Alongside tourism and mining, agriculture and food production are two major sources of income in Benguet. Known as the “salad bowl” of the Philippines, the province contributes to about 80% of Luzon’s daily supply of lettuce, broccoli, carrots, potatoes, cabbage, and other semi-temperate crops. This is why, during his Deep Dive—a brief immersion into the health realities on the ground—Gov. Melchor Diclas was taken aback when malnutrition cases were reported in the province.

Addressing malnutrition using a multi-sectoral approach

One of the challenges of being a mountainous province is the people’s difficulty in accessing basic healthcare services. After conducting an intense and in-depth analysis of Benguet’s healthcare situation, Diclas, along with the Department of Health Cordillera, Zuellig Family Foundation (ZFF), and the Provincial Health team, went on a deep dive and visited the two families with reported malnutrition cases in Atok, one of the province’s geographically isolated and disadvantaged area (GIDA) municipalities.

As a governor and a medical doctor, Diclas knows the importance of health and nutrition in children’s development and the future of the province. He immediately took action and pushed the provincial government team to prioritize the development of livelihood opportunities and agricultural interventions to address the food insufficiency in the area. He also directed the strengthening of the Provincial Nutrition Action Team and provided training for parents to ensure that the children’s nutrition and priority health needs are met.

Realizing the community’s need for better access to a nearby health facility, the governor also included the construction of a health facility in their local development plan to ensure that children’s health and nutrition are monitored regularly and that people do not need to walk long hours to access the nearest health station.

Institutionalizing healthcare for all

Diclas firmly believes that access to healthcare is a fundamental right of every citizen. So, when Benguet was chosen as one of the pilot areas for Universal Health Care (UHC), the province immediately signed up and started the local health system reforms.

He has put in place extensive measures to guarantee that everyone has access to healthcare, especially in isolated and underprivileged communities. To reach remote locations, mobile health clinics have been used, giving people access to essential medical care and health information.

An important feature of Benguet is its people’s deeply rooted cultural beliefs and traditions. Having a good grasp of this as an Igorot himself, Diclas understands the hesitations of people in choosing medical services over traditional healing techniques. Instead of forcing them to accept and adjust to the available health programs and services, he led the innovation of developing culturally sensitive facilities and service deliveries to cater to what the people need.

On the way to a healthier Benguet

The proactive and forward-thinking leadership of Diclas is helping Benguet move toward a healthier future. He has transformed the healthcare landscape by making sure health programs and services are culturally sensitive, investing in a stronger provincial health team, and leading health system reforms by encouraging multi-sectoral action.

He has transformed challenges into innovations grounded in his constituents’ needs and respectful of his people’s culture.#

(Published September 27, 2023)

From setting up teen hubs and centers in every public school and village to the creation of a council that will drive all programs for adolescents, Naga City is taking bolder yet wiser steps to curb teenage births through a newly passed ordinance.

Known as the “AYSRH Ordinance,” the measure was enacted last month, a critical move that would finally institutionalize and bring harmony to the city’s wide-ranging adolescent and youth sexual and reproductive health programs and services.

“The ordinance is like an arm or an instrument for us to be able to achieve our purpose, which is for adolescent girls to avoid being pregnant and for them to better prepare themselves for the years ahead because this lay down the acts that we have to do,” said Naga City Mayor Nelson Legacion.

Naga City’s adolescent birth rate has continuously dropped for the last four years, from a high of 30.21 in 2019 to 20.10 in 2022. But it has observed an uptick in repeat pregnancy in teenage mothers from a low 39 in 2020 to 56 in 2021 and 62 last year.

The mayor is pushing for zero teenage pregnancy in three years as it works under the guidance of The Challenge Initiative (TCI), a program co-managed by the Zuellig Family Foundation (ZFF) with the Bill and Melinda Gates Institute for Population and Reproductive Health.

Launched in 2020, the program aims to stem teenage pregnancies in the country by improving access to family planning programs and promoting positive health-seeking behavior among youth and adolescents.

Road to ‘zero’

Legacion expressed confidence that the “ambitious target” was doable with an ordinance that will strengthen the city leadership team and its information service delivery network (ISDN), composed of various stakeholders that will journey with the city government to achieve such dream, and with the continued support of TCI and ZFF.

Among the many things the ordinance would set in motion are the creation of the City Adolescent and Youth Sexual and Reproductive Health (AYSRH) Council, which will act as the advisory, planning, and policy-making body for the full implementation of the law, and the provision of a comprehensive culture-sensitive, age- and development-appropriate sex education in schools and the communities.

The law also obliges the city government to provide sufficient funding annually for all its AYSRH programs and services and to strengthen the capability of barangay health workers, nutrition scholars, and other frontline health and social workers in providing care and education tailored to the needs of adolescents and the youth.

Since joining the TCI, the city gradually increased its investments in ASYRH services from Php728,000 in 2020 to over P1 million in 2022, the start of the program implementation. It quadrupled to P4.1 million in 2023.

Adolescent-friendly spaces in all schools and villages

The ordinance also mandates the establishment of teen hubs in all public schools and teen centers in the barangays that will give adolescents and out-of-school youths an exclusive schedule to avail of reproductive health services with confidence and privacy.

So far, teen centers or adolescent-friendly facilities have been created in Barangays Concepcion Pequeña, Balatas, and Calauag.

“Part of the services we ask from teen centers and teen hubs is to address the stigmatization because it is one of the reasons why there is poor health-seeking behavior among our teenagers,” said Councilor Gayle Abonal-Gomez, author of the ordinance.

She also said the city was looking forward to getting private schools on board to set up their own teen hubs and mining data from its body of research on ASYRH to further improve the local government’s programs.

Underscoring the importance of the role of parents in teenage pregnancy prevention, the ordinance shall also see the implementation of a family support program that will provide parents of adolescents with the necessary education and support that encourage parental involvement.

“We are closely monitoring the rise in repeat pregnancies among teenage mothers…and based on observations and with our dealings with the barangays, the role of the family and parents plays a big part in this,” she said.

Widening of networks and programs

Another major component of the ordinance is the formal establishment of ISDN that will “harmonize all existing services and program interventions” on ASYRH in the city.

Under the newly enacted law, the City Population and Nutrition Office will spearhead gathering and linking up various stakeholders involved in the provision of ASRYH services to form a referral system and provide health services tailor-fit to the specific needs of adolescents.

“Before this ordinance, we already have many public and private partners and linkages, there are many programs and services [on ASYRH] available in the city. But the concern was that efforts were not institutionalized and harmonized,” said Abonal-Gomez.

“One advantage of this ordinance is that it will unify all our actions and with everyone officially on board, we will be able to grow our networks and the programs itself,” she added.

This article first appeared on the official website of the City Government of Naga.

(Published June 9, 2023)

By Cristina Eloisa Baclig

MANILA, Philippines—As the country continues to address teenage pregnancies among Filipino girls, two cities—Cagayan de Oro and Dipolog City—have already started seeing a significant decrease in the birth rate for adolescent mothers through effective interventions.

After a year since the prevention of teenage pregnancies had been declared a “national priority,” the adolescent birth rate (ABR) in Dipolog City fell from a high 73.8 per 1,000 girls (aged 15-19 years) to 30 in 2022.

Similarly, Cagayan de Oro has observed a huge reduction in its ABR from 47.4 five years ago to 34 in 2022.

The decline in the number of Filipino women in Dipolog and Cagayan de Oro cities who are confronting pregnancy at an early age was attributed to “data-driven innovations and high-impact programs” that heavily focused on youth involvement.

Among these programs undertaken by the city governments to provide solutions to curb teenage pregnancies was The Challenge Initiative (TCI), a five-year urban reproductive health program co-managed by the Zuellig Family Foundation (ZFF) and the Bill & Melinda Gates Institute for Population and Reproductive Health.

The program, which started in 2020, encouraged several areas nationwide to transform into adolescent-friendly cities that actively address the sexual and reproductive health needs of the youth in their communities to reduce unintended teenage pregnancies.

It also aimed to enhance the accessibility of family planning programs and promote positive health-seeking behavior among Filipino youth and adolescents.

Successful interventions

In just two years after Dipolog City joined an earlier ZFF program, which spanned from 2017 to 2020, the local government was able to address and reduce the growing cases of teenage pregnancies in the city.

In October 2020, Dipolog City was accepted as one of the pilot cities under TCI, which led to high-impact interventions to engage city governments, health providers, communities, adolescents and youth, and other stakeholders in providing adolescent and youth sexual and reproductive health (AYSRH) information and services in urban communities.

As part of the initial batch of cities engaged with TCI in the Philippines, the local government of Dipolog launched the “Team Batang Ama Batang Ina Initiative” or BABII—a task force created to address Adolescent and Youth Sexual Reproductive Health (AYSRH) issues including teenage pregnancies in the city.

The Child and Youth Code, “which included provisions on health education for the youth, addressing mortality and morbidity of teenage pregnancy, and promoting reproductive health and family planning for youth parents,” was enacted into a local ordinance last year.

Aside from the city’s well-developed and well-functioning AYSRH system, the local government also increased the modern contraceptive prevalence rate (mCPR) from 39 percent in 2018 to 53.72 percent last year.

This year, the city was given resources—around P9M in investments—to create more family planning programs to further bring down cases of teenage pregnancy in the city.

Cagayan de Oro City, also among the early TCI sites, has also recorded an increase in mCPR from 29 percent in 2020 to 36 percent in 2022—an achievement attributed to “engaging the youth through various programs that speak their language.”

Several youth-led initiatives were also launched in the city through the ZFF’s Youth Leadership and Governance Program—which trained youth leaders of the Sangguniang Kabataan, or youth council, to lead in the creation and implementation of AYSRH programs in different areas in the city.

“The TCI is a vital driver to help us expand our initiatives to become an adolescent- and youth-friendly city as we create a safe space where young girls and boys can easily access ASRH services and engage in programs for comprehensive health development,” said Cagayan de Oro Mayor Rolando “Klarex” Uy.

From one concern to another

Latest figures showed that cases of teenage pregnancy are already declining, not only in Dipolog and Cagayan de Oro cities, but also in other cities across the country.

According to data from the Philippine Statistics Authority (PSA), there were 5.4 percent of women 15 to 19 years of age who have been pregnant in 2022, lower than 8.6 percent in 2017, 10.1 percent in 2013, 9.9 percent in 2008 and 8 percent in 2003.

However, the Commission on Population and Development (PopCom) stressed that pregnancies among 10 to 14-year-olds saw an increase from 2,113 cases in 2020 to 2,299 in 2021—citing data from PSA and the Department of Health (DOH).

“Our concern now are births from [aged] 10 to 14 – the much younger teenage girls. The statistics vary depending on the source of data, but they are all worrying. And If I may emphasize, the 10 to 14 [age group] is now something that we need to look into,” said PopCom executive director Lisa Grace Bersales.

This article first appeared on INQUIRER.net.

(Published April 27, 2023)

Two abstracts by Zuellig Family Foundation’s local health system (LHS) team were part of the poster presentation during the 25th University of the Philippines (UP) Manila National Institutes of Health Anniversary Conference held on February 27 and 28, 2023 at the UP Bonifacio Global City.

This year’s conference theme was “Transforming Health Systems Toward Universal Health Care (UHC) Through Research Partnerships.” It provided a venue to learn from the latest research and best practices and network with experts and colleagues.

Co-authored by Dr. Catherine Chung and Dr. Jenilyn Dabu, the two abstracts presented were: (1) “The role of regional UHC core teams in accelerating UHC in the provinces;” and (2) “Realizing Universal Health Care in the Barangays: The Dinalupihan Case Study.”

UHC core team training

Under the “Bayang Malusog” Regional Leadership Development Program, a capability development program co-designed with the Department of Health Field Implementation and Coordination Team of North Luzon, the leadership and technical competencies of the regional UHC core teams were enhanced to ensure quality facilitation of the UHC implementation in the provinces. After 10 months, all UHC sites in Ilocos, Cagayan Valley, and Cordillera Administrative regions achieved the national target for the preparatory level (above 70%) in the UHC LHS maturity standards set by the DOH.

Improving primary care

Under the Provincial Leadership and Governance Program, barangay officials and municipal health team leaders in Dinalupihan (Bataan) underwent capacity-building training for better primary care services. Their enhanced competencies resulted in improved health system monitoring that helped develop evidence-based decision-making and better primary care facilities in managing noncommunicable diseases.

Learn more about ZFF’s programs on improving local health systems: https://zuelligfoundation.org/programs/local-health-system/.

(Published February 28, 2023)

What is the Minimum Initial Service Package for Sexual and Reproductive Health (MISP for SRH)? And what can local government leaders do to ensure continuous delivery of SRH needs amid emergencies? To answer these questions and more, the Zuellig Family Foundation (ZFF) came up with an informational video and a technical roadmap following the colloquium of ZFF’s MISP for SRH training course.

A partnership with the United Nations Population Fund (UNFPA) and funded by Australian Aid, the training course strengthened the competencies of provincial leaders to implement life-saving SRH information and services during natural disasters and other public health emergencies. The program aims to avoid overlooking the provision of family planning (FP) commodities and counseling during emergencies and prevent life-threatening complications for pregnant women and girls.

Pilot sites

Three pilot provinces were chosen due to their situations that contribute to increased maternal and infant deaths and a high incidence of gender-based violence. Catanduanes was hit by back-to-back typhoons; Laguna experienced high COVID-19 cases; while Maguindanao faced instability wrought by protracted armed conflicts.

During the colloquium, Catanduanes reported 90% accomplishment of targets. Among the province’s milestones was the drafting of Executive Order no. 19. s. 2022, which is an order “Re-organizing The Provincial Reproductive Health Coordinating Team for MISP-SRH of Catanduanes” to institutionalize its MISP for SRH initiatives.  

For Laguna, the next step is to properly monitor and verify the services that are already being implemented under its Provincial MISP for SRH Roadmap.  The province expanded its core team to include the other sectors to ensure collaborative efforts toward the implementation of MISP for SRH.

Meanwhile, Maguindanao will be incorporating its MISP for SRH plans into the provincial disaster risk resilience and management plan. Health care services in the province were also added to the administration’s 10-point development agenda for 2023 to 2025.

MISP for SRH training course

The executive course uses a blended learning approach through asynchronous sessions and online workshops with participants from the offices of the governor, vice governor, provincial health, provincial disaster risk reduction and management, budget, social welfare and development, planning and development, and administrator.

The MISP for SRH is a set of priority activities during emergencies that prevent and manage SRH issues and help plan for comprehensive SRH services during the recovery and rehabilitation phase of an emergency response. Activities include the continued provision of FP commodities and counseling and establishing women and child-friendly health spaces. Participants will acquire the basic leadership knowledge, skills, and attitude to create a shared change agenda and more responsive plan to address the gaps in their health systems toward increasing access to SRH services.

For inquiries about the MISP for SRH program, email communications@zuelligfoundation.org.

(Published October 28, 2022)

Read Ambassador Roberto Romulo’s Philippine Star column on July 26, 2019 by clicking on the link below:

World View by Roberto R. Romulo

You can also read the copy by clicking on the link below:

PDF copy of Ambassador Romulo’s column

At least 60 percent of Filipino households are experiencing moderate to severe food insecurity amid the pandemic, a 2020 Food and Nutrition Research Institute survey showed. The first 1,000 days (F1KD) population proved to be most at risk, with reported higher food insecurity among households with pregnant women and children (including those below two years).

To address food insecurity in their communities, the provincial governments of Zamboanga del Norte, Northern Samar, and Samar under the Provincial Nutrition Governance Program (PNGP) increased their budget allocation and utilization for integrated health and nutrition programs.

PNGP, a partnership between the Zuellig Family Foundation and the United Nations Children’s Fund, aims to have a comprehensive and integrated nutrition program wherein health and nutrition sectors work with other agencies, including education, agriculture, and social welfare.

Ground-level efforts
In an online executive session titled “Deepening Leadership: Sustaining Gains and Managing Change for F1KD” last July 21, Zamboanga del Norte shared its Enhanced Gasang Bahandianon para sa Umahan (eGBU), an anti-poverty program and social entrepreneurship project that integrates health and nutrition information, services, education, environment, and agriculture.

At the household level, the eGBU operates by distributing starter kits containing seeds, fertilizer, and basic planting equipment. Under this initiative, the participants learn farming, food processing, and marketing to have direct access to food and a source of sustainable income and livelihood.

Produce from the eGBU will also be used for the Bigas Monggo (BiMo) food packs, which will serve as supplementary food for children and pregnant women.

Meanwhile, the provincial government of Samar has an ongoing partnership with the Department of Science and Technology for complimentary food processing. It also plans to implement backyard farming.

Likewise, in Northern Samar, the local government plans to organize province-wide communal gardening to engage the community toward food security.

With disrupted nutrition-related services amid the pandemic, the World Health Organization (WHO) is expecting an increase in the levels of malnutrition among vulnerable households. In the Philippines, one in every five children under two years old is stunted or too short for their age and 7 percent is wasted or too thin for their height, according to a 2019 Food and Nutrition Research Institute (FNRI) survey.

To effectively manage these numbers, studies have shown that community engagement plays an important role. Anchored on this, governors of Basilan and Sarangani are enhancing their capacities toward gaining increased support from the ground level through the Provincial Nutrition Governance Program (PNGP).

Designed based on positive results
A second partnership project of the Zuellig Family Foundation (ZFF) and Kristian Gerhard Jebsen Foundation, PNGP focuses on addressing nutrition problems in the crucial first 1,000 days (F1KD) of life—from conception up to two years of age. Stunting during this stage, in particular, may have is irreversible effects on the cognitive development and growth of children, according to WHO.

These efforts reduced the stunting rate among the municipalities’ 0 to 23-month-old children from 19 percent in 2017 to 15 percent in 2019, lower than the national rate of 21.9 percent, according to FNRI.

Community participation
Among the interventions, executive sessions titled “Nutrition Leadership and Governance: Instituting Change for Co-Ownership and Co-Creation” were held for Governors Jim Hataman-Sallimana (Basilan) and Steve Chiongbian Solon (Sarangani) on March 30 and April 15, respectively.

The sessions highlighted increasing community engagement by transforming into sensitive leaders who can understand the culture and behavior of the community. This will help the leader gain a deeper connection and shared responsibility of improving nutrition security, and eventually, having an integrated nutrition system toward a reduction in stunting and wasting among children.

This strategy includes strengthened leadership, improved messaging, and locally-tailored health and nutrition service design and delivery toward continuous ground-level support. This is especially important amid an increase in food insecurity due to food supply chain disruptions, interrupted market movement due to quarantine restrictions, and higher prices of nutritious foods during the pandemic.

Other tried and tested ZFF strategies in improving the numbers of nutritionally at-risk pregnant women, low birth weight infants, and stunted and wasted children, and ensuring the proper health of pregnant women and infants were also discussed.

A 4th class municipality in Capiz, Dao was among the Zuellig Family Foundation’s (ZFF) nine pilot sites for its Health Change Model (HCM) in 2009. Up to date, then-mayor and now vice mayor Joselito “Bo” Escutin still credits much of the municipality’s success to its local government’s partnership with ZFF: “Thanks to ZFF, I learned what governance should be.”

Anchored on the Bridging Leadership (BL) framework, the HCM focuses on building local health leadership and governance capacities to address health inequities. Interventions include training, coaching, and mentoring.

Through the years, Dao recognizes the role of multi-stakeholder engagement toward a strong, stable, and resilient community—demonstrating the ownership, co-ownership, and co-creation cycle of the ZFF program. The local government commits to achieving better health outcomes for its more than 38,000 citizens in 20 barangays without any exceptions.

Proof of its consistent and collective efforts, Dao has received several health awards, including the 2017 Purple Ribbon Award for its reproductive health programs and the 2017 Regional Local Health System Award (first place). The municipality was also awarded the Seal of Good Local Governance by the Department of the Interior and Local Government in 2015, 2017, and 2019.

Vice Mayor Escutin, the then-vice mayor and now Sangguniang Bayan member Loreto Eslaban, and municipal health officer Dr. Humbelyn Horneja were all ZFF awardees for being outstanding Bridging Leaders in Public Health. Their BL skills helped propel not just Dao’s health care system but also its overall economic progress.

A feature video of Dao can be found on the municipality’s Facebook Page: https://fb.watch/91FEfLi7Tu/.