Second National Communications 2.5 Provincial Investment Plan for Health (PIPH) As part of the ongoing health sector reform agenda, the Department of health has sought out to begin an initiative in integrating health and development plans in the different local government units. Templates and processes towards rationalizing and increasing health have been made. The central office together with the Centers for Health and Development (CHDs), the regional DOH representative office, is spearheading the technical assistance as provincial health managers sit down with the planning and development office of the province in order to institutionalize this process as the LGUs undergo their annual investment planning exercises. Health budgets are being deliberated on and given their due importance. It is seen that this will become the venue for expanding the coverage to look at the climate change and health impacts in consideration of the health needs –both the physical and social infrastructure of the localities. The three pilot sites have already passed their PIPH documents and will review them in consideration of climate change. 2.6 Population increase The Philippines is also among the world's fastest urbanizing countries, and overcrowded cities present their own challenges. A total of 47 percent of the population lives in urban areas, compared with 31 percent in Thailand and 16 percent in Cambodia; further, the country has more than 200 urban areas that have populations of more than 50,000, notes the country's Commission on Population (POPCOM). By World Bank estimates, these urban centers could expand to some 600 by 2020, largely because high levels of rural poverty are pushing people into the cities.19 Rate of Natural Increase (birth rate minus death rate, expressed as a percentage) is 2.2%. At that level, the Population for 2025 and 2050 (projected) is 115,500,000M and 145,700,000M respectively. The demands on health services will be terribly high if we will not be able to cope with this runaway population. Unless we are able to manage this aspect of our development, it will be a persistent cause of the vicious poverty cycle that we are in and would in great part possibly contribute to our development stagnation. Of big concern is the amount of resources that this population will need in order to go about their daily living. The public health concern will be a big toll on top of the climate change impacts that we will be experiencing ahead. It is in this context that we should look at the management of our population and look at how we will be able to increase quality over quantity. 19 Yvette Collymore. Rapid population growth, crowded cities present challenges in the Philippines. Population References Bureau, 2003. Avaialble from http://www.prb.org/Articles/2003/RapidPopulationGrowthCrowdedCitiesPresentChallengesinthePhilippines.aspx 12