Department of Health – Office of the Secretary

class: center, middle, inverse, title-slide

.title[
# Department of Health – Office of the Secretary
]
.subtitle[
## The FY 2027 proposed budget in context, 2018-2027
]
.date[
### September 2026
]

---

## Executive summary -- and the FY 2027 proposal

- **The FY 2027 proposal (NEP) is PHP 264B for DOH-OSEC** -- up about PHP 10B (+4%) on the FY 2026 proposal, and the largest DOH proposal yet. It is a *rising*, not shrinking, proposal.
- **But it again sits far below what Congress enacts.** The FY 2026 GAA was PHP 297B -- PHP 44B above that year's proposal. The FY 2027 NEP is PHP 34B below the 2026 enacted level, a gap Congress has filled every year.
- **The programs Congress most reliably restores are proposed low again.** Medical assistance (**MAIFIP**) is proposed **flat at PHP 24B** (Congress enacted PHP 52B in 2026); **HFEP** flat at PHP 15B (enacted PHP 22B). So "medical assistance halved" would misread the proposal -- MAIFIP is proposed at the *same* level as 2026; the drop is only relative to the Congress-inflated enacted figure.
- **Within the proposal, the Executive tilts toward service delivery:** regional-hospital operations **+PHP 7.6B**, health workforce (NHWSS) +PHP 2.0B, the **Cancer Assistance Fund +PHP 2.5B (tripled)**, and personnel benefits +PHP 2.7B. It trims health IT (-PHP 1.8B) and some nationally-procured commodities (family health, prevention).
- **The absorption problem persists and is mostly a Capital Outlay problem** (PS ~98%; CO only 14-37%). HFEP's chronic 22-29% cash use sits on that baseline -- directly relevant to any push to restore its funding.
- **Hospital operations dominate composition** and grow fastest; the 2025 PREXC reorganization split public health into a policy/strategy line (`3501`) and a local-health-support line (`3502`).
- **The scrutiny question for advocates:** will Congress again restore MAIFIP and HFEP -- and is proposing these popular, needed programs low every year an honest basis for planning?

---

## A few notes on the data

- **Period:** FY 2018-2027. **FY 2027 is the NEP (the Executive's proposal) only** -- not yet debated or enacted, and with no execution data. FY 2026 reflects NEP/GAA only; P/A/P-level execution runs FY 2018-2025. Because Congress raises the DOH budget well above the proposal every year, the FY 2027 NEP is best read as a floor.
- **Scope:** "Current New Appropriations" only -- excludes Continuing Appropriations, Automatic Appropriations, and transfers from Special Purpose Funds and Unprogrammed Appropriations. Numbers here therefore understate the DOH's full spending envelope.
- **2025 PREXC re-coding:** DOH re-numbered its program codes in 2025. Where the same P/A/P appears under both an old and a new UACS code (e.g. `3201` -> `3601` for hospitals; `3301` -> `3701` for regulation; `3401` -> `3801` for patient assistance), they are treated as the same P/A/P.
- **Two P/A/P renames consolidated:** "Assistance to Indigent Patients..." -> MAIFIP, and "HRH Deployment" (3102) -> NHWSS (the program was re-coded and renamed in 2022). Both are reported as continuous single lines throughout.
- **Absorptive capacity denominator:** Adjusted Allotments (AdjAllot), the closer proxy for what the agency was actually given to spend.

---

## Big picture: the budget keeps growing

---

## Big picture: a few takeaways

<table class="table table-condensed" style="font-size: 16px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> PHP B </th>
   <th style="text-align:right;"> 2018 </th>
   <th style="text-align:right;"> 2019 </th>
   <th style="text-align:right;"> 2020 </th>
   <th style="text-align:right;"> 2021 </th>
   <th style="text-align:right;"> 2022 </th>
   <th style="text-align:right;"> 2023 </th>
   <th style="text-align:right;"> 2024 </th>
   <th style="text-align:right;"> 2025 </th>
   <th style="text-align:right;"> 2026 </th>
   <th style="text-align:right;"> 2027 </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> NEP </td>
   <td style="text-align:right;"> 104.7 </td>
   <td style="text-align:right;"> 71.0 </td>
   <td style="text-align:right;"> 88.7 </td>
   <td style="text-align:right;"> 127.8 </td>
   <td style="text-align:right;"> 157.5 </td>
   <td style="text-align:right;"> 191.2 </td>
   <td style="text-align:right;"> 199.5 </td>
   <td style="text-align:right;"> 217.8 </td>
   <td style="text-align:right;"> 253.8 </td>
   <td style="text-align:right;"> 264 </td>
  </tr>
  <tr>
   <td style="text-align:left;"> GAA </td>
   <td style="text-align:right;"> 107.2 </td>
   <td style="text-align:right;"> 98.6 </td>
   <td style="text-align:right;"> 101.0 </td>
   <td style="text-align:right;"> 134.9 </td>
   <td style="text-align:right;"> 183.9 </td>
   <td style="text-align:right;"> 209.6 </td>
   <td style="text-align:right;"> 241.6 </td>
   <td style="text-align:right;"> 247.9 </td>
   <td style="text-align:right;"> 297.9 </td>
   <td style="text-align:right;">  </td>
  </tr>
  <tr>
   <td style="text-align:left;"> AdjAllot </td>
   <td style="text-align:right;"> 102.9 </td>
   <td style="text-align:right;"> 93.1 </td>
   <td style="text-align:right;"> 98.7 </td>
   <td style="text-align:right;"> 134.5 </td>
   <td style="text-align:right;"> 180.6 </td>
   <td style="text-align:right;"> 208.8 </td>
   <td style="text-align:right;"> 230.5 </td>
   <td style="text-align:right;"> 225.3 </td>
   <td style="text-align:right;">  </td>
   <td style="text-align:right;">  </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Obligations </td>
   <td style="text-align:right;"> 96.7 </td>
   <td style="text-align:right;"> 82.9 </td>
   <td style="text-align:right;"> 86.7 </td>
   <td style="text-align:right;"> 126.3 </td>
   <td style="text-align:right;"> 156.9 </td>
   <td style="text-align:right;"> 191.4 </td>
   <td style="text-align:right;"> 209.9 </td>
   <td style="text-align:right;"> 192.9 </td>
   <td style="text-align:right;">  </td>
   <td style="text-align:right;">  </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Disbursements </td>
   <td style="text-align:right;"> 54.8 </td>
   <td style="text-align:right;"> 61.2 </td>
   <td style="text-align:right;"> 70.0 </td>
   <td style="text-align:right;"> 98.4 </td>
   <td style="text-align:right;"> 122.4 </td>
   <td style="text-align:right;"> 154.6 </td>
   <td style="text-align:right;"> 167.0 </td>
   <td style="text-align:right;"> 156.5 </td>
   <td style="text-align:right;">  </td>
   <td style="text-align:right;">  </td>
  </tr>
</tbody>
</table>

- **Congress consistently augments DOH:** GAA has exceeded NEP every year of the period -- by PHP 2B in 2018, PHP 27B in 2019 (after the budget impasse), PHP 42B in 2024, and a proposed PHP 44B add-on for 2026.
- **The disbursement story is two-sided:** the disbursement-to-allotment ratio has improved from a low of 53% (2018) to ~70% (2021-2025), but the absolute disbursement gap has roughly doubled (PHP 48B in 2018 -> PHP 69B in 2025) as the agency has scaled.
- **2026 NEP ~ PHP 253B; 2026 GAA ~ PHP 297B** -- already a record high before execution begins.

---

## Where the money goes (by functional category)

---

## Composition by Expense Class

---

## The 2025 reorganization: 3501/3502 explained

The reorganization had two patterns:

**Simple renumbering (same scope, new code):**
`3201 -> 3601` Hospital Operations; `3301 -> 3701` Regulation; `3401 -> 3801` Social Health Protection.

**The substantive split:** the old five programs (`3101`-`3105`) covering policy, systems, public health, epidemiology, and emergencies were collapsed into two new programs. The dividing principle is **policy/strategy vs. local implementation**.

<table class="table table-condensed table-striped" style="font-size: 13px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> P/A/P </th>
   <th style="text-align:left;"> Old (pre-2025) </th>
   <th style="text-align:left;"> New (2025+) </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> Health Sector Policy and Plan Development </td>
   <td style="text-align:left;"> 3101 Health Policy and Standards </td>
   <td style="text-align:left;"> 3501 Policy &amp; Systems Strengthening </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Pharmaceutical Management </td>
   <td style="text-align:left;"> 3102 Health Systems Strengthening </td>
   <td style="text-align:left;"> 3501 Policy &amp; Systems Strengthening </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Promotion </td>
   <td style="text-align:left;"> 3102 Health Systems Strengthening </td>
   <td style="text-align:left;"> 3501 Policy &amp; Systems Strengthening </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Epidemiology and Surveillance </td>
   <td style="text-align:left;"> 3104 Epidemiology and Surveillance </td>
   <td style="text-align:left;"> 3501 Policy &amp; Systems Strengthening </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Quick Response Fund </td>
   <td style="text-align:left;"> 3105 Health Emergency Management </td>
   <td style="text-align:left;"> 3501 Policy &amp; Systems Strengthening </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Facilities Enhancement Program (HFEP) </td>
   <td style="text-align:left;"> 3102 Health Systems Strengthening </td>
   <td style="text-align:left;"> 3502 Local Health System Support </td>
  </tr>
  <tr>
   <td style="text-align:left;"> National Health Workforce Support System (NHWSS) </td>
   <td style="text-align:left;"> 3102 Health Systems Strengthening </td>
   <td style="text-align:left;"> 3502 Local Health System Support </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities (5 new lines) </td>
   <td style="text-align:left;"> (part of 3103 programs) </td>
   <td style="text-align:left;"> 3502 Local Health System Support </td>
  </tr>
</tbody>
</table>

---

## The ten largest P/A/Ps (FY 2027 NEP, proposed)

---

## What changes in the FY 2027 proposal (NEP 2026 -> NEP 2027)

.small[
Comparing the two *proposals* (not proposal-vs-enacted) isolates what the Executive actually chose to change. MAIFIP and HFEP are absent here because they are proposed **flat** -- their apparent "cuts" are only versus the Congress-inflated 2026 GAA.
]

---

## Congress's favorite P/A/Ps to augment

---

## MAIFIP: a flagship that exploded

---

## MAIFIP: a few things worth noticing

- **Twelve-fold growth in the GAA:** from PHP 4.9B in 2018 to PHP 58.1B in 2024.
- **NEP << GAA, almost every year:**
  - 2024: NEP PHP 22.3B -> GAA **PHP 58.1B** (PHP 35.8B Congressional plus-up)
  - 2025: NEP PHP 22.3B -> GAA PHP 41.2B (PHP 18.9B plus-up)
  - 2026: NEP PHP 24.2B -> GAA **PHP 51.7B** (PHP 27.4B plus-up)
- **Execution looks strong on paper but the lag is real:** in 2024 MAIFIP obligated PHP 49.6B of PHP 58.1B (85%) but disbursed only PHP 31.7B (55% of allotment). Even in 2018 the program disbursed only 66% of its much smaller PHP 4.9B allotment.
- **FY 2027:** the Executive again proposes **PHP 24.2B -- identical to its 2026 proposal.** If the pattern holds, Congress will roughly double it at enactment. Reading this as a "cut" versus the PHP 51.7B 2026 GAA would be a proposal-vs-enacted error.
- **Open question:** is MAIFIP a de facto substitute for PhilHealth case-rate coverage, or a discretionary "ayuda" line item? The proposed-vs-enacted gap suggests the latter dynamic is strong -- and makes the annual restoration a live advocacy question, not a foregone conclusion.

---

## Absorptive capacity: aggregate

---

## Absorption by Expense Class

---

## What the expense-class data reveals

- **The absorption problem is largely a Capital Outlay problem.** CO disburses at 14-37% of allotment across the full period; PS at ~98%; MOOE in between (50-70%). When the aggregate DOH-OSEC D/A reads as "weak", what's actually weak is the infrastructure pipeline.
- **HFEP's chronic 22-29% disbursement is not an HFEP-specific problem.** HFEP is almost entirely Capital Outlay -- its number sits squarely on the systemwide CO baseline. Fixing HFEP means fixing CO execution capacity in general.
- **MAIFIP is pure MOOE** (cash assistance), and its 55-71% D/A sits in the middle of the MOOE distribution. Not exceptional in either direction.
- **Congressional augmentation goes overwhelmingly to MOOE.** Cumulative 2018-2026: PHP 125B added to MOOE, PHP 68B to CO, only PHP 17B to PS. Congress' fiscal preference is operating-expense-heavy (commodities, ayuda lines, contracted services).
- **CO disbursement is deteriorating.** From 37% in 2021 to 19% in 2025 -- the floor keeps dropping even as the GAA grew. The 2026 GAA cut to HFEP and other CO-heavy lines may be Congress finally pricing this in.

---

## Strongest absorbers (FY 2025)

<table class="table table-condensed" style="font-size: 13px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> P/A/P </th>
   <th style="text-align:right;"> Adj. Allotment (PHP B) </th>
   <th style="text-align:right;"> Oblig./Allot. </th>
   <th style="text-align:right;"> Disb./Allot. </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> Administration of Personnel Benefits </td>
   <td style="text-align:right;"> 11.95 </td>
   <td style="text-align:right;"> 100% </td>
   <td style="text-align:right;"> 97% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Regulation of Health Establishments and Products </td>
   <td style="text-align:right;"> 0.50 </td>
   <td style="text-align:right;"> 100% </td>
   <td style="text-align:right;"> 99% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> National Health Workforce Support System (NHWSS) </td>
   <td style="text-align:right;"> 17.92 </td>
   <td style="text-align:right;"> 100% </td>
   <td style="text-align:right;"> 95% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operation of Dangerous Drug Abuse Treatment and Rehabilitation Centers </td>
   <td style="text-align:right;"> 1.76 </td>
   <td style="text-align:right;"> 99% </td>
   <td style="text-align:right;"> 95% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Cancer Assistance Fund </td>
   <td style="text-align:right;"> 1.25 </td>
   <td style="text-align:right;"> 99% </td>
   <td style="text-align:right;"> 92% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of DOH Hospitals in Metro Manila (MM) </td>
   <td style="text-align:right;"> 21.91 </td>
   <td style="text-align:right;"> 99% </td>
   <td style="text-align:right;"> 86% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of DOH Regional Hospitals and Other Health Facilities </td>
   <td style="text-align:right;"> 73.71 </td>
   <td style="text-align:right;"> 97% </td>
   <td style="text-align:right;"> 87% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Foreign-Assisted Project: Philippine Multi-Sectoral Nutrition Project WB Loan No. 9382-PH </td>
   <td style="text-align:right;"> 1.44 </td>
   <td style="text-align:right;"> 97% </td>
   <td style="text-align:right;"> 96% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Local Health Systems Development and Assistance </td>
   <td style="text-align:right;"> 0.66 </td>
   <td style="text-align:right;"> 94% </td>
   <td style="text-align:right;"> 76% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of Blood Centers and National Voluntary Blood Services Program </td>
   <td style="text-align:right;"> 0.65 </td>
   <td style="text-align:right;"> 93% </td>
   <td style="text-align:right;"> 45% </td>
  </tr>
</tbody>
</table>

- The full-obligation list is dominated by **personnel-type spending** (salaries, HCW benefits, NHWSS) -- structurally obligated up front.
- Hospital operations (Regional Hospitals, MM Hospitals, DDA centers) round out the top end -- recurring operational lines absorb cleanly.

---

## Weakest absorbers (FY 2025)

<table class="table table-condensed" style="font-size: 13px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> P/A/P </th>
   <th style="text-align:right;"> Adj. Allotment (PHP B) </th>
   <th style="text-align:right;"> Oblig./Allot. </th>
   <th style="text-align:right;"> Disb./Allot. </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Family Planning and Reproductive Health </td>
   <td style="text-align:right;"> 0.75 </td>
   <td style="text-align:right;"> 0% </td>
   <td style="text-align:right;"> 0% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Prevention and Control of Non-Communicable Diseases </td>
   <td style="text-align:right;"> 3.48 </td>
   <td style="text-align:right;"> 13% </td>
   <td style="text-align:right;"> 0% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Family Health, Immunization, Nutrition and Responsible Parenting </td>
   <td style="text-align:right;"> 10.18 </td>
   <td style="text-align:right;"> 56% </td>
   <td style="text-align:right;"> 6% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Quick Response Fund </td>
   <td style="text-align:right;"> 0.50 </td>
   <td style="text-align:right;"> 50% </td>
   <td style="text-align:right;"> 6% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Information Technology </td>
   <td style="text-align:right;"> 2.30 </td>
   <td style="text-align:right;"> 10% </td>
   <td style="text-align:right;"> 8% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Prevention and Control of Communicable Diseases </td>
   <td style="text-align:right;"> 5.14 </td>
   <td style="text-align:right;"> 31% </td>
   <td style="text-align:right;"> 21% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Facilities Enhancement Program </td>
   <td style="text-align:right;"> 16.61 </td>
   <td style="text-align:right;"> 62% </td>
   <td style="text-align:right;"> 22% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of Philippine Health Laboratory System </td>
   <td style="text-align:right;"> 0.75 </td>
   <td style="text-align:right;"> 60% </td>
   <td style="text-align:right;"> 26% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Supply Chain Management </td>
   <td style="text-align:right;"> 0.90 </td>
   <td style="text-align:right;"> 76% </td>
   <td style="text-align:right;"> 38% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of Blood Centers and National Voluntary Blood Services Program </td>
   <td style="text-align:right;"> 0.65 </td>
   <td style="text-align:right;"> 93% </td>
   <td style="text-align:right;"> 45% </td>
  </tr>
</tbody>
</table>

- **The new (2025) commodities programs** under PREXC `3502` came in catastrophically under-absorbed -- three of them disbursed near-zero in their first year. Coding-transition artefact or real procurement bottleneck?
- **HFEP** disbursed only **22%** of its PHP 16.6B allotment -- consistent with its long-running implementation lag.
- **Quick Response Fund** disbursed only **6%** of its PHP 500M ceiling -- a recurring story.

---

## Trajectories of the largest health programs

---

## Trend takeaways for the heavyweights

- **Regional Hospitals:** the steadiest workhorse -- GAA, allotment, and disbursements move almost in lockstep. The PHP 75.6B 2025 GAA was about 92% disbursed.
- **MAIFIP:** runaway GAA growth (2x in 2024 alone), but disbursement runs 30 ppt below GAA. Adding more money has not translated 1:1 into spending.
- **MM Hospitals:** mirrors Regional Hospitals in pattern -- recurring operations absorb cleanly (~84% disbursed in 2025).
- **NHWSS (formerly HRH Deployment):** the country's frontline-health-workforce line. The program was renamed and re-coded in 2022 but represents one continuing function. Scaled from PHP 9.6B (2018) to PHP 23.4B (2026), absorbing cleanly throughout (D/A 87-98%) -- one of the few large programs that grows without an execution lag.
- **HFEP:** a flat-line disbursement curve despite a GAA that doubled then halved between 2022 and 2025. The persistent 22-29% disbursement-to-allotment ratio is the deepest structural absorption issue in the portfolio.
- **Administration of Personnel Benefits:** straightforward payroll line -- obligated and disbursed at near-100% every year.

---

## Zooming in on HFEP

---

## HFEP: what the numbers tell us

<table class="table table-condensed" style="font-size: 14px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> FY </th>
   <th style="text-align:right;"> NEP (B) </th>
   <th style="text-align:right;"> GAA (B) </th>
   <th style="text-align:right;"> Allotment (B) </th>
   <th style="text-align:right;"> Disbursed (B) </th>
   <th style="text-align:right;"> D/A </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> 2018 </td>
   <td style="text-align:right;"> 29.0 </td>
   <td style="text-align:right;"> 30.3 </td>
   <td style="text-align:right;"> 30.3 </td>
   <td style="text-align:right;"> 8.4 </td>
   <td style="text-align:right;"> 28% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2019 </td>
   <td style="text-align:right;"> 0.0 </td>
   <td style="text-align:right;"> 15.9 </td>
   <td style="text-align:right;"> 15.6 </td>
   <td style="text-align:right;"> 2.0 </td>
   <td style="text-align:right;"> 13% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2020 </td>
   <td style="text-align:right;"> 5.9 </td>
   <td style="text-align:right;"> 8.4 </td>
   <td style="text-align:right;"> 8.3 </td>
   <td style="text-align:right;"> 2.7 </td>
   <td style="text-align:right;"> 32% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2021 </td>
   <td style="text-align:right;"> 4.8 </td>
   <td style="text-align:right;"> 7.8 </td>
   <td style="text-align:right;"> 7.8 </td>
   <td style="text-align:right;"> 2.5 </td>
   <td style="text-align:right;"> 32% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2022 </td>
   <td style="text-align:right;"> 19.6 </td>
   <td style="text-align:right;"> 23.1 </td>
   <td style="text-align:right;"> 23.1 </td>
   <td style="text-align:right;"> 6.7 </td>
   <td style="text-align:right;"> 29% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2023 </td>
   <td style="text-align:right;"> 23.0 </td>
   <td style="text-align:right;"> 26.8 </td>
   <td style="text-align:right;"> 26.8 </td>
   <td style="text-align:right;"> 7.7 </td>
   <td style="text-align:right;"> 29% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2024 </td>
   <td style="text-align:right;"> 23.0 </td>
   <td style="text-align:right;"> 28.6 </td>
   <td style="text-align:right;"> 18.1 </td>
   <td style="text-align:right;"> 4.2 </td>
   <td style="text-align:right;"> 23% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> 2025 </td>
   <td style="text-align:right;"> 23.0 </td>
   <td style="text-align:right;"> 35.4 </td>
   <td style="text-align:right;"> 16.6 </td>
   <td style="text-align:right;"> 3.7 </td>
   <td style="text-align:right;"> 22% </td>
  </tr>
</tbody>
</table>

- **DBM has been cutting HFEP releases.** GAA reached PHP 35.4B in 2025 but only PHP 16.6B was allotted -- the Adjusted Allotment in 2024 and 2025 ran PHP 10-19B below GAA. Whatever the absorption story is, DBM is already pricing it in.
- **The 2026 GAA fell to PHP 22.3B** (from PHP 35.4B in 2025) -- the first major reversal since HFEP's 2022 recovery from the 2019-2021 dip. Congress appears to be acknowledging the absorption ceiling.
- **The absorption ceiling is structural.** D/A has never exceeded 32% in any year on record (the 2020-2021 peak). Cumulative unspent allotment across 2018-2025 is approximately **PHP 109B** -- close to four full years of average HFEP allotment.
- **Procurement and LGU coordination** are the usual diagnoses. The question for this audience: which specific reform would actually move the needle?

---

## Trajectories of the lowest-absorbing programs

---

## Line-item reference: the FY 2027 proposal in context

<table class="table table-condensed table-striped" style="font-size: 11px; color: black; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> P/A/P </th>
   <th style="text-align:right;"> NEP 2027 (B) </th>
   <th style="text-align:right;"> NEP 2026 (B) </th>
   <th style="text-align:right;"> GAA 2026 (B) </th>
   <th style="text-align:right;"> D/A 2025 </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;"> Operations of DOH Regional Hospitals and Ot... </td>
   <td style="text-align:right;"> 102.87 </td>
   <td style="text-align:right;"> 95.26 </td>
   <td style="text-align:right;"> 101.75 </td>
   <td style="text-align:right;"> 87% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operations of DOH Hospitals in Metro Manila... </td>
   <td style="text-align:right;"> 26.93 </td>
   <td style="text-align:right;"> 26.47 </td>
   <td style="text-align:right;"> 29.98 </td>
   <td style="text-align:right;"> 86% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> National Health Workforce Support System (N... </td>
   <td style="text-align:right;"> 25.39 </td>
   <td style="text-align:right;"> 23.36 </td>
   <td style="text-align:right;"> 23.36 </td>
   <td style="text-align:right;"> 95% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Medical Assistance to Indigent and Financia... </td>
   <td style="text-align:right;"> 24.24 </td>
   <td style="text-align:right;"> 24.24 </td>
   <td style="text-align:right;"> 51.65 </td>
   <td style="text-align:right;"> 61% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Administration of Personnel Benefits </td>
   <td style="text-align:right;"> 16.98 </td>
   <td style="text-align:right;"> 14.28 </td>
   <td style="text-align:right;"> 14.28 </td>
   <td style="text-align:right;"> 97% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Facilities Enhancement Program </td>
   <td style="text-align:right;"> 14.54 </td>
   <td style="text-align:right;"> 14.54 </td>
   <td style="text-align:right;"> 22.29 </td>
   <td style="text-align:right;"> 22% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Family ... </td>
   <td style="text-align:right;"> 9.10 </td>
   <td style="text-align:right;"> 10.24 </td>
   <td style="text-align:right;"> 10.24 </td>
   <td style="text-align:right;"> 6% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Foreign-Assisted Project: Philippines Healt... </td>
   <td style="text-align:right;"> 7.73 </td>
   <td style="text-align:right;"> 8.67 </td>
   <td style="text-align:right;"> 8.67 </td>
   <td style="text-align:right;">  </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Prevent... </td>
   <td style="text-align:right;"> 6.89 </td>
   <td style="text-align:right;"> 7.72 </td>
   <td style="text-align:right;"> 7.72 </td>
   <td style="text-align:right;"> 21% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> General Management and Supervision </td>
   <td style="text-align:right;"> 3.77 </td>
   <td style="text-align:right;"> 3.82 </td>
   <td style="text-align:right;"> 3.82 </td>
   <td style="text-align:right;"> 85% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Cancer Assistance Fund </td>
   <td style="text-align:right;"> 3.75 </td>
   <td style="text-align:right;"> 1.25 </td>
   <td style="text-align:right;"> 1.50 </td>
   <td style="text-align:right;"> 92% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Disease Prevention and Control </td>
   <td style="text-align:right;"> 3.12 </td>
   <td style="text-align:right;"> 3.30 </td>
   <td style="text-align:right;"> 3.30 </td>
   <td style="text-align:right;"> 71% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Prevent... </td>
   <td style="text-align:right;"> 2.73 </td>
   <td style="text-align:right;"> 2.73 </td>
   <td style="text-align:right;"> 2.73 </td>
   <td style="text-align:right;"> 0% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Promotion </td>
   <td style="text-align:right;"> 2.54 </td>
   <td style="text-align:right;"> 2.53 </td>
   <td style="text-align:right;"> 1.11 </td>
   <td style="text-align:right;"> 46% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Operation of Dangerous Drug Abuse Treatment... </td>
   <td style="text-align:right;"> 2.38 </td>
   <td style="text-align:right;"> 2.79 </td>
   <td style="text-align:right;"> 2.79 </td>
   <td style="text-align:right;"> 95% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Local Health Systems Development and Assist... </td>
   <td style="text-align:right;"> 1.50 </td>
   <td style="text-align:right;"> 1.41 </td>
   <td style="text-align:right;"> 1.41 </td>
   <td style="text-align:right;"> 76% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Supply Chain Management </td>
   <td style="text-align:right;"> 1.24 </td>
   <td style="text-align:right;"> 1.22 </td>
   <td style="text-align:right;"> 1.22 </td>
   <td style="text-align:right;"> 38% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Health Information Technology </td>
   <td style="text-align:right;"> 0.70 </td>
   <td style="text-align:right;"> 2.53 </td>
   <td style="text-align:right;"> 1.14 </td>
   <td style="text-align:right;"> 8% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Regulation of Health Establishments and Pro... </td>
   <td style="text-align:right;"> 0.68 </td>
   <td style="text-align:right;"> 0.62 </td>
   <td style="text-align:right;"> 0.62 </td>
   <td style="text-align:right;"> 99% </td>
  </tr>
  <tr>
   <td style="text-align:left;"> Nationally-procured Commodities for Family ... </td>
   <td style="text-align:right;"> 0.66 </td>
   <td style="text-align:right;"> 0.75 </td>
   <td style="text-align:right;"> 0.75 </td>
   <td style="text-align:right;"> 0% </td>
  </tr>
</tbody>
</table>

.footnote[FY 2027 = proposed (NEP). Compare "NEP 2027" to "NEP 2026" for the proposal-to-proposal change, and to "GAA 2026" to see how far the enacted level has run above the proposal. D/A 2025 shows each line's most recent absorption.]

---

## For discussion -- scrutinising the FY 2027 proposal

1. **Is the proposal honest?** The Executive again proposes MAIFIP (PHP 24B) and HFEP (PHP 15B) far below what Congress enacts. Under-proposing programs everyone expects to grow makes the NEP a weak basis for planning -- should advocates press for a proposal that reflects the likely enacted level?
2. **Will Congress restore them -- and how?** If MAIFIP is doubled again at enactment, advocates may have more leverage over *how* it is targeted (who qualifies, how funds reach patients) than over the NEP itself. What safeguards would make the plus-up equitable?
3. **The within-proposal tilt.** The Executive's own priorities shift toward hospital operations, the health workforce and a tripled Cancer Assistance Fund, while trimming health IT and some commodities. Are those the right trade-offs for access and prevention?
4. **HFEP's chronic absorption gap:** even if Congress restores it, HFEP disburses only 22-29%. What would push it past 50% -- procurement reform, multi-year obligation authority, NGA-LGU coordination?
5. **The operations share keeps rising.** Is DOH-OSEC slowly becoming an agency that operates hospitals first and stewards the health system second?

---

class: center, middle

# Thank you

Questions, pushback, and counter-stories welcome.

.footnote[Underlying data: DBM NEP & GAA and DBM-published execution data for the DOH-OSEC (Current New Appropriations only), NEP FY 2018-2027, GAA and execution FY 2018-2026/2025. FY 2027 is the proposed NEP only.]