Progress and Challenges of Local Governments in Implementing the Philippine Universal Health Care Act: A Multiple Case Study of Advanced Implementation Sites
1
Institute of Public Health, Jagiellonian University, Krakow, Poland
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
The Philippines enacted the Universal Health Care (UHC) Act in 2019, representing a major policy shift toward equitable access to affordable and quality health services for all Filipinos¹–². The law mandates coordinated action across multiple levels of governance, with local governments playing a central role in integrating health systems and addressing long-standing fragmentation³–⁵. Understanding how local governments implement UHC is critical, particularly among advanced implementers navigating decentralized contexts.
METHODS:
This study examined the progress of advanced UHC implementers through a multiple embedded case study design involving three provinces (Tarlac, Quezon, and Oriental Mindoro), their selected municipalities, and one highly urbanized city, Puerto Princesa. Data sources included a comprehensive review of national and local UHC policies, implementation records, and semi-structured interviews with stakeholders at the regional, provincial/city, and municipal levels. Data were analyzed to generate contextualized insights into implementation processes, challenges, and enabling factors.
RESULTS:
National policies provided a foundational framework, particularly in primary care, service delivery, health financing, and managerial integration. However, local implementation outcomes were shaped by contextual factors. Key enablers included proactive provincial leadership, capacity-building initiatives, stakeholder engagement, and the presence of implementation incentives. Persistent challenges involved political fragmentation, delayed or unclear operational guidance, policy gaps, and resource constraints. Five years after enactment, study sites showed notable progress but continued to face difficulties in achieving full financial integration, meeting primary care facility standards, addressing human resource shortages, and establishing interoperable health information systems.
CONCLUSIONS:
The findings highlight the importance of adaptive governance, sustained technical support, and policy flexibility to respond to local contexts. These insights contribute to a deeper understanding of UHC implementation in decentralized settings and offer practical considerations for strengthening nationwide health system integration.
The Philippines enacted the Universal Health Care (UHC) Act in 2019, representing a major policy shift toward equitable access to affordable and quality health services for all Filipinos¹–². The law mandates coordinated action across multiple levels of governance, with local governments playing a central role in integrating health systems and addressing long-standing fragmentation³–⁵. Understanding how local governments implement UHC is critical, particularly among advanced implementers navigating decentralized contexts.
METHODS:
This study examined the progress of advanced UHC implementers through a multiple embedded case study design involving three provinces (Tarlac, Quezon, and Oriental Mindoro), their selected municipalities, and one highly urbanized city, Puerto Princesa. Data sources included a comprehensive review of national and local UHC policies, implementation records, and semi-structured interviews with stakeholders at the regional, provincial/city, and municipal levels. Data were analyzed to generate contextualized insights into implementation processes, challenges, and enabling factors.
RESULTS:
National policies provided a foundational framework, particularly in primary care, service delivery, health financing, and managerial integration. However, local implementation outcomes were shaped by contextual factors. Key enablers included proactive provincial leadership, capacity-building initiatives, stakeholder engagement, and the presence of implementation incentives. Persistent challenges involved political fragmentation, delayed or unclear operational guidance, policy gaps, and resource constraints. Five years after enactment, study sites showed notable progress but continued to face difficulties in achieving full financial integration, meeting primary care facility standards, addressing human resource shortages, and establishing interoperable health information systems.
CONCLUSIONS:
The findings highlight the importance of adaptive governance, sustained technical support, and policy flexibility to respond to local contexts. These insights contribute to a deeper understanding of UHC implementation in decentralized settings and offer practical considerations for strengthening nationwide health system integration.
| eISSN: | 2654-1459 |
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