What COA Found

The HFEP is a nationalprogram that assists in enabling government health facilities provide quality health care towards Kalusugan Pangkalahatan through the allocation of capital outlay for the procurement of health infrastructure and medical equipment.

 

Issues relating to availability of project sites, realignment and modifications on the projects, work suspensions, delays in the approval of Memorandum Of Agreement (MOA) and permits by Local Government Units (LGUs) and delays in the release of SARO impact on the timely implementation and completion of the project. Hence, percentages of projects completed in the same year they were funded and completion of projects as planned were below 50%, while delays in completion of projects ranged from three months to more than a year. Similarly, procurement for the equipping of health facilities was not all based on the identified needs resulting in unutilized equipment in health facilities, used for other purposes and reallocation of equipment from intended beneficiaries to other health facilities. Delayed procurement and delivery, undistributed equipment at DOH Regional Offices (ROs), Provincial Health Offices (PHOs), City Health Offices (CHOs), as well as acceptance of defective and inferior quality of equipment at health facilities were noted in the review of related documents and validation at the National Capital Region (NCR) health facilities.

Specifically, the project establishing 5,700 Barangay Health Stations (BHS) in public schools in 2015 and 2016 was obstructed by ineligible and non-workable project sites that were not fully validated before project contracting and implementation due to absence of specific guidelines. Adhering to the annual availment guidelines for HFEP project which requires validation and review of proposals could have minimized if not prevented the inclusion of unworkable sites in the project. Delayed and non-completion of the total BHS contracted again impacts on the procured equipment which remain idle or undistributed to intended school-based BHS.

These program implementation gaps in the provision of health facilities and equipment, as well as low budget utilization and absence of continuous and robust monitoring did not contribute to the efficient, economical, and effective implementation of HFEP. These recurring gaps since 2013 are not totally resolved in spite of remedial measures instituted to address them.

Lastly, the DOH has yet to conduct a continuous and more comprehensive impact evaluation to apprise the implementers and stakeholders of the program’s level of success as far as attainment of goals.

 

Why COA did this study

One of the major challenges in the Philippine health sector is providing access to appropriate health facilities for the poor and marginalized sector of the society. One of the banner programs of DOH which is directly linked to this concern is the Health Facilities Enhancement Program (HFEP). The budget of the program has significantly increased from ₱1.7 billion in 2008 to ₱26.9 billion in 2016.

COA had determined the program goals, objectives and performance indicators of the HFEP. It also assessed the extent to which the HFEP facilities and equipment helped in the achievement of program goals and objectives.

COA examined relevant laws, rules, regulations, and related program guidelines, plans and reports to determine the Program’s goals and objectives and assessed program implementation taking into consideration the principles of efficiency, economy and effectiveness. The existing performance indicators, targets and program results were reviewed to assess the extent of attainment of goals and objectives.

The audit primarily covered selected transactions of DOH Central Office, Health Facilities Development Bureau, and NCR Regional Office during the period 2014 to 2016. Transactions and data pertaining to 2017 and prior to 2014 including data for the nationwide program implementation were included in the review and analysis, when necessary.

 

What COA recommends

DOH should continue to improve its program implementation by addressing the implementation gaps not only through remedial measures but through preventive measures by continuously enhancing the guidelines and observing strict adherence thereto and to other relevant laws, rules and regulations promoting efficient, economical and effective program implementation. Improvements and strengthening of controls should be focused on procurement planning; screening, review and approval of project proposals; acceptance and inspection of procured items; budget utilization; coordination with LGUs and other implementing partners; and monitoring for efficient and economical provision of health facilities and equipment. Moreover, enhancement of program results indicators, target setting and impact evaluation reporting to track accountability and extent of attainment of HFEP’s desired future state will bring about relevant information and feedback for effective program implementation.