Local government units (LGUs) should not let their guard down despite the reported decline in new COVID-19 cases. The season of get-together is once again upon us and that can translate to another spike in COVID-19 cases.

According to Bloomberg’s COVID Resilience Ranking of 53 countries last September, the Philippines is the worst place to be amid the pandemic in terms of virus containment, economy, and opening up. Unless the Philippines wants to stay behind, LGUs should heed the advice of former Health Secretary Manuel Dayrit to have an integrated local COVID-19 response system.

Dayrit, also a trustee of the Zuellig Family Foundation (ZFF), shared some tips on how LGUs can handle COVID-19 more effectively during a webinar with the governors of Agusan del Sur, Aklan, and Bataan. The webinar held last July 30 was part of ZFF’s Provincial Leadership and Governance Program (PLGP), which helps provinces manage the pandemic while preparing them for Universal Health Care systems integration.

Dayrit said that LGUs should enhance their Prevent-Detect-Isolate-Treat-Reintegrate (PDITR) strategy by increasing testing capacity, upgrading hospital and isolation facilities, improving contact tracing, locating clusters in the barangays, and understanding the transmission patterns.

He also highlighted the critical role of data-driven strategies in fast-tracking the containment of the virus. More aggressive testing should be done about 3 to 5 times than normal, especially with the highly infectious Delta variant. Dayrit reiterated using the results of contact tracing as part of ground-level risk communication to help stop transmission, especially within households.

Related story: Effective contact tracing, key in curbing COVID-19 transmission

Best practices of LGUs
Even while under General Community Quarantine (GCQ) status, Agusan del Sur implemented heightened border controls with strict adherence to health protocols. The local government also passed an ordinance penalizing people who do not follow minimum health standards. Further, the One Caraga Shield has laid out unified plans for the region’s COVID-19 response.

In Aklan, all tourism personnel was vaccinated to lessen the transmission among workers. The province also shared its strategies with the other LGUs within Western Visayas.

Meanwhile, Bataan has been concentrating prevention efforts at the barangay level to address super-spreader events. New vaccination sites are also opened weekly to fast-track the vaccination rollout as the province enjoys a fair share of vaccines being near Metro Manila.

Educating and empowering her fellow youth to reduce teenage pregnancies in their barangay is a mission shared by May Ann Jacob in her speech during the “Adolescent and Youth Sexual and Reproductive Health (AYSRH) in Action” webinar held last September 22.

Jacob, 25, a Sangguniang Kabataan (SK) councilor from Canitoan, Cagayan de Oro City, represented the youth leaders who trained under The Challenge Initiative (TCI) in the Philippines during the “Youth in Action: Stories from the front lines of TCI” presentation of the webinar.

Co-managed and co-funded by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health, TCI aims to establish adolescent-friendly health facilities that promote positive health-seeking behavior and improve access to family planning programs.

Behavior change design
Jacob’s experience during the Leadership for Adolescent and Youth Friendly Cities training of TCI and in partnership with the Commission on Population and Development taught her that having informed and empowered youth is vital in making adolescent and youth-friendly cities toward reduced teenage pregnancies.

“[The training] taught me that through behavior change design (BCD), we could help our fellow youth in practicing positive behavior to decrease teenage pregnancies,” Jacob said.

The BCD is a human-centered approach that blends insights and methods to come up with best practices in identifying the desired new behavior. The identified change in behavior will then be reinforced among teenagers through innovative solutions. The 8-step process emphasizes the deep dive, which is Step 2.

Deep dive
The deep dive is integral in ZFF programs and gives leaders an opportunity to immerse themselves in unfamiliar environments and different contexts to gain a wider perspective of the real situation and build relationships with stakeholders. “It was an eye-opener on the major challenge of the high incidence of teenage pregnancies in our barangay and the city,” Jacob shared.

Together with their SK Chairman Jun Nador, Jacob came up with an advocacy campaign dubbed “Project Trese” after a deep dive wherein they learned that teenage mothers and fathers in their community lack information and access to AYSRH programs. The project focuses on information and educational activities. In partnership with their barangay health workers, they plan to conduct skills training and give livelihood opportunities to the youth.

World Contraception Day
Held in celebration of World Contraception Day, the webinar hosted by the Gates Institute also showcased the stories of youth leaders and advocates from other TCI hubs in East Africa, Francophone West Africa, and India. There were also presentations on what works in youth advocacy, and contraceptive dynamics during COVID-19 in Nairobi, Kenya.

Observed every September 26, World Contraception Day aims to raise awareness about contraception and guide couples to an informed decision about family planning so that every pregnancy is wanted. This year’s theme was “Contraception: it’s your life, it’s your responsibility.”

Providing access to the right information on adolescent sexual reproductive health (ASRH), family planning, and education through traditional and cultural approaches to reduce teenage pregnancies—this is the vision of Janifah Unda, 24, a youth leader in Masiu, Lanao del Sur. She takes part in the Zuellig Family Foundation’s (ZFF) Youth Leadership and Governance Program (YLGP), a partnership with the United Nations Population Fund (UNFPA) since 2018.

In 2019, an estimated seven girls aged 10 to 14 gave birth every day in the Philippines–a three-fold increase from 2000–according to the Commission on Population and Development (POPCOM). The YLGP aims to help reduce adolescent pregnancies in 10 rural municipalities of Sarangani, Sultan Kudarat, and Lanao del Sur by molding competent youth leaders who can spearhead and engage their community in youth-related health programs. Interventions include leadership and technical training, practicum, coaching, and mentoring.

Islam-compliant ASRH programs
Sharing during the mid-practicum presentation as part of the two-day YLGP virtual workshop held last February 18 and 19, Unda said that there was a common misconception that using family planning is against the teachings of Islam. Through the deep dive activities, she witnessed how poverty and lack of access to proper ASRH information and education have led to early marriages and teenage pregnancies in their municipality.

Deep dives are integral in the ZFF training, wherein leaders immerse themselves in unfamiliar environments and different contexts to gain a wider perspective of the real situation and build relationships with stakeholders. Unda talked to pregnant adolescents, witnessed their circumstances, and learned the lack of ASRH programs both at the barangay and municipal levels.

Stepping up to her role as Sangguniang Kabataan (SK) vice president in providing and engaging the youth in ASRH programs, Unda—together with the other SK leaders in Masiu—sought the engagement of Muslim Religious Leaders (Ulama Council) in the promotion of SRH to young people, particularly family planning from the Islamic perspective. The youth and their parents as well were able to debunk the notion that family planning equates to killing an unborn child in the mother’s womb, which is forbidden in the practice of Islam. They learned that family planning can be done to prevent conception. This helped them to be more open and understanding of the issues of early marriage and teenage pregnancy.

Related article: ‘Girls Not Brides’ Act Reinforces ZFF’s ASRH Initiatives

Decreased teenage pregnancies
Though limited to the records of pregnant women who visit their health centers, teenage pregnancies in Masiu dropped from 34 in 2018 (start of YLGP) to 25 in 2020. Unda’s team plan to continue the implementation of the Adolescent Pregnancy Tracking and Profiling, which they started in December 2020, to get more accurate data on teenage pregnancies.

Other accomplishments include having a functional Local Youth Development Council, and increased numbers of adolescent- and youth-led activities in SRH and adolescents reached with information and life skills on SRH.

Participating LGUs in the YLGP are guided by a technical roadmap that represents the status of their current system. With the desired impact of reducing pregnancies among adolescents and young people, an array of services should be provided, including health education, life-skills building, health promotion of available services, and provision of actual preventive services.

Related article: Establishing adolescent and youth-friendly cities seen to help curb teenage pregnancies

Continued youth engagement and LGU support
Faced with weak participation from other SK leaders and limited funding amid a pandemic, Unda and her team are still determined to achieve “a secure and diverse community that respects, empowers, nurtures, educates, and encourages a healthy and responsible youth population.” They are set to seek local government funding for ASRH programs such as the Peer Education Roll-out, which aims to create more youth leaders who can share the right information on SRH.

The YLGP is ZFF’s pilot program for engaging youth leaders. It was supposed to run for 18 months ending in December 2020, but the pandemic led to its extension until October 2021.

Know more about the ZFF health leadership training programs here: Public Health Leadership Formation.

Department of Health (DOH) Undersecretary Dr. Gerardo Bayugo said that “motivating people to rally behind a common health vision is not something easily taught and learned.” This, according to him, is the gap that Zuellig Family Foundation (ZFF) and the United States Agency for International Development (USAID) have been bridging through the Institutionalization of Health Leadership and Governance Program (IHLGP).

The IHLGP, introduced in 2017, focused on turning local chief executives (LCEs) into health champions who address health inequities in their communities.

Barangay captain Marlon Tabac of Gusa, Cagayan de Oro City shared that through IHLGP, they were able to hold meaningful dialogues and build trust between provincial-municipal-barangay leaders and their constituents. Thus, when COVID-19 struck, people were quick to follow the LGUs’ policies and programs.

Dr. Yolanda Oliveros, USAID Office of Health (OH) deputy director, said that IHLGP has a unique approach that strengthened the LCEs’ health governance and helped them build the capacity of potential leaders around them. “When we talk of IHLGP, there are things consistent and inherent to the program, like the use of health systems roadmaps, scorecards, coaching system, deep dive, bridging leadership, partnership building as a social capital, systems thinking, and adaptive management,” added Oliveros.

Earlier this month, USAID OH agreement officer representative Maria Teresa Carpio shared a similar insight. “Instead of operating in silos, cities are talking with barangays, regions, and provinces. The legacies of IHLGP have shifted the leadership paradigm from what is visible to what is substantive. It’s about nurturing relationships, getting the buy-in, and applying bridging leadership competencies (or owning and co-owning realities and challenges, and co-creating solutions).”

DOH Undersecretary Dr. Abdullah Dumama Jr. also recognized how IHLGP contributed in expanding local health boards, improving barangay engagement, establishing more adolescent-friendly facilities, and increasing the LCEs’ ownership of health challenges. The National Handover and Sustainability Ceremony was held last September 29, 2020 as culmination activity of IHLGP.

Managing health systems is complicated enough without the COVID-19 pandemic. The Zuellig Family Foundation is proud to have trained mayors who have ably risen to the challenge. All underwent the ZFF’s health leadership and governance program.

Toni Yulo-Loyzaga, a ZFF trustee, pointed out the observed leadership skills, starting with leveraging personal and professional background.

During the recently concluded online forum organized by ZFF, local chief executives from its partner provinces and cities mentioned their different careers before joining politics. This, according to Loyzaga, adds value to their role because it allows them to use a wider lens in understanding health challenges. Koronadal City Vice Mayor Peter Miguel developed advocacy for reducing maternal deaths when his late wife, who worked as an obstetrician-gynecologist, told him that no mother should die of childbirth. He strengthened maternal and child care in his city by upskilling the barangay health workers (BHWs).

Loyzaga noted that ZFF LCEs value partnerships with the academe and the private sector, whom Loyzaga said must be valued not just as donors, but as co-implementers. Zamboanga City Mayor Ma. Isabelle Climaco-Salazar involved private groups and government agencies in the city’s health agenda focusing on teenage pregnancy, rights of women and children, tuberculosis, and contraceptive use. Collaborations with the private sector allowed the city to manage the influx of locally stranded individuals and returning Filipinos amid the pandemic.

But effective health leadership does not end with owning and creating solutions. Loyzaga pointed out how trust-building is at the heart of behavioral change and public governance. LCEs must reach out to understand and build trust with their constituents. “It is the glue that binds our communities,” said Loyzaga.

Lastly, Loyzaga reminded the leaders to recognize the value of risk communications and the need to integrate it into their health programs at the very beginning. Risk communication builds trust and cooperation among the people and enables mutual dialogue and participatory decision-making. ZFF conducted a series of online forums to highlight the accomplishments of its partner local government units (LGU) whose health leaders participated in the USAID-supported Institutionalization of Health Leadership and Governance Program. The IHLGP aimed to help LGUs provide constituents easier access to quality healthcare services and improve health outcomes.

One-and-a-half months since the imposition of the enhanced community quarantine, some provinces in the Philippines remained COVID-free. Agusan del Sur is one of them.

Governor Santiago Cane Jr. attributed this to the good teamwork among provincial and local government leaders and personnel. They also strictly adhered to the ECQ guidelines and protocols.

“What must be allowed must be allowed, and what is not must not be allowed. If we become complacent, then the problem will become uncontrollable. We have been blessed with people who can work hand-in-hand with each other,” Cane said.

Provincial health officer II Dr. Jacqueline Momville said the local government began distributing information, education and communication materials on COVID-19 in every barangay in early March. Even without a confirmed case, the LGU set up a COVID hotline and implemented strict monitoring of people entering the province.

The doctor also said its low population density could have contributed to Agusan del Sur’s zero COVID-19 case. And she linked this to the province’s intensive campaign on contraceptive use, a long-running campaign of the province in partnership with ZFF.

Preparing the people for the worst

Despite their success, the governor admitted they face issues now that the province is transitioning to general community quarantine (GCQ). One major concern is their inadequate number of healthcare personnel and equipment. And while it has enough community quarantine beds for mild and severe cases, it lacks ICU beds for critical cases should an outbreak occur.

Agusan del Sur is also adjacent to provinces with positive COVID-19 cases. Therefore, Dr. Jomar Rabajante of University of the Philippines Los Baños Institute of Mathematical Sciences and Physics said the province must guard their borders.

As a measure to fight the pandemic, Momville said the local government unit (LGU) are already planning to conduct province-wide training for disaster resilience in health to improve case detection, contact tracing, and address proliferation of fake news during emergencies.

ZFF trustee Dr. Dayrit said the key to keep COVID-19 cases zero lies in creating a communication system that would keep people informed of their own roles in combating the virus, as well as the concerted efforts of all levels of the LGU to protect the public.

Cane said their greatest defense now is the people’s compliance to staying at home. “We have to face this. I believe that this kind of war can only be won if we retreat to our homes. Ang mga duwag ang mananalo (The cowards will triumph). Follow the protocols.”

Another crucial step is providing PPE sets for all healthcare staff especially since they have inadequate number of personnel. The LGU was advised by Dayrit to also look into the possibility of tapping private organizations to assist them in establishing testing facilities since the current turnaround time for tests takes at least a week.

Improving capacities to overcome threats

Testing for the Caraga Region is done in Davao City. Department of Health regional director Dr. Jose Llacuna Jr. said he has asked the DOH national office to accredit the Caraga Regional Hospital and Butuan Medical Center as test centers to minimize the turnaround time.

Llacuna also said the Regional Task Force for Coronavirus Disease 2019 (RTF COVID-19) One Caraga Shield had been laying out plans for the region’s shift to the general community quarantine (GCQ).

Cane then said they will be procuring more PPE sets, as well as ventilators. He also said they will continue giving support for provincial surveillance team, establishing risk communication and hazard contingency plan, capacitating all levels on disaster resiliency and management, establishing additional isolation facilities, establishing COVID test lab and more ICU beds, and strengthening psychosocial support for patients, the patients’ families, and front-liners.

As the province braces itself for possible new waves of the infection, its people can take comfort in their health leaders’ decisiveness, and ability to adapt and collaborate. As Momville said, “Every day is learning by doing. We learn what needs to be done better. We become better persons. We are not ready in many ways, but we are doing our best. It’s bringing out the best in us.”

The discussion with the Agusan de Sur health leadership team was held last April 30. This executive session is part of ZFF’s efforts to help its partner-provinces effectively manage the COVID-19.

When the Philippines recorded its first COVID-19 case in January, Aklan was regarded as one of the hotspots because it had direct flights from Wuhan, China and tourists continued to flock to Boracay. But the provincial government’s quick actions proved effective in containing the virus. In fact, as of April 24, the province only had six confirmed COVID-19 cases, four of which have since recovered, and zero COVID-19 death.

During the recent executive session for governors facilitated by the Zuellig Family Foundation, UP COVID-19 Response Team member Dr. Jomar Rabajante said Aklan is still in the preventive stage, which means there is no COVID-19 outbreak in the province.

What worked in Aklan was its immediate response. It enforced border and port controls, and the closure of the international airport. It intensified its information campaigns across media platforms. It activated the municipal health officer-led Barangay Health Emergency Response Team for monitoring of identified or suspected cases. A mobile app was developed for COVID-19 hotlines, pharmacies, and food deliveries. Sanitation tents were set up in hospital entrances.

Aklan Governor Florencio Miraflores acknowledges that they have been “lucky” not to have local transmissions until now. But he also admitted the pressure to restart the tourism industry is great considering it is a major source of income where funds for the healthcare system also come from.

Enhanced community quarantine could be lifted soon in Aklan.

Still, prepare for the worst

Rabajante, however, reminded Aklan to still prepare for the worst scenario given the province’s lack of facilities to accommodate many cases should an outbreak occur. At present, Aklan only has a maximum capacity of 178 community quarantine beds, 31 hospital beds, 9 intensive care unit (ICU) beds, and 4 mechanical ventilators.

The province has not yet crafted a comprehensive plan for the reopening of the province that is why Miraflores is cautious. He knows “the chances of an outbreak is still there considering that Aklan is a tourist destination.” Thus, their next challenge is making sure there will be no widespread infection after COVID-19 related restrictions are removed.

ZFF Deputy Executive Director Dr. Anthony Faraon recommended taking this time for the provincial government to consult with all municipal mayors while they are still at the preventive stage. To further strengthen their preventive measures, Faraon suggested mobilizing a province-wide contact tracing team, focusing on the hotspot municipalities, strengthening community-based management, and finding continuous supplies of personal protective equipment (PPE) sets for community health workers.

Communicate well the risks, test more, protect health workers

ZFF Trustee Dr. Manuel Dayrit said the LGU should strengthen its risk communication strategies so every Aklanon knows the risks of getting and spreading the virus. And instead of buying, Dayrit also encouraged the making of face masks by ordinary citizens.

He said the province should identify the places where exponential growth could occur and build testing facilities near tourist areas so faster detection and isolation of probable COVID-19 patients are possible. “Outbreak potential increases with delay,” Dayrit added.

On the use of Bayanihan funds, Dayrit suggested prioritizing the purchase of PPE for healthcare workers. He also urged Aklan to fill the gaps in its healthcare systems particularly on the number of facilities in order to remain on top of the situation.

Routine activities to keep COVID-19 at bay

According Dayrit, COVID-19 will stay as long as no vaccine is discovered. Hence, another crucial move for Aklan is to establish barangay-to-regional routine activities to effectively monitor probable infection in communities, and activities in hospitals and quarantine facilities. He recommended creating a provincial command group that will be in touch with all levels of the LGU and ensure non-COVID needs are also taken into account.

Department of Health-Center for Health Development in Western Visayas director Dr. Marlyn Convocar said the testing capacity in the region is limited especially since it also caters to Region IV-B; hence, the delay in results. She suggested tapping private groups to increase Aklan’s laboratory testing capacities.

She also recommended clustering of influenza cases while gradually lifting community quarantine. She added that stringent measures be in place to limit and check the arrival of tourists and repatriates, impose strict healthcare measures in the workplace and schools, and continue surveillance in the community even after the lifting of community quarantine.

Miraflores thanked Dayrit for essentially spelling out the steps they have to take, and Convocar for the added inputs to what and how they should proceed post-ECQ. The challenge is to strike a balance between livelihood and public health.

The executive session, held last April 25, is part of ZFF’s efforts to assist its partner provinces in responding to the threats of COVID-19.

Outside Metro Manila, Bataan is among the provinces with rising cases of COVID-19. Before the Luzon-wide lockdown, it recorded only one confirmed case. As of April 24, there were 77 cases. More worrisome is the 55 COVID-19 cases among health workers of the Bataan General Hospital and Medical Center (BGHMC), a Department of Health-run facility.

Being a partner-province of the Zuellig Family Foundation, a virtual executive session for the governor and his health team was facilitated by ZFF to help analyze Bataan’s situation and recommend ways forward.

A resource person during this coaching was UP Response Team member Dr. Jomar Rabajante, who said that based on the trend in the province, interventions have been effective in slowing down the virus.

Some of these interventions are intensified information campaign using different platforms, contact tracing, free transportation services for health workers, training by the BGHMC of health personnel and inter-agency task force on infection control and prevention measures, scheduled public market operations, and heightened surveillance.

But Rabajante cautioned the province from being complacent. It should, according to Rabajante, intensify its detection, tracing, and testing capacities especially in the identified hotspot areas or those localities with high number of positive COVID-19 cases such as Balanga, Orani Orion, Samal, and Limay.

He highlighted the importance of preparing for worst case scenarios. He said that, if the ECQ is lifted after April 30, the peak of infection in the province may happen sometime in the first week of May. In that case, the province would require facilities and equipment beyond the present capacity of Bataan hospitals.

Given this probability, Bataan Governor Albert Garcia plans to develop a real-time monitoring system to get ahead of the problem, while adding, “We need health experts to guide us. I’d like to ask for hand-holding partnership to be ahead of the problem before it gets bigger.”

Public-private partnership for COVID-19 containment

To contain COVID-19 cases in BGHMC, the province signed a formal agreement with the DOH Central Luzon office/BGHMC, and the private hospital Centro Medico de Santisimo Rosario for the private hospital to treat emergency medical services after the closure of BGHMC’s out-patient department. The provincial government shoulders indigent residents’ expenses as BGHMC becomes exclusive to COVID-19 cases.

Aside from Centro Medico, patients needing elective surgeries, direct consultations, and other health needs not related to COVID-19 can go to the district hospitals.

ICTs for COVID-19 Response

As a step to mitigate the further spread of COVID-19, the province also intends to maximize all available information and communication technologies (ICTs). “This COVID-19 crisis made us realize so many things, and most of it are hard lessons. It made us realize the inefficiencies of our health system, fragmented layers of government, and even disoriented communication,” Garcia admitted.

ZFF Trustee Dr. Manuel Dayrit said everybody has to be on the same page so the LGU must do granular strategies in conducting risk assessments, which means, according to Dayrit, risk assessment must be done at different levels: individual, household, barangay, municipal, and provincial. Doing so would enable the LGU to make more precise plans and manage resources based on the priority needs of each level.

In response, Garcia shared their plan of setting up a call hub that will serve as a health command center. This command center will then be the central repository of all data related to COVID-19 cases within the jurisdiction of Bataan. It will enable faster detection and isolation of probable cases and consequently, speed up actions from the local health leadership.

Not just health response but employment as well

In addition, Bataan is also looking into the efficiency of texting mechanism to gather data from households and even hospitals. According to Garcia, texting might be a great platform since there are 170,000-180,000 cellphone users in Bataan. It can be an opportunity to reach many people about preventive measures and as a means to monitor the well-being of household members.

The LGU is also eyeing to maximize the presence of social media by setting up chatbots since majority of the population own social media accounts and it offers faster reply mechanisms. It will also give the people more options to send out their concerns given the limitations of short messaging service (SMS) or text.

This system will also provide employment as it requires manpower who will be responsible for collecting data from the callers and processing gathered data into comprehensible information. Likewise, data collected will enable the local chief executives to see if initiatives are flattening the curve and to plan their next actions. The executive session was held last April 21 is part of ZFF’s efforts to assist its partner provinces in responding to the threats of COVID-19.

There will likely be more stunted, wasted, and underweight children because of COVID-19. Without proper interventions, these children are put to a disadvantaged up to their adult lives.

It was Cabinet Secretary Karlo Nograles, who also heads the government’s hunger task force, who expressed the bleak expectation following the September SWS poll that showed 7.6 million households had experienced involuntary hunger at least once in the past three months.

The Zuellig Family Foundation, through its City Nutrition Governance Program, works with Puerto Princesa, Tacurong, and Tagum to improve nutrition in the first 1000 days, and mitigate the impacts of the pandemic as well as integrate nutrition into their overall COVID-19 response programs.

The city mayors aim to address the unsustainability of food packs distribution and cash amelioration programs, and then make their constituents more food self-sufficient.

Puerto Princesa supports the organic backyard gardening by distributing gardening and farming tools, seedlings, and information materials to families in barangays where malnutrition cases are high.

Tacurong City appointed a new city action nutrition officer, activated the city and barangay nutrition councils, and upgraded front-line health workers’ skills.  Pregnant women and mothers with malnourished children get priority seed allocation.

Tagum City’s agriculture office introduced programs that brought fresh produce directly to barangays, encouraged residents to plant on vacant lots around the city, and gave residents free access to seeds and seedlings.