Ma. Ysabel Leanne P. Brual1, Catherine A. Chung1, Lucille B. Isnani1, Arianna Maever L. Amit2,3,4, Theo Prudencio Juhani Z. Capeding2, Veincent Christian F. Pepito2, Manuel M. Dayrit1,2
Background: The Philippines’ Universal Health Care (UHC) Law seeks to integrate local health systems for equitable, efficient, and high-quality service delivery. Financial integration, a core UHC dimension, is operationalized through the Special Health Fund (SHF), which pools resources from national agencies, local government units (LGUs), PhilHealth, and development partners. Despite its potential, SHF implementation remains complex, with many LGUs still navigating its pilot phase. This study examines early implementation experiences in two Philippine provinces, focusing on key actors, processes, and factors influencing SHF operationalization.
Methods: A qualitative case study approach was used, including document review and key informant interviews with officials from the health, budget, and accounting offices of the LGUs. Data were analyzed thematically to map processes and identify critical actors.
Results: Seventeen actors (nine major, eight supporting) were identified across core processes, including the establishment of a Management Support Unit (MSU), opening SHF accounts, pooling of funds, planning for utilization, budget execution, disbursement, and accounting. Enabling factors for successful SHF implementation included a functional Provincial Health Board with active support from local chief executives, LGU commitment to UHC, the use of Department of Health (DOH)-issued SHF manuals and guidelines, dedicated MSU teams collaborating with key actors, and integrated financial planning that improved fund approval. Key challenges included complex and unclear requirements from Department of Budget and Management (DBM), Commission on Audit (COA), DOH, and PhilHealth; capacity gaps in financial management; delays in downloading PhilHealth funds; and weak coordination among internal and external stakeholders.
Conclusions: Effective SHF implementation relies on clear governance structures, active coordination, and strengthened technical and administrative capacities. Developing standardized SHF implementation models, enhancing financial management skills, clarifying inter-office roles, and institutionalizing regular financial and performance reviews can support financial integration and accelerate UHC implementation at the local level.
