PART 1: EVOLUTION OF DECENTRALISED GOVERNANCE

HISTORY OF DECENTRALISATION Before 1521 independent villages called barangays were the basic units of government. When the Spaniards established a centralised colonial government system in the Philippines, this weakened the barangays. The Americans, who conquered the country in 1898, saw it convenient to keep the Spanish system of centralised government. This centralist pattern was passed on to the Republic by the Constitution drafted in 1935, and further strengthened by the martial law constitution of 1973. In 1986 the Filipinos waged the peaceful people-power revolution in Metro Manila and installed Corazon Aquino as President. Aquino's victory paved the way for greater people participation in government, a principle that was enshrined in the 1987 constitution. This people-power euphoria led Congress to move towards decentralisation of power to the grassroots. In 1991, after 470 years of centralised governance, Congress passed the Local Government Code (Republic Act 7160, referred to here as Code) revolutionised the local government system through: 1. devolution of basic services from the central government to the local government units (LGUs) at all levels, 2. increasing financial support to LGUs by raising their share of internal revenue collections from 20% to 40%, and 3. institutionalising people's participation in local governance. DECENTRALISATION THROUGH DEVOLUTION The most drastic change is in the swift decentralisation through devolution. Section 17 of the Code devolved powers to LGUs to provide basic services--health, welfare, agriculture, and environmental protection. 1 The degree of devolution, however, depends on the level of local authority; e.g., more complex and expensive activities are assigned to intermediate local governments (provinces), and the primary service to the basic units (cities and municipalities). For instance, primary health care is assigned to the cities and municipalities while tertiary health care responsibility is given to the provinces. The sub-municipal level (barangays) also have responsibilities, such as the distribution of seedlings to farmers, the maintenance of day care centers, and, if affordable, establishment of barangay health centres. This devolution carries with it powers to appoint the personnel and the heads of the offices responsible for providing the services. It also carries with it the responsibilities of service delivery and financing. To assist the LGUs in financing the devolved services, their internal revenue allotments (IRA) were increased. Shares are computed based on population, area, and equal sharing, and determined by level of local authority. People's participation in local governance may take several forms. Political participation is achieved through initiatives (to get ordinances passed in councils), recall (to remove erring
1

Public works was also included, but it has not really been devolved.

elected officials) and plebiscites (so residents may act on laws affecting them). Sectoral representation in local councils is also provided, but no special elections have been held for the three sectors specified -- women, workers, and special groups. Active participation in governance is encouraged through the creation of local special bodies (Health Board, School Board, Peace and Order Council, Pre-qualification, Bids and Awards, and the much expanded Local Development Councils . Local Development Councils at all levels have provisions for at least 1/4 of their membership coming from Non-governmental Organisations (NGOs) and Peoples Organisations (POs), of which more than 20,000 exist in the country. Thus, decentralisation in the Philippines is achieved through devolution and the active participation of people in governance. Of course, because of the quick manner in which devolution was implemented, problems occurred in the initial years of implementation. The huge expenditures in health prompted Congress to pass a law decentralising the health service, but that was vetoed by President Fidel Ramos who reiterated the central government's policy of devolution. Complementing the Local Government Code is the Social Reform Agenda of the Ramos government which focuses development efforts on the 20 poorest provinces and uses the minimum basic needs (MBN) approach to ensure the delivery of the most basic of services to the grassroots. The MBN approach utilises the puroks, which are the communities below the village government (barangay), in providing data used for planning and service delivery. 2 The new administration of President Joseph Estrada also uses the MBN approach in its anti-poverty program which focuses on food security. Although the Code provided a great leap forward from centralisation to devolution, gradual moves had been made before 1991 to achieve local autonomy. The barangays, for example, had been electing their own officials by virtue of the old Barrio Charter and the Revised Barrio Charter. Cities and municipalities enjoyed zoning autonomy through the Local Autonomy Act. The Decentralisation Act of 1967 had allowed local authorities to supplement rural health and agricultural extension efforts if they could afford it. By and large, however, the dominance of the central government over the LGUs was so well entrenched that the 1991 Code's provisions are considered revolutionary. Filipino local officials hail the Code's passage as a solution to their main problem of having responsibility for their constituents without the corresponding authority. While the experience of decentralised governance has not been uniformly successful, it has been successful in many areas.

PART 2: DECENTRALISED PRIMARY HEALTH CARE SUCCESS

Since passage of the Code, several institutions have been documenting good practices in local government. Among these are the Asian Institute of Management and the Local Government Academy which gives the Galing Pook (Good Local Unit) award, the Department of the Interior and Local Government which gives the Clean and Green awards and nominates to the President the Pamana ng Lahi (Heritage) Award, the Konrad Adenauer Foundation, the Asian Development Bank, and the USAID's GOLD project. Even before the passage of the Code the Department of Health and the German Gesellschaft fuer Technische Zusammenarbeit (GTZ) had been giving the
2

The purok is not a political unit; it is only a geographic unit of the barangay.

HAMIS (Health and Information System) award. However, because the award-giving bodies give different kinds of prizes, there are no definitive criteria for their choice of local governments. After reviewing the diversity of experiences among LGUs in terms of programme focus as well as geographic and political similarities, we chose three award-winning programmes, each of which started with primary health care and then expanded to other services. These are located in three different rural local government units, two municipalities and one component city3. Each LGU is located in a different major island group in the country. The programmes selected are: 1. The Irosin Integrated Area Development Project (IIADP) which started from more modest efforts in health and later branched to agriculture and land reform (Irosin, Sorsogon in Luzon). 2. The Countryside Action Programme (CAP) in Balilihan, Bohol that drew its inspiration from the primary health care programme of the central government (Balilihan, Bohol in the Visayan Islands). 3. The Primary Health Care Women's Clubs (PHC) of Surigao City which involved the entire community in health and related activities (Surigao City in Mindanao). LOCAL GOVERNMENT-CIVIL SOCIETY RELATIONS IN IROSIN, SORSOGON Irosin, Sorsogon is a rural municipality in the southeastern tip of Luzon Island in the province of Sorsogon in the Bicol region. It has a small population of 41,005 (1995 Census) and an area of 15,880 hectares. Irosin is a predominantly agricultural municipality, where 13,258 hectares are devoted to the production of major crops such as rice, abaca, citrus, coconut, vegetables and root crops. PRIMARY HEALTH CARE FOCUS The Municipal Health Office, which operates six clinics providing prenatal and postnatal care, implements the primary health care program. There are volunteer Barangay Health Workers (BHWs) whose tasks include weighing of children to determine presence of malnutrition, providing immunisation, and preparing data boards every quarter by indicating the status of each household using key health indicators including sanitation and family planning. BHWs are deployed in nine barangay health stations. They are assigned to puroks, each of which is composed of 25-40 households and directly supervised by midwives. The person responsible for putting Irosin into the limelight as the municipality reaped national awards and international recognition is Mayor Eddie Dorotan, a graduate of the College of Medicine of the University of the Philippines in Manila. Dr. Dorotan chose to return to his hometown to practice medicine and to be active in the voluntary sector. He was one of the founders of LIKAS (Lingap para sa Kalusugan ng Sambayanan or Caring for the Health of the People), a non-governmental organisation (NGO) initiated by the Center for Community Services of Ateneo de Manila University in 1979. LIKAS started its operation in Irosin in 1982, focusing on community-based health care. (Dr. Dorotan served as its coordinator in 1982-87.) Although the health project was doing well,
A component city is like a municipality in that the province (see Fig 1) supervises it. The province does not supervise highly urbanised cities.
3

LIKAS realised that in order to sustain the health programme an economic programme was needed. It organised farmers into a co-operative called Sandigan ng Magsasaka that started operating a rice mill and branched out to other activities. LIKAS started an Integrated Rural Development Programme in 1988 in the context of the national Comprehensive Agrarian Reform Programme (CARP). INTEGRATED DEVELOPMENT APPROACH In 1992, Dr. Dorotan ran for Mayor. When he won, he immediately held a strategic planning workshop and launched the Irosin Integrated Area Development Programme (IIADP). In planning his programme Mayor Dorotan involved the Municipal Development Council (MDC). Irosin's MDC has a large membership of 110, involving municipal officials and representatives of national agencies, NGO and PO representatives. The MDC identified five basic services and sought to improve their delivery--health, nutrition, and sanitation; social welfare; education and sports; transportation and communication; and physical infrastructure. In health, nutrition and sanitation, the focus was on the improvement of maternal and childcare services, immunisation, family planning, control of communicable diseases, nutrition, and environmental sanitation. To assure continued attention to land reform the Mayor created the Municipal Agrarian Reform Council (MARC) which has direct links with the Barangay Agrarian Reform Council (BARC). Thus, through the MDC and the MARC as well as through other organisations the Mayor created, co-ordination of efforts for the IIADP was assured. DIVERSIFIED FUNDING Funding for the entire programme comes from: 1. appropriations of the municipality for each of the services involved in IIADP, 2. financing of specific programmes from the central government, and 3. 20% development fund earmarked from the internal revenue tax shares (IRA) or internal revenue allotments of the municipality. The comprehensive land reform component led to the transfer of tenanted land to 594 beneficiaries in only five years. Of these, 528.21 hectares involve leasehold arrangement, benefiting 104 farmers and representing 69% of total land area targeted for distribution (Table 1). For this, Irosin received an award from Galing Pook.
Table 1: Hectares of Land Distributed and Number of Farmer-Beneficiaries Under the Agrarian Land Reform Program in Irosin, 1993-1997 Year No. of Land Distributed with Ownership Certificate of Land (Hectares 409.3251 54.1638 121.5569 507.9325 35.0439 No. of Lands in Leasehold Beneficiaries 503.2762 5.8852 17.3412 1.7159

1993 1994 1995 1996 1997

No. of Beneficiaries 228 22 55 269 20

No. of Beneficiaries 93 4 4 3

Total

1128.0222

594

528.2185

104

Source: Municipal Agrarian Reform Office, Irosin, Sorsogon, 1993-1997

EXCEEDING THEIR GOALS As the LIKAS programme started with health, health remains an I mportant concern of Irosin. The rural health unit of Irosin exceeded its immunisation targets for children 0-1 year old by 122% in 1993, 104% in 1994, and 117% in 1995 (Table 2). For nutrition, Irosin's programme showed drastic decreases in cases of malnutrition for children of pre-school age; reduction in first degree malnutrition by 44.44% in 1992, 38.53% in 1993, 35.77% in 1994, and 54.7% in 1995 (Table 3). Moreover, infant death had remained low because of the impressive accomplishments in health. Irosin received prestigious awards from both government and the private sector. LIKAS received two HAMIS awards. Table 2: Health Targets vs. Accomplishments, 1993-1995
Immunization of 0-1 yr. Child-Birth Deliveries Family Planning New Acceptors Current Users Target 1150 1343 576 1516 1993 Acc 1400 1060 374 617 % 122 79 65 41 Target 1199 1198 603 1306 1994 Acc 1242 1302 503 673 % 104 109 83 52 Target 1203 1203 603 1586 1995 Acc 1408 1338 290 989 % 117 111 48 62

Table 3: Malnutrition Profile in Irosin, 1992-1995

1992 No 1st Degree (Mild) 2nd Degree (Moderate) 3rd Degree (Severe) 3356 1655 % 44.44 22.34 No 3174 1410 1993 % 38.53 17.12 No 3.064 1205 1994 % 35.77 14.06 No 3029 1085 1995 % 34.7 12.4

231

2.82

173

2.10

145

1.69

118

1.3

STRONG NGO/PO PARTICIPATION One characteristic which sets Irosin apart from many other municipalities is that people are actively involved in NGOs and POs. While LIKAS may be considered as pioneer and catalyst for people's community participation, the local government unit itself under the leadership of Mayor Dorotan in 1992-98 provided the needed push for more active people participation in governance. The 1991 Code mandated the establishment of five local special bodies to involve people in governance. Irosin established more, bringing the total to 18 (Table 4). Unique to Irosin are the expanded Municipal Development Council of 110 members, the Municipal Agrarian Reform Council, the Municipal Tripartite Partnership on Upland Development, and the Municipal Traditional Medicine Council. In Irosin, the municipal officials, national government representatives, and the people work together in planning and implementation of anti-poverty project within the Integrated Area Development Programme. As chair of the MDC and other 5

bodies like the Municipal Agrarian Reform Council, Mayor Dorotan was able to steer the Council into activity following a common vision derived from a strategic planning workshop held as soon as he became mayor in 1992.
Table 4: Local Special Bodies Total Nos. of Members A. 1. 2. 3. 4. 5. 6. 7. 8. B. 9. 10. 11. 12. C. 13. 14. 15. 16. 17. 18. 1991 LGC Mandated LSBs Pre-qualification, Bids and Awards Committee Local School Board Local Health Board Peace and Order Council People's Law Enforcement Board Municipal Disaster Coordinating Council Liga ng mga Barangay Sangguniang Kabataan Federation LSBs Unique to Irosin Expanded Municipal Development Council Municipal Agrarian Reform Council Municipal Tripartite Partnership on Upland Development Municipal Traditional Medicine Council Others Office of Senior Citizens Affairs/Asso. Of Senior Citizens Irosin Waterworks and Sanitation Association Personnel Selection and Promotion Board Local Finance Committee Municipal Coordinating Team Local Price Control Council 8 8 5 8 5 12 28 28 110 11 27 10

873 1499 5 5 19 12

Source: Measuring Area Development in Irosin, Sorsogon By Florencia Casanova Dorotan Lingap para sa Kalusugan (LIKAS), Inc

IMPACT ANALYSIS From three focus group discussions held by our research staff in Irosin, we analysed the impact of the IIADP (which received another Galing Pook Award) using the following criteria: 1. people's awareness of the components of the programme, 2. their participation in its implementation, and 3. their assessment on how the programme has affected the quality of their lives. The discussions revealed that overall, the beneficiaries were aware of the programme components of land reform, health and sanitation, environmental protection, and livelihood. They also indicated that they were directly involved in planning programme activities and implementation since they provide data for planning and monitoring and their representatives are members of the Municipal Development Council. Although they cannot quantify the effects of their programmes in their lives, the majority noted improvements in their living conditions. They cited the following changes: increase in family income, increasing capacity to send their children to school, improved roads to provide their 6

access to markets and other service, and the presence of multi-purpose centers for their meetings, day care and other activities. While Irosin may not be an urban community with high income, it is a municipality where people feel better empowered and feel that the quality of their lives are changing for the better. As the quantitative data has shown, services were effectively delivered with achievements exceeding 100% of their objectives for some indicators. Quality of life as described, was measured only in qualitative terms, based on people's perception of their own improved conditions which they could not quantify. Mayor Dorotan and the municipality of Irosin were again cited for these programs. Irosin won the Konrad Adenauer Medal of Excellence in 1997.

THE MUNICIPAL GOVERNMENT OF BALILIHAN, BOHOL IN PARTNERSHIP WITH THE PEOPLE Balilihan, Bohol is a small rural town 22 kilometres from Tagbilaran City, the capital of the island province. Its population in 1996 was 15,439, with very low population increase. Farming remains the main source of livelihood for 70% of the population. PHC/CAP STRATEGY The Municipal Health Officer implemented the primary health care (PHC) strategy of the Department of Health in 1983. The PHC strategy utilises puroks in data gathering and implementation. When Edgar Chatto, an economics graduate from the University of the Philippines who later became a lawyer, won as Mayor in 1988 he decided to utilise the PHC mechanism to launch his Countryside Action Programme (CAP). CAP uses the PHC's purok-based strategy to pursue seven sectoral concerns: (1) health and sanitation, (2) agricultural development, (3) education, (4) livelihood and environmental protection, (5) peace and order, (6) infrastructure, and (7) youth and sports development. PUROK KIOSKS Mayor Chatto elicited the assistance of prominent members of the community to donate small pieces of land where purok kiosks were constructed. Each kiosk area is equipped with the following: purok records and charts, spot map, kitchen for feeding malnourished children, a water sealed toilet, a vegetable garden, an herbal garden, a medicine kit, and a compost pit. Purok members congregate in the kiosks for meetings and activities. Health activities involve immunisation, operation timbang (weighing of pre-school children) and nutri-feeding, and first aid remedies. Puroks have also embarked on income-generating projects, such as livestock dispersal, socialised credit, rice vending, peanut production, and vending of basic commodities. Funds for initial projects are raised from no interest loans given by the municipal government.

CAP ORGANISATION The CAP is systematically organised from the municipal to the barangay to the purok level, with rationalised linkages from one level to another. The Mayor serves as overall project director assisted by heads of technical departments in the municipality. At the barangay level, the barangay chairman serves as CAP chairman, assisted by the Councilmen. At the purok level the members (usually heads of the 15-25 households covered) select their chairman, secretary and treasurer, who elicit the support of the volunteers for each sectoral program (Figures 5 and 6).
Figure 5: CAP Organisational Structure, Purok Level, Balilihan Bohol

Purok Chairperson (Barangay Councilman)

Purok Secretary

Purok Treasurer

Health & Nutrition (Barangay Health Worker)

Infrastructure

Agriculture

Education

Peace & Order

Youth & Seniors

Livelihood & Environment

Note: BHW automatically becomes the assistance to the chairperson

Figure 6: CAP Organisational Chart, Municipal and Barangay Levels, Balilihan Bohol

Project Director (Municipal Mayor)

Head of Offices

Barangay Captain

National Government Agencies

Barangay Secretary

Barangay Treasurer

Barangay Councilman (BC) No. 1

BC Purok 1

BC Purok 2

BC Purok 3

BC Purok 4

BC Purok 5

BC Purok 6

CAP is financed from the development fund (composed of 20% of the municipality's shares from their internal revenue allotment), appropriations for the sectoral departments such as health, welfare, and agriculture and other sources of funds. Purok members contribute money or raise funds from income-generating projects. To make CAP work, the municipality launched a series of capability-building seminars to orient members to the programme as well as to provide them basic managerial skills. CAP's accomplishments were reported by the municipal government in 1996 for all sectoral areas (Table 5). While the reports do not show targets and rates of accomplishment, they do show activities by programme. This garnered a Galing Pook Award. ASSESSING SUCCESS Although purok leaders and residents in two focus group discussions conducted were not able to quantify their individual income gains as a result of CAP, they are nonetheless aware of their collectively improved living conditions. According to them they are now able to support their basic needs. Moreover, health education has helped them improve their personal health and environmental hygiene. 9

The people of Balilihan agree that CAP taught them that "in unity there is strength". Unity provides them the capability to improve the quality of their lives through: Congruence between central and local policies; Suitability of CAP programme to their needs; Dynamic leadership and support by the municipal government; and Efficacy of the purok as a mechanism for mobilisation and involvement. Table 5. CAP Sectoral Accomplishments, Balilihan, Bohol
SECTORS ACCOMPLISHMENTS The PHC has been strengthened Effective delivery of health services has been fast-tracked Propagated alternative herbal medicines Extended the expertise of the Barangay Volunteer Health Workers Establish the 2 Boticas Binhi ran by BHW with a plan to establish a botica for every 6 barangays = 1 health zone Construction, rehabilitation and improvement of purok kiosks complete with purok toilet, kitchen, herbal and vegetable garden, purok nursery, health data boards and other records Accomplished at least 95% of its 1996 Performance Targets Established a municipal nursery under the 20% Development Fund Established communal farms and introduced contour farming Developed vegetable and herbal gardens and introduced the same to every household, monitored such activity and conducted annual evaluation for the Annual Agro-Industrial Fair Distributed 90 sows and 10 boars under the swine dispersal program Introduced new technology to anthurium growers and cooperatives Trained agriculture volunteers in technology Initiated sessions on values re-orientation and moral recovery Conducted leadership training and skills development program Opened Non-formal Education in coordination with TESDA Established 31 barangay day care centers with the MSWDO Conducted information campaigns on education, causing enrolment rates to increase and lower drop-out rate Conducted seminar-workshop on income generating-project management Provided initial capital without interest to purok cooperatives Conducted tree-planting activities Actively participated in the Clean and Green Program Implemented the Bantay Lasang (forest watch) program Trained volunteer workers in livelihood and environmental protection Strengthened the crime prevention and detection system Developed the purok-based peace and order plan Organized citizens crime watch and volunteers Contributed in the eradication of insurgency problem Established the existing 186 purok kiosks or activity centers Trained volunteer infrastructure workers Monitored the implementation of various infrastructure projects Held yearly youth summer camp Sponsored sports activities, leadership training and organizational development seminars as income-generating activities Conducted Seminars on income-generating activities and project management especially for out-of- school youths

Health & Nutrition

Agriculture

Education

Livelihood & Environment

Peace & Order

Infrastructure

Youth & Sports

10

Source: Municipal Planning and Development Coordinator's Office, November 1996

Citizens agreed that CAP has fostered participation among the people and democratisation of the government structure. In Balilihan, NGO's are not as active as elsewhere. The focus of the activity is the purok where people themselves work for their own mutual welfare, with the financial support and motivation by the municipal government. WOMEN AND LOCAL GOVERNANCE: LESSONS FROM SURIGAO CITY Surigao City is the capital of the province of Surigao del Norte in the northeastern tip of Mindanao. While a city by nomenclature, it is actually an agricultural town, where 54.7% of its surface area is devoted to agriculture. Twenty-two of the city's 54 barangays are islands in the Surigao Strait. The 1995 census placed its population at 104,909. PHC MOTHERS CLUBS Surigao City is known to award-giving national and international bodies through its primary health care program initiated and implemented through women's clubs. In 1976 Mrs. Zenaida Arana, a midwife of the City Health Office assigned to two barangays, began organising mothers at the purok level and training them in nutrition, responsible parenthood, and sanitation so they could assist in the delivery of PHC services. Barangay Health Workers (BHWs) assisted Mrs. Arana in her pioneering tasks. By the 1980's mothers clubs had become very visible in the city. Because of their success, local politicians took advantage of them and converted them into their private organisation. This confused the members, and the organisation died within one year. It took Mrs. Arana two years of hard work in 1985 and 1986 to form another set of ten mother's clubs. LOCAL GOVERNMENT SUPPORT In 1988 the new City Health Officer gave recognition to Mrs. Arana's efforts and assigned her as overall coordinator of the primary health care programme for all 54 barangays of the city. Because of that support Mrs. Arana was able to organise a functional PHC Women's Club in all the barangays. In 1991 the groups formed a federation. In 1992 it became the Surigao City Primary Health Care Federated Women's Club, Inc., and since then has been instrumental in propagating the PHC strategy. FAMILY PARTICIPATION The women involved their husbands in primary health care activities. The men got into the program by organising the BESIG (Barangay Environmental Sanitation and Implementing Group). The PHC Youth composed of 12-21 year-old family members and the Mini-Youth (from 7-12 years old) were subsequently organised by Mrs. Arana. By 1990 BESIG had become an indispensable partner of the PHC womens clubs. TRAINING AND AWARENESS The PHC activities involve immunisation, family planning, nutrition, implementation of the national tuberculosis programme, and control of the diarrhoeal projects. Believing in the capacity of mothers to implement PHC, the programme put emphasis on training women in leadership, 11

community development, and management. PHC also runs a weekly radio programme to promote health awareness and serve as a communications facility among the members. ORGANISATION The federation is organised like a pyramid, with the 7,200 members of 180 chapters at the base. The chapters are grouped into seven districts composed of five to 12 contiguous barangays (Figure 7). Each level of organisation has its own set of officers, including its representative to the next higher level. The PHC structure involves the City Mayor and Vice-Mayor as PHC Committee chair and co-chair, respectively. Mrs. Arana remains as PHC Coordinator and adviser. Figure 7: Structure of the Surigao City PHC, Federated Womens Club Inc.

12

City Level

Federation

Districts (7)

District Level

PHC Integrated

Barangay Level

Chapters (180)

Purok/Sitio Level

Grassroots Level

Individual Members (7,200)

FINANCING The PHC gets financial support from the development fund (20% of the City's IRA). The City budget also funds its health projects. However, the organisation is essentially self-supporting. The annual membership fee is P10.00 (ten pesos). Each member also contributes P60.00 a year for funeral assistance to members. The organisation also raises funds from special projects and accepts donations from external sources; cash awards from HAMIS (Health and Management Information System) in 1991 and 1994 went into the financing of PHC activities. MEASURING SUCCESS Infant mortality in Surigao City was a high 76.6% in 1981 and 69% in 1984. After PHC became active it was drastically reduced to 29.5%. By 1996 it was only 19.1%. Maternal mortality rate also went down from 1.9% in 1975 to .5% in 1996. In the years PHC was inactive, both infant and maternal mortality rates were high. Nutrition rates for pre-school children have also improved. In 1980 there were only 38.1% of children who had normal weights. Although the figures fluctuated, the rates were lowest when 13

PHC was inactive. In the last few years of PHC's re-emergence the rate of children with normal weights had been high--- 54.7% in 1992, 59.19% in 1993, 61.02% in 1995, and 62.54% in 1996. The establishment of BESIG in 1990 has increased household access to sanitary toilets (Table 8). Conversely, households without access to sanitary toilets decreased at a rate of 31% in 1990-96. These figures show the impact of the PHC Women's Club in the lives of Surigao City residents. Table 8: Households with Sanitary Toilets, From 1883 - 1995
Year 1993 1994 1995 Total No. of Households 6,745 6,936 6,948 Households With Sanitary Toilets 5,021 4,902 4,785 Percentage 74.44 70.67 68.86

In focus-group discussions held in January 1998 PHC leaders validated the official statistics above. They recognised the emergence of a higher level of health consciousness in the community as a result of the program. They also observed the marked decline in the incidence of communicable diseases. Their health and mortuary contributions have also eased the burden of expenses when emergencies occur. The PHC programme has actively involved the people at the grassroots. Participation is achieved through the network of community organisations, which makes it easier for the city government to deliver services to the people. Moreover, the PHC/BESIG/Youth organisations have brought families closer, working for causes that also benefit them.

PART 3: ANALYSIS OF KEYS TO SUCCESS

The Ingredients for Success stem from establishing a Local Government Partnership with the People. Several key factors contributed to this possibility. WINDOW OF OPPORTUNITY These three cases show that, while all programmes were initiated before the passage of the Local Government Code, the Code provided local officials the needed impetus to accelerate programme activities. In the case of Irosin the NGO leader ran for public office in 1992 just when the Code was implemented. From his new position as Mayor, Dr. Dorotan was able to utilise the government's resources to promote the NGO programme, which was adopted and elaborated upon by the community. Mayor Chatto of Balilihan, who adopted the primary health care approach in implementing his project, was able to earmark municipal resources to support his project. In Surigao City the midwife (Mrs. Arana) worked alone and was relatively successful, but became more effective when she received the imprimatur from the City Health Officer to co-ordinate the PHC programme city-wide. LOCAL GOVERNMENT UNIT ADOPTION All three cases show the need for the LGU to adopt the programme. No matter how active NGOs are, they cannot be very effective without the support of government. On the other hand, the LGU cannot give much support unless it adopts the programme as its own. The cases showed that, with 14

the adoption of the programme the LGUs were able to directly provide resources to them. As shown, the local officials earmarked their 20% (IRA) development fund for the implementation of their programmes, and appropriated funds from the sectoral departments to further support them. No matter how poor a community is, government always has command of available resources. STRATEGIC INITIATION The case studies also show that different actors initiated the programmes in different ways. In Irosin, an NGO started the programme by first organising the community. The people were given training in skills such as sanitation and given exposure to new knowledge, such as gender sensitivity, and organised into co-operatives. By the time the programme itself was implemented, the people were ready to assume responsibilities. In Balilihan, the Mayor himself initiated the programme and organised the people as purok members. In Surigao City a midwife initiated the programme and organised the women to implement it. The variety of approaches suggests that each was strategically appropriate to the setting in which it was initiated and a one-shoe-fits-all strategy was not the case. DYNAMIC CATALYST In all these cases, what is evident is that, each programme needed a dynamic catalyst or change agent. This factor was observed in an earlier study of successful cooperatives.4 The catalyst in Irosin was the NGO, LIKAS; in Balilihan, the Mayor himself, with the help of the Municipal Health Officer; in Surigao City, the midwife. All the catalysts started by organising the people to prepare them to perform tasks to meet the desired ends related to their own needs. ESSENTIAL PARTICIPATION Perhaps, what makes the three cases similar, and what makes them really interesting, is the clear role that participation plays in the success of the programmes studied. The Irosin case illustrates best the important role of LGU/People partnerships. LIKAS, working on its own, involved the people. When the Mayor adopted the enlarged programme he involved the people actively in many aspects. First, he involved all organisations in the strategic planning workshop at the start of his term. Then, to assure continued support from the NGOs he coopted them as members of the Municipal Development Council (MDC) thus increasing its membership to as much as 120. Through the MDC, continuous project identification is made possible, and implementation of the programme is monitored. Service delivery also involves the people in co-operative, health and farming activities. In Balilihan, the people directly participate as residents of the purok. The purok plans its activities, raises part of the funds to support them, and implements the projects. For instance, each purok seeks loans for livelihood projects from the municipal government and then undertakes the projects. In Surigao City the people participate in health-related organisations--mothers, fathers, and children alike. They plan, seek funds for, and implement their own activities. Perhaps the most sophisticated form of participation is found in Irosin where people are organised and participate in municipal activities as organisations . The municipality has also
4

See Perla E. Legaspi. The Genesis, Viability and Effectiveness of Community Organizations: The Case of Pangasinan Credit Cooperatives. Local Government Center, UP. 1990

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institutionalised their participation through local special bodies which are in fact more than mandated by the Local Government Code. In Balilihan, people's participation is through the local government-initiated mechanism in the puroks, while in Surigao, it is through organisations initiated by the City Health Office. In our observations in the field and our focus group discussions with community leaders and residents, we found that: The people are enthusiastic and feel empowered. They know their participation counts. They are not only consulted, they do actual planning. They are not only beneficiaries, they directly participate in project implementation. Moreover, they know they are the beneficiaries.

SUSTAINABILITY They also assert that, with their local leadership and their own sense of empowerment, they have been able to sustain the programmes, and think they will be able to sustain them. Many of them have internalised the values learned in the program --unity in Balilihan, family solidarity in Surigao, and outright empowerment in Irosin. In Irosin, in fact, people have imbibed gender sensitivity. This is shown in their attitudes toward women working outside the home and men's shared family responsibilities. In all three cases, partnership between the government and the people has been institutionalised at the local level. Whatever the window of opportunity, strategic approach, or leadership quality, without broad-based participation and the acceptance it connotes, sustainability would be dubious. Qualitative and Quantitative Measures. Without scientific quantification, people in all three cases assert that the quality of their lives has improved because of the programmes. They conclude they are better able to send their children to school, fix their houses, and have food on the table, even if they are not financially richer as a result of the programmes. Health, nutrition, agricultural productivity, and land reform statistics in all three locations have shown marked improvement after the participative mechanisms for programme design and implementation were in place. As mentioned in the programme description preceding these official statistics were validated by people's impressions during the focus group discussions.

PART 4: POLICY LESSONS LEARNED FROM SUCCESS

The decentralisation efforts in the Philippines have been hailed by observers within and outside the country as examples of real devolution. The Philippine government encountered initial problems in the implementation of the Local Government Code, but by and large, the promises of the Code have been fulfilled in many areas. These three case studies illustrate the success of devolution in the Philippines and provide lessons for replication of the programme in other areas of the country. It must be cautioned, however, that devolution cannot be imposed, nor can it be expected to succeed in all areas simply because it is available. It may, in a gradual process, succeed in the 16

end, but, as the case studies have shown, certain ingredients have to be present for it to succeed. In some areas, as in the case studies, the ingredients are already well in place. Others have these factors gradually developing, while in many areas they still have to emerge. The Lessons Learned from the municipalities of Irosin and Balilihan and the City of Surigao are as follows: CHANGE AGENT (1) In the initiation of programmes that involve the people, a change agent with whom the people can identify must be able to organise the people and enable them to plan and implement their own programmes. In each area studied there was a different type of change agent/catalyst. In Irosin it was a group of persons in the NGO LIKAS; in Balilihan it was the Municipal Health Officer; in Surigao it was a midwife in the City Health Office. Through their efforts the people were organised. Irosin perhaps had the most sophisticated approach since the NGO has fairly advanced methods and a strategic plan. COMMUNITY ORGANISING (2) Community organising is a vital preparation for community action and must be done by the people themselves, with assistance from a catalyst they identify with. The NGO in Irosin organised people at the barangay level, first for health service delivery and later for livelihood projects. LIKAS sustained the organising efforts through various training and workshops to provide skills and knowledge to sustain their organisations. In Balilihan the purok was strengthened as a mechanism for delivering services. Training became a continuing process. In Surigao women were organised into Mothers Clubs to assist in health service delivery. Later the PHC gave birth to the organisation of fathers and children. FINANCIAL SUPPORT (3) The enlargement of decentralised programmes needs the financial support of government. The local leader plays an important role in harnessing government resources for the program and providing guidance if not direction. Mayor Dorotan of Irosin had been exceptionally effective because he came from the change organisation that initiated the programme. His election as local chief executive made the programme vibrant. He involved the people directly in the municipal planning process and in the implementation of those plans. He infused the programme with funds and, due to his track record in LIKAS, was able to get additional external funding. For Balilihan, the leadership of Mayor Chatto propelled the puroks into greater activity. He was able to provide funds for programmes and the direction needed. Surigao Citys mayor let the womens club perform its functions unhampered, but provided it with logistical support. POLITICAL SUPPORT (4) The Local governments support to organised communities led to effective partnership between the government and the people. Together, the government leadership and the peoples organisations worked towards the attainment of the programme goals. 17

Empowered communities with the support from the local government have led to effective delivery of services to the people and eventually, to the people concluding that the quality of their lives has improved. In Irosin the researchers observed that the people have high morale, are convinced that they are empowered, and that they live better lives. In Balilihan, the sense of community is strong. People are used to doing things together and feel confident that their joint efforts contribute to their individual well being. Surigao Citys women and men have found that working in complementary community activities is a means for strengthening their domestic partnership. In all the areas, confidence that the local government continues to support their efforts boosts the morale of the people. EFFECTIVE DELIVERY THROUGH PARTNERSHIP (5) Because of the partnership between the local government and the people basic services are more effectively delivered. Accomplishment reports by the LGUs show that strides have been made towards better health conditions, improved agricultural productivity (as in Irosin), effective livelihood projects (as in Balilihan) and increased sanitation (as in Surigao City.) Moreover, the people validate these improvements, are satisfied with the service and are proud of their role in its delivery. IMPROVED QUALITY OF LIFE (6) The successful outcome of local government-people partnership is a better quality of life for the people. While statistics cannot back up this assertion and the people cannot t lk in terms of increased a income, most of those who attended the focus group discussions could categorically say that the quality of their lives had improved. They are able to meet their minimum basic needs, and more.

CONCLUSION
In the Philippines, government policies on decentralised governance have served as an impetus for local leaders and people to embark on development programme for sustainable development at the grassroots level. However, these alone are not enough. Such programmes need the efforts of empowered communities who have been initially organised by dynamic catalysts, and the continuing support of the local leaders who are able to commit government resources to sustain these activities. Success, after all, is being able to meet the goals set forth in a programme. In the Philippines, the requisites of success in local development programmes are empowered communities, dedicated leaders, and forward-looking decentralisation policies. Although our study covers only three areas, they were carefully chosen in terms of relative homogeneity. Our framework can be used to study other areas of decentralised governance in the country.

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C. Documents City of Surigao. Surigao City Primary Health Care Federated Women's Club, Inc. Presentation Script. n.d. _______. Socio Economic and Physical Profile of Surigao City. 1997. _______. Surigao City Development Plan, 1993-1998. 1993. _______. Surigao City Annual Report. 1986-1996. Municipality of Balilihan, Bohol. Statement of Sectoral Development (Accomplishment) During the Implementation of the Countryside Action Program. n.d. _______. Unnumbered Ordinance Institutionalising the Purok System in the Balilihan CAP in Every Barangay Within the Municipality. 1997. _______. Utilisation of the 20% Development Fund for CY 1997. Municipality of Irosin, Sorsogon, Executive Agenda for the Municipality of Irosin, 1992-95. 1992. _______. Executive Order No. 5 "Creating the Traditional Medicine Coordinating Council for the Municipality of Irosin, October 28, 1996. _______. Municipal Budget, FY 1998. _______. Report to the People, 1996-97 D. LIKAS Publications Dorotan, Florendo C. "Measuring Area Development in Irosin, Sorsogon. LIKAS. 1996. Irosin Cooperative Federation: A Profile. 1996. _____. Strategic Assessment and Planning. 1994. Sandigan ng Magsasaka: Organisational Profile. 1995. Republic of the Philippines. Republic Act 7160, The Local Government Code of 1991. _____. The Social Reform Agenda. 1994.

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