The Zuellig Family Foundation (ZFF) continues to work alongside the Local Government Units (LGUs) of Del Carmen and San Francisco, Surigao del Norte, under the Department of Environment and Natural Resources’ (DENR) Project TRANSFORM (Transdisciplinary Approach for Resilient and Sustainable Communities). The partnership aims to improve health and nutrition systems as part of building resilience against disruptions like natural disasters and addressing ongoing issues such as hunger and malnutrition.

During the midline assessment validation on November 11-12, 2024, municipal leaders reviewed their progress on the First 1,000 Days (F1KD) nutrition roadmaps. The discussion focused on milestones achieved and remaining gaps in health and nutrition governance, as identified in the past year’s data.

with Mayor Alfredo Coro II, Del Carmen

Mayors Alfredo Coro II of Del Carmen and Val Pinat of San Francisco led the session, highlighting strategies for improving health outcomes based on assessment results. Mayor Coro shared a key insight: “Inuna namin ang social determinants of health and nutrition, dahil paulit-ulit pa rin ang problema kung hindi naka-sentro sa tao ang solusyon.” (“We prioritized the social determinants of health and nutrition because the problems keep recurring if the solutions are not centered on people.”)

with Mayor Val Pinat, San Francisco

The session featured presentations from the Municipal Nutrition Action Officer and the Municipal Agriculturist of Del Carmen, who showcased the Farm-to-Spoon Program. This initiative connects food stability efforts with targeted nutrition interventions, specifically supporting nutritionally at-risk families among farmers and fisherfolk.

Module 2 of the Nutrition and Health Leadership for Resilience learning track as part of the Project TRANSFORM, conducted last November 14-15, 2024, emphasized adaptive leadership and team resilience. With tools for better governance, the module aimed to reinforce good practices that strengthen local nutrition systems, making them more responsive and functional.

Collaboration with the Provincial Government of Surigao del Norte, the National Nutrition Council of CARAGA, Department of Health (DOH)-Surigao del Norte, and various national and local partners has led to significant progress. Both municipalities have reported improvements in their F1KD nutrition roadmaps, setting a strong foundation for further action against malnutrition.

The journey continues, with both LGUs committed to enhancing their health systems and sustaining their gains, even beyond Project TRANSFORM’s timelines.

Author: Dr. Jenilyn Ann Dabu, ZFF LHS Program Manager

The visit by the Zuellig Family Foundation last October 23, 2024 yielded significant insights into the ongoing initiatives aimed at enhancing healthcare delivery in Benguet. 

As one of the first four provinces designated as a PhilHealth Health Care Provider Network (HCPN) Demonstration Site, Benguet is focused on translating proof of concepts into practical applications. This initiative seeks to illustrate how comprehensive health system reforms and interconnected policies can effectively establish a functional patient referral system and gatekeeping mechanisms, all supported by pooled financial arrangements.

Dr. Meliarazon Dulay, the Provincial Health Officer II, emphasized that the successful implementation of these reforms hinges on three key elements: robust data on population health needs through an integrated health information system, effective public health financial management, and a seamless patient referral system that guarantees continuity of care. These components are essential in creating a healthcare environment that is responsive to the needs of the community.

The establishment of the HCPN Demonstration Site resonates strongly with the findings of The Lancet Global Health Commission on Financing Primary Health Care (2022).¹ Both emphasize the critical importance of comprehensive health system reforms and the need for effective financing mechanisms to ensure equitable access to quality healthcare services.

The Lancet Commission highlights that primary health care (PHC) is fundamental to achieving Universal Health Care (UHC), yet many health systems, especially in low- and middle-income countries (LMICs), face challenges. These include insufficient public funding, inequitable access to services, and a reliance on out-of-pocket payments that can deter individuals from seeking necessary care. This mirrors the situation in Benguet, where the provincial health board is actively working to address these very issues through its HCPN initiative.

Integrating health information system

One of the key recommendations from The Lancet Commission is the need for robust data systems to inform health financing and service delivery decisions. In Benguet, Dr. Meliarazon Dulay stressed the importance of having good data on population health needs through an integrated health information system. This aligns with the assertion that effective financing arrangements must be underpinned by accurate data to allocate resources efficiently and equitably. The ability to collect and analyze health data allows for better identification of community needs, enabling healthcare providers to tailor services accordingly. This not only improves patient outcomes but also ensures that financial resources are directed where they are most needed, a principle strongly advocated by Dr. Dulay.

Effective Public Health Financial Management

With the devolved health functions, the HCPN demonstration initiatives are aimed at financial integration through operationalizing the Special Health Fund. Multiple funding flows, fragmented budgeting processes, and the need for decisions about the allocation of these funds between health and other sectors from municipal to provincial can be consolidated in local health funds. However, these priorities are prone to diverge between political and technical aspects, hence, key implementers like the provincial health officers, should have a strong grasp on budget formulation processes and budget execution. The former entails program budget, budget rules and allocations, and conditional grants. Whereas the latter covers policy on resource allocation formula, provider payments, contracting and monitoring, facility funding, and benefit specification.

As shared by Dr. Dulay, they are now in the process of finalizing next year’s financing health plans with the municipalities. Effective public health financial management reflects this need for sustainable funding models. By ensuring that financial resources are allocated strategically and protected as they flow through the system, Benguet aims to create a more resilient healthcare financing model that aligns with the principles outlined in the UHC law.

Seamless Patient Referral Systems

The establishment of a functional patient referral system is a crucial element emphasized in the HCPN initiative to achieve the goals of UHC. In Benguet, the objective is to create well-defined pathways for patient referrals among primary care facilities, rural health units (RHUs), Benguet General Hospital, and apex hospitals such as Baguio General Hospital and Medical Center, thereby forming a comprehensive healthcare provider network. This network may include private, public, or mixed healthcare providers and will be overseen by a managing board funded through pooled financial resources. The seamless referral process not only improves continuity of care but also helps identify methods to deliver healthcare services, goods, and interventions in a packaged manner.

The initiatives currently being implemented in Benguet demonstrate how local governments can align their healthcare reforms with a people-centered, multi-stakeholder approach. By prioritizing integrated data systems, effective financial management, streamlined referral processes, and equitable access to services, Benguet is making significant strides toward developing a more inclusive and efficient healthcare system. Achieving UHC requires not only sufficient funding but also a commitment to reforming existing systems to better serve the needs of all individuals within the community. The lessons learned from the experiences in Benguet can offer valuable insights for other provinces aiming to enhance their primary healthcare systems in line with UHC objectives.

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¹ Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., … & Wurie, H. (2022). The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Global Health, 10(5), e715-e772.

In August 2022, just over a month into his term, Mayor George Falgui first learned about the serious nutrition issues in Kiamba, Sarangani. As a first-time mayor, he did not expect the extent of the problem.

During Zuellig Family Foundation (ZFF)’s Municipal Nutrition Governance Program (MNGP) training, Dr. Arvin Alejandro, the Provincial Nutrition Action Officer, presented a health report. The report shocked Mayor Falgui—1,668 children in his town were stunted, meaning their growth was permanently affected by malnutrition. Kiamba had the third highest stunting rate in Region 12, at 22.54%.

One story that stuck with him was about a girl named ‘Shiela’. She was two and a half years old, severely underweight, and stunted. Though she received treatment for pneumonia, her family was too poor to sustain her nutrition needs. Sadly, Shiela died in 2020. “During her treatment, everything appeared to be going well for her, but then she acquired aspiration pneumonia,” Dr. Alejandro shared. Two of her nine siblings had already died from malnutrition. This hit home for Mayor Falgui—Kiamba’s health system had to do more, and fast.

The Challenge of Kiamba

Kiamba, a town of about 65,774 people, is in Sarangani, bordered by mountains and the sea. This makes accessing health services difficult. Most people depend on farming, but poverty remains high. Nearly a third of the population belongs to Indigenous groups, while the rest of the population are an intricate mix of languages and cultures. Only two out of 19 barangays are considered geographically isolated, but many areas still lack access to basic services due to the tough terrain.

In 2022, Mayor Falgui faced an uphill battle in his election. But his background in veterinary medicine and work in sales taught him the value of persistence. “I ran in the elections with no sufficient funds; my greatest capital was goodness to the people—especially the unwanted or neglected ones.”

As a mayor, he decided to open his leadership to new partnerships, especially in health and nutrition. He quickly embraced ZFF’s Nutrition Governance Program, hoping to tackle Kiamba’s malnutrition problem head-on.

A Deep Dive into the Problem

In November 2022, Mayor Falgui and his team participated in a Deep Dive activity, a guided community immersion, facilitated by ZFF. During the Deep Dive, they met ‘Nico’, an eight-month-old boy living in an isolated area. Nico weighed only 4.5 kilograms—severely underweight and stunted. His family lived on a meager income of 3,000 pesos per month, and his siblings were barely surviving.

This experience drove home the urgency of the situation for Mayor Falgui. Nutrition could not be seen as just a health issue; it was a community-wide problem that needed every sector’s involvement. The Deep Dive inspired a new push to track and support malnourished children and at-risk mothers.

Taking Action

Mayor Falgui and his team began focusing on three key areas: leadership, human resources, and financing. They strengthened collaboration between the executive and legislative branches, with the mayor appointing Dr. Antonio Yasaña, a former provincial health officer, to lead the town’s nutrition efforts.

They created a Municipal Nutrition Action Officer (MNAO) position to provide more focus on the problem. Mayor Falgui also oversaw the increase in the town’s nutrition budget from just 1 million pesos to nearly 10 million in 2023.

The mayor appointed Ronilyne Grace Moneva, a registered nurse with experience in nutrition, for the position of MNAO. Under her leadership, nutrition efforts accelerated. All barangays developed nutrition action plans, secured funding for projects, and formed Barangay Nutrition Councils.

Kiamba also held a three-day Nutrition Summit in October 2023, gathering barangay leaders and nutrition workers. The mayor laid out his vision and got barangays to develop their own nutrition plans, linking them to the municipality’s larger goals.

Interventions for Change

Kiamba’s approach became multi-sectoral. The Agriculture Office prioritized providing chickens and vegetable gardening kits to families with malnourished children, giving them access to a stable protein source. The Social Welfare Office involved families in the ‘Cash for Work’ program, helping them earn a living while contributing to public works.

In 2023, Kiamba was selected as one of 275 municipalities for the World Bank-funded Philippine Multisectoral Nutrition Project (PMNP). This brought additional resources for nutrition, including medical equipment, new staff, and more community support. During the PMNP Mayors Forum, Mayor Falgui shared, “Without ZFF, I wouldn’t have realized that my leadership is crucial in driving impact—not just in terms of numbers, but in saving every life at stake against malnutrition.”

Hope for the Future

Kiamba saw its stunting rate drop from 22.54% in 2018 to 8.34% in 2023 and 6.96% in 2024. But Mayor Falgui isn’t satisfied yet. He’s committed to bringing the number down even more. Among the ongoing initiatives is the Triple A+ Kiamba Cares project, which has been a catalyst of behavior changes in food, health, and sanitation among the Kiambahanons.

“Though we still have red flags, our goal is to minimize them as much as possible,” he said.

With continued efforts from all sectors, Kiamba is hopeful that there will be no more deaths like Shiela’s.

On September 25, 2024, Zuellig Family Foundation (ZFF) President Austere Panadero and Board of Trustees member Dr. Manuel Dayrit, and guest Dr. Jaemin Park, accompanied by Basilan Provincial Administrator Manny Muarip, Provincial Health Officer Dr. Sharifa Ann Abbas, Provincial Nutrition Action Officer Nadzwa Sabandal, and Alex Cotales of the Provincial Agriculture Office, visited the municipality of Tabuan Lasa, one of the five ZFF Municipal Nutrition Governance Program (MNGP) expansion areas in Basilan.

Tabuan Lasa, along with six other municipalities, was established in 2006 when Basilan was part of the defunct Autonomous Region in Muslim Mindanao (ARMM). Its name, Tabuan Lasa, was derived from its four major islands: Tapiantana, Bubuan, Lanawan, and Saluping. In the Tausug dialect, Tabuan Lasa means “Market of Love.” The municipality comprises 12 barangays and has a population of nearly thirty thousand, predominantly made up of ethnic groups, including Yakan, Tausug, Sama, and Badjao, with a notable mobile population.

Despite its rich cultural diversity, Tabuan Lasa faces significant challenges. It ranks first in stunting rates, is among the top five in wasting, and has some of the lowest health indicators in the province. Local leaders attribute these alarming statistics to deeply entrenched cultural beliefs and practices that affect early child care and discourage effective health-seeking behaviors within the community.

In his welcome remarks, Mayor Moner Manisan expressed his appreciation for ZFF’s visit. He shared how his involvement in MNGP has heightened his awareness of the health and nutrition challenges in his municipality. Mayor Manisan is committed to leading his MNGP team in exploring barriers to health improvement and addressing them effectively. “Ginagawa namin ang lahat, subalit kinkailangang paigtingin ang pag tutulungan.”(We are doing everything, but collaboration needs to be intensified.)

In just three months since joining MNGP, the team has set ambitious goals: enhancing the capacity of health and nutrition workers, intensifying targeted health communication campaigns to improve health-seeking behavior and promote basic health services, fostering collaboration among line agencies, and integrating nutrition programs with the Pantawid Pamilyang Pilipino Program (4Ps) and other social protection initiatives in the municipality. 

Eager to improve health services in his municipality, Mayor Manisan has recently recruited a new doctor, a Doctor to the Barrio (DTTB), whom he also designated as the Municipal Health Officer (MHO). Although a position for MHO has existed in the plantilla, there have been no takers for years. Moreover, Tabuan Lasa is well-equipped with health facilities and personnel; all barangays have health stations manned by a midwife, supported by 112 BHWs, and every barangay has at least one Barangay Nutrition Scholar (BNS). The presence of the MHO will also facilitate PhilHealth accreditation of health facilities and boost health financing and program implementation.

During the visit, members of the MNGP team and other department heads were also present, fostering a collaborative atmosphere. Cotales distributed vegetable seeds and fertilizers, which will primarily benefit families with Nutritionally at Risk (NAR) and First 1,000 Days (F1KD) populations.

Through concerted efforts and collaborative strategies, Tabuan Lasa is poised to make strides in improving health and nutrition outcomes for its constituents.

Dr. Hydee Salao’s public health career began when she was a Medical Officer at Barlig District Hospital in the Mountain Province, but it was her role as a Municipal Health Officer (MHO) at the Rural Health Unit of Barlig that truly exposed her to the harsh realities of public health.

The lack of access in Geographically Isolated and Disadvantaged Areas (GIDA), where patients often arrived late for treatment due to the long distances they had to travel, and the lack of funds to fulfill their healthcare needs was starkly evident. “Most patients would have common illnesses; however, because of the lack of funds or health facilities, when they get to the district hospital, their condition becomes worse,” Dr. Salao shares. The consumption of alcohol leading to lifestyle diseases was particularly prevalent. As one of the few doctors in the area, she had to rely on her skills and ingenuity to provide care, often facing the challenge of stabilizing patients and referring them to higher-level facilities due to limited resources.

Dr. Salao took the post of MHO briefly, where she faced the daunting task of managing the rural health unit with a meager budget of only Php 10,000. This experience underscored the need for sufficient funding and resources to deliver adequate healthcare services. She recalls, “I would often wonder how I could convince the patients and their families to bring the patient to a higher-level facility when they were limited in terms of resources. At times, I would find a way to transfer the patients.”

Lessons from Stakeholder Engagement

The transition from MHO to adjunct faculty, working alongside development partners, allowed her to gain valuable lessons in working with local chief executives on health leadership and governance. Later, her work with the regional DOH equipped her with a diverse skill set and a deep understanding of health disparities, fueling her passion for addressing them.

As an adjunct faculty member during the Municipal Leadership and Governance Program (MLGP), her experience and insights proved invaluable in her work. Focused on improving health indicators at the municipal level through engaged local stakeholders, the MLGP showcased her foresight and commitment to empowering local government units (LGUs). She spearheaded programs offering leadership development at all levels, from regional to barangay, ensuring a holistic approach that involved all stakeholders, including finance officers and local legislators.

Making a Universal Impact

With the passage of the UHC law, a comprehensive healthcare reform that provides healthcare access and inclusion in PhilHealth for all Filipinos regardless of financial capabilities, Dr. Salao was assigned as the UHC Coordinator for the Cordillera Administrative Region (CAR). Her dedication to this cause was unwavering. Her experience came into play as she took on facilitating UHC implementation in the region.

“The whole concept of UHC is the most challenging,” Dr. Salao states. “How do we convince crucial stakeholders to accept the implementation? How do we make them feel ownership in implementing the UHC? Quality health service delivery means strengthening healthcare facilities, which is crucial to bringing UHC to fruition.”

One of Dr. Salao’s notable achievements was the successful integration of UHC in CAR. Her approach involved building relationships with provincial leaders, understanding their unique leadership styles, and empowering Provincial Health Team Leaders (PHTLs) to serve as technical experts and coaches. This strategy fostered collaboration and trust, leading to a more effective implementation of UHC initiatives.

The UHC law has significantly impacted healthcare in CAR, improving access to services and reducing financial barriers. Under Dr. Salao’s guidance, the region witnessed tangible improvements in healthcare delivery. She emphasized the importance of data-driven decision-making and the need to understand the unique challenges of LGUs. This approach has led to more effective and efficient healthcare in the region.

Fundamental Lessons in Change Management

Effective change management requires being grounded. Regional leaders must listen to those on the ground to create responsive programs, ensuring co-ownership and success. This approach was evident in the Bayang Malusog Leadership Development Program (LDP) of the Zuellig Family Foundation (ZFF). This program focuses on health financing and primary care. Voluntary participation led to high engagement, addressing knowledge gaps in these areas and improving healthcare delivery in the Cordillera region.

Strengthening internal capacities by harmonizing UHC interventions and team-based provincial monitoring proved effective. Continuous learning and content mastery are crucial for providing better technical assistance. Dr. Salao and her team revisited UHC policies and other regions’ experiences to redesign their technical assistance for better responsiveness.

Through the Bayang Malusog program, regional leaders and PHTLs gained a better orientation on UHC, enabling them to understand their roles in its implementation. The program has significantly impacted healthcare in the region, improving health financing and primary care.

During the Provincial Leadership Development Program (PLDP) and technical sessions, onboarding accountants and non-health members ensured comprehensive participation and understanding. This program has been instrumental in building the capacity of local health leaders and improving healthcare delivery in the region.

Dr. Salao’s leadership is most evident in her willingness to address her team’s synergy challenges. Despite their high productivity and efficiency, trust among team members needed to be built. She saw the need for staff development and fostering a growth mindset, even though most health workers are job order employees rather than permanent hires. Dr. Salao took it upon herself to train and coach her team, encouraging division chiefs to do the same, empowering their staff by entrusting them with responsibilities.

Finding Purpose as a True UHC Champion

Dr. Hydee Salao’s contributions to healthcare in the Philippines, particularly in facilitating UHC implementation in CAR, have been transformative. Her dedication to improving health systems, innovative approach to leadership development, and ability to foster collaboration among stakeholders have made her a true champion of universal healthcare. With continued support from partners like ZFF, Dr. Salao’s vision of accessible and quality healthcare for all Filipinos is a promising reality. She continues to serve not just in her capacity as UHC Coordinator, but as an inspiration for all healthcare professionals. She says, “I realized that we have a huge responsibility to the public; we want everyone to benefit from healthcare and improve their lives. Little by little, one by one, people are being convinced to join the cause.”

Mayor Victor James “Tata” Yap, Sr. of Glan, Sarangani, calls himself a “recycled” mayor. He held the position for three terms, served as vice mayor for one, and returned to the mayor’s office in 2022.

Glan, a coastal municipality, is the top producer of copra in Region 12. It spans 533.51 square kilometers with a population of 109,547 (2020 census), making it the largest and most densely populated in Sarangani. Under Mayor Yap’s leadership, Glan has made strides in health and nutrition, keeping malnutrition rates low.

When Mayor Yap first joined the Municipal Health Leadership Governance Program (MHLGP) in 2018, his goal was to improve Glan’s health outcomes. This program, part of a partnership between the Zuellig Family Foundation and the United Nations Population Fund (UNFPA), was rolled out across Sarangani through the Department of Health.

One of his key initiatives from this journey was “Bahay ni Nanay” (Mother’s House), which provides pregnant women with food and medicine to ensure safe deliveries. “It was challenging because we are predominantly Muslim. ‘Pag buntis at manganganak na, sa Bahay tumutuloy, tapos iyong tatay ang nagluluto. Ito ang ginawa namin para ma-achieve ang zero maternal deaths.” (When the mother is pregnant and about to give birth, she stays in the Bahay, and the fathers do the cooking. This is what we did to achieve zero maternal deaths.)

Facing New Health Challenges

Re-elected in 2022, Mayor Yap faced new challenges in health and nutrition. The Municipal Nutrition Governance Program (MNGP), presented by ZFF, Sarangani’s provincial government, and the Department of Health, painted a stark picture. Glan’s health and nutrition indicators were mostly in red, reflecting poor performance in areas like leadership, human resources, and service delivery.

Mayor Yap initially thought malnutrition could be solved with feeding programs, but through MNGP, he realized the need for deeper, systemic change.

Eye-Opening Deep Dive

During the Deep Dive (guided community immersion) activity as part of the MNGP, Mayor Yap encountered a stunted child from a household that was not poor. This made him rethink his assumption that malnutrition was simply a poverty issue. The child’s mother, a solo parent, had stopped breastfeeding early and relied on the grandmother for caregiving. The mayor learned that improving nutrition goes beyond income—it requires understanding and addressing gaps in knowledge and care.

“No’ng nagsimula ako sa MLGP, sinabi kong gagawin natin ang lahat para wala nang mamatay na nanay dahil sa panganganak. Ngayon naman, bagong hamon ito sa akin, pero gagawin ko rin ang lahat para walang magiging stunted at tuluyang mamatay dahil sa malnutrisyon,” he said. (When I was starting in the MLGP program, I said I will do my best to ensure that no mother dies giving birth. This one is a new challenge for me, but I will do everything to ensure that no child becomes stunted and dies because of malnutrition).

Taking Action

Inspired to make a change, Mayor Yap created the Nutrition Officer III position to lead Glan’s nutrition efforts. He approved budgets for supplies, feeding programs, and training. Under his leadership, they launched “Munisipyo sa Barangay,” bringing health and nutrition services to remote areas, with a mobile clinic and 24/7 teleconsultation.

They also passed the FAITH (Food Always In The Home) Ordinance, promoting communal gardens in schools and barangays. Families with malnourished children received seeds, animals, and were prioritized for employment programs of the Department of Labor and Employment.

Progress and Reflections

During the Executive Session for Mayors under the MNGP, Mayor Yap proudly reported that 13 of Glan’s previously red indicators had turned green or yellow. He highlighted the establishment of a nutrition office and a position dedicated to nutrition, alongside efforts to integrate families of malnourished children into social protection programs.

“We need strong relationships between the barangay, the LGU, and all stakeholders to improve nutrition,” said the mayor. Referring to a child named Monera who died from malnourishment, he summed up the goal for the town: “Wala nang magiging Monera sa bayan ng Glan.” (No more Monera in Glan.)

Author: Dr. Catherine Chung, ZFF LHS Portfolio Director

The promise of universal health care (UHC) in the Philippines represents one of the country’s most significant reforms, aimed at ensuring that every Filipino has access to essential health services without the burden of financial hardship. A webinar, held on August 15, 2024, by the Zuellig Family Foundation’s (ZFF) Local Health System Portfolio in collaboration with the University of the Philippines College of Public Health, provided an overview of the progress made in five selected regions (CAR, Ilocos, Cagayan Valley, CALABARZON, and Eastern Visayas) under the DOH-ZFF Bayang Malusog Program.

The webinar focused on the accomplishments in primary care on the ground, which include accreditation and licensing of primary care facilities and the implementation of Konsultasyong Silt at Tama (KONSULTA), a comprehensive outpatient benefits program by PhilHealth. The discussion spotlighted progress but it also illuminated the disparities that persist between policy and practice. While most regions have achieved the target organizational level of 70% UHC maturity by the end of 2023, the webinar discussion shows that full integration is still a work in progress. Full integration of UHC is targeted to be achieved by 2029 and while the timeline is still far off, the local government units and DOH Center for Health and Development offices (DOHCHD) are working closely to achieve its targets. The availability of primary care services in the community is critical in terms of making accessible healthcare felt on the ground. 

Performance of regions in KONSULTA accreditation

For the webinar, we determined the progress of our partner regions by gathering and analyzing the available data from PhilHealth as of December 31, 2023. The partner regions have accredited approximately 622 primary care facilities (PCFs), with the majority being government-owned and only 10% being privately-owned. These are only 51% of the estimated needed PCFs by 2025 and nine of the ZFF Local Health System (LHS) areas have no private KONSULTA provider. Given this, it is important to involve the private sector to help provide necessary health services to serve the entire population. 

Notably, Region 4A (CALABARZON) boasts the highest number of accredited KONSULTA providers, while the Cordillera Administrative Region (CAR) has the least number. Of the 25 LHS provinces only nine or 36%, have successfully achieved accreditation. 

Three factors have contributed to the progress made by local government units (LGUs).

1. In some regions like CAR, harmonized accreditation and licensing processes, coupled with the collaboration between regional health authorities and PhilHealth, have streamlined compliance efforts.
2. Strong leadership from local governors, who encouraged mayors to ensure that health facilities are both licensed and accredited, plays a pivotal role.
3. The inclusion of PhilHealth in the province’s UHC Core Group further enhanced the efficiency of the accreditation process.

Despite these advancements, challenges persist. Some LGUs reported unclear communication regarding the accreditation process and requirements during the initial phase of UHC implementation. Additionally, ongoing construction of Rural Health Units (RHUs) and the lack of personnel to manage the accreditation process have hindered progress in certain areas.

Perfomance of regions in PhilHealth registration

To ensure high-quality primary care services, PhilHealth mandated the registration and assignment of beneficiaries to accredited PCFs to ensure the high quality of primary care services. When making this decision, PhilHealth accounted for both the beneficiaries’ preferences and the maximum catchment population, also known as the committed annual load (CAL). However, only 12 million people, or about 46% of the total population, have registered in the LHS areas. Region 4A, despite having the highest number of registered beneficiaries, covers only 29% of its population. Pangasinan leads with 2.5 million registered beneficiaries, followed by Laguna (1.5 million) and Leyte (1.1 million). In terms of registration rates, Mountain Province stands out with a 102% registration rate, attributed to a comprehensive barangay-level campaign and rigorous data monitoring. 

KONSULTA Implementation Data Summary

• Primary Care Provider Network (sandbox): Baguio City and Quezon exceeded PCPN targets, with 137,208 registered and 733,356 registered respectively.
• Health Care Provider Network Demo site: Only Aklan and Benguet registered more than half of their population, Laguna had the lowest with 44%.
• KONSULTA regular: Over half of remaining LHS areas registered at least half of their population, with Mountain Province having the highest rate.

In terms of facility type, the majority are registered in accredited government health facilities (96%), and about 64% are registered in RHUs since there are more accredited government health facilities than private facilities. It is also critical to note that, among the areas, Pangasinan and the three Samar provinces have a higher registration rate in hospitals than in RHUs. 

Several best practices emerged from the webinar, highlighting strategies that have aided LGUs. These include engaging non-health sectors like the Philippine National Police (PNP) and Barangay Federated Presidents (BFP) in the registration process, implementing a Center for Health Development (CHD) program requiring all employees to register and complete the First Patient Encounter (FPE), and securing strong support from provincial governments for health advocacy and outreach activities. Additionally, PhilHealth’s one-barangay-at-a-time (OBAT) approach, which was piloted in North Samar, significantly accelerated KONSULTA implementation and yielded the highest FPE capitation in the Eastern Visayas Region.

However, the journey towards providing access to primary care services thru PhilHealth’s KONSULTA is not without its obstacles. IT system issues, including frequent outages and slow operations, have impeded the encoding of registration and FPE records. Moreover, a lack of public awareness about the health services offered at PCFs, coupled with registration challenges related to PhilHealth Identification Numbers (PINs), further complicates the process. As a result, only 7% (857,789) of the 12 million registered beneficiaries across all LHS areas had undergone FPE in 2023, with Region 1 (Ilocos Region) having the highest FPE completion rate.

Policy versus Practice

Despite the commendable legislative framework that underpins UHC and other policies supporting the law, the reality on the ground reveals that many Filipinos, particularly those in underserved and rural areas, continue to struggle with access to free, quality healthcare. The webinar underscored the various challenges that hinder effective implementation of PhilHealth’s KONSULTA, which has resulted in slow integration of health services across the public and private sectors and exacerbate disparities, leaving vulnerable populations at risk. Due to ongoing delays and challenges in uploading claims, coupled with glitches in the health information system supporting primary care facilities, the presentation has yet to fully capture the true scope of the situation. Despite these setbacks, leaders remain hopeful that these claims will play a critical role in securing funding to enhance health services for vulnerable populations. Along with data from KONSULTA registration and FPE, the indicators included in the DOH-LHS Maturity Level will provide a clearer picture of the implementation of the Universal Health Care (UHC) law.

While the Philippines has made significant progress in its journey toward Universal Health Care (UHC), disparities in policy execution highlight the need for a more targeted and inclusive approach. Beyond the previously discussed aspects, the successful integration of UHC requires attention to technical, managerial, and financial challenges. Five years into the implementation of the UHC law, the country remains far from fully achieving its goal of equitable and accessible healthcare for all. Many Filipinos, our Juan and Juanas, continue to hope for healthier and better lives. Overcoming these challenges will demand strong political will, effective governance, and the active engagement of all stakeholders. Only through such collective efforts can we truly realize the vision of UHC, ensuring that no Filipino remains behind.

On September 25, 2024, Governor Gerard Espina of the Province of Biliran participated in the Executive Session for Governors under Zuellig Family Foundation (ZFF)’s Provincial Leadership Development Program (PLDP), where he shared a narrative on the multifaceted health challenges faced by his community. His story centered around a moving experience in Culaba, Biliran, where he met an underweight pregnant mother and her malnourished children, living in dire circumstances.

This  heart-wrenching reality was a stark reminder of the impact of poverty on families. “It is unfortunate that due to financial hardships,” he reflected, “this family struggles to meet their most basic needs.” The husband, a fisherman, was forced to travel by foot to reach fish farming locations, reflecting the immense sacrifices families must make just to put food on the table.

This struggle was not just about immediate hunger; poverty hindered access to nutritious food, healthcare services, and essential medications. Social determinants, such as lack of transportation, financial resources, and educational opportunities, played significant roles in worsening health disparities within the community. The Governor’s words painted a picture of the uphill battle many families faced, battling not just hunger but a cycle of poor health and limited opportunities.

Yet, amidst these challenges, his spirit shone brightly. Governor Espina’s leadership and vision for the province transformed despair into hope. Under his guidance, Biliran earned the prestigious National Walang Gutom Award, a testament to his tireless efforts to combat hunger and malnutrition.

Determined to reverse the effects of poverty on health outcomes, he introduced innovative strategies to support small farmers through a ‘garden-to-table’ initiative. This program was designed to empower every barangay by creating sustainable sources of livelihood while simultaneously addressing nutritional needs. By providing fresh produce to local karinderya or community kitchens, the initiative ensured that families not only had access to healthy meals but also secured income for local farmers.

Governor Espina’s comprehensive approach to health and nutrition exemplifies the impact that innovative leadership can have in transforming communities. By confronting the root causes of poor health and providing practical solutions, he inspires hope and resilience among the people of Biliran. “Together, we can pave the way toward a healthier and more prosperous future for all.”

Through stories like his, it becomes evident that effective leadership is not only about governance; it is also about fostering a community that thrives together, overcoming hardship through unity and determination.

Executive Session for Governor Sharee Ann Tan of Samar

During the Executive Session for Governors under the Provincial Leadership Development Program Module 3 last September 23-25, 2024, Governor Sharee Ann Tan shared how the Province of Samar is spearheading efforts to deliver equitable and effective healthcare through their accelerated implementation of the Universal Health Care (UHC) Law. At the heart of this initiative is the establishment of a Province-Wide Health System (PWHS) and a Health Care Provider Network (HCPN), designed to strengthen primary care and ensure seamless referral systems across various health facilities.

Key Strategies for Health System Strengthening

The UHC initiative in Samar adopts a two-pronged strategy—preventive and curative—focused on improving the health outcomes of its population, especially in underserved areas. This involves:

1. Strengthening Primary Health Care: Investments in Barangay Health Stations (BHS) and the augmentation of human resources in health ensure that primary care services are accessible at the community level. These efforts are bolstered by bloodletting programs and the re-engineering of personnel to address the immediate healthcare needs.
2. Upgrading Hospital Services: Samar is upgrading its healthcare infrastructure, with a focus on improving hospital facilities and services, particularly in rural areas. Through policies like the No Balance Billing (NBB), the province aims to eliminate financial barriers to healthcare. The expansion of health services includes infrastructure improvements, higher staff salaries, and enhanced benefits to attract and retain healthcare professionals.

Addressing Youth Health Challenges

One of the standout features of the UHC initiative in Samar is its focus on adolescent health. Programs like the ‘Purple Desk’ initiative provide critical mental health support to young people in schools, reaching over 18,000 adolescents. Furthermore, reproductive health services are being enhanced to address rising concerns about adolescent pregnancy, with dedicated programs aimed at improving youth awareness and access to healthcare.

Tackling Infrastructure and Access Barriers

The initiative also focuses on improving access to healthcare in geographically isolated and disadvantaged areas (GIDA). The lack of road and internet connectivity poses significant challenges in these regions, which the UHC program seeks to overcome through improved road networks, telemedicine, and satellite clinics.

Leadership and Governance in Health

The success of the UHC implementation in Samar is driven by strong leadership and governance. The initiative emphasizes unified health governance, strategic planning, and sound financial management. By opening Special Health Fund (SHF) accounts, expanding Provincial Health Board membership, and developing technical guidelines for procurement and supply chain management, Samar is laying the groundwork for a sustainable and resilient health system.

The Road Ahead

While the province has made significant strides, challenges remain in fully integrating health systems and ensuring functional health facilities in strategic areas. Continued focus on leadership development, investment in health infrastructure, and performance monitoring will be crucial in achieving the goals of UHC. Through these transformative initiatives, Samar is on its way to providing better health outcomes and a healthier future for all Samarnons.