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Chapter 2 Change and Development in a Municipality
I inherit from the past of my family, my city, my tribe, my nation, a variety of debts, inheritance, rightful expectations, and obligations. These constitute the given of my life, my moral starting point. --an Athenian Oath
A leader is a man who has the ability to get other people to do what they don’t want to do and like it. --Harry Truman
Public health managers and local chief executives confront the same dilemma when they try to introduce change in the health behavior of a community. The community, like the frog, could be swimming in water that is heated slowly through time that it hardly notices the heat that could soon be fatal. Change starts with questioning what is “normal” by challenging currently accepted norms. The frog should have questioned why the water was becoming hot. Instead he just swam around the assumption that the water was just warm enough for swimming, not for getting boiled. This same mentality pervades many municipalities and cities. For example, air pollution increased gradually in Metro Manila until it reached toxic levels. Metro Manilans have learned to live with the gray, sticky air that stings the eyes and reeks with gasoline fumes. Tap water is no longer safe to drink, and drinking bottled water (from plastic bottles that pile up the landfills) is suddenly the norm. The mountain of garbage grew taller with each passing day in Payatas, until it was an avalanche just waiting to happen. In Appari, human waste was disposed of in the beaches for years. Not surprisingly the morbidity rate due to diarrhea has been high in these localities for decades. In Alimudian (as in many other places in the Philippines), differently-abled people have been constantly teased by their neighbors, children by other children. A common practice among Filipino families is to keep differently-abled family members in the confines of their home because of the stigma or sense of “hiya” that that family member brings to the family. The mentioned cases bear out the boiled frog phenomenon. It shows that a certain locality’s long-standing health behaviors may be harmful. Like the frog, the citizens may be ignoring harmful elements in their environment or in their culture, and go on inflicting harm upon themselves as they continue to accept and perpetuate these realities. But how does one change age-old practices? How does one press the alarm button to rouse a people out of their own stuporous complacency? How does the public health manager go against the tide of what is accepted as “normal” and change the status quo?
Continuous Improvement or Programmed Change. The Olongapo Solid Waste Management Program is an example of a project that is triggered by a recognition of an emerging problem. Like the crisis-induced change, no external party is needed to point out the need for change. Unlike the crisis-induced change, the intervention happens before the crisis occurs. The project is therefore proactive, rather than reactive, anticipating and solving problems before they occur. Table 1 below is a summary of the triggers of change in the ten cases.
Table 1 – Triggers of Change in the Cases
Complaint-Induced Change. Citizen complaints can also trigger change. In his discussion of Total Quality Governance, Bolongaita shows how feedback from constituents-customers can benchmark what local government needs to act upon, what it will and what it will not act upon. Table 2: Priority Governance Matrix
Bolongaita (1996)1
Governance Beyond the Boiled Frog Government “of the people, for the people, by the people” was assumed to naturally result in good governance. Devolution was designed to heighten the strengths of democratic government by putting power and resources for governance closer to the communities. (quote JP Perez paper from McNamara) In theory, people chose their mayors and governors in democratic elections and could easily remove low-performance mayors after three years. In theory, a Mayor would throughout his term attempt to satisfy the needs of his constituency or else he would not get reelected. Over time, only high-performance mayors would remain in power because the citizens were satisfied with the quality of his governance. Yet this does not happen. Excellent government programs are still the exception and not the rule. Many mayors continue with mediocre programs, building roads and waiting sheds and plod along only to win in the next elections.
Source: Zaltman, Management of Change readings (look for better citation)
The beauty of this approach to development is that it is learning-driven rather than resource-driven. The boiled frog does not need external funding support to get itself out of hot water. It just had to be nudged out of it’s stupor and it solved its problem pretty much on its own. With a learning-driven approach to public health (and development in general), financial constraints will seldom be an obstacle, and if they are obstacles they will be minor ones. As the cases later in this book will show, even poor municipalities can come up with sensational health programs. The only barriers to development would be the refusal to learn.
The Axes of Governance So what is governance? Generations of thinkers and political scientists - from Aristotle and Machiavelli to the likes of Osborne and Gablier--have pondered and produced voluminous texts on this matter. If we are to adopt a people-centered approach, governance is basically managing the area system so that it addresses the new needs and wants of the people that live in it. This definition is anchored on the premise that humans are evolving/growing in complexity as beings within a system, and it follows that a system has to evolve in complexity to address increasing human needs while maintaining long-term system viability. Governance could also mean managing the market of economic goods and services and managing the market of values and ideas, culture and social learning. It could also involve the regulation of the “consumption” of values and ideals. This book presents the dynamics of governance along five axes (lines). This will allow for a more systematic analysis of governance processes that hopes to be neither simplistic nor confounded by the complexity of the concepts.
Case 1 Appari’s Clean Sea, Healthy Community
Because of its distance from urban centers, the northernmost Philippine island of Appari lacked sanitary facilities for its people. The shores covering five barangays at the eastern part of Appari were used as defecation area. Residents did not care about the serious damage dumping of refuse and human wastes posed to their health and the environment. These unsightly shores became favorite breeding ground for disease-carrying insects. Due to the deteriorating physical environment, Apparianos were exposed to health problems. Potable water source was left often susceptible to all kinds of impurities and bacteria. Makeshift houses also dotted the coastal areas, and residents had nowhere to dispose of all sorts of garbage but the waters below their homes.
In 1993, a wake up call for Apparianos came with a bang through a TV program. Magandang Gabi Bayan, anchored by Noli de Castro of ABS-CBN, featured Appari’s shores as the “longest toilet in the world.” This branding on national TV alarmed the Apparianos, especially the local chief executive.
This ill-reputation broadcast on television pushed Apparianos to unabated action. Mayor Tumaru dialogued with the members of Sangguniang Bayan and the Association of Barangay Councils to institutionalize “Clean Appari through KALINISAN SA BUDHI, SA SARILI, AT SA KAPALIGIRAN.” This then, started a collective decision to change.
Affected residents agreed to relocate their houses at identified sites through the “bayanihan” spirit of volunteerism. As stewards of the environment, they were tasked to level the ground and maintain cleanliness in their respective vicinity.
The municipal and barangay government constructed public toilets to answer the sanitation needs of barangay folks. Artesian wells were likewise installed. The users of the public toilets and water facilities were organized into groups and provided financial contributions for the daily upkeep of the facilities.
Clean up and rehabilitation of the shores were not done overnight. It became the community’s never ending commitment. Added to the beauty of the now rehabilitated Appari shores were picnic shades, which eventually became a source of auxiliary income for the town folks. In San Antonio beach, each resident acted as caretaker with permanent assigned picnicker’s shed to maintain. Incentive derived thru rentals of P50 per shed was divided equally between the Barangay Council and caretaker.
Training/seminars on entrepreneurship and livelihood generation were also provided to residents. An aggregate financial assistance amounting to Four Hundred Thirty Seven Thousand pesos was channeled to various livelihood projects and self-employment programs enjoyed by 172 beneficiaries of three coastal barangays.
I inherit from the past of my family, my city, my tribe, my nation, a variety of debts, inheritance, rightful expectations, and obligations. These constitute the given of my life, my moral starting point. --an Athenian Oath
A leader is a man who has the ability to get other people to do what they don’t want to do and like it. --Harry Truman
The Fable of the Boiled Frog (It says that if a frog is placed in a pot of water that is at room temperature and then the water is heated very, very slowly, the frog will hardly notice that the water is getting hot. As the water temperature rises, the frog would swim around, enjoying the warm water and oblivious to the gradually increasing heat. As the water gets closer to the boiling point, the frog is both literally and figuratively in hot water. Rendered sluggish and drowsy by the heat, the frog is already helpless by the time the water is already too hot for swimming. Thus, the frog ends up unconscious and boiled (and yes, dead). On the other hand, a frog dropped into a pot of very hot water would feel the heat immediately and will struggle to jump out and be saved. ) The Parable of the Boiled Frog
The parable of the boiled frog is told so well by MIT scientist and educator Peter Senge to illustrate maladaptation to gradually building threats. If you place a frog in a pot of boiling water, it will immediately try to scramble out to save itself. But if you place the frog in room temperature water, he'll stay put. If you just gradually turn up the temperature, something very interesting happens. As the temperature rises slowly, the frog will do nothing and may even show every sign of enjoying himself. As the temperature gradually increases, the frog will become too helpless to climb out. Though there is nothing restraining him, the frog will sit there, boil and die.
Challenging the Status Quo
Public health managers and local chief executives confront the same dilemma when they try to introduce change in the health behavior of a community. The community, like the frog, could be swimming in water that is heated slowly through time that it hardly notices the heat that could soon be fatal. Change starts with questioning what is “normal” by challenging currently accepted norms. The frog should have questioned why the water was becoming hot. Instead he just swam around the assumption that the water was just warm enough for swimming, not for getting boiled. This same mentality pervades many municipalities and cities. For example, air pollution increased gradually in Metro Manila until it reached toxic levels. Metro Manilans have learned to live with the gray, sticky air that stings the eyes and reeks with gasoline fumes. Tap water is no longer safe to drink, and drinking bottled water (from plastic bottles that pile up the landfills) is suddenly the norm. The mountain of garbage grew taller with each passing day in Payatas, until it was an avalanche just waiting to happen. In Appari, human waste was disposed of in the beaches for years. Not surprisingly the morbidity rate due to diarrhea has been high in these localities for decades. In Alimudian (as in many other places in the Philippines), differently-abled people have been constantly teased by their neighbors, children by other children. A common practice among Filipino families is to keep differently-abled family members in the confines of their home because of the stigma or sense of “hiya” that that family member brings to the family. The mentioned cases bear out the boiled frog phenomenon. It shows that a certain locality’s long-standing health behaviors may be harmful. Like the frog, the citizens may be ignoring harmful elements in their environment or in their culture, and go on inflicting harm upon themselves as they continue to accept and perpetuate these realities. But how does one change age-old practices? How does one press the alarm button to rouse a people out of their own stuporous complacency? How does the public health manager go against the tide of what is accepted as “normal” and change the status quo? The Sky is Falling: Disturbing the Unwanted Peace
Challenging the norm is risky business. One risks being tagged an alarmist or doomsdayer. If a leader sounds the alarm too often for perils that the crowd cannot yet discern, he may be brushed off and ignored. His ego may be hurt and his credibility will because of his alarmist attitude—until the crisis that he warned about erupts. Then all he can say is “I told you so.”
External Critic-Induced Change. Fortunately, there are ways of inducing change that do not put one’s reputation at risk. In the case of Aparri in Cagayan, the LGU initiative to embark on a health project was triggered by the television feature of Channel 2’s Magandang Gabi Bayan. Appari was touted as having the “longest toilet in the world,” exposing the local’s practice of hurling their wastes to the long stretch of beaches in their town.
The news was not new to Aparrianos. The knew it all along. But the program segment touched the sensitivity of the Apparianos. The newly elected mayor --a doctor by profession who already knew of this situation long before the national broadcast was made—rallied the Apparianos to solve the unhealthy situation of their beaches and launched the “Marenu nga Bevay, Gauagagauyan ba Tatolay” (A Clean Sea, A Healthy Community) project. Because of an outsider’s criticism, the infamous “toilets” of Appari ultimately got the upkeep and attention of the indignant, and newly sensitized, citizenry. Alimodian has another story to tell. Outsiders, the staff of DOH’s Community-Based Rehabilitation Program, met with the citizenry and pointed out the plight of the differently–abled individuals in the community. In the same breath proposed an inexpensive solution which won the people’s support. With the people’s support, Alimudian’s Community-Based Rehabilitation Program pushed through, improving the lives of the differently-abled and winning recognition for the town in the process.Crisis-Induced Change. Not all change is externally induced. Davao acted on a because of a blood shortage. With unusually high death rates primarily caused by failure to have blood transfusions, the provincial government was prompted to set up a blood self-sufficiency program.
Statistics showed that only one out of every five hundred Davaweños voluntarily donated blood. Of every ten persons needing blood, only three sourced blood from such donors. The rest relied on paid donors. Still, paid donors from blood banks in their locality could only supply less than twenty percent of the demand. Another five percent is supplied by the central blood banks of Davao City. The provincial government responded by setting up barangay blood pools to solve the problem.Benchmarking. The Bulacan health program is interesting because it was triggered by a report from the Regional Health Office that the province lagged behind other provinces in the region as far as nutrition was concerned. A “kulelat complex” was triggered by performance comparison. The otherwise silent and undramatic problem of malnutrition suddenly became the focus of attention.
Only one out of the ten cases was triggered by an administrative report. Seemingly, when public health leaders are sensitive enough, they will respond to gaps in their system as shown when compared with other LGUs. High-performing LGUs, thus become the model and the standard for other LGUs to measure themselves against. For national government, this is one method that promises to help make improvements more widespread across the country.
Continuous Improvement or Programmed Change. The Olongapo Solid Waste Management Program is an example of a project that is triggered by a recognition of an emerging problem. Like the crisis-induced change, no external party is needed to point out the need for change. Unlike the crisis-induced change, the intervention happens before the crisis occurs. The project is therefore proactive, rather than reactive, anticipating and solving problems before they occur. Table 1 below is a summary of the triggers of change in the ten cases.
Table 1 – Triggers of Change in the Cases
Case | Trigger of Change |
| Aparri | External Critic, Negative News coverage on national TV |
| Olongapo | Recognition of emerging problem, failure of past attempts |
| Bustos | No information, called garbage town |
| Sebaste | Ongoing problem, poverty and distance of community to urban health centers |
| Guimaras | External critic identifies problems and proposes solution |
| Davao | Crisis, lack of blood supply |
| Pangasinan | Crisis, calamity triggers plan |
| Alimudian | External critic identifies problem and proposes solution |
| Bulacan | News that province lags within the region |
| Surigao | Recognition of emerging problems, ongoing expansion of health programs |
Complaint-Induced Change. Citizen complaints can also trigger change. In his discussion of Total Quality Governance, Bolongaita shows how feedback from constituents-customers can benchmark what local government needs to act upon, what it will and what it will not act upon. Table 2: Priority Governance Matrix
| Perceived high severity problem | Perceived low severity problem | |
| Government is not doing anything about the problem | Area of high priority (AHP) | Area of indifference (AOI) |
| Government is doing something about the problem | Area of lower priority (ALP) | Area of satisfaction (AOS) |
Bolongaita’s survey of one business district’s service delivery system to constituents shows that while the local government was already doing something about the problem (mostly in city cleanliness, beautification, and maintenance), a lot of services are not yet delivered to other areas of high priority (curbing prostitution, pornography, vandalism, etc.) Not only did the constituents-customers show the local government where the demand is, they also show that they want change to happen, to make good things better.
Lengthen the discussion on this.Governance Beyond the Boiled Frog Government “of the people, for the people, by the people” was assumed to naturally result in good governance. Devolution was designed to heighten the strengths of democratic government by putting power and resources for governance closer to the communities. (quote JP Perez paper from McNamara) In theory, people chose their mayors and governors in democratic elections and could easily remove low-performance mayors after three years. In theory, a Mayor would throughout his term attempt to satisfy the needs of his constituency or else he would not get reelected. Over time, only high-performance mayors would remain in power because the citizens were satisfied with the quality of his governance. Yet this does not happen. Excellent government programs are still the exception and not the rule. Many mayors continue with mediocre programs, building roads and waiting sheds and plod along only to win in the next elections.
The Politics of Angkan and Utang-na-loob
The electoral processes installed by the Americans did not work very as a feedback mechanism in the Filipino culture. The assumption in an electoral system is that the vote would be used as an objective, unbiased mechanism for allowing a citizenry to choose their leader freely. In the towns, people were not as free. Hollsteiner in her book, “The Dynamics of Power in a Philippine Municipality” points to four basic socio-structural relationships that exist in a typical locality. These relationships are as follows: angkan or clan relations, affinity, ritual kinship and friendship. The clan is the immediate social relationship one is literally born into. Affinity, on the other hand, is relationship acquired through marriages –one’s husband or wife is eventually integrated into her/his nuclear family. The third socio-structural relationship existing in local communities is the ritual kinship or the kumpare system. This is common among the Christian community. This kinship is established through the rituals of baptism and marriage. Lastly, Hollnsteiner identified friendship as the fourth basic structural relationship that binds communities. Utang na loob, or debt of gratitude in Philippine society is an important Filipino social construct. Utang na loob is the indebtedness of Person A to Person B for a favor received. In Philippine culture, the bigger the favor received, the bigger the utang na loob. Utang na loob is also familial, thus the indebtedness of Person A to Person B is also the indebtedness of Person A’s spouse and children, even Person A’s clan, to Person B. Utang na loob is a debt to be taken seriously, a debt that should not to be forgotten. Person A erases his utang na loob by returning the favor in another form at some later date to Person B. When the mechanisms of utang na loob are used constructively, it results in a healthy balanced exchange of favors and goodwill that flows between peers or neighbors as equals. Sadly, utang na loob is often harnessed as a basis for shady, counterproductive exchanges. When the Americans introduced the elections, however, the vote became a currency for individuals, families, and clans to pay their utang na loob to politicians. For example, tenants and their angkan who owed their landlords for the many favors granted to them “paid” their utang na loob by voting for their landlords into position. Local physicians, with the hundreds or thousands of patients they have seen over the years could also count the utang na loob of their patients as political capital that could thrust them into position if they wanted to. And when a politician won, they in turn paid back their utang na loob by awarding jobs and dispensing favors to their political supporters recirculating the utang na loob back into the relationships. This system is often referred to as patronage politics. Bolongaita points out that patron-politicians court people for their votes. Democracy assumes equality among citizens, thus they will vote based on quality of governance. Patronage politics, however, has citizens indebted to patrons, thus they vote for the patron regardless of political performance. Patronage politics doesn’t usually result in change for the better. Its not always that bad though. The cases of excellence in local governance show how it is possible to break out of this cycle or achieve excellence within this system. The point is that elections + utang na loob + clan systems + boiled frogs = a curious, complex, colorful, and spicy, socio-economic-political brew in the Philippines. (And then there’s vote-buying, partisan politics, the adversarial NGOs, the hypercritical media…) The effective public health leader has to understand all that.Cultural Evolution
The public health leader should also learn to keep his hopes up though. The rest of this book discusses how things can go right and stay right. The situation can change for the better if only the public health manager knows how to trigger change and then how to sustain it. Zaltman defines social change as “the relearning of an individual or group in response to newly-perceived requirements of a given situation requiring action and which results in a change in the structure and/or function of social systems.” Table 3 below summarizes the different changes that occur until they become permanent. The Appari Case bears this out. First individuals are disturbed by the news story, so they change their daily waste disposal behaviors and improve their habits for a lifetime. Communities are mobilized to clean up the beaches. Organizational change is implemented by installing a caretaker system to keep the beach and the kiosks clean. In the end, the Appariano’s have cleaner beaches and a better image of themselves. Their children will grow up with clean beaches and better waste disposal habits than their parents. The culture has evolved.| Unit of Change | Short-term | Long-term |
| Individual | type 1 attitude change behavioral change | type2 life cycle change |
| Family community institution organization | type 3 normative change administrative change | type 4 organizational change |
| Society | type 5 invention-innovation revolution | type 6 socio-cultural evolution |
The beauty of this approach to development is that it is learning-driven rather than resource-driven. The boiled frog does not need external funding support to get itself out of hot water. It just had to be nudged out of it’s stupor and it solved its problem pretty much on its own. With a learning-driven approach to public health (and development in general), financial constraints will seldom be an obstacle, and if they are obstacles they will be minor ones. As the cases later in this book will show, even poor municipalities can come up with sensational health programs. The only barriers to development would be the refusal to learn.
The Axes of Governance So what is governance? Generations of thinkers and political scientists - from Aristotle and Machiavelli to the likes of Osborne and Gablier--have pondered and produced voluminous texts on this matter. If we are to adopt a people-centered approach, governance is basically managing the area system so that it addresses the new needs and wants of the people that live in it. This definition is anchored on the premise that humans are evolving/growing in complexity as beings within a system, and it follows that a system has to evolve in complexity to address increasing human needs while maintaining long-term system viability. Governance could also mean managing the market of economic goods and services and managing the market of values and ideas, culture and social learning. It could also involve the regulation of the “consumption” of values and ideals. This book presents the dynamics of governance along five axes (lines). This will allow for a more systematic analysis of governance processes that hopes to be neither simplistic nor confounded by the complexity of the concepts.
Why an Axis?
The axis is a linear representation of a range or a series of phenomena. Being a linear representation, an axis provides directional or polar tendencies. It could be up or down, to the left or to the right. Lines parallel to each other can also show parallel phenomena. If horizontal, an axis presents the phenomena in a non-judgmental way—no point is higher than the other. The axis also represents even intersecting phenomena along one line. The line represents the phenomena in a simple way despite governance and its dynamics being complex concepts. The linear representation gives us a way of chunking together complex items so that we could better understand these phenomena. Phenomena in governance are clustered along five axes namely: leadership, meaning, organizational, technical and resource. From this point on, chapters in this book deal with the axes. Chapter 3: Leadership Axis discusses the leader as the initiator of change. It presents how the leader transforms his insights into action, and how he can get as many hands to work with him. Chapter 4: Managing Meanings Axis answers the question: How can a leader drive people to action? It discusses how leaders can manage meanings so that people can know what they are engaged in and why. In Chapter 5: Organizational Axis, we discuss how people -- driven by shared meanings -- can organize themselves to action. Chapter 6: Technical Axis shows how the technical processes have to be managed scientifically. Chapter 7: Resource Management Axis discusses a major component for starting and sustaining change—resources and how leaders can mobilize which resource for use and replenishment. Now that all components are in, we will also study in Chapter 8: LGU Dynamics, dynamics in local governments that affect our health programs—political relationships, etc. Finally, towards the conclusion, this book sees the healing in meaning; how from initially being involved in and benefiting from health projects community people “heal” and enrich their lives with meaning.Case 1 Appari’s Clean Sea, Healthy Community
Because of its distance from urban centers, the northernmost Philippine island of Appari lacked sanitary facilities for its people. The shores covering five barangays at the eastern part of Appari were used as defecation area. Residents did not care about the serious damage dumping of refuse and human wastes posed to their health and the environment. These unsightly shores became favorite breeding ground for disease-carrying insects. Due to the deteriorating physical environment, Apparianos were exposed to health problems. Potable water source was left often susceptible to all kinds of impurities and bacteria. Makeshift houses also dotted the coastal areas, and residents had nowhere to dispose of all sorts of garbage but the waters below their homes.
In 1993, a wake up call for Apparianos came with a bang through a TV program. Magandang Gabi Bayan, anchored by Noli de Castro of ABS-CBN, featured Appari’s shores as the “longest toilet in the world.” This branding on national TV alarmed the Apparianos, especially the local chief executive.
This ill-reputation broadcast on television pushed Apparianos to unabated action. Mayor Tumaru dialogued with the members of Sangguniang Bayan and the Association of Barangay Councils to institutionalize “Clean Appari through KALINISAN SA BUDHI, SA SARILI, AT SA KAPALIGIRAN.” This then, started a collective decision to change.
Affected residents agreed to relocate their houses at identified sites through the “bayanihan” spirit of volunteerism. As stewards of the environment, they were tasked to level the ground and maintain cleanliness in their respective vicinity.
The municipal and barangay government constructed public toilets to answer the sanitation needs of barangay folks. Artesian wells were likewise installed. The users of the public toilets and water facilities were organized into groups and provided financial contributions for the daily upkeep of the facilities.
Clean up and rehabilitation of the shores were not done overnight. It became the community’s never ending commitment. Added to the beauty of the now rehabilitated Appari shores were picnic shades, which eventually became a source of auxiliary income for the town folks. In San Antonio beach, each resident acted as caretaker with permanent assigned picnicker’s shed to maintain. Incentive derived thru rentals of P50 per shed was divided equally between the Barangay Council and caretaker.
Training/seminars on entrepreneurship and livelihood generation were also provided to residents. An aggregate financial assistance amounting to Four Hundred Thirty Seven Thousand pesos was channeled to various livelihood projects and self-employment programs enjoyed by 172 beneficiaries of three coastal barangays.
1 Bolongaita, E., Total Quality Governance, Treating the Citizen as Customer, The Asian Manager, Asian Institute of Management, Makati, 1996
