With the onset of devolution in 1992, the operationalization of our hospitals and rural Health Units has indeed suffered a tremendous setback in terms of services due to lack of technical capabilities and financial capacity to manage public health services and hospital operations.

However, the general picture slowly improved with some considerable gains through the assistance of some foreign assisted health programs as well as DOH-initiated programs. But somehow, other issues and concerns have to be attended to especially the fact that health is not a priority among most Local Chief Executives. Insufficient budget in some major issue to contend with especially on the MOOE part.

To ensure and sustain quality of care in health services, there is a need to attend to the following issues, such as inadequate health monitoring system, absence of barangay/municipal health plans, the need to strengthen two-way referral system, inadequate human resource capability, health workers' non-availment of Magna Carta benefits and most of all the strengthening of Local Area Health Development Zones in terms of implementation.

Health Status
The province's Crude Birth Rate in 2001 was placed at 18.46 births per 1,000 population a bit lower than the 2000 figure. Crude Death Rate has increased from 3.29 in 2000 to 3.37 in 2001 per 1,000 populations. Infant Mortality Rate was placed at 14.29 per 1,000 live births and Maternal Mortality Rate was recorded at 1.6 percent.
In the same year, bronchitis, pneumonia ARI and diarrhea remained to be the top among the province's morbidity cases while cardio-vascular diseases, pneumonia and cancer as among the leading causes of death. Pneumonia ranked first on infant morbidity and mortality.

Meanwhile, malnutrition is still prevalent in the province. About half of the pre-school children and school children weighed in 2001 suffering from nutritional deficiency.
Results of the Operation Timbang revealed that incidence of severe malnutrition has increased by 12.06 percent between 2000 and 2001, moderate by 4.17 while mild reduced by 2.72 percent.
The improved result could be attributed to the efforts of the intensified implementation of other nutrition related services such as distribution of Nutroplex Vitamins and weaning food to 3rd degree malnourished pre-school children. There was also distribution of iodized salt as a solution to one of the nutritional problems called Iodine Deficiency Disorders (IDD).

Health Manpower and Facilities
Serving the health needs of the people are 490 health personnel, 373 for public health and 117 for hospital. Of the total number, 49 are doctors, 77 are nurses, 183 are rural health midwives, 28 are dentists, 20 are dental aides, 34 are Medical technologists, 1 Sanitary engineer, 51 Sanitary inspectors, 15 Nutritionist-dietitians, 25 Nursing attendants and 7 pharmacists.

Aside from the 18 Rural Health Units/Center, 1 City health and 194 barangay health stations/centers, there are 9 government and 9 private hospitals in the province delivering health services to the people. This includes a 100 bed capacity medical center in the capital town.

Water and Sanitation
To date approximately 23 percent of the provincial households is still without and/or with unsanitary toilets. This situation invariably exposes a large proportion of the population to diseases like malaria schistosomiasis and filariasis especially in the barangays.
Meanwhile, about 72 percent of the households have access to potable water. Relatedly water-borne diseases continued to be a health problem particularly among the rural population.