Disability Governance Under the Universal Health Care Act of 2019: Evidence from Persons with Disabilities in Tacloban City, Philippines

This study examines Republic Act No. 11223, the Universal Health Care (UHC) Act of 2019, and its implications for health service delivery in Tacloban City, Eastern Visayas, Philippines, with particular attention to the needs of the persons with disabilities (PWD) population. The analysis focuses on governance dimensions such as institutional structures, accountability mechanisms, and inter-agency coordination that shape the implementation of universal health care at the local level. Employing a quantitative approach, the study utilizes a descriptive survey research design to assess the effectiveness of governance in selected health service areas, namely medical examination, hospitalization, laboratory services, medication, rehabilitation, and medical diagnostics. Data were gathered from 340 PWD respondents, providing empirical insight into how universal health care policies are experienced by marginalized populations in a decentralized and resource-constrained setting. The findings reveal persistent governance challenges, including weak inter-agency coordination, insufficient devolution and targeting of disability-related health resources, and the absence of systematic monitoring and accountability mechanisms led and implemented by PWDs themselves. While the UHC Act ensures formal inclusion through automatic enrollment, these governance gaps limit substantive access to health services, particularly in disability-specific areas such as rehabilitation. Based on these findings, the study advances governance-oriented recommendations, including strengthening PWD-led accountability systems, developing integrated inter-agency coordination mechanisms, enhancing local government capacity through disability-responsive budget allocation, and mainstreaming disability across all levels and dimensions of health system governance. This paper contributes empirical evidence to the growing literature on disability governance and underscores the importance of examining universal health care implementation in disaster-prone and resource-constrained contexts, where structural inequalities are most pronounced.