The Zuellig Family Foundation, through The Challenge Initiative – The Philippines, supported the Manila Health Department’s (MHD) workshop on the Deployment of the Adolescent Sexuality and Reproductive Health – Family Planning Module in the City of Manila last March 19, 2025. The workshop aimed to enhance Health Service Providers (HSPs)’ capacities in managing adolescent health issues, particularly in sexual and reproductive health.

The sessions had clear objectives: 

• Familiarize healthcare providers with the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidal Ideation, and Safety (HEEADSSS) assessment framework for comprehensive adolescent care;
• Train personnel on accurately completing and interpreting the assessment in the WAH EMR (Wireless Access for Health Electronic Medical Record) system;
• Ensure the consistent use of the form to capture holistic health data;
• Enhance ability to identify psychosocial risks and mental health concerns; and
• Standardize documentation to ensure continuity of care.

Dominie Busacay of the Commission on Population and Development (CPD) provided an insightful overview of the Adolescent Job Aid 2.0 (AJA), which is designed to equip HSPs with the knowledge, skills, and attitudes necessary to provide sensitive, effective care for adolescents. The AJA 2.0 is divided into five parts, covering self-reflection and self-care for HSPs, understanding adolescent behaviors and health concerns, navigating health systems to ensure care, evaluation and supportive supervision for continuous improvement, and detailed protocols for common adolescent health conditions such as mental health, nutrition, sexual health, and abuse. All components align with the Department of Health (DOH)’s Omnibus Guidelines for Adolescent Health.

Despite the clear need for specialized adolescent healthcare, concerns were raised by several MHD physicians in attendance. A striking issue was that, out of the 50+ doctors employed by the city government, only four had received training on AJA. This situation is not unique to Manila; it appears to be a widespread issue across the National Capital Region (NCR) and possibly nationwide. This highlights several critical gaps in health worker capacity, including insufficient training on adolescent-specific healthcare, limited access to up-to-date resources, and systemic barriers such as overburdened workloads. Additionally, many healthcare workers struggle with biases and stigmatization, particularly when addressing sexual and reproductive health with adolescents.

Encouragingly, DOH-NCR will soon conduct a Training of Trainers on AJA for NCR Local Government Units (LGUs). However, it is concerning that only two trainers per city will be selected, leaving individual cities responsible for rolling out the training. This limited scope may further exacerbate the challenge of scaling adolescent-friendly services across the region.

In light of these challenges, various stakeholders must take on critical roles. The DOH and the CPD must prioritize expanding training opportunities for health workers, ensuring that all healthcare providers in adolescent-focused settings are equipped with the necessary skills and resources. LGUs must take responsibility for facilitating and implementing these programs at the local level, ensuring that a sufficient number of healthcare providers are trained to meet the demand. Meanwhile, organizations like ZFF-TCI, alongside other partners, can continue to offer support through advocacy, resource mobilization, and the provision of specialized training materials.

Adolescents are navigating a critical phase of rapid physical, emotional, and social change, and their healthcare needs require specialized attention. Despite this, many healthcare systems still struggle to provide appropriate care tailored to young people. Tools like AJA are invaluable in empowering healthcare workers with the resources and strategies they need to deliver comprehensive, age-appropriate, and empowering care. Training healthcare providers on these approaches is not just beneficial—it is essential. To improve adolescent health outcomes, all involved stakeholders must come together to address gaps in training, resources, and support, ensuring that young people receive the care and attention they deserve during this formative stage of life.

The Zuellig Family Foundation (ZFF), in its ongoing efforts to improve health outcomes in underserved communities across the Philippines, recently conducted a scoping visit to Sulu Province. From February 11 to 12, 2025, the ZFF team, led by its Board of Trustees and key staff, embarked on a mission to better understand the province’s health challenges and opportunities. The visit aimed to lay the groundwork for potential collaborations and program implementations tailored to Sulu’s unique healthcare needs.

The delegation included ZFF Chairman Dr. Manuel Dayrit, President and Executive Director Austere Panadero, and Board of Trustees members Daniel Zuellig and Dr. Jaemin Park, along with Manila-based and Mindanao-based ZFF staff. They were joined by resource persons and guests, led by Jonas Zuellig and Pascal Gueissaz, who brought valuable insights and expertise to the discussions.

Over three days, the team engaged in dialogues and site visits to explore partnerships with local stakeholders. The itinerary included meetings with key leaders such as Sulu Governor Abdusakur “Sakur” Tan and other local government unit (LGU) officials. The team also visited rural health units (RHUs) and hospitals, gaining firsthand insights into the province’s healthcare infrastructure and services.

A key highlight of the visit was the engagement with the academic community, including meetings with Notre Dame of Jolo College and representatives from the Mindanao State University-Sulu Campus. These discussions provided an opportunity to explore how education and community extension services can contribute to addressing health challenges. Additionally, a dialogue with the Philippine Army Brigade underscored the importance of security and stability in ensuring the success of health programs in the province.

This visit marks a significant step in ZFF’s mission to strengthen local health systems and improve community well-being. By gaining a deeper understanding of Sulu’s health landscape, the foundation aims to identify opportunities for partnerships and sustainable interventions that can enhance health outcomes.

Main photo by Dr. Manuel Dayrit

Fau Sarani was the acting health officer and head of the rural health unit in Simunul, Tawi-Tawi when he first joined Zuellig Family Foundation’s (ZFF) Community Health Partnership Program (CHPP) in 2011. This ZFF program equips leaders with the necessary knowledge, skills, and strategies to tackle complex health issues in their community effectively using the Health Change Model (HCM). The Health Change Model is premised on the assumption that local health leadership—the mayor, the municipal health officer and community leaders—is the key to changing systems and inclusive programs that lead to better health outcomes.

“The CHPP program has a significant contribution to knowledge skills and attitude in terms of leadership organization and management and helped me to connect with partners and stakeholders in the community. As head of rural health unit, I am the overall program in-charge of all public health programs. Technically and Administratively, ako po in charge running isang health unit in Simunul,” Sarani shared.

Currently, Sarani is a public health nurse and the head of the rural health unit in Simunul, Tawi-Tawi. “I have been the acting health officer and head of the rural health unit. I stand alone as head of 15 barangays with a total population of about 37 thousand, in addition to the lack of manpower.”

“Fau has not only demonstrated a deep understanding of healthcare challenges but also shown a proactive approach in addressing them,” observed Deputy Executive Director Anthony Faraon, who met Sarani recently during the ZFF visit to Tawi-Tawi, thirteen years after Sarani finished the Community Health Partnership program.  He demonstrates exceptional leadership skills and dedication to improving community health, embodying the values and skills of a Zuellig Family Foundation (ZFF) Bridging Leader.

Collaborating with his mayor and a tri-leader team to complete ZFF’s Community Health Partnership Program (CHPP) in 2011 is a testament to his commitment to continuous learning and improvement in the field of public health. By applying the insights gained from the CHPP, Sarani was able to drive positive change and sustainable health initiatives in Simunul, Tawi-Tawi. His leadership, combined with a collaborative approach, improved access to quality healthcare services, raised awareness about health issues, and ultimately enhanced the well-being of the residents in this far-flung municipality facing unique health challenges.

Sarani has demonstrated a remarkable ability to sustain and further innovate essential health programs in Simunul, Tawi-Tawi. One of the key areas where his impact can be seen is in the implementation of innovative programs such as pregnancy tracking, which plays a vital role in ensuring the well-being of expectant mothers and promoting maternal health.

“Isa sa major programs ng public health ang maternal health. Our main objective is to promote safe motherhood among pregnant women in Simunul and increase awareness of all pregnant women on practices promoting proper antenatal care, facility-based deliveries, and child-rearing.

Part of our advocacy is a community-driven approach, we always emphasize that health is not just a DOH business. Everyone should be concerned and be engaged,” added Sarani.

By introducing and maintaining the pregnancy tracking program, Sarani has shown a proactive approach to monitoring and managing the health of pregnant women in the community. This initiative not only helps in providing timely and appropriate care but also contributes to reducing maternal mortality rates and improving birth outcomes in the region.

His commitment to utilizing data in decision-making processes has been instrumental in improving overall health service delivery in Simunul. By leveraging data-driven insights, he can identify health trends, prioritize interventions, and allocate resources effectively, ensuring that community health programs are targeted and impactful.

“We are also proud despite many challenges, facility-based deliveries significantly increased in our area. The knowledge we learned from the ZFF Bridging Leadership program is that it should be translated to the barangay level or other stakeholders to have larger ownership of the health problems or concerns of the community to ensure they are also part of the solution,” Sarani stressed.

Through his sustained efforts in implementing and enhancing these innovative programs, Sarani continues to make a significant difference in the lives of residents in Simunul, Tawi-Tawi. His dedication to promoting evidence-based practices, utilizing data for strategic decision-making, and focusing on preventive healthcare measures exemplifies a holistic and forward-thinking approach to public health leadership.

 

The province of Tawi-Tawi, located in the southernmost part of the Philippines, possesses a rich tapestry of history and culture. Being the first stronghold of Islam in the Philippines, Tawi-Tawi’s population is comprised mainly of the Sama, Tausug, Badjao, and Jama Mapun tribes and have cultivated a unique societal fabric that has influenced every aspect of life, including health. The Zuellig Family Foundation’s visit to the province was a gateway to understanding the intricate interplay between Tawi-Tawi’s heritage, geographical challenges, socio-economic conditions, and the health status of its inhabitants.

Historical and Cultural Influences on Health

Tawi-Tawi’s historical and cultural context significantly impacts its health landscape. “Understanding our past is crucial to addressing the health challenges we face today,” remarked Dr. Sangkula Laja, provincial health officer of Tawi-Tawi, during the visit. This perspective is vital in a province where traditional beliefs often influence health-seeking behaviors. The reverence for history and tradition among the populace underscores the importance of integrating cultural sensitivities into health interventions.

Geographical and Socio-Economic Challenges

The archipelagic nature of Tawi-Tawi, consisting of over 300 islands, presents logistical challenges in healthcare delivery. Coupled with its status as one of the Philippines’ poorest provinces, with a poverty incidence of 36.5% as of 2021, the challenges are magnified. This isolation and economic hardship hinder not only access to basic healthcare services but also the ability to sustain them. “Our geographical isolation compounds the difficulties we face, making it hard for support from Manila and Cotabato City to reach us,” Dr. Laja shared, highlighting the need for innovative solutions to improve healthcare accessibility and sustainability in the province.

Health System and Persistent Challenges

Tawi-Tawi’s reported Infant Mortality Rate (IMR) for 2022 currently stands at 3.84. This rate is substantially lower than the national average of 10.36 and better than the BARMM’s aggregate of 3.96. Moreover, while the BARMM records the lowest Facility-Based Delivery (FBD) and Skilled Birth Attendance (SBA) rates among regions at 68.34% and 74.66%, respectively, Tawi-Tawi boasts the second-highest FBD and SBA rates within BARMM, at 72.86% and 79.81%.

Despite these improvements, Tawi-Tawi faces ongoing health challenges. The current Committee Chair on Health of the provincial board, Dr. SP Sukarno Asri, highlighted the persistent issues of malnutrition, as evidenced by the 2023 Operation Timbang report. This report unveiled a concerning low coverage of 35% with a 6% stunting and 14% wasting rate among children aged 0-5 years. Additionally, the Maternal Mortality Ratio (MMR) is an urgent concern; Tawi-Tawi has an MMR of 115.21, the highest within the Bangsamoro region (BARMM) and significantly exceeding the national average of 64.68.

The situation is exacerbated by the complex terrain of the healthcare system in BARMM being non-devolved. “In BARMM, unlike other areas in the country, the regional government acts in some ways similarly to a single LGU, and as such, the region is responsible for ensuring health care service delivery, with provincial and municipal LGU support on as-needed basis,” said Board Member Ishmael. Furthermore, the challenge in achieving universal healthcare coverage remains a significant hurdle.

Reflections and Ways Forward

Reflecting on the information gathered during the visit, it’s evident that Tawi-Tawi’s health challenges cannot be viewed in isolation. They are inextricably linked to its unique cultural, historical, geographical, and socio-economic contexts. As such, health interventions must be culturally appropriate, geographically sensitive, and economically feasible. Integrating health programs with cultural practices may improve health-seeking behaviors among the indigenous populations. Furthermore, embedding health governance at the community level ensures that interventions are culturally appropriate and meet the actual needs of the people.

The World Bank, in a 2020 publication entitled “The Transition to Universal Health Coverage in BARMM,” recommends that the Ministry of Health (MOH) should undertake a comprehensive and inclusive strategic planning process that explicitly articulates funding and service delivery priorities, partner responsibilities (especially provincial and municipal LGUs and other local stakeholders), and quantitative mechanisms for tracking progress. It also advises the MOH to give a high priority to strengthening the building blocks of health service delivery in its regional planning efforts, specifically considering the unique supply-side and health care access constraints facing each province.

Community empowerment is crucial. “We need to leverage our strong community bonds to foster a culture of health,” Dr. Asri suggested. This approach involves training community health workers from within the tribes, who can navigate the cultural nuances more effectively. Moreover, strengthening the collaboration between the local government, BARMM, and non-governmental organizations like the Zuellig Family Foundation can enhance resource allocation and program implementation.

Addressing economic impediments is also vital. Initiatives to stimulate local economies and improve market access can indirectly boost health outcomes by reducing poverty-related health issues. Sustainable development projects, alongside health programs, could be a game-changer for Tawi-Tawi.

The visit to Tawi-Tawi by the Zuellig Family Foundation has provided invaluable insights into the province’s unique health challenges and opportunities. As a community deeply rooted in its historical and cultural heritage, solutions to its health challenges must be approached with sensitivity and innovation. As one health worker poignantly put it, “In the heart of our challenges lie the seeds of our triumphs. We must plant them wisely and nurture them together.