Determining the Functionality of Local Health Boards in the Philippines: Perspectives from Local Government Units

Background In the Philippines, Local Health Boards (LHBs) are the cornerstone of a decentralized health system by coordinating local health priorities, budgeting, and implementation. However, their performance remains highly variable across different regions. While national policies set the groundwork for Universal Health Care (UHC), actual service delivery hinges on local functionality. This study sought to define the constructs that define functionality of local health boards in the Philippine context, drawing from the experiences and perspectives of those directly involved in local health governance. Methods We conducted a series of in-depth focus group discussions (FGDs) with members of LHBs across four different provinces in the Philippines. Participants included local chief executives, health officers, barangay representatives and civil society leaders. The discussions were designed to explore governance dynamics, barriers to implementation, and enabling conditions for effective board performance. Thematic analysis was employed to identify recurring patterns and insights from the narratives. Results Across all provinces, the most consistently cited determinant of a functional LHB was the active engagement and political will of the local chief executive (LCE). While national frameworks and mandates exist, their successful localization depends heavily on whether the LCE prioritizes health. Participants highlighted significant operational barriers, particularly in fund utilization, due to stringent national guidelines that limit spending flexibility. A proactive and well-resourced Technical Working Group (TWG) was identified as vital in operationalizing LHB decisions and bridging policy with practice. Additionally, community engagement efforts were found to be vulnerable to political transitions, especially when frontline workers such as Barangay Health Workers (BHWs) lack protection from changes in local leadership. Conclusion The functionality of LHBs is shaped less by formal compliance and more by the quality of local governance and institutional support. The political commitment of the LCE, when combined with a capable TWG and mechanisms to shield community health workers from political transitions, significantly enhances board performances. As the Philippines moves toward full implementation of Universal Health Care (UHC), reinforcing the governance capacity of LHBs offers a pragmatic and necessary pathway to more responsive and resilient local health systems.