Abstract:Background: The Philippines’ Universal Health Care (UHC) Law mandates the integration of local health systems to ensure more equitable, efficient, and high-quality service delivery. This integration is anchored on three core dimensions: managerial, technical, and financial. Central to financial integration is the pooling resources from national government, local government units (LGUs), PhilHealth, and development partners into a Special Health Fund (SHF). The SHF is intended to support province- and city-wide health system integration, enabling strategic, unified financing at the local level. However, operationalizing the SHF requires LGUs to navigate complex financial, administrative, and governance processes, with its implementation still being piloted in selected areas. Objectives: This paper presents early implementation experiences of the SHF in the provinces of Batangas and Quezon. It identifies the key actors, processes, and mechanisms involved, as well as the enabling and hindering factors in the establishment and management of SHF at the local level. Materials and Methods: A qualitative case study approach was used, including document review and key informant interviews with officials from the health, budget, and accounting offices of the LGUs. Data were analyzed thematically to map processes and identify critical actors. Results: Nine major and eight supporting actors were identified in SHF implementation. Enabling factors included strong political leadership, dedicated Management Support Unit staff, and consistent inter-office coordination. Major barriers included overlapping roles, delays in opening trust fund accounts, limited municipal-level awareness, and procurement inefficiencies. Planning and fund pooling were most effective when aligned with local investment plans and supported by proactive Provincial Health Boards. Conclusions: Effective SHF implementation requires strong stakeholder coordination, clearly defined roles, and adequate technical and administrative capacity. Early lessons from Batangas and Quezon offer practical insights for other LGUs and inform policy refinements for more effective financial integration, which is critical for realizing UHC goals.
Keywords: Health Systems and Universal Health Coverage (UHC), universal health care, universal health coverage, health financing, special health fund, financial integration, challenges, governance, local health boards, health system integration
