A whole-of-society—not just a whole-of-government—approach was the main solution to achieve a Universal Health Care (UHC), which guarantees equitable access to quality and affordable health care for all Filipinos, amid the pandemic. All three governors under the Provincial Leadership and Governance Program (PLGP) of the Zuellig Family Foundation (ZFF) shared this lesson during the colloquium held on April 19.

But it takes good leadership and governance to orchestrate a successful whole-of-society approach to health. Just as ZFF Chairman Ernesto D. Garilao puts it: “Committed, competent, and dedicated executives play critical roles in improving the health indicators of constituents.” This is where the work of ZFF comes into play. PLGP helps develop the bridging leadership (BL) competencies of provincial health leaders in establishing the necessary structures and policies to implement the mandates under the UHC law. The BL framework, through the three processes of ownership, co-ownership, and co-creation, fosters greater personal accountability for social health issues and harmonious collaboration with different stakeholders to overcome challenges.

Compared to other UHC sites, the three provinces under PLGP—Agusan del Sur, Aklan, and Bataan—are progressing faster toward attaining UHC despite the pandemic, making them possible models for the rest of the country when Congress reviews the UHC law’s implementation in 2025.

Multisectoral engagement
The three provinces collaborated with stakeholders from different sectors, including the government and private sectors and the communities to ensure the sustainability of programs and the resilience of communities. This meant building strong ties with indigenous and tribal communities, integrating health services to COVID-19 response, and improving access to health care services in far-flung areas, among others. These efforts helped the provinces complete vital preparatory activities based on the UHC maturity model of the Department of Health (DOH). As of March 2022, Agusan del Sur has achieved 87%, and Aklan and Bataan are at 75%. The maturity model is used to monitor the progress of local health systems integration as provided by the UHC Act and its implementing rules and regulations.

According to Agusan del Sur Gov. Santiago Cane, Jr., “I have to make sure that my line of communication was always open. The most effective way of leading a bureaucracy is to see to it that you are always understood. I asked the employees to march with me in realizing the mission and vision of a quality health care system with empowered healthy and happy people.”

The province also concentrated on establishing a health promotion office, which is aligned to the UHC goal of attaining health literacy. It also established an inter-local health system, and an online information system. Agusan del Sur was a top-performing province in population testing rate for tuberculosis in the Caraga region for 2021 and the best performing local government unit for national COVID-19 vaccination days among provinces with second dose coverage.

“We had to get all the players on board, including the private sector, to make them realize that they also have to share their resources. We were able to communicate to them effectively that we are all in this together,” said Aklan Gov. Florencio Miraflores: “The people of Aklan cooperated with us that is why we are able to control the surge of the Delta variant in 5 weeks,” he said.

Aklan allocated 40% of its provincial budget to health. It also built a molecular laboratory and launched a mental health program as part of its COVID-19 response.

Before the pandemic, Bataan has been establishing a service delivery network (SDN) connecting barangay and municipal health facilities to the hospitals when the province was under the second cycle of PLGP. Bataan General Hospital and Medical Center was designated as the apex hospital or the main referral hospital. During the pandemic, the province partnered with private hospitals to upgrade the system. It also launched a COVID-19 real-time dashboard monitoring system and a hospital bed tracker app for the efficient referral of COVID and non-COVID patients. With an SDN already in place, Bataan has a head start in building a health care provider network (HCPN), which is the backbone of UHC.

Bataan is number 1 in COVID-19 herd immunity in Region 3 because of its pandemic response efforts, including building a mega treatment facility and an RT-PCR (reverse transcription-polymerase chain reaction) laboratory. The 1Bataan seal of COVID-free barangay, an incentive-based engagement program for villages that meet COVID-19 targets, is being adapted to strengthen primary health care.

In congratulating the three provinces on their accomplishments under PLGP, Health Undersecretary Myrna C. Cabotaje reiterated Gov. Garcia’s statement that “UHC is being implemented not just for the sake of implementation but for people to live long and healthy.” As Director Irma L. Asuncion of the Bureau of Local Health Systems Development-DOH pointed out: “The success of UHC can only be measured by the wellbeing of our fellow Filipinos.” Under PLGP, the improvement of maternal and child indicators, epidemiologic parameters, and access to noncommunicable disease services were monitored and evaluated for the provinces to make outcomes-oriented decisions. In 2021, the infant mortality rate (infant deaths per 1,000 live births) for the three provinces under PLGP were below the 2022 national target of 15. For the same year, Agusan del Sur and Aklan recorded maternal mortality ratios (maternal death per 100,000 live births) of 51 and 16, respectively, which are well below the 2022 national target of 90.

For more insights on the challenges and innovations of UHC implementation amid the pandemic, watch the recording of the colloquium on ZFF’s Facebook Page: https://bit.ly/3EoDKZA.

Provincial health officials reconnected with their life’s purpose and agreed to work toward attaining Universal Health Care (UHC) after attending a two-day leadership training. As one group of provincial health team leaders (PHTLs) declared for their region, “Sa CAR (Cordillera Administrative Region), saan mang sulok, kalusugan ay maabot.”

The training, attended by 18 PHTLs and three UHC coordinators from CAR, Ilocos Region, and Cagayan Valley region, is part of the Leadership for Development Program (LDP) to Accelerate UHC Implementation. This is a partnership between the Department of Health’s Field Implementation and Coordination Team (DOH-FICT) in northern Luzon and the Zuellig Family Foundation (ZFF).

The PHTLs will cascade their learnings to their teams of development management officers so they too build their leadership capacities. They defined the ways to win over their critical stakeholders in co-owning the challenges in attaining UHC, a crucial step given the arduous tasks to build province-wide health systems. To do this, they will localize the intent of the UHC law to make its relevance clearer to local officials who will hopefully be moved to take urgent actions.

These initial efforts are intended to attain within the second quarter of 2022 the objectives of having dedicated provincial teams for health promotion and disaster risk reduction and management in health, as well as functional epidemiologic and surveillance units in the provinces. Through these, provinces would have met at least 70% of the conditions set under the preparatory level for UHC.

PHTLs’ active and proper guidance will help local government units fulfill the conditions under the 2019 UHC law. They are responsible for carrying out the DOH functions that include planning, advocating, mobilizing resources, providing technical assistance, and collaborating with the provinces.

Unfortunately, many PHTLs have faced roadblocks. The pandemic forced all local government units to focus on COVID-19 management. There are also fundamental gaps in health promotion and education, information systems, and human resources.

The first module focused on applying the competencies under the bridging leadership framework of owning the issues, co-owning them with the stakeholders, and co-creating the solutions. Participating PHTLs underwent discussions and exercises in situational analysis, creating team vision, and planning stakeholder engagement and other next steps.

Undersecretary Myrna Cabotaje, who heads DOH-FICT northern Luzon and NCR clusters, reminded the PHTLs about their role in catalyzing improvements within the DOH and sharing their knowledge, especially with governors and mayors, since local chief executives’ policies and actions will determine the reduction of health inequities and sustainability of health improvements.

The next training for PHTLs will happen in July 2022. Cabotaje, a participant in ZFF’s past leadership program for DOH regional directors, asked ZFF to replicate its programs for three partner provinces that progressed considerably toward UHC despite the pandemic. The DOH regional leadership wanted similar transformations in the capacities of their key officials so they can also coach and mentor provincial and city health leaders on what and how things should be done to attain UHC.

The Zuellig Family Foundation (ZFF) signed a three-year partnership with the Local Government Academy (LGA), which aims to boost the capacity of local government units (LGUs) to deliver basic services, including health, following the full devolution of such services to the LGUs.

For the LGUs to take on additional functions, the local chief executives must gain new knowledge and skills to better strategize and invest in effective measures that will immediately improve health outcomes and bring about inclusive growth.

During the online signing event held last July 16, Executive Director Austere Panadero represented the ZFF, with Deputy Executive Director Dr. Anthony Faraon acting as a witness to the signing. Their counterparts were LGA Executive Director Thelma Vecina and Director Esmeralda Daphne Purnell.

The partnership will address Universal Health Care (UHC) implementation readiness, nutrition during the first 1,000 days of life (F1KD), adolescent sexual and reproductive health (ASRH), pandemic response, and local health system resiliency.

A recording of the signing ceremony can be found on ZFF’s Facebook Page: https://bit.ly/3iFQArS.

Local government units (LGUs) do not only lack COVID-19 vaccines, but they also do not have enough vaccinators. This concern was echoed among the participants in the webinar “May Bakuna Pero Walang Magbabakuna: What Can LGUs Do?” of the Zuellig Family Foundation (ZFF) and the Philippine Center for Population and Development.

During the webinar held last June 18, Dr. Aleli Annie Grace Sudiacal of the Department of Health assured that the national government would urgently hire needed personnel.

Inadequate human resources
Due to the shortage of personnel, most LGUs rely heavily on volunteers. Some volunteers, however, are not as committed and unwilling to take on other related tasks. Some do not even show up.

Another consideration among LGUs is balancing the team members onsite and doing house to house for the marginalized sector, such as the bedridden senior citizens.

Having inadequate manpower is especially felt in small towns and geographically isolated and disadvantaged areas (GIDA). Rural health units in small towns only have one doctor and two nurses.

Sustainable solutions
The DOH emphasized developing a national deployment vaccination plan for a successful vaccination program toward herd immunity by vaccinating 70% of the population. Further, the plan should be reviewed to employ innovative strategies and mechanisms in addressing emerging challenges.

To stop relying on volunteers, pharmacists and midwives can now administer vaccines in addition to doctors, nurses, and dentists. Administrative and support functions can also be given to non-health care workers. Graduates of health science education courses who are not yet licensed may be part of the vaccination teams provided that they are under the supervision of licensed health professionals. Other health professionals, such as medical technicians, cannot administer the vaccine but can be part of the vaccination team.

Simply adding personnel, however, is not sustainable. For Sudiacal, the national government and private sector should consider regulatory and financing interventions requiring all graduates of health-related courses to render mandatory service as members of the vaccination team and the vaccination to be covered by health and maintenance organizations (HMOs).

A recording of the webinar can be found on ZFF’s Facebook Page: https://bit.ly/2Uhb4id.

At least 495 babies are born every day to Filipino girls aged 10 to 19 years, according to the 2019 data of the Philippine Statistics Authority. To address this, Malacañang declared as a national priority the implementation of measures to prevent teenage pregnancy through Executive Order (EO) No. 141, which further mobilized government agencies, the youth, and the community to work together in addressing the root causes of the problem.

Ahead of the EO signed on June 25, an additional 10 cities already heeded the call of The Challenge Initiative (TCI) in the Philippines to reduce teenage pregnancies. TCI aims to establish adolescent-friendly health facilities that promote positive health-seeking behavior and improve access to family planning programs.

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

Started in 2020, the TCI in the Philippines is co-managed and co-funded by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health. The five-year project has been implemented in three pilot sites (Dipolog, Cagayan de Oro, and Puerto Princesa cities) in collaboration with the Commission on Population and Development (Popcom).

10 scale-up cities
The 10 scale-up cities are Santiago (Isabela), Baguio, San Jose (Nueva Ecija), Biñan (Laguna), Naga (Camarines Sur), Tacloban, Iloilo, Tagum (Davao del Norte), Tacurong (Sultan Kudarat), and General Santos. These were selected based on high political commitment, available budget and other resources, health system readiness, size of potential impact, and identified stakeholders.

The participating cities will be given technical assistance and guidance on TCI’s proven high-impact approaches on leadership and governance, quality adolescent and youth sexual and reproductive (AYSRH) health services, youth engagement, and demand generation.

Interventions include comprehensive sexuality education, inter-generational dialogue, policy development, and information and service delivery network for adolescent health and development.

Related story: Youth-led participation of religious sector in reducing teenage pregnancies

According to experts, clusters are the main engine transmission of the COVID-19 pandemic. That is why knowing where, when, and why they happen through effective contact tracing could help curb the transmission rate while the COVID-19 vaccine is not yet widely available.

In a series of executive coaching sessions with the provincial governments of Agusan del Sur, Aklan, and Bataan, former Health Secretary Manuel Dayrit highlighted the importance of mapping out contact tracing and utilizing the results as part of risk communication.

Creating visual stories
Dr. Dayrit, also a trustee of the Zuellig Family Foundation (ZFF), pointed out that an effective contact tracing entails testing all contacts, identifying and isolating symptomatic and asymptomatic contacts, locating clusters in the barangays, and understanding the transmission patterns.

Citing a good practice in Taguig City, Dr. Dayrit recommends developing the results of contact tracing into visual stories to warn people of how COVID-19 transmission happens. For example, a gym instructor conducting classes without a mask reportedly infected 21 people (who further infected other people) in three days.

The online sessions held on April 23 and 28, and May 7 were part of ZFF’s Provincial Leadership and Governance Program (PLGP). The program aims to prepare provinces for Universal Health Care systems integration.

Addressing complacency
In all three provinces, people’s complacency in following minimum health standards has resulted in super spreading events and clustering of cases.

Agusan del Sur has eased border controls but is counting on stricter implementation of health protocols as its best defense against COVID-19. The provincial government distributed 85,000 face masks throughout the province and drafted an ordinance penalizing people who do not follow minimum health standards.

A more personal approach to enforce the minimum health standards is needed in Bataan, as the province’s main challenge is the authorized persons outside of residence (APOR) returning on weekends. Dr. Dayrit suggested the governor reach out to each family to make the message more personal and appealing to them. The local leaders are also looking into a policy that will allow residents working outside Bataan to go home only after doing a mandatory quarantine.

Meanwhile, Aklan is already on the right track when it comes to contact tracing. But the province still wants to focus on effective messaging to avoid super spreader events in places such as Boracay. Another challenge is the financing of treatment for COVID-19 patients as reimbursements from PhilHealth are too slow.

In a pandemic, people must receive accurate and timely information so they can make informed choices. To help provincial health leaders in their critical risk communication task, Zuellig Family Foundation (ZFF) co-created a manual with the governments of Agusan del Sur, Aklan, and Bataan.

The manual contains the basic steps, worksheets, templates, and recommended activities in enhancing risk communication plans. It is available here: https://bit.ly/3ft3Bn6.

Webinar on COVID-19 vaccine
ZFF also addressed concerns about the COVID-19 vaccine by holding a webinar on May 17. Safety emerged as a common concern among the participants, particularly to those with comorbidities such as chronic respiratory disease, hypertension, cardiovascular disease, malignancy, diabetes mellitus, obesity, and chronic kidney disease.

Dr. Catherine Chung, ZFF director, reiterated that the COVID-19 vaccine is safe and effective even for those with underlying medical conditions. However, those with autoimmune conditions, (human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or cancer, and those who had a transplant or are bedridden need medical clearance to get the vaccine.

Dr. Anthony Faraon, ZFF deputy executive director, also clarified that the vaccine is not advisable for people with allergies to the ingredients of the vaccine and those who had severe allergic reactions after their first dose. Minors, too, are not yet advised to take the vaccine.

Questions about side effects were also raised. Dr. Ramir Blanco, ZFF director, noted that blood clotting due to the COVID-19 vaccine is rare (about 4 in 1 million). The common side effects are pain, redness, itchiness or swelling on the area of injection, and flu-like symptoms (chills, joint pains, headache) that will all subside in one to three days. These are signs that the body is building immunity to the virus.

The webinar also showed the BIDA BakuNation video of the Department of Health (DOH) on the 10 common questions about the COVID-19 vaccine as narrated by public health expert Dr. Beverly Lorraine Ho. The video highlighted the need to have at least 70 percent of the population be vaccinated to achieve herd community and effectively protect everyone from the COVID-19 virus.

A recording of the webinar can be found on ZFF’s Facebook Page: https://bit.ly/3hCKDNo.

Among the provinces in Eastern Visayas, Samar recorded the highest stunting (impaired growth and development) prevalence among children under two years old at 29.4 percent in 2019. Acknowledging the urgency of addressing malnutrition, the provincial government of Samar launched its “Tatak Tangkad” program to fast-track its efforts in improving nutrition among pregnant and the first 1,000 days (F1KD) population—children 0 to 23 months old.

In his opening remarks during the program launch yesterday, Samar Governor Reynolds Michael Tan highlighted that stunting does not only concern height, but also the overall brain development of the child that could lead to severe consequences later in life if neglected. According to the World Health Organization, the most crucial period to address stunting is during the F1KD of a child’s life because this is a period of rapid physical growth and accelerated mental development.

Improved F1KD numbers
Through the “Tatak Tangkad” program, the provincial government aims to bring down stunting and wasting (too thin for a given height) prevalence among children below two years old by 25 and 10 percent in 2025, respectively. It also aims to reduce the number of nutritionally-at-risk pregnant women and low birth weight infants.

Since July 2020, Samar has been undergoing interventions for improved F1KD nutrition under the Provincial Nutrition Governance Program (PNGP) of the Zuellig Family Foundation and United Nations Children’s Fund. PNGP aims to have a comprehensive and integrated nutrition program that will have health and nutrition sectors working with other agencies, including education, agriculture, and social welfare.

Declaration of commitment
Governor Tan also called on the local leaders, partners, other agencies, and the community to support the “Tangkad Tatak” program: “Help us end the cycle of child malnutrition in Samar. There is no better time to do it but now.”

The Samar community affirmed its collective response in addressing malnutrition with the signing of a declaration, committing themselves to become “champions for the improvement of maternal and child nutrition” in the province.

Tatak Tangkad will be an intersectoral collaboration targeted at the vulnerable and disadvantaged F1KD population. Tracking, monitoring, and referrals of malnutrition cases will be handled by a so-called team of navigators composed of parent leaders, youth representatives, barangay health workers, and barangay nutrition scholars. Identified at-risk individuals will be enrolled in the program.

The provision of family planning (FP) commodities and counseling takes a back seat during emergencies, posing life-threatening complications to pregnant women and girls. The new program of the Zuellig Family Foundation (ZFF) aims to avoid this scenario by introducing local government units to the Minimum Initial Service Package (MISP) for Sexual Reproductive Health (SRH) training course.

The initiative, a partnership with the United Nations Population Fund (UNFPA) and funded by the Australian Aid, will strengthen the competencies of provincial leaders to implement life-saving SRH information and services during natural disasters and other public health emergencies. The pilot sites are the provinces of Catanduanes, Laguna, and Maguindanao.

Catanduanes
Last July 30, ZFF and UNFPA rolled out the executive course on MISP for SRH to Catanduanes. The provincial leaders will be training until September 2021 to ensure that the province has the funds and an integrated system for the continuous delivery of SRH services and commodities amid disasters, pandemics, and other emergencies.

Known as the “Land of the Howling Winds,” the province of Catanduanes is frequently visited by typhoons. Last year, at least 8,000 pregnant women—20 percent of which are adolescents—lacked access to SRH services after the back-to-back typhoons Rolly and Ulysses amid the COVID-19 pandemic. Women and girls are also at risk of unintended pregnancies, sexual violence, exploitation, and HIV infection during such situations.

MISP for SRH
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.