It was in a quiet coastal municipality in Sultan Kudarat where Dr. Anna De Guzman’s passion for medicine and public health began. Her father, who was the town’s rural health physician, exposed her to the plights of their community, “Growing up with my father, I saw the lack of knowledge in handling healthcare and how some patients would need a pump boat and, sometimes, even horses and carabaos to get to where the basic health services were located.” Her father focused on the preventive and promotive side of public health, so that they would know how to manage their healthcare. This experience has inspired Dr. De Guzman to become a doctor. 

After completing her medical degree, Dr. De Guzman planned on specializing in obstetrics and gynecology. “It was influenced by my desire to educate mothers on family planning, caring for their children, and reducing the mortality associated with having multiple children.” However, her path changed when her father became a municipal health officer (MHO) in Region 12 with the Department of Health (DOH). Around the same time, the Philippines’ governance system underwent a devolution that transferred the responsibility of delivering basic health services from the national government to local government units (LGUs). “The advantage of this was that the services were truly localized because the LGU understands the health situation. But what happens if you get an LGU that does not prioritize health?”

Embracing Public Health

Filled with purpose and passion, she went back to her region. A decade may have passed since she was last in the province, but the improvements in public health were limited. Dr. De Guzman quickly realized the pressing need for public health interventions.

Dr. De Guzman also found the time to take a course at the University of the Philippines, where she learned more about community empowerment and engagement. “Through situational gap analysis, we were able to define our objectives and goals and share them with our stakeholders. This included legislative bodies, as they play a crucial role in passing policies. Next, we engaged health workers, aiming to motivate and inspire them to educate the community and prioritize better health outcomes. The focus was really preventive measures, because curative ones would be very expensive; the people in the municipality would not have the means to pay you.” Dr. De Guzman also believed in the spirit of volunteerism, knowing that the volunteers are deeply entrenched in their own communities and understand the plights of their communities personally.

Change Location, Same Passion

The decision to start a family brought Dr. De Guzman to Pangasinan, her husband’s province. Dr. Marlo De Guzman, her husband, requested her transfer to be a Medical Specialist III, assigning her to the Regional Tuberculosis Prevention and Control program. Her work in tuberculosis control marked a significant milestone, as Pangasinan witnessed a notable reduction in tuberculosis-related morbidity and mortality.

Dr. De Guzman led the planning for the Pangasinan local investment plan for health and coached Pangasinan to develop the province-wide investment plan. She realized that by transferring to Pangasinan, Dr. De Guzman was able to make an impact and contribute to achieving various health outcomes in Region 1.

Even with the change of location, Dr. De Guzman’s passion for healthcare for all remained strong. She says, “I have always been passionate about advocating for policies, interventions, and strategies, even before the Universal Health Care (UHC) Law. My background in serving Sultan Kudarat exposed me to poverty, inadequate services, limited education, and cultural disparities. I consistently strive for an improved healthcare system wherever I am assigned. I am deeply committed to my job, driven by a desire to make a meaningful difference, and I feel a moral responsibility to the community.”

Advocating for UHC

Dr. De Guzman’s advocacy for UHC was fueled by the challenges posed by the 1991 devolution. She recognized the need for an integrated health system capable of providing equitable and comprehensive health services. Republic Act No. 11223, the UHC Law, became a cornerstone of her efforts. She states, “The UHC inspires and motivates me to push further. It gives me hope because UHC is reintegrating all localities, municipalities, and cities to provide a wide-reaching health system.” This law signed in 2019, declares all Filipinos as PhilHealth members, ensuring financial protection and access to quality primary health care services. “It is also people-centered, so the healthcare services we have are currently being improved with a focus on people’s needs, not just when they are sick, but also when they are well. If they are very sick, they can be helped to be admitted to different hospitals, with financial protection through PhilHealth.”

This focus on people’s needs and the government’s response is perhaps the strength of the UHC, and Dr. De Guzman hopes it will improve the way Filipinos behavior in seeking healthcare.

Implementing UHC in Pangasinan

In 2022, under the leadership of Governor Ramon Guico III, Pangasinan officially integrated UHC into its health system. Dr. De Guzman played a pivotal role in this transformation, engaging 46 of 47 LGUs in the province. Through extensive consultations and collaborations, she secured the commitment of local chief executives, health workers, and community leaders. This led to establishing the Provincial Health Board and formulating policies and guidelines for the Special Health Fund (SHF). 

The implementation of UHC in Pangasinan has yielded remarkable outcomes. The province now boasts 46 PhilHealth-accredited health facilities, ensuring access to comprehensive primary health care with improved Health outcomes in the heath programs. The maternal mortality rate has significantly decreased and the province’s tuberculosis control program has also seen notable success, removing tuberculosis from the leading causes of morbidity and mortality in the province. Nutrition programs have led to a substantial reduction in malnutrition and stunting among children that Dr. De Guzman was recognized by the National Nutrition Council as the National Outstanding Provincial Nutrition Action Officer in 2022.

Transforming Pangasinan’s Health System with ZFF

The Zuellig Family Foundation (ZFF) has been pivotal in advancing UHC in Pangasinan, supporting Dr. De Guzman and her initiatives. An alumna of ZFF’s Provincial Leadership Governance Program in 2016, she is currently enrolled in the Bayang Malusog Provincial Leadership Development Program as a scholar of DOH Region 1. These programs are important to Dr. De Guzman, especially in her role as President of the Provincial Health Officers Association of the Philippines. Through such programs, ZFF has empowered Dr. De Guzman and her team with the skills and knowledge to navigate complex health challenges and implement effective health strategies. 

These programs have fostered a collaborative approach, bringing together local health officers, public health nurses, and community leaders to work towards common health goals. ZFF’s emphasis on ownership, co-ownership, and co-creation has helped Dr. De Guzman build a robust health system that addresses the unique needs of Pangasinan’s diverse population. The Foundation’s continuous mentorship and capacity-building efforts have enhanced the local health workforce’s technical and managerial capabilities and instilled a strong commitment and passion for achieving UHC.

Challenges and Solutions

Dr. De Guzman’s journey was challenging. The transition to UHC required overcoming political hurdles, cultural barriers, and logistical constraints. However, her strategic approach, rooted in ownership, co-ownership, and co-creation principles, facilitated effective communication and collaboration among stakeholders. The engagement of local health officers, public health nurses, and volunteers was crucial in addressing the unique health needs of diverse communities, including indigenous populations. “We are now at the end of this phase of the acceleration of UHC, and we are now empowered to push for all these strategies in Pangasinan because we have ZFF that continues to help us.”

Legacy and Inspiration

As Pangasinan continues to advance its health system, Dr. De Guzman envisions a future where the province becomes a model of health excellence in the Philippines. The focus is on sustaining and expanding the gains achieved through UHC. This includes continuous capacity building for health workers, enhancing health facilities, and ensuring the financial sustainability of health programs through the SHF. 

Dr. De Guzman’s legacy is one of dedication, passion, and resilience. She embodies the principles of compassionate leadership, emphasizing the importance of integrity, commitment, diligence with focus and a shared vision for better health outcomes. She says, “Leaders should be very passionate and dedicated if they want to effect change. They should be able to communicate their vision and their strategies. You should also be a role model, lead by example, always have integrity, and hold on to your values. I want Pangasinan to remember me as a humble and very committed, passionate leader. Leadership is not about being the best, but it’s about pushing everyone to become better.” 

The story of Dr. Anna De Guzman and the Provincial Health Office of Pangasinan is a testament to the power of visionary leadership in achieving UHC. Through relentless advocacy, strategic planning, and collaborative efforts, they have made significant strides in ensuring that quality health services are accessible to all.

• Empowering Tomorrow’s Voices: Case Study Report 2023 This report compiles 10 stories from Youth Leadership Governance Program (YLGP) sites showcasing how youth leaders in Sarangani, Sultan Kudarat, and Lanao del Sur have effectively advocated for adolescent sexual and reproductive health (ASRH)-responsive policies and programs, enhanced contraceptive utilization among adolescent parents, and facilitated the establishment of adolescent-friendly health facilities.

• Capitalizing on the role of local youth leaders in addressing adolescent pregnancies: Lessons and policy recommendations This policy recommendation paper explores the insights and experiences of local youth leaders involved in the Youth Leadership and Governance Program (YLGP) for adolescent sexual and reproductive health, proposing strategies for national and local governments to leverage their role in preventing adolescent pregnancies across communities.

• Developing Youth Leadership Capacities in Preventing Adolescent Pregnancies in the Philippines From 2019 to 2022, UNFPA Philippines and the Zuellig Family Foundation implemented the Youth Leadership and Governance Program (YLGP) across 10 municipalities in southern Philippines, enhancing youth participation in adolescent sexual and reproductive health (ASRH), improving youth leaders’ capacity in program implementation and policy advocacy, and strengthening data management for effective youth development initiatives.

• Partnerships to Scale Up Implementation of Philippine Population Development in Cities The Commission on Population Development, the Zuellig Family Foundation and The Challenge Initiative facilitated the Philippine Population Development Program by integrating family planning and adolescent health initiatives, enabling city governments to formulate comprehensive plans for population and adolescent health, establish service delivery networks, and integrate reproductive health into the Universal Health Care framework.

• Using Equity Matrix as a Tool for Increased and Targeted Financing of Services for Adolescent Sexual and Reproductive Health and Family Planning in Cities The Philippine Department of Health and the World Health Organization introduced the Urban Health Equity Assessment and Responsive Tool (Urban HEART), adapted by The Challenge Initiative to a city-level health equity matrix and implemented in 10 cities, leading to enhanced Adolescent and Youth Sexual Reproductive Health (AYSRH) and Family Planning program outcomes.

• Improved Family Planning and AYSRH Service Delivery Using the Information Service Delivery Network of Cagayan de Oro City, Philippines The study highlights the establishment and formalization of Cagayan de Oro City’s Information and Service Delivery Network (ISDN) in 2018, facilitated by The Challenge Initiative to implement high-impact interventions for Adolescent and Youth Sexual Reproductive Health (AYSRH), focusing on reducing teen pregnancies.

• Abstract: The Zuellig Family Foundation Accelerated Leadership Development Program: Advancing Universal Health Care in the Provinces The Zuellig Family Foundation’s Accelerated Leadership Development Program aims to expedite Universal Health Care (UHC) implementation in Philippine provinces by enhancing leadership and technical skills among Department of Health regional UHC core teams, critical for overcoming setbacks caused by the COVID-19 pandemic.

• Abstract: Realizing Universal Health Care in the Barangays: The Dinalupihan Case Study The study introduces the Barangay Leadership Management Program (BLMP) in Dinalupihan, Bataan, demonstrating its role in enhancing health leadership and management capacity at the barangay level to bolster primary care and integrate health services effectively.

• A Case Study on the Primary Health Care System of Balete and New Washington in Aklan In this case study, leadership plays a pivotal role in driving health systems reform in Balete and New Washington municipalities, with both mayors leveraging health leadership programs to achieve comparable health outcomes despite differing economic standings, demonstrating effective integration into the Aklan Provincial Health System and adherence to principles of Bridging Leadership essential for realizing Universal Health Care goals.

• Enhancing 1BSHB: Contributions to increased life expectancy in Bataan using a participatory barangay-based incentive approach This policy brief advocates for strengthening Bataan’s barangay-based incentive program as a strategy to mitigate the rising burden of non-communicable diseases (NCDs), emphasizing the importance of bolstering primary care to enhance early detection and treatment, thereby freeing resources for broader community development and improving the province’s Human Development Index (HDI).

• Institutionalizing Health Promotion System at the Local Level to Ensure Community Engagement Toward Achieving Health Literacy This policy paper examines gaps in the Philippines’ health system capacity to achieve universal health literacy under Universal Health Care and presents insights and recommendations for developing coherent strategies to institutionalize efficient and sustainable community-based health promotion and literacy programs at the local level.

• Integrated Provincial Health Systems Development Program (January 2019 – April 2022): End-line Study The end-line study of the Integrated Provincial Health Systems Development Program (IPHSDP) highlights its role in enhancing leadership and health system resilience, achieving significant progress in Universal Health Care implementation and COVID-19 response across participating provinces, while underscoring the need for sustained collaboration and digital infrastructure improvement for effective policy-making and continued program success.

• Leadership and Governance in Nutrition for the First 1000 Days Intervention Package in Samar, Northern Samar, and Zamboanga del Norte: Baseline Assessment of Three Philippine Provinces This baseline assessment report evaluates the existing governance measures related to the implementation of First 1000 Days services in Samar, Northern Samar, and Zamboanga del Norte, providing a detailed analysis of current nutrition and governance landscapes and offering strategic recommendations for improvement.

• A Case Study on Sarangani’s Nutrition Program Implementation This case study analyzes the factors that contributed to the improvement of Sarangani Province’s nutritional outcomes from 2018 to 2022, describing changes in nutritional outcomes, identifying effective strategies and mechanisms, and examining the influence of leadership and governance interventions as well as lessons learned in planning, implementing, and monitoring nutrition programs.

• Supporting accelerated improvements in Sarangani Province: Pivotal role of nutrition governance From 2019 to 2022, Sarangani Province made significant improvements in the nutritional status of pregnant women, infants, and children due to strong political commitment, substantial health system investments, and active convergence programs, though challenges remain in the coherence and integration of nutrition-specific and nutrition-sensitive programs, necessitating local legislation and enhanced convergence mechanisms.

• Survey on the health and nutrition service delivery and nutritional outcomes in Tacurong City, Tagum City, and Puerto Princesa City Recognizing the critical importance of nutrition during the First 1000 Days of life for a child’s health and development, the Zuellig Family Foundation and Nutritional International commissioned a survey to assess health and nutrition service delivery and outcomes in Puerto Princesa City, Tacurong City, and Tagum City to support their project on developing urban nutrition systems in the Philippines.

Malapatan, named from the Blaan words malah and fatan meaning “place where pepper is abundant”, has roots as a pepper trading settlement in the pre-Spanish era. It is home to the Blaan Lumad tribe, governed by Fulong wisemen, and includes Blaan indigenous peoples, Moro groups, and Luzon and Visayan settlers. The Sarangani town spans 609 square kilometers, with five of twelve barangays classified as Geographically Isolated and Disadvantaged Areas (GIDAs).

Mayor Salway Sumbo, Jr., a full-blooded Blaan, is in his second term as Malapatan’s mayor, having previously served as Barangay Captain of Kinam from 2013 to 2018.

During his term as Barangay Captain, he joined the program on Indigenous People Bridging Leadership and Governance Program (IPBLGP), which was a continuation of the Province of Sarangani’s partnership “Strengthening Provincial and Municipal Champions for Health” with the Zuellig Family Foundation (ZFF) and the United Nations Population Fund (UNFPA).

The provincial government recognized the importance of leadership at the barangay level for developing equitable, context-based strategies. Through the IPBLGP, barangays created IP-sensitive technical roadmaps for inclusion in municipal and provincial plans.

As Barangay Captain, Mayor Sumbo achieved significant health milestones, reducing stunting rates in Kinam from 18.72% to 6.32% in one year and decreasing elementary and daycare dropout rates. He promoted tribe sensitivity, encouraging births in accredited birthing homes.

As Mayor, Sumbo prioritized GIDA and IP community concerns, focusing on opening access roads to improve economic and educational opportunities. During his first term, Malapatan achieved 40% progress in constructing new roads, enhancing access to education, health, and nutrition services.

Introduction to ZFF’s Municipal Nutrition Governance Program

In 2019, Malapatan successfully piloted an upland rice production program, boosting community income and enabling families to afford education. However, nutrition was not a priority for Mayor Sumbo at the time.

In June 2022, Mayor Sumbo participated in ZFF’s Municipal Nutrition Governance Program (MNGP), realizing the importance of addressing malnutrition, which, despite being low at 3%, still affected 400 children. The MNGP emphasized leadership in tackling malnutrition, especially during the critical First 1,000 days of life (F1KD). 

Mayor Sumbo acknowledged his administration’s role in nutrition and took full ownership of the problem. He quipped, “There’s guilt because there’s an earlier perception that our institution has no role in nutrition, but now I realized that we have a critical role.”

During the MNGP workshop, Mayor Sumbo’s team identified food insecurity as a major issue, particularly in GIDA communities. They created a vision: “Masaganang pamayanan tungo sa malusog na mamamayan ng Malapatan tungo sa 2025, arangkada Malapatan,” focusing on inclusive development through improved access roads and support for all community groups.

In August 2022, they formulated a comprehensive Nutrition Action Plan for 2023-2025 with ZFF and National Nutrition Council Region XII. This plan included interventions like micronutrient supplementation, deworming, infant and young child feeding promotion, lactation management, maternal health programs, supplementary feeding, and treatment facilities for severe malnutrition.

Other identified issues were food inaccessibility, low family income, and lack of community motivation and awareness. More than half the population (56.58%) lived below the poverty threshold, with decreasing fish catches affecting income. A family of five with farming as the main livelihood had an annual income of roughly Php 20,000.00, translating to Php 11.00 per meal per person per day.

Gulayan sa Malapatan: Addressing Food Insecurity

Mayor Sumbo launched the “Gulayan sa Malapatan” program to address food insecurity and malnutrition by incorporating it into his Executive Legislative Agenda. The initiative started with government employees planting various vegetables on a one-hectare land in Barangay Poblacion, aiming to inspire the community to follow suit. “If the people see that we’re doing these efforts, they will follow,” he said.

Vegetables planted included radish, cucumber, eggplant, pechay, string beans, upland kangkong, okra, green chili, bitter melon, bottle gourd, and spring onions, all rich in nutrients to combat deficiencies.

The program integrated with the Department of Social Welfare and Development’s “Cash for Work” program, engaging parents of malnourished children who planted vegetables in exchange for a Php 3,000.00 grant. Harvests supported local police and jail feeding programs, and produce was sold in markets. A weekly farmers’ market was also established.

The program reduced stunting and wasting rates in Malapatan, from 3.53% to 2.10% and from 0.54% to 0.43%, respectively, in one year. In March 2023, the local government unit passed an ordinance promoting communal vegetable gardens in schools, barangays, and households.

Mayor Sumbo also completed 95% of farm-to-market road constructions and is planning a local college to address long-term food insecurity and high teenage pregnancy rates (21% in 2022). He believes education will keep youths engaged and reduce early pregnancies.

Indeed, the MNGP helped Mayor Sumbo and his team identify health and nutrition problems in Malapatan and develop effective intervention programs. It emphasized the importance of monitoring children’s nutrition, shifting the responsibility from just the Municipal Nutrition Action Officer to all stakeholders.

Thanks to these realizations, the mayor and his team committed to improving the nutrition situation collaboratively. Malapatan is now in a better place. There are still a lot of problems to be solved, but they are working hard on getting there.

We came together for Zuellig Family Foundation (ZFF)’s Bayang Malusog Community of Practice, uniting nine areas: Aklan, Apayao, Baguio City, Benguet, Biliran, La Union, Laguna, Northern Samar, and Quezon. Fostering collective learning to drive forward Universal Health Care (UHC) and a healthier future for all Filipinos, let us look into the story of Bauang, La Union.

A well-established integrated health information system (iHIS) is a vital factor to effective healthcare delivery as it provides accurate, comprehensive, and timely health information that are essential for assessing community needs, planning interventions, and evaluating programs.

In 2022, the municipality of Bauang, La Union underwent a comprehensive digitalization which revolutionized its healthcare delivery system. Spearheaded by dedicated professionals, Bauang has fundamentally reshaped the way patients receive care in the municipality. By 2023, the entire system had gone fully digital, marking a significant milestone in the healthcare system of Bauang.

Digital Transformation of Bauang’s Healthcare System

Trained by the Development Bank of the Philippines-Data Center Inc. (DBP-DCI) in July 2022, the team revamped its healthcare system, transitioning to a Windows-based platform and achieving full digitization. By scaling up digitization efforts and improving the capabilities of primary care providers, Bauang has harnessed available electronic medical record (EMR) technology to revolutionize healthcare delivery. Collaborating closely with EMR developers, the platform has been continuously improved to address the specific needs of Bauang. The technical improvements, such as the queue tab, were coupled with process improvements like utilizing routing slips for consultations, which enabled the RHU to categorize patients based on priority – whether they are elders or in need of immediate treatment. The platform co-created with the Bauang LGU also helped establish the province’s referral system, where patients from RHUs needing higher level medical care were endorsed to referral facilities or apex facilities using the platform, ensuring continuity of care and efficient management of patient records.

Similarly, other advanced features were developed: access to laboratory and radiology instructions and results, which helps healthcare providers access crucial diagnostic information in real-time; a medication tab, where prescriptions are inputted and helped streamline the prescription process and  ensured easy access to details and instructions for better medication management. This was further complemented by acquiring digital diagnosis equipment, such as the portable ultrasound scans that improved the accuracy and speed of diagnosis. 

The EMR platform also helped facilitate the transmission of patient information for processing Konsulta payments, benefiting eligible patients and simplifying administrative processes. Financial transactions within the healthcare system have also been streamlined since the EMR system also provides for a comprehensive platform that integrates PhilHealth Electronic Konsulta Availment Slip (eKAS) and Electronic Prescription Slip (ePresS) functionalities.

Community Health Initiatives and Workforce Training

Beyond individual patient care, Bauang is also committed to community health initiatives. Quarterly assessments of non-communicable diseases (NCDs) were conducted and services to barangays without internet access through the GABAY program were extended. Barangay Health Workers (BHWs) were also trained to use EMR for Konsulta and referral purposes, which further strengthens local health infrastructure, capabilities, and capacities of its health workforce. 

This resulted in significant improvements in patient care by streamlining consultations, enhancing diagnostic accuracy, and optimizing medication management. In 2023 alone, Bauang provided consultations to an impressive 24,233 patients, highlighting the impact of its innovative healthcare approach. 

Furthermore, the integration of the EMR system enables timely decision-making through comprehensive Field Health Services Information System (FHSIS) reports, while interoperability with eKonsulta and referral systems ensures accurate reporting to PhilHealth and seamless transitions between healthcare facilities. Through the generation of FHSIS reports, Bauang continuously evaluates and improves its healthcare delivery, ensuring programs remain responsive to the needs of its community.

To address internet connectivity issues, Bauang utilized paper-based intake of patients, prioritizing service delivery over implementation convenience. 

Bauang’s full digitization of healthcare processes is a testament to its leaders’ commitment in overcoming technological, funding, and capacity challenges to provide the best possible health services and programs to their constituents.

We came together for Zuellig Family Foundation (ZFF)’s Bayang Malusog Community of Practice, uniting nine areas: Aklan, Apayao, Baguio City, Benguet, Biliran, La Union, Laguna, Northern Samar, and Quezon. Fostering collective learning to drive forward Universal Health Care (UHC) and a healthier future for all Filipinos, let us look into the story of La Union.

The province of La Union is actively seeking to accomplish a visionary framework- one that envisions not just a healthy La Union, but a happy one too. The province’s transformative health framework focuses on the improvement of integrated health service delivery, aligned with the principles of Universal Health Care (UHC).

Building a Resilient Health Care Provider Network 

Lessons from the pandemic became the catalyst for innovation in La Union. A step-down care process was implemented, relieving pressure on overwhelmed facilities and ensuring that resources were allocated efficiently. This preparatory phase set the stage for La Union’s designation as a UHC implementation site, marking a significant milestone in the healthcare journey of the province. This led to the formation of the current Health Care Provider Network (HCPN), allowing for a more resilient and interconnected healthcare system. Formalized agreements with healthcare facilities have been established to facilitate step-down care and complementation of health services.

Digital Transformation in Health Services

The province has leveraged lessons learned from the pandemic to enhance patient monitoring and health service delivery. This has driven the adoption of digital technologies across health facilities, enabling paperless consultations and improving the accuracy of patient data. Additionally, advancements in monitoring and data collection tools have been implemented. Notable examples include the two-way health referral forms, which track both incoming and outgoing referrals, and the patient satisfaction form, designed to refine healthcare delivery within the province.

Strengthening Collaboration and Stakeholder Engagement

Collaboration also emerged as an important factor, with various stakeholders across the healthcare system coming together. Leveraging relationships with the private sector is instrumental in enhancing the referral and Electronic Medical Record (EMR) systems, as well as improving Maternal, Neonatal, Child Health and Nutrition (MNCHN) services and adolescent health services in the province.

Municipal-Level Innovations: The Case of Bauang

These province-wide health system improvements were mirrored in the municipalities, such as in Bauang municipality where healthcare professionals now use a Windows-based platform. Patients also now use routing slips for diagnostic services, while prescription processes and access to laboratory test results are now fully digital. To support these efforts, Bauang trained its Barangay Health Workers (BHWs) to improve health workforce capacities that can provide basic patient profiling and health service to patients. 

Although challenges persist, La Union leaders are actively working to address them, leveraging partnerships and exploring innovative solutions to ensure everyone has access to healthcare services. Looking ahead, La Union is committed to further strengthen its healthcare infrastructure and enhance the capacity of its workforce. 

As La Union continues its journey towards a healthier future, its story serves as inspiration for communities far and wide, demonstrating that even in the face of adversity, progress is possible. Through ongoing collaboration and a steadfast commitment to innovation, La Union is steadily going towards a healthier, happier future for all its residents.

In a community vastly populated by Indigenous Peoples (IP), it pays to have one of the IP’s own as local chief executive. An IP’s heart will, without a doubt, always beat for their people. The municipality of Malungon in the province of Sarangani stands testament to this truth, reaping the benefits of Mayor Maria Theresa “Tessa” Constantino’s leadership, hailing from the Blaan ethnolinguistic group.

Mayor Constantino intimately understands the challenges faced by IPs, their struggles, and needs. Leveraging this firsthand knowledge, she spearheaded an IP-centered and inclusive government in Malungon, where nearly half of the population belongs to various minority ethnolinguistic groups — Blaan, Tagakaolo, Mandaya, Subanon, Bagobo, and Kalagan.

Malungon, a first-class municipality in Sarangani province, home to 105,465 residents with a poverty rate of 40.2%, faces unique challenges, notably in Geographically Isolated and Disadvantaged Areas (GIDAs), where 19 of the 31 barangays are located, hindering access to social services.

Since assuming office in 2016, Mayor Constantino has led Malungon to significant improvements, particularly in Maternal, Neonatal, Child Health, and Nutrition (MNCHN). Despite the disruptions caused by the COVID-19 pandemic, her focused interventions yielded commendable results, surpassing national benchmarks.

Initiating the Journey: Municipal Leadership and Governance Program

Mayor Constantino’s tenure commenced with critical health indicators in the red, highlighting deficiencies in maternal and infant care. Her participation in Zuellig Family Foundation (ZFF)’s Municipal Leadership and Governance Program (MLGP) strengthened her understanding of leadership and governance. This journey aimed to reduce maternal mortality and enhance healthcare delivery, engaging local executives, health officials, and technical staff.

As part of MLGP, Mayor Constantino enacted the “Maternal Neonatal Health and Nutrition Ordinance”, prioritizing maternal and neonatal care. She empowered IP women as barangay health workers (BHWs), established dialogues with tribal leaders, and adopted the Sarangani Indigenous Peoples Comprehensive Welfare and Development Code. Notably, she also tackled early child marriages prevalent among IPs.

Mayor Constantino’s proactive measures led to a substantial increase in pregnant women accessing healthcare, from 60% at the start of her term to 90% by 2018. Her efforts were lauded nationally, earning her the National Nutrition Council’s Nutrition Honor Award in 2018.

Continuing the ZFF Journey: Municipal Nutrition Governance Program 

Mayor Constantino led Malungon to embark on the Municipal Nutrition Governance Program (MNGP), emphasizing the critical First 1,000 Days (F1KD) of infants. Recognizing the multifaceted nature of malnutrition, she increased the nutrition budget, fostered collaborations with the private sector, and engaged communities through behavior-centered interventions. “In the fight against malnutrition, one must put his money where one’s mouth is. There is no shortcut,” she said. In 2022, Mayor Constantino increased the budget for nutrition programs to Php 105 million from Php 95 million in 2021.

Fully aware of the importance of involving the barangay captains in co-owning the problem on nutrition, Mayor Constantino also signed an ordinance that prohibits the termination of barangay workers due to political affiliations. This retention policy enabled the barangays to sustain capacities, which was crucial as barangay health workers are the frontliners of health and nutrition services. Mayor Constantino explained, “Nutrition governance is beyond politics; we should continue empowering BNS staff because they are the ones on the ground. How we prioritize our BNS is how we prioritize our Nutrition Programs.”

A Deeper Commitment

Despite achievements, Mayor Constantino remains vigilant, acknowledging persistent challenges. As part of the MNGP, Mayor Constantino and the Malungon Nutrition Core Team did their Deep Dive, a guided community immersion, in Datal Batung, a far-flung barangay that had a high incidence of adolescent pregnancy. 

The team met a stunted young mother whose young children were diagnosed with Moderately Acute Malnutrition (MAM). The mother, who became pregnant at 16, had never received government assistance despite working hard for a monthly income of around Php 3,000. Taking immediate action, Mayor Constantino provided financial assistance, enrolled the mother in an Alternative Learning System (ALS), and ensured a constant supply of food and milk for the children. This experience gave attention to the persistent intergenerational cycle of malnutrition and poverty, prompting the Mayor to advocate for more aggressive education campaigns to increase awareness and access to municipal services.

Looking Ahead

Reflecting on her MNGP journey, Mayor Constantino expressed sadness that there are still malnutrition cases in the municipality. “We thought that there would be no malnutrition cases in our locality, yet here we are, dissecting another facet of the issue,” she said.

Malungon is eyeing additional partners such as Mahintana Foundation, Inc. and Dole Philippines, Inc. in establishing their Nutri-Bakery to complement their established nutrition and health service delivery with a social enterprise that will heavily promote good nutrition and healthy local produce in the circulation for children and mothers in Malungon.

Looking back at the inception of the MNGP, Mayor Constantino understands that there is still a lot to improve on in her municipality, but she is ready to take on the challenge.

“Political will is critical in the context of indigenous peoples. I am thankful to ZFF for always challenging us and our systems to become better. I am always grateful that I have a good working relationship with my team. I want to serve with a happy heart, but I cannot do this without love. Love is the solid foundation, the encompassing drive of my leadership journey,” she said.

We came together for Zuellig Family Foundation (ZFF)’s Bayang Malusog Community of Practice, uniting nine areas: Aklan, Apayao, Baguio City, Benguet, Biliran, La Union, Laguna, Northern Samar, and Quezon. Fostering collective learning to drive forward Universal Health Care (UHC) and a healthier future for all Filipinos, let us look into the story of Catarman, Northern Samar.

Introducing a new health program into a province is a challenging feat. Communities may not be welcoming of new initiatives due to past disappointments. Ms. Joanna Manalili, Head of  PhilHealth Local Health Insurance Office in Catarman, expressed the difficulties in reintroducing the Konsultasyong Sulit at Tama (KonSulTa) program to the locality, especially when previous programs had yet to prove their worth. Understanding the community’s concerns early on, Ms. Manalili made a concerted effort to engage with residents and understand their needs. Through these dialogues, key challenges were uncovered.

One-Barangay-at-a-Time Approach

When the KonSulTa program was first introduced, Rural Health Units (RHU), and even mayors, were initially resistant. “May utang pa nga kayo sa amin eh. Pinalitan niyo lang pangalan niyan,” some exclaimed, reflecting their skepticism. The resistance from the RHUs was so intense that the office devised different strategies, one of which was the one-barangay-at-a-time (OBAT) approach. Launched in January 2023 with Catarman, Samar as the pilot, the OBAT initiative aimed to intensify the program’s implementation and develop a successful model. According to Ms. Manalili, the goal was to demonstrate that “kaya ng PhilHealth, kaya ng RHU kahit marami silang ginagawa” (PhilHealth and the RHU can handle it despite their many responsibilities).

As an RHU with multiple Geographically Isolated and Disadvantaged Areas (GIDA) barangays, most patients prefer going to barangay health stations instead of traveling to the RHU. To ensure basic health services are delivered, RHU doctors, nurses and midwives conduct regular barangay visits. Barangay Health Workers and Barangay Nutrition Scholars were trained to conduct patient profiling and get vital signs of clients. RHU nurses and midwives were also trained on Integrated Management of Childhood Illness (IMCI) and the Philippine Package of Essential Non-Communicable (PhilPEN) Disease Interventions. Each barangay was equipped with materials needed for patient monitoring, and laboratory follow-ups were scheduled on patients’ birth months for easier tracking.

Leadership and Governance: The Pillars of Success

Since the launch of the initiative, Catarman has continued to excel in improving each health system building block. Dr. Blessie Norona, Medical Officer V of RHU-Catarman and President of the Association of Municipal Health Officers of the Philippines (AMHOP) Northern Samar Chapter, shared Catarman’s experience and the reasons behind its success.

Catarman’s success is exemplified in the leadership and governance of its health system. Despite not having an extensive background in health, Mayor Francisco Aurelio Rosales III supported the innovations. Together with the Local Health Board (LHB), Mayor Rosales recognized the significance of the KonSulTa program in improving their health system, as PhilHealth reimbursements comprise the majority of the funding for their health and nutrition activities. From having only P73,000 in KonSulTa benefit payments for the RHU in 2021 and 2022, the Catarman RHU received P9.4 million as the first capitation for first patient encounters in 2023. Since the OBAT initiative, Catarman received the highest FPE paid to a single local government unit in Region VIII.

What is most promising about the RHU is its well-planned allocation for the expected capitation. “Kahit ‘di pa nare-receive (capitation from PhilHealth), may plano na ‘yan kung saan mapupunta,” Dr. Blessie emphasized.

With its proven success, Catarman has positioned itself as a model RHU for the KonSulTa program. While there is still much work to be done, investing in its people and having steadfast leadership and dedication towards improving health services will continue to make Catarman a model of a people-centered health system.