In the Philippines, the enactment of the 1991 Local Government Code (the 1991 Code) led to further fiscal decentralization; in addition, it brought about significant devolution of the provision of public services. One of the most affected sectors was the health sector. The responsibility for providing health services was devolved in a drastic manner to the lower tiers of government following the enforcement of the 1991 Code. A considerable number of personnel were transferred from the central to local governments in the health sector, and local responsibility for providing health services was significantly expanded. Provincial governments became responsible for secondary and tertiary services, including the management and maintenance of hospitals, whereas municipal governments became responsible for public health services, i.e., the promotion of health care and the prevention of diseases.