key reforms include an organizational performance indicators framework mediumterm expenditure framework bottomup budgeting performanceinformed budgeting and twotier budgeting approaches in contrast to the nationallevel the link is weak between the local health budget and strategic plans and targets in the mtpdp as well as the department of health doh national health objectives in the budget formulation process for health at the local government unit lgu level there are several reasons for this one is that each of the more than provinces cities and municipalities has fiscal autonomy and yet most are highly dependent on their formuladriven internal revenue shares from the national government