The Politics of Collaborative Governance in Local Health Promotion in the Philippines: Determinants, Risks, and Institutional Reforms
Main Article Content
Abstract
Public health promotion at the local level is a critical yet often overlooked aspect of health governance in the Philippines. While health promotion initiatives have been studied, there is limited empirical analysis on how local governance structures, political dynamics, and institutional coordination shape health promotion implementation at the local level. Giv- en the decentralized nature of health governance in the country, frontline health workers, local officials, formal and informal institutions play a pivotal role in health promotion. Yet, their actions are often constrained by transaction costs and political disincentives.
Building on the Institutional Collective Action (ICA) framework and the Political Market Framework, this paper tackles the factors shaping collaborative governance in health pro- motion by local government units (LGUs). Specifically, it raises the questions: What are the factors impeding collaboration among health promotion stakeholders at the local lev- el? How do coordination, division, and defection risks shape day-to-day implementation? What formal and informal reforms have been adopted to mitigate those risks?
A qualitative study is employed using Malabon City as a case study. Key informant inter- views, focus group discussions, and policy document review provide qualitative insight into the governance dynamics across 21 barangays constituting the smallest administra- tive units in the Philippine governance system.
Findings reveal that: (i) ambiguous mandates and overlapping roles inflate negotiation, monitoring, and enforcement costs; (ii) partisan gatekeeping turns health promotion ben- efits into club goods, producing spatially and politically uneven service access; and (iii) informal networks and social capital of Barangay Health Workers (BHW) partially substi- tute for formal mechanisms but remain vulnerable to electoral turnover. Where transac- tion costs are minimized – e.g., through ordinances institutionalizing Health Promotion Units, pooled budgeting for multi-barangay health centers, and merit-based BHW tenure – collaboration gains stability and scale.
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REGIE MANUEL, Reiou; B. CRUZ, Rizalino.
The Politics of Collaborative Governance in Local Health Promotion in the Philippines: Determinants, Risks, and Institutional Reforms.
Policy & Governance Review, [S.l.], v. 10, n. 1, p. 38-52, jan. 2026.
ISSN 2580-4820.
Available at: <https://www.jurnal.iapa.or.id/pgr/article/view/1350>. Date accessed: 22 apr. 2026.
doi: https://doi.org/10.30589/pgr.v10i1.1350.
Section
Articles
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
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Fernandez, D. D. (2015). Barangay health workers on the sustainability of primary health care. The Trinitian Researcher, 7(1).
Frant, H. (1996). High-powered and low-powered incentives in the public sector. Journal of Public Administration Research and Theory, 6(3), 365–381. http://www.jstor.org/stable/1181665
Horn, M. (1995). The political economy of public administration: Institutional choice in the public sector. Cambridge University Press.
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Kickbusch, I. (2010). Health in all policies: Where to from here? Health Promotion International, 25(3), 261–264. https://doi.org/10.1093/heapro/daq055
Kim, S. (2021). Integration of policy decision making for sustainable land use within cities. Sustainability, 13(18), 10390. https://doi.org/10.3390/su131810390
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Langran, I. V. (2011). Decentralization, democratization, and health: The Philippine experiment. Journal of Asian and African Studies, 46(4), 361–374. https://doi.org/10.1177/0021909611399730
Layug, A. S., Pantig, I. M., Bolong, L. E., & Lavado, R. F. (2009). Do barangays really matter in local service delivery?: Some issues and policy options. Philippine Institute for Development Studies. https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspjd09-2barangays.pdf
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Lilly, K., Kean, B., Hallett, J., Robinson, S. & Selvey, L.A. (2023). Factors of the policy process influencing Health in All Policies in local government: A scoping review. Front Public Health, 2023. https://doi.org/10.3389/fpubh.2023.1010335
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Nutbeam, D., & Muscat, D. M. (2021). Health promotion glossary 2021. Health Promotion International, 36(6), 1578–1598. https://doi.org/10.1093/heapro/daaa157
Republic Act No. 11223. (2019). Implementing rules and regulations of the Universal Health Care Act.
Ruiz, K. E., & Brillantes, A. B. (2020). Issues and concerns on decentralization in some Asian countries: An indicative picture. King Prajadhipok’s Institute Journal of Democracy and Governance, 2, 27–63.
Song, M. (2020). Testing the forms and consequences of collaboration risk in emergency management networks. The Social Science Journal, 1–16. https://doi.org/10.1080/03623319.2020.1744949
Steinacker, A. (2010). The institutional collective action perspective on self-organizing mechanisms. In R. C. Feiock & J. T. Scholz (Eds.), Self-organizing federalism (pp. 51–72). Cambridge University Press.
Storm, I., Aartes, M. J., Harting, J., & Schuit, A. J. (2011). Opportunities to reduce health inequalities by “Health in All Policies” in the Netherlands. Health Policy, 103(2–3), 130–140. https://doi.org/10.1016/j.healthpol.2011.09.009
Sullivan, K., & Strach, P. (2025). Ideas, municipal sanitation, and the transformation of public health. Urban Affairs Review. https://doi.org/10.1177/10780874251332254
Taburnal, M. V. (2020). Knowledge and competence of Barangay Health Workers (BHWs). International Journal of Innovation, Creativity and Change, 14(1), 1301–1320.
Trounstine, J., & Goldman-Mellor, S. (2022). County-level segregation and racial disparities in COVID-19 outcomes. Journal of Health Politics, Policy and Law. https://doi.org/10.1215/03616878-10234170
Wilberg, A., Saboga-Nunes, L., & Stock, C. (2021). Are we there yet? Use of the Ottawa Charter action areas from the perspective of European health promotion professionals. Journal of Public Health, 29(1), 1–7. https://doi.org/10.1007/s10389-019-01108-x
Williamson, O. (1985). The economic institutions of capitalism. The Free Press.
Amit, A. M. L., Pepito, V. C. F., & Dayrit, M. M. (2022). Advancing universal health coverage in the Philippines through self-care interventions. The Lancet Regional Health – Western Pacific, 26, 100579. https://doi.org/10.1016/j.lanwpc.2022.100579
Bae, J., & Feiock, R. (2012). Forms of government and climate change policies in U.S. cities. Urban Studies, 50(4), 776–788. https://doi.org/10.1177/0042098012450481
Baliola, M. Y. T., Golpe, M. R., & Advincula-Lopez, L. (2024). Gains and challenges of the Barangay Health Worker (BHW) program during COVID-19 in selected cities in the Philippines. Journal of Health Research, 38(1). https://doi.org/10.56808/2586-940X.1060
Bertone, M. P., Falisse, J. B., Russo, G., & Witter, S. (2018). Context matters (but how and why?): A hypothesis-led literature review of performance-based financing in fragile and conflict-affected health systems. PLOS ONE, 13(4). https://doi.org/10.1371/journal.pone.0195301
Brown, M. (2025). For an urban politics of public health. Urban Affairs Review. https://doi.org/10.1177/10780874251332262
Caloocan City Planning and Development Department. (2024). Comprehensive Development Plan 2023–2028. City Government of Caloocan.
Capuno, J. J., & Panganiban, M. (2012). The ties that do not bind: Party affiliations and the delivery of devolved health services in the Philippines. Philippine Political Science Journal, 33(1), 63–80. https://doi.org/10.1080/01154451.2012.684517
Carr, J. B., & Karuppusamy, S. (2008). The adapted cities framework. Urban Affairs Review, 43(6), 875–886. https://doi.org/10.1177/1078087407311396
Carr, J. B. (2015). What have we learned about the performance of council–manager government? A review and synthesis of the research. Public Administration Review, 75(5), 673–689. https://doi.org/10.1111/puar.12415
Cruz, R. B. (2015). Political markets. In D. Bearfield & M. Dubnick (Eds.), Encyclopedia of Public Administration and Public Policy (3rd ed., pp. 623–630). Taylor & Francis.
Curley, C., Federman, P. S., & Shen, R. (2023). Expanding the political market framework to explain executive decision making during the COVID-19 crisis. Public Administration Review, 83. https://doi.org/10.1111/puar.13613
Deslatte, A. (2018). Managerial friction and land-use policy punctuations in the fragmented metropolis. Policy Studies Journal. https://doi.org/10.1111/psj.12275
Deslatte, A., Tavares, A., & Feiock, R. C. (2016). Policy of delay: Evidence from a Bayesian analysis of metropolitan land-use choices. Policy Studies Journal, 46(3), 674–699. https://doi.org/10.1111/psj.12188
Deslatte, A., & Feiock, R. C. (2018). The collaboration riskscape: Fragmentation, problem types and preference divergence in urban sustainability. Publius: The Journal of Federalism, 49(2), 352–377. https://doi.org/10.1093/publius/pjy020
Dixit, A. K. (1998). The making of economic policy: A transaction-cost politics perspective. MIT Press.
Diokno-Sicat, C. J., Castillo, A. F. G., & Maddawin, R. B. (2020). Philippine local government public expenditure review: A survey of national government–local government support programs. Philippine Institute for Development Studies. https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps2048.pdf
Department of Health. (2022). Devolution Transition Plan 2022–2024. https://www.dbm.gov.ph/wp-content/uploads/Mandanas-Garcia-Case/Approved-DTPs-and-Related-Documents/4-Approved-Joint-DOH-NNC-DTP-dated-20-January-2022.pdf
Executive Order No. 138. Full Devolution of Certain Functions of the Executive Branch to Local Governments, Creation of a Committee on Devolution, and for other Purposes.
Feiock, R. C. (2002). A quasi-market framework for development competition. Journal of Urban Affairs, 24(2), 123–142. https://doi.org/10.1111/1467-9906.00118
Feiock, R. C. (2009). Metropolitan governance and institutional collective action. Urban Affairs Review, 44(3), 356–377. https://doi.org/10.1177/1078087408324000
Feiock, R. C. (2013). The institutional collective action framework. Policy Studies Journal, 41(3), 397–425. https://doi.org/10.1111/psj.12023
Feiock, R. (2023). Handbook on local and regional governance (pp. 362–374). Edward Elgar. https://doi.org/10.4337/9781800371200.00036
Feiock, R. C., & Kim, S. (2021). The political market and sustainability policy. Sustainability, 13(6), 3344. https://doi.org/10.3390/su13063344
Fernandez, D. D. (2015). Barangay health workers on the sustainability of primary health care. The Trinitian Researcher, 7(1).
Frant, H. (1996). High-powered and low-powered incentives in the public sector. Journal of Public Administration Research and Theory, 6(3), 365–381. http://www.jstor.org/stable/1181665
Horn, M. (1995). The political economy of public administration: Institutional choice in the public sector. Cambridge University Press.
Jansson, E., Fosse, E., & Tillgren, P. (2011). National public health policy in a local context: Implementation in two Swedish municipalities. Health Policy, 103(2–3), 219–227. https://doi.org/10.1016/j.healthpol.2011.08.013
Kickbusch, I. (2010). Health in all policies: Where to from here? Health Promotion International, 25(3), 261–264. https://doi.org/10.1093/heapro/daq055
Kim, S. (2021). Integration of policy decision making for sustainable land use within cities. Sustainability, 13(18), 10390. https://doi.org/10.3390/su131810390
Kim, S. Y., Swann, W. L., Weible, C. M., Bolognesi, T., Krause, R. M., Park, A. Y. S., Tang, T., Maletsky, K., & Feiock, R. C. (2022). Updating the institutional collective action framework. Policy Studies Journal, 50(1), 9–34. https://doi.org/10.1111/psj.12392
Kneale, D., Rojas-Garcia, A., & Thomas, J. (2019). Obstacles and opportunities to using research evidence in local public health decision making in England. Health Research Policy and Systems, 17, 61. https://doi.org/10.1186/s12961-019-0446-x
Lacuesta, M. C., Sarangani, S. T., & Amoyen, N. D. (1993). A diagnostic study of the DOH health volunteer workers program. Philippines population journal, 9(1–4), 26–36.
Langran, I. V. (2011). Decentralization, democratization, and health: The Philippine experiment. Journal of Asian and African Studies, 46(4), 361–374. https://doi.org/10.1177/0021909611399730
Layug, A. S., Pantig, I. M., Bolong, L. E., & Lavado, R. F. (2009). Do barangays really matter in local service delivery?: Some issues and policy options. Philippine Institute for Development Studies. https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspjd09-2barangays.pdf
Leinonen, J., & Syväjärvi, A. (2022). Barriers to health promotion strategy work in Finnish municipalities. Health Promotion International, 37(3), daac091. https://doi.org/10.1093/heapro/daac091
Lilly, K., Kean, B., Hallett, J., Robinson, S. & Selvey, L.A. (2023). Factors of the policy process influencing Health in All Policies in local government: A scoping review. Front Public Health, 2023. https://doi.org/10.3389/fpubh.2023.1010335
Liwanag, H. J., & Wyss, K. (2018). What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. PLoS ONE, 13(11), 1–20. https://doi.org/10.1371/journal.pone.0206809
Liwanag, H. J., & Wyss, K. (2020). Who should decide for local health services? A mixed methods study of preferences for decision-making in the decentralized Philippine health system. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05174-w
Lubell, M., Feiock, R. C., & de la Cruz, E. E. R. (2009). Local institutions and the politics of urban growth. American Journal of Political Science, 53(3), 649–665. https://doi.org/10.1111/j.1540-5907.2009.00392.x
Mallari, E., Lasco, G., Sayman, D. J., Amit, A. M. L., Balabanova, D., McKee, M., Mendoza, J., Palileo-Villanueva, L., Renedo, A., Seguin, M., & Palafox, B. (2020). Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05699-0
Manuel, R. R. (2024, November 13). Harnessing social capital: Empowering barangay health in health promotion governance [Poster presentation]. 2024 Joint Conference and Symposium on Health: International Conference on Interdisciplinary Approaches to Health (ICIAH 2024). https://doi. org/10.13140/RG.2.2.13224.48642
Marmot, M., Friel, S., Bell, R., Houweling, T. A., & Taylor, S. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669. https://doi.org/10.1016/s0140-6736(08)61690-6
McCaffrey, M., & Salerno, J. T. (2011). A theory of political entrepreneurship. Modern Economy, 2(4), 552–560. https://doi.org/10.4236/me.2011.24061
McCollum, R., Taegtmeyer, M., Otiso, L., Muturi, N., Barasa, E., Molyneux, S., Martineau, T. & Theobald, S. (2018). “Sometimes it is difficult for us to stand up and change this”: an analysis of power within priority-setting for health following devolution in Kenya. BMC Health Services Research, 18(1), 1–14. https://doi.org/10.1186/s12913-018-3706-5
North, D. C. (1990). Institutions, institutional change and economic performance. Cambridge University Press.
Nutbeam, D., & Muscat, D. M. (2021). Health promotion glossary 2021. Health Promotion International, 36(6), 1578–1598. https://doi.org/10.1093/heapro/daaa157
Republic Act No. 11223. (2019). Implementing rules and regulations of the Universal Health Care Act.
Ruiz, K. E., & Brillantes, A. B. (2020). Issues and concerns on decentralization in some Asian countries: An indicative picture. King Prajadhipok’s Institute Journal of Democracy and Governance, 2, 27–63.
Song, M. (2020). Testing the forms and consequences of collaboration risk in emergency management networks. The Social Science Journal, 1–16. https://doi.org/10.1080/03623319.2020.1744949
Steinacker, A. (2010). The institutional collective action perspective on self-organizing mechanisms. In R. C. Feiock & J. T. Scholz (Eds.), Self-organizing federalism (pp. 51–72). Cambridge University Press.
Storm, I., Aartes, M. J., Harting, J., & Schuit, A. J. (2011). Opportunities to reduce health inequalities by “Health in All Policies” in the Netherlands. Health Policy, 103(2–3), 130–140. https://doi.org/10.1016/j.healthpol.2011.09.009
Sullivan, K., & Strach, P. (2025). Ideas, municipal sanitation, and the transformation of public health. Urban Affairs Review. https://doi.org/10.1177/10780874251332254
Taburnal, M. V. (2020). Knowledge and competence of Barangay Health Workers (BHWs). International Journal of Innovation, Creativity and Change, 14(1), 1301–1320.
Trounstine, J., & Goldman-Mellor, S. (2022). County-level segregation and racial disparities in COVID-19 outcomes. Journal of Health Politics, Policy and Law. https://doi.org/10.1215/03616878-10234170
Wilberg, A., Saboga-Nunes, L., & Stock, C. (2021). Are we there yet? Use of the Ottawa Charter action areas from the perspective of European health promotion professionals. Journal of Public Health, 29(1), 1–7. https://doi.org/10.1007/s10389-019-01108-x
Williamson, O. (1985). The economic institutions of capitalism. The Free Press.