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Evaluation of Health Facilities Enhancement Program
Oscar PicazoIda Marie PantigDanica Aisa Ortiz
Nina Ashley Dela CruzMelanie Aldeon
Juan Alfonso Tanghal
1
Philippine Institute for Development StudiesSurian sa mga Pag-aaral Pangkaunlaran ng Pilipinas
www.pids.gov.ph
June 15, 2016
Outlinei. Introductionii. Background of the studyiii. Phase 1: Process Evaluation
Receipt, completion, functionality and sustainability of HFEP investments
iv. Phase 2: Impact Evaluation Assessment of net effect of the program (utilization)
v. HFEP General Findingsvi. Policy Options
2
Introduction
3www.pids.gov.ph
Health Facilities Enhancement Program (HFEP)Health Facilities Enhancement Program is one of the banner programs of the Aquino Administration for the upgrading of facilities through investments in infrastructure and medical equipment.
HFEP aims to:
(1) upgrade priority BHSs and RHUs to provide BEmONC services for the reduction of maternal mortality;
(2) upgrade government hospitals and health facilities in provinces to make them more responsive to the health needs of the catchment population;
(3) upgrade lower level facilities to be able to accommodate nursing students and to establish gate-keeping functions to avoid congestion in higher level hospitals, and;
(4) expand the services of existing tertiary hospitals to provide higher tertiary care and as teaching, training hospitals.
4
Priorities:o2010: B/CEmONC, blood facilities in regions with high MMR
o2011: BEmONCs, DOH hospitals
o2012: government hospitals; expansion of tertiary hospitals
o2014: centralized bidding for equipment (big ticket items) and procurement
o2015: NHTS/GIDA/NAPC areas; non-compliant hospitals (DOH and PhilHealth)
o2017: upgrading of Level 1 to Level 2 DOH hospitals; psychiatric health services; MOOE budget for hiring, monitoring and evaluation, etc.
5
0.0441.7 2.1
3.3
7.15.1
10.7 9.3
13,271,393,000.0
billion
26,872,368,000.0 billion
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
HFEP budget has swelled to PHP 26.9 billion in 2016
from PHP 43 million in 2007.
Source: General Appropriations Act
Health Facilities Enhancement Program (HFEP)
Background of the Study
6
Background of the Study
2013: DBM requested PIDS to conduct an impact evaluation of big ticket government projects
HFEP Impact Evaluation at PIDS:◦Phase 1: Process Evaluation (June 2014-April 2015)◦Phase 2: Impact Evaluation (May 2015-January 2016)
7
Literature Review
8
Available literature on the HFEPBontile, HL (n.d.). An Assessment of Change in the Utilization of DOH Retained Hospitals with the Implementation of Health Facility Enhancement Program, 2009-2012. HPDPB. Department of Health.
Coenegrachts, M, JM Nanagas, OF Picazo, J Sharpley (2012). Final Evaluation of the Health Sector Policy Support Project I and II and the Mindanao Health Sector Policy Support Project. Report Submitted to the European Union.
Lavado, RF (2011). Improvement of the Implementation Procedures and management Systems for the Health Facilities Enhancement Grant of the Department of Health. Philippine Institute for Development Studies. July.
Matsuda, Y (2013). Detailed Program Review: Health Facilities Enhancement Program, Department of Health. The World Bank. May. Unpublished draft.
Sepe, SC (n.d.) A Descriptive Study on the Utilization of Maternal Care Services Among Selected Rural Health Units Given 2011 Health Facilities Enhancement Program Funding. HPDPB. Department of Health.
Literature Review
9
HFEP Process for:Identification and Planning Lacks technical rigor No link between allocation and province’s poverty
incidence/needs based on PIPH Serious design limitationsBudget Allocation and Control Delayed and abandoned projects due to poor
internal control Underestimation of time and resource constraintsProject Execution and Completion 2009-2010: 200-300 days before funds are released Delays in completion due to micromanagement
Effectiveness and Cost-effectiveness Certain investments were able to correct existing
spatial maldistribution of facilities But there were also facilities that were built too close
to each other/lacked geographic planning No other literature were located on cost effectiveness
Functionality and Availability of Services and Commodities BEmONC RHUs had improved service abilities after
HFEP investments Serious stockouts in FP commodities and
occasional stockouts for TB drugs and kits (2013-2014)
Utilization of Services in Hospitals Evidences of increased utilization of outpatient and
inpatient services in DOH hospitals which received HFEP
Sustainability of Financing Downward trend of LGU financing to hospitals at the
time when HFEP allocations are increasing
10
Purpose of the study◦ State of funding and completion of HFEP projects◦ Functionality of the completed projects◦ Utilization of health services◦ Sustainability of HFEP investments
Scope of work of the studyBudgeting &
allocationCosting &
procurementProject
implementation & completion
Functionality and utilization Sustainability
Not covered Covered
Objectives, Scope of Work
Sources of Data
11
Secondary data• Philippine Statistical Yearbooks• DOH Health Facilities Development Bureau
Hospital Statistical Reports (HSR)Individual Facility Survey Basic Facility Profile
• Emergency obstetric capacity• License level of facility
HFEP Support Received• HFEP Investments (Infrastructure and Equipment)• Completion and Functionality of Investment• Infirmary and Hospital Capacity• Problems Encountered: HFEP Infrastructure and Equipment• Marginal Impact of HFEP
Outputs and Operational Indicators• Number of birth deliveries per month, inpatients per day and
OPD consultations per day• PS and MOOE support• PhilHealth accreditation, reimbursements and members
Survey Instrument of HFEP Impact Evaluation Facility Code No. _____________________________
Respondent’s Name: _________________________________________________________________
Position: _________________________________________________________________
Phone No.: _________________________________________________________________
E‐mail: _________________________________________________________________
SECTION A: BASIC FACILITY PROFILE
1. Name and Location of Health Facility: i. Name of health facility ________________________________________________ ii. Barangay of _________________________________________________________ iii. Municipality of _______________________________________________________ iv. Province of __________________________________________________________
2. Type of Health Facility: Encircle appropriate number and letter
i. (a) Stand‐alone BHS ii. (a) RHU; (b) CHU iii. Infirmary or hospital
3. Emergency obstetric capacity: Encircle appropriate number
i. BEMONC ii. CEMONC iii. No emergency obstetric capacity
4. Licensed Level: Ask about the licensed level of the hospital, before 2013 and at present. (Check
appropriate cell.)
License Level License level before 2013
License level at present
Infirmary
Level 1
Level 2
Facilities Visited31 Provinces
174 RHUs, BHSs, CHOs
123 Hospitals and Infirmaries
PIDS determined the provinces and municipalities, but PHO/PEO modified sampling of health facilities based on logistics
No BHSs were included due to budgetary and time constraints
No DOH-retained hospitals were included
12
Provinces visited
Facilities VisitedPhase 1: 18 RHUs; 19 hospitalsPhase 2: 156 RHUs; 104 hospitals
13
Provinces BHSs, RHUs and CHOs Infirmaries and Hospitals
Camarines Sur 8 4
Camiguin 4 2
Cebu 6 3
Compostela Valley 4 2
Davao del Norte 5 3
Ilocos Norte 6 5
Laguna 6 6
Misamis Occidental 8 6
Misamis Oriental 3 4
National Capital Region 3 1
Negros Oriental 6 6
Palawan 7 3
Pangasinan 6 7
Romblon 9 4
Sarangani 5 3
South Cotabato 3 4
Southern Leyte 6 6
Surigao del Norte 7 3
Sorsogon 6 6
Zambales 8 3
Total 156 104
Phase 1: Process Evaluation (June 2014-April 2015)Provinces BHSs, RHUs and CHOs Infirmaries and Hospitals
Tarlac 3 1
Quezon 1 3
Capiz 4 2
Zamboanga del Norte 6 3
Surigao del Sur 2 4
Catanduanes 2 6
Total 18 19
Phase 2: Impact Evaluation (June 2015-January 2016)Provinces BHSs, RHUs and CHOs Infirmaries and Hospitals
Agusan del Norte 7 3
Aklan 4 3
Antique 5 5
Batangas 9 6
Benguet 8 5
Biliran 7 1
Survey Results:Completion and Functionality
14
Completion and Functionality
4
3.7
3
1.8
1
0 1 2 3 4 5
Level 2 hospital
Level 1 hospital
Infirmary
Rural or city health unit
Birthing clinic, stand-alone
Average number of years it takes to complete HFEP-supported facilities
15
Source: This study
Type TotalFunctionality
Completed OngoingFully Functional
Partly Functional
Non-functional
RHUs & birthing centers 23 11 5 5 21 2Hospitals & infirmaries 19 8 5 1 14 5Total 42 19 10 6 35 7
16
Completion and functionality
Balaoang RHU Birthing Center,Paniqui, Tarlac
No doctor
Caramoran District Hospital, Catanduanes
Adult male and female wards not separated; toilet not separated
Source: This study
17
83
28
22
22
17
11
11
11
0 10 20 30 40 50 60 70 80 90
Facilities that reported any problem
Decanting of patients while infra isongoing
Delayed startup of infra
Minor defects in infra
Major defects in infra
Delayed completion of infra
Incorrect specifications of completedinfra
Poor siting
Share (%) of RHUs and birthing centers that encountered problems in
civil works
Baras-baras RHU, TarlacMinor and major defects
Hinatuan RHU, Surigao del SurConstruction delay
Ivisan RHU, CapizPoor quality
Source: This study
Share (%) of hospitals and infirmaries that encountered problems in civil works
84
26
26
26
21
21
11
11
5
0 10 20 30 40 50 60 70 80 90
Health facilities that reported any problem
Delayed completion of infra
Minor defects in infra
Delayed startup of infra
Variance between approved HFEP infraand licensed level of facility
Inadequate funding to complete infra
Major defects in infra
Incorrect specifications of completed infra
Decanting of patients while construction isongoing
Source: This study
Manukan CH, Zambo del Norte
Poor decanting of patients while construction is going on
Cortes MH, Surigao del Sur
Unfinished constructions; x-ray room not up to standard; additional funding shouldered by PLGU
Sen. G. Roxas Mem DH, CapizApproved by HFEP as Level 1
hospital; declared by Licensing Unit as infirmary
Triangulation: % of health facilities that completed HFEP-requested civil works as scheduled, based on KP OM system of HPDP
43.5
47.3
51
2013 3RDQ 2013 4THQ 2014 1STQ
Subprovincial/District Hospitals
48.744
58.7
2013 3RDQ 2013 4THQ 2014 1STQ
Rural Health Units
Source: Tan/HPDP, 2014
Share (%) of RHUs and birthing centers that encountered problems in the delivery and installation of medical equipment
89
28
28
17
11
11
11
6
6
6
0 20 40 60 80 100
Health facilities that reported any problem
Nondelivery of equipment
Delivery of unrequested, unnecessary, orduplicative equipment
Value of equiment deemed much less thanclaimed
Too early delivery of equipment
Delivery of inferior or substandard equipment
Late delivery of equipment
Voltage problems with major equiment
Delayed installation and lack of orientation onequipment installation and calibration
Locally unavailable consumables and spareparts for major equipment
Source: This study
Almost everywhereEquipment waiting to be installed
Zamboanga del Norte RHUsRaining with microscopes
San Miguel RHU, Catanduanes
Dental chair with faulty hydraulics
Pres. Roxas RHU, Capiz
Voltage problems
Pres. M.A. Roxas RHU, Zamboanga del NorteDental chair won’t fit in dental room
Share (%) of hospitals and infirmaries that encountered problems in the delivery and installation of medical equipment
74
47
26
21
16
16
16
16
16
11
5
0 10 20 30 40 50 60 70 80
Health facilities that reported any problem
Nondelivery of equipment
Delivery of inferior or substandard equipment
Delivery of unrequested, unnecessary, orduplicative equipment
Late delivery of equipment
Voltage problems with major equipment
Delayed installation and lack of orientation onequipment installation and calibration
Lapse of warranty period prior to use and poorafter-sales servicing
Locally unavailable consumables and spareparts for major equipment
Value of equipment deemed much less thanclaimed
Too early delivery of equipment
Source: This study
Tarlac PH and 2 hospitalsLapse of warranty period prior to use
and poor after-sales servicing
Viga DH, Catanduanes; ManukanCH, Zambo Norte; and other
hospitalsDelayed installation of equipment
Nine infirmaries and hospitals
Non-delivery of equipment
Triangulation: % of health facilities that received HFEP-requested equipmentas scheduled, based on KP OM system of HPDP
44.2
43.1
40
2013 3RDQ 2013 4THQ 2014 1STQ
Subprovincial/District Hospitals
64.3
4953.4
2013 3RDQ 2013 4THQ 2014 1STQ
Rural Health Units
Source: Tan/HPDP, 2014
Survey Findings: Utilization and Sustainability
Average number of patient consultations per day in RHUs
20
35
60
70
70
100
100
100
0 20 40 60 80 100 120
Pres. Roxas, Zambo Norte
Pres. Roxas, Capiz
Katipunan, Zambo Norte
Sindangan, Zambo Norte
Viga, Catanduanes
Hinatuan, Surigao del Sur
San Agustin, Surigao del Sur
San Miguel, Catanduanes
Source: This study
San Miguel RHU J. Aguirre Birthing Center
Viga RHU
Generally high utilization rates of RHUs
Average number of birth deliveries per month in RHUs and birthing centers
300
97
90
50
35
30
25
25
20
17
14
12
9
0 50 100 150 200 250 300 350
Polanco, Zambo NorteSan Miguel, Catanduanes
Tayabas CHO, QuezonPres. Roxas, Capiz
Pres. Roxas, Zambo NorteKatipunan, Zambo Norte
San Agustin, Surigao del SurPanitan, Capiz
Baras-baras, Tarlac CitySigma, Capiz
J. Aguirre Birthing Center, Manukan,…Ramos, Tarlac
Rizal, Zambo Norte
Source: This study
Polanco RHU
Katipunan RHU
San Agustin RHU
Average number of OPD consultations per day in hospitals and infirmaries
150
90
70
65
55
50
38
35
32
30
25
23
13
10
0 20 40 60 80 100 120 140 160
Eastern Bicol MCGumaca DH
Roxas Memorial PH OPDBislig DH
A.S. Ty MMCHinatuan DHPandan DH
Candelaria MHJuan M. Alberto MDH
Viga DHBato MCH
Caramoran MHGuinayangan MH
Cortes CH
Source: This study
Bislig DH, Surigao del Sur
Roxas Memorial PH OPD, Capiz
Gumaca DH, Quezon
Share (%) of facilities accredited for PhilHealth benefit packages after HFEP, 2015
RHUS & BIRTHING CENTERS
74% 68%80%
14%
TB DOTS Maternity CarePackage
OutpatientBenefit
Package/PCB1
Animal BiteClinic
HOSPITALS & INFIRMARIES
42%
100%
53%38%
100%
TB DOTS MaternityCare
Package
NewbornScreening
Animal BiteClinic
In-patientcare
Source: This study
PhilHealth in Hospitals
40
40
46
50
50
63
65
65
78
80
95
0 20 40 60 80 100
Bato MCH
Viga DH
J.M. Alberto MDH
Caramoran MH
Pinan DH
Pandan DH
Hinatuan DH
A.S. Ty MMC
Sindangan DH
Bislig DH
Guinayangan DH
Share (%) of inpatients enrolled in PhilHealthin hospitals and infirmaries, 2015
91 45 15 16 7 6 3
64
24 23
12
6.2 4.90.6
0
10
20
30
40
50
60
70
0
10
20
30
40
50
60
70
80
90
100
In m
illion
pes
os
Annual PhilHealth revenues (PHP Mn) and daily PHIC inpatients in hospitals and infirmaries, 2015
PHIC Inpax Per DayPHIC Revenues Per Year
Source: This study
How to measure trends and patterns for “with” and “without”
36
Comparison of trends for the period 2006-2015 for facilities “with” and “without”* HFEP
Comparison of trends for “with” and “without” facilities before, during and after HFEP
*“Without” HFEP includes facilities with grants for infrastructure not directly related to the delivery of medical care (e.g. waiting shed, etc.)
The positive result of HFEP was evident in hospitals for inpatient care.
37
81 8286
94 96 95
111117
122114
2529 29 29 31 34 36
3239
48
0
20
40
60
80
100
120
140
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average number of birth deliveries per month
With HFEP (n=77) Without HFEP (n=6)
65 6468
72 73 72 73 73 73 71
28 29 28 26 28 29 31 3237
49
0
10
20
30
40
50
60
70
80
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average number of outpatients per day
With HFEP (n=76) Without HFEP (n=6)
37 3840
45
49 5052
56 57 57
17 17
28 2831
28 27 2826
14
0
10
20
30
40
50
60
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average number of inpatients per day
With HFEP (n=77) Without HFEP (n=6)
Results for RHUs “with” and “without” HFEP on utilization did not come out as expected.
38
47 49 48 47 48 46 46 46 49
24
4448 48 50 52
56 5663
73
88
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average number of birth deliveries per month in RHUs and CHOs with and without HFEP, 2006-
2015
With HFEP (n=8) Without HFEP (n=8)
49 52
60 60 62 6268
7781
86
4448 50 52
56 5663
73
8488
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average number of outpatient consultations per day in RHUs and CHOs with and without HFEP,
2006-2015
With HFEP (n=9) Without HFEP (n=9)
Defining Before, During and After HFEP
2007 2008 2009 2010 2011 2012 2013 2014 2015Facility 1Facility 2Facility 3Facility 4Facility 5
39
BeforeDuringAfter
Before, During and After HFEPThere are three challenges of making a “before and after” HFEP comparison of health facilities.
I. The staggered and prolonged construction and rehabilitation period requires health service data running as far back as ten years. For instance, the Sarrat RHU (Ilocos Norte) and Cuenca District Hospital (Batangas) has taken as long as 7-9 years, and they are still not finished. Typically, an RHU takes 2-5 years to finish its HFEP project; an infirmary or hospital typically takes 3-7 years.
II. There is no clear demarcation of “before” and “after”; health service utilization continues “during” the construction and rehabilitation project, often under adverse conditions of crowding, noise, dust and pollution, and patients’ discomfort.
III. While most HFEP investments occurred on the same site, a handful of projects were done on a different site (Mabitac RHU, Aborlan Hospital in Palawan, Capiz OPD Center). For these transferred sites, services before and after HFEP may no longer be comparable.
40
41
Utilization of health services increased after HFEP.
0
10
20
30
40
50
60
70
80
RHUs and CHOs (n=60) Hospitals and infirmaries (n=57)
Average number of Outpatient Consultations per day
Before HFEP During HFEP After HFEP
0
20
40
60
80
100
120
140
RHUs and CHOs (n=59) Hospitals and infirmaries (n=61)
Average number of Birth Deliveries per month
Before HFEP During HFEP After HFEP
0
10
20
30
40
50
60
Hospitals and infirmaries (n=58)
Average number of inpatients per day
Before HFEP During HFEP After HFEP
The rate of increase for “with” facilities is greater than “without” facilities.
42
85
29
115
35
0
20
40
60
80
100
120
140
With HFEP (n=61) Without HFEP (n=6)
Average Number of Birth Deliveries Per Month in RHUs and CHOs With and Without HFEP Before and After
HFEP, 2006-2014
Before After
66
28
75
32
0
10
20
30
40
50
60
70
80
With HFEP (n=57) Without HFEP (n=6)
Average Number of Outpatients Per Day in Hospitals and Infirmaries With and Without HFEP and Before and
After HFEP, 2006-2014
Before After
40
24
57
27
0
10
20
30
40
50
60
With HFEP (n=58) Without HFEP (n=6)
Average Number of Outpatients Per Day in Hospitals and Infirmaries With and Without HFEP and Before and
After HFEP, 2006-2014
Before After
Summary
43
Overall ImpressionsDespite the generally high utilization of services in health facilities, the following must be noted:
I. There has been little, if any, increase in the number of RHUs, although there has been a significant increase in barangay health stations, many of which are being turned into birthing centers.
II. For the most part, HFEP is just replacing old hospital capacity. There has been no completely new hospitals; the new constructions are merely replacing old existing hospitals, with no major expansion in bed capacity.
III. New services are being established with the new, improved health facilities. These include CEmONCs, animal bite centers, modern diagnostic and imaging centers, sewage treatment plants, and new morgues.
IV. The service expansion is most pronounced in RHUs which now have separate rooms or facilities for birthing/delivery, TB DOTS, dentistry, etc.
V. The impact of capital investments is often diluted by staff shortage and dramatic contractualization of health workers, as well as persistent drug shortage.
44
Analytical challenges Confounding factors from the demand side – higher health service
utilization can be attributed partially to social health insurance reforms of PhilHealth under the KP initiative: Increasing number of enrolled Filipinos Stricter enforcement of No Balance Billing (NBB) policy Migration and urbanization which increase the catchment population around the
hospital
45
Analytical challengesConfounding factors from the supply side – despite the improved
supply side arising from HFEP, lower health service utilization can be observed due to the following: Positive impact of family planning program – led to a decline in births in birthing
centers (e.g. Ivisan RHU, Capiz) Increasing number of birthing centers in outlying barangays – lowered the
utilization of birthing centers in RHU/poblacion (e.g. Kibungan RHU in Benguet, Tayabas CHO in Quezon) Increasing incidence of teenage pregnancy – need to be referred to a higher
level facility (CEmONC) and reduces utilization of BHS/RHU birthing centers(BEmONCs, e.g. San Miguel RHU in Catanduanes) Increasing role of private sector in more affluent urban areas Change in licensing standard in 2013 which lowered the status of primary
hospitals into infirmaries and secondary hospitals into primary hospitals
46
Analytical challenges Essential difference between IE of individuals/households and
institutions:
47
Individuals/Households Institutions (RHUs, Hospitals) Same biology of individual No change in individual knowledge, attitudes, and
practices (KAP), except the KAP being measured Small changes in households (addition or subtraction
of members) Same residence Changes in socioeconomic status caused by the
intervention
Governance changes (elections) Organizational changes (e.g., Palawan provincial
government “centralization” of hospitals under PEO and away from PHO; intensive M&E in Batangas)
Management changes (retirements, recruitments) Staff changes (national staff deployment programs,
contractualization of staff, training of staff) Technology changes Regulatory changes (change in DOH licensing,
accreditation) Financing changes (IRA, PHIC reimbursements,
donors) Changes in health facility site
Conclusion HFEP Shortcomings Problems with construction and
equipping Poor coordination and infrequent
monitoring
Lack of service delivery network plan for expansion and upgrading (including human resources)
Building “incrementalism” mentality Financial sustainability
48
Building “incrementalism” mentality
Pres. Roxas RHU, Capiz
San Agustin RHU, Surigao del Sur
Good examples of functionality and/or resource generation
Infirmaries and hospitals◦ Roxas Memorial PH OPD, Capiz◦ Guinayangan MH, Quezon◦ Gumaca DH, Quezon◦ Hinatuan DH, Surigao del Sur◦ Juan M. Alberto MDH, Catanduanes
RHUs, CHOs, and birthing centers◦ Tayabas CH Unit birthing centers,
Quezon◦ San Agustin RHU, Surigao del Sur◦ Polanco RHU, Zamboanga del Norte◦ Don Jose Aguirre birthing center,
Manukan, Zamboanga del Norte
Recommendations:Funding, contracting, and contract managementOrganize facilities to be supported by HFEP into sets, lots, or tranches
that can be offered to would-be contractors under “contracting in lots”approach, preferably on a turn-key basis
Replace the current practice of incremental, multi-year infrastructure funding with “finish one-at-a-time but quickly” approach
Recommendations: Monitoring and commissioning Hold an initial project meeting with all stakeholders (including DOH,
LGU, PHIC, health facility itself) on the rationale, specifications, schedule, equipping and other deliverables
Require signage indicating the amount and schedule of completion Formulate a Manual of Operations for the entire commissioning
process Address all issues on the “Punch List” before final payment of the
contractor
Recommendations: Ensuring sustainability Explore how the DBM requirement limiting the proportion of IRA that
can be spent on PE (personal emoluments) can be waived Seek NG support for an augmentation budget for human resources
in lieu of the current direct provision of them through various staff augmentation programs
Declare blanket accreditation of all LGU health facilities that have been licensed by DOH for specific public health services (TB DOTS, neonatal screening, birth delivery/MCP, animal bite, etc.)
Implement fee retention, or at least establish a Trust Fund for health in each LGU so that these revenues can be ring-fenced
Philippine Institute for Development Studies
Surian sa mga Pag-aaral Pangkaunlaran ng Pilipinas
Service through policy research
54
WEBSITE: www.pids.gov.ph
FACEBOOK: facebook.com/PIDS.PH
TWITTER: twitter.com/PIDS_PH
EMAIL: [email protected]
Thank you
