of times in many other government hospitals all over the country), it is imperative that not only must public pressure be put upon the provincial government to assume responsibility for better supervision and oversight over the operations of its district hospitals, but, more importantly, some mechanism or process must be created and implemented for the sole purpose of insulating local government hospitals from the negative effects of politics and political pressure.

One suggestion has been to amend existing laws and return direct control and funding of the district hospitals back to the national government. Whether that will work out under present circumstances and political realities remains a big question. And many local politicians in power would not take kindly to the removal of local hospitals from their spheres of influence.

But one thing is sure. The mess at the LDH may have been partially cleaned up for now but there is no assurance that that is the end of the matter. Unless something is done about the very realities and conditions that encourage and promote the abuse and misuse of government funds and facilities in government hospitals at the municipal and district levels, these same problems are bound to repeat themselves time and time again. And, as usual, it will be the poorest of the poor, those who desperately need urgent, low cost health care assistance the most, who will end up the worst for it.

1 comment:

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