The Fourmula One for Health:
The Road Map for Health Sector
Reforms in the
Philippines 2005 - 2010
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FIGURES/TABLES *
| Fourmula One Functional Management Arrangement |
Targeted Activities for the Immediate Phase |
What is FOURmula ONE
for Health?:
Defining the Road Map for Reforms
Starting the Race with the End in Mind:
Fourmula
One for Health Goals and
Objectives
Over-all
Goals:
The implementation of FOURmula ONE for Health is
directed towards achieving the following end goals, in consonance with the
health system goals identified by the World Health Organization, the
Millennium Development Goals, and the Medium Term Philippine Development
Plan:
* Better
health outcomes;
* More responsive health system; and
*
More equitable healthcare financing.
General
Objective:
FOURmula
ONE for Health is aimed at achieving critical reforms with speed,
precision and effective coordination
directed at improving the quality, efficiency,
effectiveness and equity of the Philippine
health system in a manner that is felt and appreciated by Filipinos,
especially the poor.
Specific
Objectives:
Fourmula
One for Health will strive, within the medium term, to:
*
Secure more, better and sustained financing for health;
*
Assure the quality and affordability of health goods and services;
*
Ensure access to and availability of essential and basic health
packages; and
*
Improve performance of the health system
The
current implementation of health reforms builds upon the lessons and
experiences from the major health reform initiatives undertaken in the
last 30 years -- from the Primary Health Care approach in the late 1970s,
the Generics Act in the late 1980s, the devolution of public health system
in the early 1990s, the National Health Insurance Act of 1995, to the
Health Sector Reform Agenda (HSRA) conceptualized in the late 1990s.
Since the inception of the HSRA in 1999, health reforms have made inroads in at least 30 provinces. In
health governance, municipalities have joined together to form Inter-Local
Health Zones (ILHZs) to optimize sharing of resources and maximize joint
benefits from local health initiatives. In health regulation, local
government units have pooled their procurements to lower the price of
essential drugs. In health service delivery, key LGU facilities have been
upgraded to meet accreditation requirements and be entitled for capitation
or reimbursements from PhilHealth. In health financing, LGUs have
increased contributions needed to enroll indigents into the social health
insurance program. Not only is the coverage of health services being
improved in these localities, invaluable lessons are also being learned to
bolster confidence in the implementation of these reforms nationwide.
Hurdling Major
Roadblocks and Obstacles:
Overcoming Healthcare Challenges in the Philippines
While
the above developments in the health sector have given rise to
opportunities, especially in the last five years, there are also existing
constraints that must
be taken into account in the crafting of
relevant strategic
action plans.
For
years now, the DOH budget has been very restricted, with around 60 percent
automatically spent for personal services alone, leaving very little to
provide for operational and capital needs. Moreover, the share of health
in the national budget, as well as the real value of its actual
allocation, has declined. On the other hand, as LGUs receive larger
allocation from the internal revenue allotment, their investment for
health has also increased progressively after the devolution of health
services. However, most LGUs spend at least 70 percent of these resources
for salaries and benefits of local health personnel, also leaving very
little for operational expenses and capital investment.
Furthermore,
the allocation of public subsidies for health, across its major expense
categories (i.e. personal services, maintenance and other operating
expenses and capital outlay), has remained inflexible. Also, the national
government cash position has been very limited, causing delays in the
release of health budgets. In addition, the way existing budgets are
allocated across the various health agencies and programs has no clear
bearing on performance.
Thus,
while health budgets have declined in terms of its real value, the DOH
continues to face the difficult mandate of steering the
In
the backdrop of these opportunities and constraints, the significant
lessons learned from experiences in the last five years, with respect to
health reforms in several localities, the growing interest and support
from external development partners, the deeper understanding of the
requirements of implementing reforms, the reinforcement from partner
government agencies, and the revitalized political support for reforms
from national leadership, however suggest that the timing for full
implementation of health reforms is now.
Defining the Rules of Engagement:
Seven (7) General Guidelines for Health Reform Implementation
F1 Rule No.1:
FOURmula
ONE for Health will organize the critical reform initiatives into
four implementation components, namely, Financing, Regulation, Service
Delivery and Governance.
F1 Rule No. 2:
The implementation of FOURmula ONE for Health
will focus on a few manageable and critical interventions. Such
interventions will be identified using the following criteria:
· Doable given available resources - Critical interventions identified for each component must be deemed doable given the available time, human and financial resources.
·
Sufficient
groundwork and buy-in
- The chosen interventions must be backed by
sufficient groundwork and buy-in from implementation partners, especially
in the development of reform packages for local implementation.
·
Triggers
a reform chain reaction
- These critical interventions must be able to
trigger a chain of reaction that will spur the implementation of other FOURmula
ONE for Health interventions, within and across the four components.
· Produces tangible results and generates public support - These critical interventions must be able to show tangible results within the immediate and medium terms, which in turn generate support and cooperation from the public;
F1 Rule No. 3:
The reforms will be implemented under a sector-wide approach, which
encompasses a management perspective that covers the entire health sector
and an investment portfolio that encompasses all sources.
F1 Rule No. 4:
The National Health Insurance Program (NHIP) will serve as the main
lever to effect desired changes and outcomes in each of the four
implementation components, where the main functions of the NHIP including
enrollment, accreditation, benefit delivery, provider payment and
investment are employed to leverage the attainment of the targets for each
of the reform components.
F1 Rule No. 5:
The functional and financial management arrangements will be
defined in terms of specific offices having clear mandates, performance
targets and support systems, within well-defined time frames in the
implementation of reforms within each component.
F1 Rule No. 6:
The functional clustering of teams and assignment of specific Team Leaders
shall facilitate implementation, monitoring and supervision in a
coordinative manner and shall not, in any way, prejudice the corporate
nature of the DOH-attached agencies nor the autonomy of Local Government
Units.
F1 Rule No. 7:
The selection of FOUR-in-ONE
Convergence Sites will be governed by the following criteria:
·
Willingness of the LGU to participate in the FOURmula ONE for Health
implementation, in terms of willingness to provide the requisite
counterpart resources, and willingness to enter into formal national
government to local government, inter-local government and government to
private sector networking, partnership and resource sharing arrangements;
·
Presence of local initiatives or start-up activities relevant to FOURmula
ONE strategies, to include, but not limited to: development of
inter-local health zones, enrollment of indigents into the social health
insurance system, improvement in drug management systems, among others;
·
Relatively high feasibility of success and sustainability, to include
factors such as capacity to enter into loans, capacity to absorb
investments and sustain the reform process, etc.; and
·
Availability of funds from GOP and external sources for capital
investment requirements.
Winning Strategies to Attain FOURmula
ONE for Health Component-
Specific Objectives
F1
Component No. 1: HEALTH
FINANCING
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Objective: The objective of financing reforms under FOURmula
ONE for Health is
to secure more, better and sustained investments in health to provide
equity and improve health outcomes, especially for the poor.
Mobilizing additional
resources for health will entail increasing revenue generation capacities
of health agencies without compromising access by the poor. This may
include revenues from user fees and charges for personal health care and
regulatory services, and rationalized use of real property assets
belonging to government health agencies.
Efforts to mobilize more investments for health will
be coupled with measures to improve efficiency in the system on two
accounts: one is maximizing the expected performance outputs using the
available resources, and second is properly distributing or allocating the
resources where they would yield the optimum health impact.
The overall management of total health investments
will be undertaken using a sector wide approach. This implies that the
management perspective covers the entire health sector, and that financing
portfolio management encompasses all sources. The implementation of FOURmula
ONE for Health will be financed jointly by central and local
governments, PhilHealth, and official development agencies. Eventually,
mechanisms to mobilize private sector resources will also be developed and
implemented.
Financing of health agencies must shift
into a performance based system. This means that budget allocations and
releases will be conditioned on the achievement of performance targets.
Moreover, programs that require long term financing must be supported by
multi-year budgets. Direct subsidies from national and local governments
must be focused on priority programs, specifically basic and essential
health goods and services used by the poor.
Health agencies and facilities with
significant revenue generating capacities should not only support its own
requirements but also contribute to meet the needs of non-revenue
generating priority programs. However, such mechanisms will be designed
and introduced in a way that do not penalize or restrain fiscal
performance among revenue generating agencies.
The NHIP shall be
further strengthened by expanding enrollment coverage, improving benefits
and leveraging payments on quality of care. As the lead implementer of the
health financing reform component, PhilHealth needs to recognize that
changes in enrollment, benefits, and provider payments need to be well
orchestrated to become effective. Moreover, PhilHealth has to recognize
that it operates in local markets and would have to continue engaging
partners at that level.
F1
Component No.2: HEALTH REGULATION
|
Objective: The main objective of health regulation under FOURmula ONE for Health is assuring access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor.
On the supply side, systems and processes for
licensing, accreditation and certification will be harmonized and
streamlined to make health regulation more rational and client-responsive,
through the following strategies:
-
Establishing a “One-stop Shop” for the licensing of health facilities;
-
Automating regulatory systems and processes;
-
Integrating accreditation and certification into a unified “seal of approval”;
-
Introducing intensive, less frequent and incentive-based regulatory procedures;
-
Decentralizing appropriate regulatory functions to regional offices and LGUs; and
-
Strengthening enforcement mechanisms and regulatory oversight functions of the DOH.
Such seals indicate that a certain level
of standard or competency has been achieved, assuring providers and
clients that fair and ethical standards are met. The presence or absence
of such seals enables consumers to make informed decisions and demand
quality products and services.
The use of these seals will be expanded and
operationalized to include public and private health facilities,
laboratories, pharmacies, and devices. These
seals will be linked to incentives to meet progressively higher standards
for safety, effectiveness and quality.
Consistent with the over-all financing
strategy of FOURmula
ONE for Health, cost
recovery with income retention for health regulatory agencies and other
revenue-generating mechanisms will be pursued to ensure financial
sustainability. However, the use of retained revenues needs to be
backed by a rational and approved expenditure plan.
Also part of the FOURmula ONE regulatory
priorities is assuring the availability of low-priced yet quality
essential medicines commonly used by the poor through the following
mechanisms:
-
Promoting high quality generic pharmaceutical products;
-
Expanding pharmaceutical distribution networks (national and local hospital pharmacies, NGO-owned pharmacies, Botika ng Barangay, Botika ng Bayan);
-
Identifying alternative local and foreign sources of low-priced branded drugs; and
-
Developing mechanisms for pooled procurement among health facilities and across LGUs to realize economies of scale.
F1 Component No. 3: HEALTH SERVICE
DELIVERY
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Objective: FOURmula ONE for Health interventions in service delivery are aimed at improving the accessibility and availability of basic and essential health care for all, particularly the poor. This shall cover all public and private facilities and services
Basic and essential health service packages will be
made available in all localities while specific
and specialized health services will be made available by designated
providers in strategic locations.
The quality of both basic and specialized
health services will be assured through the following mechanisms:
-
Health facilities will have to be upgraded and human resource capability of these facilities needs to be strengthened to comply with licensing and accreditation requirements.
-
These facilities will follow accepted standards of care such as clinical practice guidelines (CPG) or diagnostic-related groups (DRGs).
-
The provision of specialized diagnostic procedures and services as well as specialty services involving the management of complicated diseases and conditions will be assigned to preferred providers as incentive for delivering quality and affordable services.
Current
efforts to reduce public health threats have to be intensified by taking
on the following strategies:
-
Undertaking disease-free zones initiative
-
Implementing intensified disease prevention and control strategy
-
Enhancing health promotion and disease surveillance
Under
the disease-free zones initiative, areas where diseases such as malaria,
filariasis, schistosomiasis, rabies, leprosy and vaccine-preventable
diseases are major health problems will be identified and targeted for
intensive campaigns to eliminate these diseases as public health threats.
Intensified
disease prevention and control strategies for other priority diseases such
as tuberculosis, HIV-AIDS and other communicable diseases will be
undertaken in intensified disease control zones where the greatest impact
from health investments could be derived.
To
reinforce the disease-free zones initiative and the intensified disease
prevention and control strategies, enhanced health promotion and disease
surveillance activities will have to be undertaken.
Disease
surveillance will be intensified to ensure that the targets for disease
elimination, prevention and control are attained.
Health
promotion interventions will be directed at the prevention and control of
health hazards and health risk-taking behaviors, particularly those
associated with lifestyle related diseases such as cardiovascular
diseases, cancer, diabetes mellitus and chronic obstructive pulmonary
disease, among others.
F1 Component No.4: GOOD GOVERNANCE IN HEALTH
|
Objective: The objective of good governance in health is to improve health systems performance at the national and local levels. FOURmula ONE for Health will introduce interventions to improve governance in local health systems, improve coordination across local health systems, enhance effective private-public partnership, and improve national capacities to manage the health sector.
Governance in local health systems may be improved by undertaking
the following strategies:
FOUR-IN-ONE Convergence Sites
have to be established. These convergence sites will undertake
integrated implementation of FOURmula
ONE for Health components in
appropriately delineated localities or inter-local health zones.
Assistance and support will be provided
to targeted provinces in the areas of financing, regulation, service
delivery and governance to improve local health systems performance.
The DOH will immediately enter into
partnership with at least 15 provinces then roll out the reform package to
another set of at least 15 provinces in the next two years, and eventually
cover the rest of the country.
In order to ensure that FOURmula ONE for Health
assistance in FOUR-IN-ONE Convergence Sites build
upon local initiatives and are able to address local conditions and needs,
the engagement will be based on a dialogue among partners (i.e. LGUs, DOH,
PhilHealth and other stakeholders), iterative in nature, and menu driven.
A FOURmula
ONE for Health LGU Scorecard
will be developed and employed to track the progress and compare the
performance of various localities or inter-local health zones.
A
FOURmula
ONE for Health Professional
Development and Career Track will be institutionalized where
competent and dedicated health personnel will provide quality
health services and sound advice to local chief executives with regard to
health reforms. To achieve this end, FOURmula
ONE for Health will pursue:
·
Improving distribution and retention of critical health
personnel, especially in under-served areas.
·
Provision of
human resource for health to underserved areas by the DOH. These personnel
shall be trained to perform necessary functions as health providers,
managers and advocates for the FOURmula
ONE for Health.
·
Developing managerial skills of local health supervisors and
improving the technical competencies of field personnel.
·
Expanding the professional career paths of qualified local
health personnel by making them “first draft picks” for central office
and Center for Health Development (CHD) placements. Career professionals
from devolved health systems shall be prioritized in the hiring of central
office and CHD personnel as an incentive for local health personnel to
remain in the service and as a mechanism to ensure that the DOH will have
a regular pool of experienced health managers.
National capacities to manage and steward
the health sector will be improved through the following strategies:
- Technical leadership and management capability at central and
regional levels will be strengthened through retooling and retraining of central office and CHD
personnel as well as tapping DOH Representatives to serve as vital
links to LGUs.
·
Public
finance and procurement management systems will be improved through:
o
Strengthening
the financial management capacity at both central and CHD levels by
developing a comprehensive and integrated financial management information
system, such as the eNGAS, MTEF, etc.
o
Strengthening
the procurement, logistics and warehousing capacity in DOH
·
Information
and communication technology capability will be strengthened to improve
connectivity of the health sector and ensure access to quality health
information.
·
Monitoring
and evaluation, research and knowledge management systems will be strengthened to support a more rational performance assessment system and
an evidence-based health policy development and decision-making process.
·
The development of rationalized and more efficient national
and local health systems will be pursued through strengthening networking
mechanisms and referral systems, sharing of resources, organizational
transformation and restructuring, and capacity building, among others.
Running the Health Reform Race:
Operational Framework for Fourmula
One Implementation
Functional Management Arrangements
|
In order to ensure the effective and efficient implementation, FOURmula ONE for Health will adopt the following management approach:
An
effective and functional management infrastructure responsible for
implementing various components of the HSRA as well as monitoring and
evaluation of target outcomes and performance benchmarks will be put into
effect.
Key
units within the DOH will be formally clustered and then designated to
manage the implementation thrusts of FOURmula
ONE for Health. Within these
units, there has to be a corps of dedicated staff that will be tasked
solely to perform functions attendant to the day-to-day operations of FOURmula
ONE for Health implementation. All other offices in the organization
will focus their efforts to contribute towards achieving FOURmula
ONE objectives.
Management
and implementation teams at all levels of the health system will
communicate and advocate the goals, objectives, strategies and activities
of FOURmula ONE for Health to build a public constituency behind it.
a.
Governance and
Management Support
i.
Sectoral Management and
Coordination Team
ii.
Internal Management and
Support Team
b.
Policy and
Standards Development and Technical Assistance
i.
Policy and Standards
Development Team for Regulation
ii.
Policy and Standards Development Team for Service Delivery
iii.
Policy and Standards
Development Team for Financing
c.
Field
Implementation and Coordination
ii. Field Implementation and Coordination Team for the
Visayas and
At
the regional level, Regional
Implementation and Coordination Teams will be organized,
consisting of the DOH-CHD, PhilHealth Regional Office, POPCOM Regional
Office, all retained health facilities and other
related agencies and organizations at the regional level.
At
the local level, Local
Implementation and Coordination Teams will be organized.
Existing Local Health Boards and Inter-Local Health Boards will serve as
the LIC team, which may be expanded to secure wider participation from the
community, civil society and the private sector.
Roles and Responsibilities
The
Executive Committee (EXECOM) – provides policy
directions for implementing FOURmula
ONE for Health. The EXECOM is chaired by the Secretary of Health and
composed of all undersecretaries, assistant secretaries, the President and
Chief Executive Officer of PhilHealth, and selected Directors in the DOH.
The
National Health Planning Committee (NHPC) -
Created under Executive Order No. 205 s. 1999, the National Health
Planning Committee serves as the National Steering Committee for the
implementation of FOURmula ONE for Health.
a.
The Sectoral Management and Coordination
Team (SMC Team) - ensures that all four thrusts of FOURmula
ONE for Health are effectively
coordinated, synchronized, and properly monitored.
The SMC Team is responsible for the overall development, monitoring
and coordination of policies, mechanisms and guidelines for the health
sector, encompassing financing, regulation, service delivery and
governance concerns as approved by the EXECOM. This includes concerns in
rationalizing public subsidies in health and the management and
implementation of the needed DOH budget reforms required in the course of
implementation of FOURmula ONE for
Health.
The SMC Team will also coordinate and manage inputs to the Field
Implementation and Coordination Teams from the other FOURmula ONE for
Health management teams concerning policies, standards and technical
assistance related to financing, service delivery, regulation, and
governance.
b.
The Internal Management Support Team (IMS Team) - is responsible for implementing DOH financial, procurement and
logistics management reforms, including building the information and
communication technology infrastructure and other management support
services.
The Internal Management Support Team will focus on the
administration of the DOH’s finance and logistics management, and
oversee the development of information and communication technology (ICT)
requirements of FOURmula ONE for
Health implementation.
As
a special committee, the COBAC, including the Procurement Division-PLS
oversees the implementation of procurement management reforms.
The Policy and Standards Development and
Technical Assistance Teams (PSD Teams) - will focus on the provision of technical guidance
and policy support for implementation at the field level. A Policy and
Standards Development Team for each major function will be assigned to
develop policies and standards, and provide technical assistance to field
level implementation in areas of regulation, service delivery, and
financing.
a.
The Policy and Standards Development Team
for Health Regulation (PSD Team for Regulation)
The PSD Team for Regulation will exercise its mandate and function
to ensure the quality and affordability of health products and services. This
pertains to the development of policies, standards and guidelines, as well
as technical capability for regulating health products, including drugs
and medicines, and health facilities and services, in tandem with the
accreditation and quality assurance systems of PhilHealth.
b.
The Policy and Standards Development Team
for Health Service Delivery
(PSD Team for
Service Delivery)
The PSD Team for Service Delivery ensures the development of
policies, standards and guidelines for health programs and the provision
of technical assistance to health service providers. This includes the
development of disease surveillance systems, program design for essential
health packages and specialized health services, health promotion and
advocacy, and upgrading of health facilities, among others.
c.
The
Policy and Standards Development Team for Health Financing (PSD Team for
Financing)
The
PSD Team for Financing will ensure that the NHIP is further strengthened
by expanding social health insurance coverage, improving benefits and
leveraging provider payments on quality of care.
The
PSD Team for Financing will coordinate with the PSD Team for Regulation
with regard to the harmonization of regulatory systems and processes.
The Field Implementation and Coordination
Teams (FIC Teams) will focus on the FOURmula
ONE for Health implementation
and coordination in their respective geographic assignments – one for
Luzon and NCR and one for the Visayas and
The
FIC Teams provide over-all coordination of the Centers for Health
Development (CHDs), PhilHealth Regional Offices (PROs), POPCOM Regional
Offices and retained health facilities in their area. Each team will also
initiate and maintain the development of the regional coordinating
facility involving government health offices such as the DOH-CHD, PRO, and
the POPCOM Regional Office, other government agencies, NGOs, the private
sector and other stakeholders at the regional level.
Its
main goal is to oversee and coordinate implementation of FOURmula
ONE for Health in partnership
with the LGUs, the private sector and other government agencies, in
consonance with the principle that reforms implemented and operated in a
decentralized manner brings results closer to the people.
The
FIC Teams will deal with technical supervision and coordination of the
implementation activities of FOURmula
ONE for Health at the local
level. Specifically, these tasks refer to FOUR-in-ONE
Convergence Site development and institutionalization of LGU governance
management structures.
As
the lead in health reform implementation, the FIC Teams will promote and
ensure the quality of the services provided for by the DOH retained
hospitals in support of, and within, the context of local health system
development.
Regional Implementation and Coordination Teams (RIC Teams)-
The FOURmula ONE for Health Regional Implementation and Coordination Teams will
carry out the following responsibilities:
-
Provide technical assistance to define the package of minimum health care for the LGUs;
-
Strengthen technical and managerial capability at the local level to improve LGU performance;
-
Facilitate compliance to accreditation requirements of health facilities, products and services;
-
Provide venues for inter-agency coordination, including other players in the health sector in a given locality;
-
Monitor and evaluate the LGU performance through the LGU scorecard;
-
Develop incentive mechanisms for LGUs towards better performance in the delivery of health care; and
-
Rationalize the role of DOH hospitals to complement health care services provided by the LGUs and the private sector.
These teams are primarily responsible for the technical supervision
and coordination of health reform implementation in the Four-in-One
convergence sites. Part of the evaluation to be conducted by the regional
teams is to determine the effective performance of the Four-in-One
convergence sites, based on the LGU scorecard.
Local Implementation and Coordination
Teams (LIC Teams) - The
LIC Teams are responsible for the over-all implementation of Fourmula
One activities in their
respective local government units or Four-in-One
Convergence sites.
Chaired by the LCEs or their duly
designated representatives, the LIC Teams will ensure local health
governance through the institutionalization of management structures
consistent with Fourmula One implementation.
Local Government Units (LGUs)
The Local Government Units will ensure
that the basic essential
health service packages are being delivered to its constituents.
The LGUs will organize themselves into
Inter-Local Health Zones that will integrate the implementation of Fourmula
One health reform strategies
The LGUs will enact the necessary
legislative issuances (ordinances, resolutions, etc.) in support of Fourmula
One implementation at the local level.
They will provide counterpart funds for
implementing and sustaining their investment plan.
They will promote and advocate for the
implementation of Fourmula One
as the health sector reform implementation framework in their
respective localities.
Civil Society
Civil society and other private sector
partners are expected to assist the DOH and the LGUs in achieving desired
health objectives.
Civil society will help point out
people’s health needs, particularly those of the vulnerable groups and
bring to the attention of the LCEs and/or LIC Teams such felt needs.
They will contribute towards enhancing
the equity, accountability and transparency of Fourmula One implementation
at the Four-in-One Convergence
sites.
Development and other Donor Agencies
Development and other donor agencies will
serve as active partners in the implementation of FOURmula ONE for Health.
They will not only provide much needed
financial assistance but will also provide invaluable support in terms of
technical assistance, based on the Fourmula
One health reform objectives and
investment plans developed by the respective Four-in-One Convergence sites.
Pump-priming Health Reform Implementation:
F1 Financing Mechanisms and Strategies
F1 Financing Mechanisms and Strategies
The financing of FOURmula
ONE for Health implementation
follows a two-pronged strategy:
1.
The first one, described earlier in the section on financing,
refers to the rational use of public subsidies, both national and local,
and the increasing role of social health insurance in paying for the
health services of Filipinos. This likewise requires aligning these
resources to sustain the strategic thrusts and programs of FOURmula
ONE.
2.
The other strategy entails using available resources, mainly those
from the foreign assistance pipeline to pump prime FOURmula
ONE for Health implementation in the immediate term.
The financing portfolio for FOUR-in-ONE Convergence Sites consists of the following:
1.
Grants – will come from development agencies such as the European
Union (EU), the German Technical Cooperation (GTZ), and the Government of
Belgium, among others.
2.
LGU Counterpart – will come from the respective Internal Revenue
Allotments (IRA) and other revenue sources of the LGUs; or from loans that
may be accessed from the Asian Development Bank (ADB) or the Kreditanstalt
für Wiederaufbau (KfW) through the
Municipal Finance Corporation (MFC), an attached agency of the Department
of Finance, and other such development or commercial banks.
3. National Government Counterpart – will come in the form of technical assistance, training and