The Philippines has made significant strides in reforming its primary health care system under the Universal Health Care Act of 2019.¹ The law mandates automatic enrollment of all Filipinos in the National Health Insurance Program via the Philippine Health Insurance Corporation (PhilHealth). The law also directs PhilHealth to improve how it pays and contracts providers to make the purchasing of health services—including primary care—more effective.² To operationalize these mandates, the health system has developed strategic purchasing for PHC through benefit design, provider selection, payment mechanisms and performance monitoring to make health care more efficient. However, persistent disparities in access and health financing—including high out-of-pocket spending and challenges in PhilHealth reimbursement—provide important context for why strengthening primary health care remains urgent.

Through the Konsulta (Konsultasyong Sulit at Tama) Package, PhilHealth ensures financial access to primary care providers delivering basic essential services at every life stage.³ The program has since evolved into the PhilHealth YAKAP (Yaman ng Kalusugan Program),⁴ which redesigns outpatient diagnostics and medicines coverage and within which the PhilHealth GAMOT (Guaranteed and Accessible Medications for Outpatient Treatment)⁵ benefit is implemented. Capitation payments for Konsulta are disbursed in performance-linked tranches, with key performance indicators including the initial patient encounter and prompt submission of encounter data.⁶ This scheme shifts health financing away from fee-for-service toward preventive and coordinated care.

More recently, the Department of Health (DOH) introduced PuroKalusugan, an initiative to improve primary health care by strengthening the capacity of barangays and puroks (sub-barangays) to address the specific health needs of their communities.⁷ PuroKalusugan delivers community-based primary care at the purok level through multidisciplinary health teams—including barangay health workers, midwives, barangay nutrition scholars, and others—offering services such as immunization, maternal and newborn care, nutrition, and non-communicable disease management, all aligned with DOH priorities and local government needs.⁷

Yet, challenges persist. Many health care providers report difficult reimbursement processing,⁸ unpaid claims, ⁹ and low Konsulta package uptake,¹⁰ all of which impair the providers’ capacity to purchase medicines, pay operational staff, or upgrade their facilities. Some local reports indicate cash-flow problems that are causing service disruptions in municipalities.¹¹ Despite PhilHealth’s expansion of its outpatient drug list to 75 medicines, including treatments for common chronic conditions, the ₱20,000 annual cap means access to essential therapies remains only partial.^{5 12 13} In 2024, total out-of-pocket health spending was estimated at ₱615 billion—about 42.7% of total health expenditure.¹⁴

Community-level financing and service innovations can help address these persistent gaps and serve as feasible complements to national reforms. These strategies are not intended to replace the existing system or any system-wide reforms, but they can function as scalable pilots adapted to the Philippine setting.

Barangay Savings Funds: At barangay level, families could contribute a small amount, say ₱100 to ₱200 monthly, into a local health savings fund, possibly matched by LGUs or PhilHealth. These funds would cover primary health care visits, teleconsultations, screening services, minor procedures, or even predetermined causes for tertiary health care utilization. Community savings groups have been shown to increase utilization of health services in small or rural communities, with members using group funds to access care.^{15 16} Formalizing this model in Philippine barangays could build local resilience, strengthen community-government health engagement, and reduce financial fragility.

Diagnostic Subscription Model: LGUs can pre-purchase diagnostic quotas (e.g., complete blood count, urinalysis, lipid/glucose panels, chest X-ray, ultrasound) and allocate them to RHUs via subscription contracts. This ensures predictable lab revenue and guaranteed access for RHUs, moving away from variable fee-for-service. Community-based diagnostic services have been used internationally and are not yet standardized in the Philippines—thus representing a viable pilot option.¹⁷

Health Financing Cooperatives: LGUs can encourage the establishment of health financing cooperatives, which could strengthen local primary care by pooling resources to pre‑purchase diagnostics, bulk medicines, and health kits, provide micro‑loans for catastrophic health expenses, and invest in essential PHC infrastructure such as barangay health stations, community diagnostic labs, and basic equipment for maternal and chronic care. Similar, albeit larger, cooperative and pooled‑financing models in other countries have improved access to services and reduced financial barriers.^{18 19} Piloting this approach at a smaller scale in the Philippines at the barangay level promises to boost service delivery, financial protection, and local health system resilience.

These community-level innovations differ from existing PhilHealth mechanisms by emphasizing local pooling of resources, predictable financing, and direct support for primary health care delivery, rather than relying solely on fee-for-service reimbursement. If implemented, they could improve service utilization, financial protection, and local health system resilience, while strengthening preventive and coordinated care. Further study is needed to evaluate their relevance, cost-effectiveness, and economic impact, as well as their scalability across different Philippine contexts.

The policy foundation for universal health care in the Philippines is robust. However, the system must tackle implementation issues and financing bottlenecks to fully unlock the potential of these policies. Pairing national policy reforms with grassroots innovation can build a primary health care system that is not only universal, but resilient, inclusive, and responsive to the health needs of every Filipino.