Dr. Redulla was the chief of the Carigara Emergency Hospital (CEH) in the late 70s and early 80s when two major innovations in health service delivery were in the initial stages of development. One was the establishment of the "ladder-curriculum" for health care professionals (midwives, nurses, doctors) at the University of the Philippines Institute of Health Sciences (now known as the School of Health Sciences). Upon the advice of the World Health Organization’s Regional Adviser for Primary Health Care, the University linked development of the new curriculum to a community and health research program to be carried out in the towns constituting the catchment area of the hospital in Carigara. The idea was to base the training courses on evidence-based community needs.

The other development was the plan, spearheaded by then Health deputy minister Jesus Azurin, to integrate hospital and public health services at a level as close as possible to delivery points. At that time, public health programs were vertically implemented with lines of control all the way through regional offices and the national office under a deputy minister. Likewise the line of control for hospitals was a single vertical line directly managed by another deputy minister. As a result, delivery of services at the frontline level was seen as fragmented and inefficient. The Carigara catchment area was one of the trials of integration at the "district" level.

As chief of the catchment area hospital, Doming Redulla was instrumental in securing the cooperation of the municipal health officers in the towns of Carigara, Barugo, Jaro, Capoocan, and San Miguel. Together, these six doctors constituted the Carigara Research and Development Team.

With help from staff of the U.P. College of Medicine as well as WHO and other UN agencies, the team put together the information that led to what is still considered the most relevant curriculum in the country for the training of health workers for rural poor communities.

The successful integration of hospital and public health services at Carigara led to the development of the District Health Services concept. The concept was executed with the implementation of integration of health functions when Dr. Azurin became health minister in 1981. Some of the information from Carigara also found their way into the formulation of a manual for district hospitals published by the WHO Regional Office for the Western Pacific in 1990.

Unfortunately, integrated health services suffered a major set-back with the passage of the Local Government Code in 1991. Localization of services once again separated hospitals from public health as provincial governors took control of the former while the latter was given over to municipal mayors.

The effort to reintegrate health services was initiated with the Estrada administration’s health sector reform agenda. The idea of inter-local health zones revived the concept of towns within catchment areas of district hospitals working together as integrated health service units. This idea owes much to unsung heroes like Dr. Dometilo Redulla and the group of municipal health officers in the catchment area of the Carigara District Hospital.

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During the last Congress, ALAGAD party list representative Rodante Marcoleta (the same politician who prominently participated in Malacañang’s successful maneuvers to foil the opposition’s impeachment attempts) managed to insert in the General Appropriations Act an allocation of 180 million pesos specifically for "artificial family planning". What followed is a classic example of the Palace’s transactional politics that ties itself up in Gordian knots so complicated that divine intervention is required to unravel them.

As a favor to the helpful congressman, Malacañang declined to invoke its line item veto power so eagerly anticipated by the much-feared conservative wing of the Catholic Church. Nevertheless, during the signing of R. A. 9401, verbal instructions were given to the Department of Health that the item was not to be used. In the subsequent transmittal letters to executing agencies, use of the line item for "artificial family planning" was severely restricted by a conditionality requiring the DOH to draft "strict budget execution guidelines for programs and activities under item III, Section C, No. 2.j of the DOH budget."

The DOH is now under severe pressure by the population management community to seek approval for a set of guidelines to enable the release of funds under Marcoleta’s line item. So far, the guidelines, already so complicated that the budget year will expire before they can be complied with, are still under study by the DOH. At this stage, it is doubtful if even Malacañang itself knows whether or when these will ever be approved.

As may be expected no one (except possibly the Palace occupant) is happy about the situation. Conservative religious groups are on edge because there is still a possibility that the funds would be released. Population and development supporters are distressed because the supply of contraceptives from USAID is really running out.

But of course the birds and the bees are delighted because they can continue to do their thing.