Situation: A public health nurse at the Rural Health Unit (RHU) of an upland municipality with several geographically isolated barangays applies primary health care (PHC) in her daily work. Residents ask that the district hospital serving their area be upgraded with a delivery room and more beds. Under the devolution of health services in the Local Government Code of 1991 (RA 7160), to which local government unit should the nurse help them direct this request?

RA 7160 devolved health services by level: the barangay maintains the barangay health station, the municipality provides primary health care through the RHU, the province provides hospital and other tertiary services, and a city provides both municipal and provincial services. District and provincial hospitals are therefore the province's responsibility.

Devolution of health services under RA 7160

The Local Government Code of 1991 (RA 7160) assigned health functions to different levels of local government. The barangay keeps the barangay health station, the municipality operates the RHU and delivers primary care, and the province takes charge of hospital services, including district and provincial hospitals. A request to upgrade a district hospital with a delivery room and more beds therefore falls under the province, not the municipality, barangay, or DOH.

Devolution means transferring power, authority, and responsibility for public services from the national government to local government units. In health care, this created a tiered system so that each level manages the services most appropriate to its capacity and population reach. The RHU provides outpatient, preventive, and primary care services close to the community, while hospitals require larger budgets, specialized staff, and broader catchment areas, which is why they were assigned to the province.

District and provincial hospitals are the province's responsibility because hospital operations demand resources and coordination that exceed municipal capacity. When residents ask for a delivery room and additional beds, they are requesting expansion of a secondary-level facility. The nurse should direct the request to the provincial government, which plans, funds, and manages hospital services under the devolved structure.

The Mandanas-Garcia ruling reinforces this framework by clarifying that the full devolution of services defined in the Local Government Code, including health services, must be implemented. Greater internal revenue allotment to local governments strengthens decentralized governance but does not change which level of government is responsible for hospitals. The province remains the accountable unit for district hospital upgrades.

Level of local government	Health facility or service	Primary responsibility
Barangay	Barangay health station	Basic community health services, first contact care
Municipality	Rural Health Unit (RHU)	Primary health care, outpatient and preventive services
Province	District and provincial hospitals	Hospital services, secondary and tertiary care
City	RHU and hospital	Both municipal and provincial health functions

Key point! The DOH sets standards, licenses facilities, and provides technical guidance, but it does not directly operate or upgrade district hospitals under the devolved setup. Watch out! A common error is choosing the municipality because the RHU is there, but hospital services are explicitly assigned to the province. The barangay is even less appropriate because it only maintains the barangay health station.