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Benchmarking the fairness of health sector reform in the Philippines

Date: Tuesday 30 October 10.45–12.15
Source: Forum 11
Authors: Dale Huntington, Technical Officer, Reproductive Health and Research, World Health Organization, Geneva
with Mike Tan, Theresa Batangan and Raul Ting

Abstract

The history of health sector reform in the Philippines presents a mixed record: sustained consensus on the need for reform, yet an uneven track record on introducing change. Reducing inequities in access is clearly a priority for the Department of Health, as demonstrated by the improved performance of the national health insurance programme PhilHealth in reaching the poor with coverage of basic health services. However indicators of success in reducing inequalities are narrowly defined around targets such as the number of enrolled indigents or the newly accredited health facilities. Broader questions of how well equity is being achieved throughout the health system are infrequently articulated in policy dialogue and indicator frameworks used for reporting on the health sector reform programme.

In 2006­2007, the World Health Organization (WHO) worked with the University of Philippines and the Department of Health to adapt an analytic framework termed the `Benchmarks of Fairness' to assess the overall fairness of women's health care in one province of Mindanao, Philippines. The results from the study are being used as one of the baseline measures of equity for measuring the impact of a World Bank- supported women's health and safe motherhood project.

Fairness is a broad ethical term that has much to do with social justice and is conceptualized by this method through three dimensions: equity, accountability and efficiency. Nine benchmarks are specified, each covering a main goal of fairness in health system performance and design related to one of the three dimensions.

Five benchmarks capture different aspects of equity, two focus on clinical and administrative efficiency, and two examine accountability and autonomy.

This paper reviews the developmental process for adapting the Benchmarks of Fairness to the evaluation of the women's health project, presents key findings for each of the nine benchmarks and discusses the policy and programmatic implications of the results.