Governance in Primary Care Systems: Experiences and Lessons from Urban, Rural, and Remote Settings in the Philippines

Abstract

Objectives. Workforce shortages, policy fragmentation, and administrative fragmentation have broadened health inequities in the absence of an effective primary care system in the Philippines. While a central component within the health system, the role of governance in strengthening primary care systems remains underexplored. Therefore, this study aims to: 1) examine governance challenges encountered upon strengthening primary care systems; and 2) provide experience-based recommendations for improving primary care services in the Philippines. Methods. Data on governance issues were obtained from participant observation and regular meetings facilitated over one year. Conducted across urban, rural, and remote settings, the present study outlines experience-near insights throughout a hierarchy of system implementers—from those in positions of authority to frontline workers. These insights were thematically analyzed and organized following the Health System Dynamics Framework. Results. This study identified six governance challenges: 1) establishing a health information system; 2) engaging leaders, healthcare staff, and communities; 3) assuring efficient financing; 4) assuring health workforce sufficiency; 5) addressing legal challenges; and 6) planning evaluation and monitoring. To address these challenges, this study forwards systemic solutions to advance effective governance and improve healthcare performance. Conclusion. A renewed approach to strengthening primary care systems is fundamental to achieving universal healthcare. This entails good governance that develops strategies, equips people with tools for proper implementation, and provides data for evidence-based policies. The experiences outlined in the present study envisions guiding policymakers toward improving health outcomes in a devolved setting.