Conflict, war and medicine (catch all).

[Uboat509]

I wonder about that. A small vignette to illustrate why...

This vignette also illustrates why the phrase "government-run" is often at the root of a problem, regardless of the government. Correct me if I am wrong Dayuhan, but I suspect that the reason that these RHU's fail more than they succeed is that, like most large scale government programs, there is little incentive for them to succeed and virtually no consequences for failure. The fact that they are Rural suggests that oversight is weak or non-existent. It clearly does not pay well enough to attract the best staff. The fact that the problem is so widespread also suggests that either there is no system for locals to redress problems with the government or that the system is extremely poor. If I was to hazard a guess, I bet that there are occasional (say, around election season) high profile cases where one of these RHU's is investigated and perhaps someone is fired or goes to jail but overall little changes because there is either a lack of incentive or a lack of resources to change things, or a combination of both. When the system is broken that leaves it up to individuals to fix things locally. Dayuhan is fortunate that the head of his local RHU is not only competent and strong willed enough to run an effective clinic but is also willing to do so for a paycheck that does not seem to have attracted the best of her peers to other clinics. That is an extremely rare thing.
This is not meant to be a dig at the government of the Philippines or developing world states specifically. It applies to rich-world states as well. Governments, no matter how well intentioned, tend to be poor stewards of large scale social programs (surprise).

[Dayuhan]

This vignette also illustrates why the phrase "government-run" is often at the root of a problem, regardless of the government. Correct me if I am wrong Dayuhan, but I suspect that the reason that these RHU's fail more than they succeed is that, like most large scale government programs, there is little incentive for them to succeed and virtually no consequences for failure. The fact that they are Rural suggests that oversight is weak or non-existent. It clearly does not pay well enough to attract the best staff. The fact that the problem is so widespread also suggests that either there is no system for locals to redress problems with the government or that the system is extremely poor. If I was to hazard a guess, I bet that there are occasional (say, around election season) high profile cases where one of these RHU's is investigated and perhaps someone is fired or goes to jail but overall little changes because there is either a lack of incentive or a lack of resources to change things, or a combination of both. When the system is broken that leaves it up to individuals to fix things locally. Dayuhan is fortunate that the head of his local RHU is not only competent and strong willed enough to run an effective clinic but is also willing to do so for a paycheck that does not seem to have attracted the best of her peers to other clinics. That is an extremely rare thing.
This is not meant to be a dig at the government of the Philippines or developing world states specifically. It applies to rich-world states as well. Governments, no matter how well intentioned, tend to be poor stewards of large scale social programs (surprise).

All of this is true, but in many cases there are few alternatives to government management of rural health, especially in developing countries. There's little money in it, and few health care professionals are willing to stick with providing GP and primary health care services out in the countryside when the "good life" in the city beckons. It's not only a problem in the developing world; even in modern countries there's real shortage of physicians in many rural communities. In the absence of material incentive (or the presence of much greater incentives elsewhere) it's difficult to find a fully private sector solution.

Of course there are systems here for oversight, but the systems, like most systems in the Philippine government, often aren't implemented with any great vigor. In much of this country there's an established culture of complacency, self-service, and corruption in government service, and those who actually want to do something find themselves slogging through a morass of bureaucratic inertia.