COA wants the people to get involved in auditing public money.
“Mamamayan, kasali ka sa pag-audit ng kaban ng bayan.”
This message welcomes visitors of i-kwenta.com, the Commission on Audit’s (COA) citizen feedback portal.
For COA, the public must play a role in ensuring that public resources are used appropriately and do not go to waste.
Citizens can participate in auditing public funds through the Citizen Participatory Audit (CPA) which, according to the website, “is a reform strategy and an audit technique that brings together civil society organizations (CSOs), citizens and auditors of the Commission on Audit (COA), as one audit team.”
The CPA, which is now on its second phase, aims “to pilot citizen-government partnerships to support the institutionalization of participatory audits in COA.”
“Since its project implementation in April 2012, several milestones have been achieved in line with the intermediate outcomes establishing an enabling framework for citizen engagement (policies, systems, and processes) and civil society organizations (CSO) being able to articulate the citizen agenda,” it said.
During the launch of the CPA’s second phase in January this year, then-COA Chairperson Ma. Gracia Pulido-Tan said: “We’ve made considerable gains in the first phase and now we are scaling up in terms of coverage. We are going out of Metro Manila and taking CPA to other places.”
In Phase 1, the CPA looked into the Department of Public Works and Highways’ (DPWH) flood control project in the Caloocan-Malabon-Navotas-Valenzuela (Camanava) area in 2013, the Solid Waste Management Program in Quezon City with an audit report dated October 2013, and barangay health services in Marikina City in the context of the Pantawid Pamilyang Pilipino Program (4Ps) with an audit report dated April 2015.
In Phase 2, audit teams will look into farm-to-market roads in Palawan and tourism roads in the Caraga region, as well as health programs in the education sector in select areas.
“The CPA is a testament that governance is not only the responsibility of government,” Tan said. “All of us are citizens first, and as citizens, it is not only our right but our duty to participate in the affairs of government.”
“As the state’s supreme audit institution, we have a duty to the public…but we also recognize that citizens are a key stakeholder in what the government does, and in what COA does,” Tan was also quoted as saying in a CPA report on disaster relief activities following typhoon Yolanda.
The audit report on disaster relief efforts also explains what the CPA is—a strategy for reform to uphold the people’s right to a clean government and the prudent utilization of public resources, founded on the premise that public accountability can prosper only with a vigilant and involved citizenry, for the promotion of transparency and effectiveness.
The CPA is also a technique for the conduct of joint audits to improve government effectiveness, transparency, and accountability, it said.
For COA, the benefits of such an audit include individuals’ increased awareness and knowledge of the government and strengthened ownership of funds, their participation in government decisions, and improved delivery of public services.
The audit report on disaster relief activities also gives us a glimpse on how a CPA may be conducted.
Six audit teams were formed for various sites of bunkhouses and cash-for-work (CFW) projects, which were the focus of the audit.
These teams were composed of regular auditors and citizens led by a regular auditor of COA.
Citizen partners included the Leyte Family Development Organization Multi-Purpose Cooperative (Lefado MPC), International Holistic Engagement for Life and Progress (iHelp), Philippine Relief and Development Services (Philrads), Philippine Institute of Certified Public Accountants (Picpa), Philippine Institute of Civil Engineers (PICE) Eastern Visayas State University Student Chapter, and Junior Philippine Institute of Accountants (JPIA) Eastern Visayas State University Student Chapter.
The citizens took part in audit planning to validating construction accomplishments, and validating compliance of beneficiaries with eligibility requirements.
Citizens also helped conduct a survey of CFW recipients and validate their residences.
Improving the community
The CPA report on barangay health centers (BHCs) in Marikina, dated April 15, 2015, said that “Marikina City was selected as the pilot service-provider-local government unit because of its proximity to the COA Central Office, thus maximizing time and people resources and facilitating the management of this CPA pilot project.”
“For audits which adopt the Citizen Participatory Audit (CPA) approach, COA selects projects/services of the government that are close to the hearts of the people, like the medical services provided by BHCs,” it added.
The audit focused on health centers in barangays (villages) Tumana, Malanday, Nangka, as well as the Pugad Lawin Health Center in Barangay Fortune. They were chosen because they have the most number of Pantawid Pamilyang Pilipino Program beneficiaries. 4Ps, also known as the conditional cash transfer (CCT) program, is the government’s flagship program that aims to reduce poverty by providing cash grants to extremely poor households.
The audit was conducted to determine how well the BHC operated based on the minimum requirements set by the Department of Health (DOH) and the Department of Social Welfare and Development (DSWD), as well as the expectations of clients.
The audit enabled the beneficiaries and service providers to rate the performance of their health center.
The CSC covered accessibility and transportation to and from the BHC; cleanliness; lighting and ventilation; waiting area; water supply; comfort rooms; waste management facility; the presence and availability of BHC staff/personnel and their attitude towards patients; equipment’s presence, availability and functionality; medicines and medical supplies’ availability, appropriateness, dispensation, and effectiveness; health services and programs, and; record-keeping and management.
Of the four BHCs, the Tumana Health Center has the most number of beneficiaries with 1,359 monitored beneficiaries.
It is followed by the Malanday Health Center which has 1,011 monitored beneficiaries; the Balubad Health Center and the Nangka Health Station, which are both located in Barangay Nangka, with a total of 393 monitored beneficiaries, and; the Pugad Lawin Health Center in Barangay Fortune with 377 monitored beneficiaries.
After the audit, several improvements were noted in the health center which has the most number of beneficiaries among the four health centers audited.
“Except for those residing in the barangay outskirts, majority of the beneficiaries find the BHCs accessible, excluding the health center of Malanday which is at the far end of the barangay,” the CPA report said.
It also found that in Barangay Fortune, as in the other health centers, there was no lying-in center. Those who were about to give birth were brought to the nearby Amang Rodriguez Medical Center.
The beneficiaries however gave good grades on water availability and cleanliness.
“All water supplies are being tested by the Marikina Clean Food Laboratory staff and Sanitation Inspector to ensure water potability, thus preventing water and food-borne diseases,” the City Health Officer said.
However, dental patients in Nangka needed to bring their own water for gargling, according to the CPA report.
In the Fortune health center, there was a lone comfort room for both men and women which was usually closed. Participants said this was because there was no personnel assigned to clean it.
“They have requested for a portable toilet from the barangay government, but it appears that the latter wants the city government to shoulder the cost,” the CPA report said.
“Validation results revealed that handrails for disabled patients were not provided in the comfort rooms of all four BHCs,” it added.
In response to the audit observation, the City Health Officer told the team that “handrails will be requested for inclusion in the Work Program of the City’s Engineering Department.”
All four health centers practice proper waste management, the CPA also observed.
The city health officer said, “Although no utilities were deployed in health centers, BHWs and health center staff maintain the cleanliness of the health facilities.”
“All health centers have a copy of the 208 Sanitation Code of Marikina, a compilation of city ordinances and resolution,” the official also commented, among others.
More health professionals needed
The audit also revealed that the four health centers in Marikina were complete with doctors, nurses, midwives, dentists, and barangay health workers but the centers were unable to cope with client demand.
Participants said that this adversely affected efficiency and quality of services.
“For example, one doctor said that the ideal doctor to population ratio is 10,000; in Marikina City, the ratio is 40,000+. For a nurse, it is 20,000; currently, the proportion is 42,000. On the average, each health center apparently needs at least four doctors and two to three nurses. All respondents strongly appealed for more health professionals (doctors, nurses, midwives, dentists),” the CPA report said.
“The health professionals can hardly cope in providing full services because they are often called to meetings, conferences, seminars, and the like, often at a moment’s notice,” it said.
The respondents suggested the posting of updated notices on bulletin boards so that patients know where the health professionals are.
In response to the audit results, the city health officer acknowledged that “although the BHCs have a physician, nurse, midwife, dentist and BHW, there is still a need to augment manpower.”
The official added that now, the “conduct of meetings, seminars and conferences are being scheduled; whereabouts of health staff are posted within their respective bulletin boards to prevent complaints from the community on absences of staff.”
Also, the CPA report noted that demand is correlated with the behavior of personnel.
“Often, “bad behavior” is highly correlated to client demand: the more patients and 4Ps beneficiaries there are at some given point, the more likely such behavior is displayed,” it said.
Respondents were however, impressed with the health workers whom they described as “generally good-natured.”
Like the health professionals, basic medical equipment were also available in all four health centers and likewise cannot cope with the demand, the audit found.
“All four health centers have basic medical equipment like stethoscopes, sphygmomanometers, thermometers, weighing scales, stool for the examination table, basic surgical equipment, first aid kit, etc. Their availability, however, is offset by the high demand for such equipment. Functionality or usability is not anymore guaranteed as most of the equipment had seen years of continuous service. While secondary health care institutions are within the proximity of the four barangays, people still prefer the BHCs as these are more accessible and less expensive; this is the reason why BHC equipment and facilities are overused,” the CPA report said.
As to medicines, the respondents said that while basic medicines and drugs are usually available, these are not enough to cope with the demand, the CPA report added.
“Medicines in the BHC have very short shelf-life due to high demand. However, the health center staff assured the 4Ps beneficiaries that they have their own medicine inventory and stocks from the DSWD,” it said.
The city health officer commented among others that the regular purchase of basic medical equipment are always part of the annual procurement plan which their office submits to the city budget office.
Anti-TB drugs provided by the DOH are centralized at the City Health Office’s Supply Office and released to BHCs that have reported cases of tuberculosis, the official said.
“Not all medicines are available in the health facility, since only the basic essential medicines and those under the Philippine National Drug Formulary are included in the Procurement Plan,” the official also said.
In the course of the audit, citizens who participated also learned of the significance of the processes involved in the government’s purchase of goods particularly in connection with the delivery of non-essential medicines.
“The BHC staff said this happens because they are not part of the procurement process; there are no mechanisms by which they can provide feedback to the procuring entities on what medicines and drugs are needed, or participate in procurement activities at the barangay or city government levels,” the CPA report noted.
“This omission in the procurement process, which affects the sufficiency of medicines at the BHC level has a direct impact on the health of community members. The lack of antibiotics, medicines for cough and colds, injectables for NTP2 and MTR3, and the absence of contingency plans in times of extensive power failure to preserve vaccines requiring cold storage facilities often lead to serious health issues.”
The report said “it was the first time that the community end-users heard about how the procurement process could impact on their health. Many of them realized the connection between the medicines and drugs they were entitled to, and the issue of procurement and good governance. Both health workers and community end-users strongly suggested for a more open and participatory approach to the procurement of medicines and drugs, at the very least. Many even suggested bringing this issue directly to the attention of the local government, for example, through the Mayor’s People’s Day,” it said.
As to health services and programs, the four barangays were complete with health center programs and services such as pre- and post-natal care and counseling, vaccination, deworming, etc. except birthing and lying-in facilities.
But although this is the case, the CPA report said that “…a major issue is how to cope with the demand given the limited number of health professionals and workers (including volunteers), not to mention inadequate resources, equipment, infrastructure and medicines.”
The audit showed that QSL requirements under the Family Planning and Cancer Control (cervical cancer screening) were not administered because of the lack of training/continuing education of BHC staff.
The QSL requirements were for tubal ligation, vasectomy, relevant laboratory examinations such as pap smear, wet smear, gram staining, pregnancy test and urinalysis and contraceptive supplies including the management of complications/side effects of family planning methods.
QSL-required manuals and program brochures/leaflets were also not available in the BHC.
In response, the city health officer said IEC materials for promotion of family planning and cancer prevention and control will be reprinted “to intensify health information dissemination.”
“Most of the end-users gave positive observations about their BHC’s health programs in terms of efficiency and appropriateness. Many of them were impressed by the BHWs who would go house-to- house informing parents about health programs, distributing vitamins, and immunizing children. Other health professionals referred patients to commercial laboratories that charge lower prices for urinalysis, sputum tests, and other diagnostic tests not offered by the health center.”
“A considerable number of patients were asking for alternative health programs. It was suggested for BHCs to consider offering non-traditional programs. Also, the BHC should consider tapping the services of community health volunteer workers, organized patient groups/community organization and NGOs which is another QSL requirement not being pursued by the BHC at the time of audit. Community participation is greatly encouraged so that other required health interventions, such as barangay assemblies, dengue linis brigade, patients’ classes, breastfeeding support groups, etc., may be implemented to further improve the delivery of health services,” it added.