[OPINION] Barangay health stations: The heart of the universal health care dream

Universal health coverage or care (UHC) is a guarantee that when someone gets sick, they are able to conveniently access quality health care without financial hardship or geographic barriers. It is a simple promise that no Filipino will be left behind by the health care system. When realized, UHC means that every Filipino will have access to health care without financial or geographical constraints; every Filipino will receive comprehensive, high-quality health care; and no Filipino will be driven into poverty as a result of catastrophic health-care expenditure.

However — and despite the passage of a law mandating it — UHC remains a dream for the country. A recent survey revealed that more than half of Filipino families still cannot afford to cover basic medical bills, with one in five needing to borrow money even for medical expenses under P1,000.

The UHC Act of 2019 is designed to pivot our health system towards a primary and integrated-care-oriented model. It positions primary care providers or PCPs as first contact points for promotion, prevention, and basic care. Barangay health stations or BHSs ideally fulfill this role by functioning as the first contact point, through PCPs and barangay health workers or BHWs, at the community level nationwide. This, therefore, positions BHSs at the heart of UHC.

In practice, many stations across the country face infrastructural, funding, and operational challenges that stagnate our progress towards UHC. Only half of Filipinos can reach a BHS within 30 minutes of travel — and even when they can, many stations are deficient in equipment, supply, and staff to effectively carry out service delivery. In fact, as of 2025, there are only 26,504 BHSs out of 42,026 barangays. This equates to 37% of barangays lacking a BHS. BHSs are seemingly highly concentrated in urban areas, leaving rural and far-flung areas underserved.

In rural areas, BHSs often operate with just a weighing scale as most facilities lack basic diagnostic tools, such as blood pressure monitors. Some stations have no reliable water and power supply. Others lack refrigerators, hindering the delivery of essential vaccinations to the population. These gaps leave the core function of BHSs largely unmet due to limitations from resource constraints and fragmented networks.

Continuity of care also remains weak. Persistent stockouts of essential medicines, poor follow-up protocols, and weak referral mechanisms reduce the nature of care to episodic encounters instead of sustained relationships. The absence of a centralized digital referral and reporting system leaves many BHSs still dependent on informal methods that leave patients and providers in the dark about treatment outcomes.

Financial and human resource constraints compound these challenges. The decentralized nature of our health system leaves many local government units (LGUs) without the fiscal capacity to maintain BHSs, adequately compensate staff, or maintain reliable supplies. As such, many BHSs in the country are understaffed or have untrained personnel who struggle to carry out maternal, child health, and family planning services.

Ideally, BHSs should serve as the entry point of every Filipino into the health system. But declining trust and the sheer lack of functioning BHSs have led them to go to secondary and tertiary care hospitals for even minor ailments that can be addressed at the community level. Consequently, this results in overcrowded wards, poor staff-to-patient ratio, long waiting times, and overconsumed resources — all of which affect the quality of care and raise equity issues.

To bring us closer to the UHC dream this 2026, the most strategic move is to revisit our health system at its front door by reorienting our priorities towards strengthening BHSs.

First, BHSs must act as the entry point to the health system, and accessibility must be ensured. Every Filipino must have a reachable station within a 30-minute travel time. When BHSs are operating at an optimal capacity, they can absorb demand and relieve pressure from hospitals, which improves efficiency and quality of care across the health system. It also allows hospitals to focus on more complex cases. 

Second, a BHS means nothing without people and services. On the provider side, the pay-for-performance model deserves more serious consideration as it rewards quality of care rather than sheer volume of services. We must also invest in our BHWs through job security and performance-based incentives that help retention and attract others into the role. BHSs must be fully equipped and operate at an optimal capacity, able to carry out the full range of services they are mandated to deliver. 

Third, an integrated and centralized system for referral and reporting must be considered. This can ensure continuity of care and track patient outcomes across service levels. Individual health data should be able to move seamlessly among stations, hospitals, local health offices, and the national level. A conscious and coordinated effort between the local and national governments and the private sector is crucial to make this work. 

Lastly, strengthening our BHSs requires a predictable, consolidated, and sustainable financing mechanism. The creation of Special Health Funds or SHFs — as enshrined in the UHC Act — offers a pathway that allows provinces and cities to pool resources from the Philippine Health Insurance Corporation and LGUs. However, crucial bottlenecks remain. Delays in fund transfers, the absence of operational guidelines, and resistance among politicians to share fiscal control continue to impede progress. If effectively operationalized in 2026, SHFs can ensure that even marginalized or geographically isolated communities receive a fair share of financing to operationalize a BHS in their communities.

Understandably, strengthening our BHSs is only a part of the bigger picture. Political will, addressing funding constraints, and capacitating local health systems are all equally important. It is also worth noting that significant efforts have been and are currently being made by the government, such as the zero balance billing initiative and shift towards value-based financing, bringing us closer to achieving the UHC dream. But if at the heart of UHC is health for all Filipinos, we need those BHSs within their reach — making it the beating heart of our shared dream where every Juan and Juana can dream bigger and live more fully. – Rappler.com

Harold Ivan Hui is a Filipino student pursuing an undergraduate degree in Global Health and Development at the University of Hong Kong, School of Public Health.