Key reforms include an Organizational Performance Indicators Framework, Medium-Term Expenditure Framework, Bottom-Up Budgeting, Performance-Informed Budgeting, and Two-tier Budgeting approaches. In contrast to the national-level, 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 1 700 provinces, cities and municipalities has fiscal autonomy, and yet most are highly dependent on their formula-driven internal revenue shares from the national government.