The Zuellig Family Foundation (ZFF) is honored to share its on-the-ground experience and knowledge while learning from others in the independent advisory board created by the Department of Health (DOH) to fast-track Universal Health Care (UHC) reforms, with the appointment of Austere A. Panadero, executive director of the ZFF as a member.

DOH officer in charge Rosario Vergeire formed the Strategic Advisory Group of Experts for UHC Implementation (UHC SAGE) to build on the gains from the public-private, multi-sectoral participation
for COVID-19 response.

Other members of the board are ZFF trustee Dr. Esperanza I. Cabral representing the Philippine Heart
Center, University of the Philippines (UP) professor Antonio Dans, M.D., UP Professor Emeritus Ernesto
Domingo, M.D., Medical City consultant and former UP professor Mary Ann Lansang, M.D., Dr. Edwin
Mercado of the DMMC Institute of Health Sciences, UP Manila Chancellor Carmencita Padilla, M.D.,
and former UP School of Economics Dean Orville Solon, Ph.D.

Based on the DOH personnel order 2022-4852 creating the group, the responsibilities of the members include the provision of technical assessments and review of documents on the following:

• Nationwide adoption of the Philippine Health Facility Development Plan as an investment plan for health
• Implementation of fiscal streamlining in public hospitals
• Implementation of the Diagnosis Related Group-Based Global Budget and the Comprehensive Outpatient Benefit Package
• Reconciliation of the databases of the Philippine Statistics Authority and PhilHealth, and the conduct of a primary care census
• Creation of a Central Medicine Store for pooled procurement

• Development of a Pharmacy Benefits package that allows PhilHealth to accredit and pay for retail pharmacies
• Streamlining of accreditation and licensing for primary care facilities
• Implementation of healthy schools, communities, and workplaces

• Establishment of the DOH Action Center and hospital fast lanes for health care workers’ concerns and benefit compensation processing
• Creation of health scholarship opportunities and the Medical Reserve Corps

ZFF’s UHC program

By the time Universal Health Care became law in 2019, ZFF had designed a program to assist three provinces—Agusan del Sur, Aklan, and Bataan— in the UHC transition. ZFF’s earlier work with provinces prompted governors to establish a functional service delivery network involving both provincial and municipal health facilities. The gains during the program provided a backbone for the three provinces’ work on UHC and response to the COVID-19 pandemic.

Provincial health boards (PHBs), whose memberships expanded, were fully activated under ZFF’s pre-UHC program. During the pandemic, the PHBs quickened the pace in localizing policies, pushing for local health reforms, and engaging various stakeholders. These provinces increased health care capacities, upgraded medical equipment and laboratories, and kept their people informed.

With ZFF guidance, the provinces remained deliberate in meeting the government-set key result areas (KRAs) for UHC maturity during the pandemic. The three fulfilled all 12 KRAs under the preparatory level six months before the government’s end-2022 target.

The developments in ZFF’s provinces prompted then Health Undersecretary Myrna Cabotaje to ask ZFF for a similar program for regional health officials. The resulting partnerships for northern Luzon officials introduced the Leadership Development Program, which improved the capacities of regional officers in mentoring and coaching local chief executives and health officials. As a result, provinces and cities moved faster in meeting targeted KRAs. In three months, the partnerships expanded to have governors enroll in the ZFF program. Before 2022 ended, ZFF had partnerships with four regional offices of the DOH: Ilocos Region, Cagayan Valley, Cordillera Administrative Region, and Eastern Visayas. These involve 15 provinces: Ilocos Norte, Ilocos Sur, La Union, Pangasinan, Apayao, Kalinga, Mt. Province, Ifugao, Benguet, Northern Samar, Samar, Eastern Samar, Biliran, Leyte, Southern Leyte.

(Published March 2, 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)

Provincial leaders in northern Luzon sharpen their knowledge on how to attain Universal Health Care (UHC) by improving health services and overall health systems. ZFF’s BayangMalusog: Provincial Leaders for UHC Acceleration program gave leaders, which included nine governors in attendance, insights on navigating the challenges UHC demands.

For Dr. Manuel Dayrit, former health secretary and a ZFF trustee, the UHC is the culmination of all health-related laws enacted since the 1950s because it calls for the health of all Filipinos.

He reminded governors and other provincial leaders that “investing in health is investing for the future” and the return on investments includes “decreased premature deaths” and “increased quality of life.”

Dr. Israel Francis Pargas, PhilHealth senior vice president, said the agency is designing its programs “to have a more comprehensive outpatient primary care package” to comply with the UHC law, which calls for every patient to pass through primary care physicians whose gatekeeping role is to ensure proper referral of cases. Ideally, therefore, all diseases are diagnosed at the primary care level.

In closing his presentation, Dayrit voiced his hopes that the governors leave a legacy of better health in their provinces.

The Department of Health (DOH) Centers for Health Development in the Cordillera Administrative Region (CAR) and Region 1 sponsored the module runs in Baguio City and Laoag City, respectively. Lending their time to support their provincial teams were DOH CAR Director Rio Magpantay, M.D., and Region 1 Director Paula Paz M. Sydiongo, M.D. Caraga Regional Director Cassion, M.D. was also present in the Baguio City module run to join Agusan del Sur Governor Santiago Cane Jr. who shared his bridging leadership journey with the other governors and the accomplishments of his province in UHC. His province has met all requirements for the preparatory level of UHC maturity—a set of standards set by the DOH—and hopes to attain the highest level of UHC functionality before his second term as governor ends in 2025.

For more on Agusan del Sur’s achievements in UHC, listen to https://spoti.fi/3zlTYRX.

CAR and Region 1 provinces will have their next module in March 2023 after an intensive practicum period which will see ZFF-trained regional leaders coaching and mentoring the governors and their teams. The provinces are expected to meet specific milestones designed to lead them toward UHC
attainment.

CAR governors present were Apayao Gov. Elias Bulut Jr., Benguet Gov. Melchor Diclas, Kalinga Gov. James Edduba, Ifugao Gov. Jerry Dalipog, and Mountain Province Gov. Bonifacio Lacwasan. For Region 1, Ilocos Norte Gov. Matthew Manotoc and La Union Gov. Raphaelle Veronical Ortega-David attended the event, which switched to hybrid following the strong quake in Northern Luzon last Oct. 25. Aklan Gov. Jose Enrique Miraflores, a first-termer whose province has been a ZFF partner since 2016, joined the Region 1 event online. Region 6 Director Adriano Suba-an was in Laoag City.

(Published December 9, 2022)

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.

In response to the exponential growth of COVID-19 infected patients since the first confirmed case in the Philippines, the Zuellig Family Foundation held a virtual round table discussion (RTD) to talk about the local government units’ (LGUs) role in combating the threats of COVID-19.

Under Proclamation No. 922, all government offices and LGUs are mandated to “render full assistance and cooperation and mobilize the necessary measures in a timely manner to curtail and eliminate the COVID-19 threat.”

“As bridging leaders, local chief executives should be fully informed of what is happening, target the cooperation and trust of constituents, and come up with new institutional arrangements to address the emergency,” said ZFF chairman and president Ernesto Garilao in his discussion of ZFF’s Leadership Framework for COVID-19.

Department of Health (DOH) Undersecretary Maria Rosario Vergeire, a resource person during the RTD, pointed out the roles of the LGUs.

Vergeire encouraged each LGU to align their mitigation initiatives with DOH’s four-point strategy of contact tracing, physical distancing, diagnostics, and medical management to fight COVID-19. Accordingly, surveillance and epidemiology units shall be mobilized to do contact tracing.

Another resource person, ZFF trustee and former DOH Secretary Dr. Manuel Dayrit, reiterated that contact tracing is a crucial stage as it is the key to identifying community members displaying symptoms of the disease, tracking people who have been in contact with patients under monitoring and investigation (PUMs and PUIs), and identifying patients who need critical care.

Dayrit cited Metro Manila’s experience to explain why early detection is fundamental, saying, “We were not able to do early detection in February. What eventually happened, many of our countrymen went home to provinces. As we can see, from DOH reports, there may already be transmission in the provinces –some of them may be carrying the virus.”

Meanwhile, municipal and city mayors as well as barangay captains are expected to enforce and monitor the implementation of social or physical distancing in their jurisdiction. This is the measure to reduce close contact between people in order to prevent the spread of contagious diseases. Hence, it is the LGU officials’ mandate to ban mass gatherings, suspend classes, and enforce mandatory community-based quarantine.

As COVID-19 spreads quickly and new protection measures are implemented, people are constantly seeking information. Here, government officials again play a crucial role to make sure effective communication is in place, where, according to another RTD resource person Vikki Luta, EON-Engage business unit head, advised local authorities to conduct social listening or taking note of the public’s opinions, questions, and complaints. Then, the government can respond appropriately. LGU officials must also be responsible for addressing false information to avoid further panic and other social disturbances.

While the DOH has already set up a centralized communication chat where all announcements are posted, LGUs are encouraged to use necessary platforms to reach their constituents, especially those in geographically isolated and disadvantaged areas. In Salcedo, Eastern Samar, Mayor Melchor Mergal uses radio and text blasts in disseminating the latest developments about the virus.

“People are confused because of many news items about COVID-19 on TV and social media. Access to correct, clear, and regular information will help government in identifying right intervention,”shared Mergal. LGUs are encouraged to tailor their communication strategies and channels—print, traditional, or new media—with the communities they serve.

In terms of diagnostics, city mayors and provincial governors are likewise given the task of mapping out primary health care facilities, which can accommodate mild and asymptomatic cases. This is to avoid congestion in hospitals that must prioritize severe and critical cases.

Bataan Governor Albert Garcia shared they are already preparing more facilities like stadiums and coliseums that can accommodate more patients. They are also looking into the possibility of using elementary schools as temporary facility for PUMs and PUIs.

To assist the national government in medical management, the DOH encourages LGUs to establish their own mechanism to collect and send samples of patients to designated laboratories while the national government is arranging the setting up of testing laboratories in each region. Vergeire also points out that LGUs can help provide transport means to health workers and essential personnel especially during the community quarantine period and take lead in designating funeral homes in handling COVID-related casualties.

Moving Forward

While COVID-19 is the urgent health concern, patients with other illnesses should not be neglected. Hence, the DOH provided a set of guidelines to help LGUs implement telemedicine while the enhanced community quarantine is in place. Telemedicine is the distribution of health-related services through electronic information and telecommunication technologies. It minimizes face-to-face interactions between patients and health workers, thus, complying with the mandate of DOH to observe social distancing.

On top of these health concerns, LGU officials should also consider the present situation as public order and security concern. Threats of riots, looting, and other social disturbances must also be managed, taking into consideration children, pregnant women, senior citizens, and people with underlying conditions as most vulnerable sectors.

ZFF recognizes that all initiatives, however big or small, require participation among the people. Combating COVID-19 is not the sole responsibility of a single sector but requires everyone’s cooperation. As Cagayan de Oro Mayor Oscar Moreno said, “The best way to handle this problem is to look beyond our boundaries. The key is teamwork at all levels, all the way to the barangay level.” The mayor had begun coordinating with mayors from neighboring towns so they work together in addressing the pandemic.

The RTD, held last March 25 and entitled “Working Together for LGU Preparedness and Response,” is part of ZFF’s efforts to continue its mission of being catalyst of better health outcomes especially now that the whole world faces a pandemic. For over a decade now, ZFF has been helping improve capacities and knowledge of local chief executives in health leadership and governance. Its interventions have been introduced to health leaders in 774 municipalities, 25 cities, and 27 provinces.

For more information about the roundtable discussion, you may email kmg@zuelligfoundation.ngo.