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.

Last May 2, 2024, health leaders in Quezon Province visited the Rural Health Unit (RHU) of Pagbilao, deep diving into their health services specifically in providing its constituents financial protection towards the full realization of Universal Health Care (UHC) in the province. As part of the Quezon Provincial Health Office (PHO)’s practicum for Bayang Malusog Provincial Leadership and Development Program of the Zuellig Family Foundation, the Quezon PHO and Pagbilao Municipal Health Office, as well as representatives from the Department of Health (DOH) and PhilHealth Regional Office IV-A gathered to learn and share insights, successes, and challenges.

The activity commenced with an overview of RHU-Pagbilao’s services, followed by interviews with health personnel and patients. These interactions provided valuable on-ground insights into the e-Konsulta Program and the overall implementation of the UHC Program.

Health personnel emphasized the importance of streamlining the e-Konsulta process, highlighting the need for efficient computer systems and reliable internet connectivity. Despite these challenges, their dedication was evident in the high registration numbers, which have yet to be fully reflected in PhilHealth’s system due to technical and manpower limitations.

PhilHealth IV-A Regional Vice President Dr. Danilo Reynes advocated for improved infrastructure and personnel support, calling for stronger partnerships with local health insurance companies to effectively navigate technical challenges.

Dr. Kristin Villaseñor, Provincial Health Officer II of Quezon Province reaffirmed the UHC vision of providing accessible health services to all Filipinos with minimal financial burden. She stressed the urgency of increasing registration numbers and enhancing facility capacities to meet ambitious targets. This, she noted, could be achieved through constant collaboration with stakeholders, such as DOH and PhilHealth.

However, significant challenges remain. Many residents are unaware of the free services available, prompting calls for intensified information dissemination efforts. Engaging Barangay Health Workers (BHWs) in grassroots campaigns emerged as a promising strategy to boost registration rates.

Pagbilao Mayor Angelica Tatlonghari, who is also a nurse, prioritizes health and pledged ongoing support for procurement and process refinement, emphasizing the elimination of service delivery bottlenecks. Collaboration with community leaders and mobilization efforts were deemed essential to maximize the Program’s reach.

Dr. Juvy Purino, Provincial Health Team Leader of Quezon Provincial DOH Office  highlighted the critical need for manpower augmentation and increased health literacy. Addressing challenges in pharmacy and dispensing, along with encoding deficiencies, were identified as immediate priorities. She said, “Ang goal natin sa implementation ng UHC ay walang maiiwan, lalong-lalo na sa mga nakakaranas ng kahirapan. Hindi katanggap-tanggap na marinig na hindi sila makakita ng doktor at makabili ng gamot dahil wala silang pera.”

The meeting concluded with a strong commitment from all stakeholders to overcome obstacles and advance the UHC agenda. Multi-sectoral collaboration was identified as the backbone for realizing the Program’s transformative potential, ensuring a healthier, more inclusive future for all.

Gathering health teams from different parts of the country, the Zuellig Family Foundation (ZFF) hosted “Championing Health Together”, the launching Bayang Malusog Community of Practice (CoP) last April 12, 2024. Shared during the event is one victory in pushing for Universal Health Care (UHC): the province of Aklan’s Governance Model for Special Health Fund (SHF).

Innovative District Health Systems

Dr. Leo B. Ismael of the Provincial Health Office (PHO) in Aklan, presented the province’s accomplishments. He highlighted the innovation of Aklan to institutionalize District Health Systems (DHS). With DHS, the government aims to have an effective health care delivery and health system management in Aklan. Additionally, they hope to streamline healthcare delivery by improving patient access through efficient navigation and referral systems through the DHS.

The DHS are managed by the District Health Board (DHB), assisted by the Technical Management Committee (TMC),  which helps enhance the integration of municipalities to DHS. In his testimony, Dr. Ismael shared that he personally facilitated all the DHB meetings and elections for each DHS. Through the meetings, they were able to discuss the challenges being faced by each municipality and their plans as the DHB. 

A challenge mentioned was the creation of guidelines on patient navigation and referral systems. To counter these challenges, the DHB planned to finalize the DHS ordinance, agreement on provincial and municipal sharing, and hiring of additional accountants and managers.

SHF Funding and Distribution

Budgetary appropriations from Aklan’s provincial government and its constituent LGUs are required to be contributed to the SHF in order to fund health-related projects, initiatives, and activities. Initially met with reluctance from some local chief executives regarding percent contribution, the PHO assured them that they will not be at a disadvantage. “If you give your share [to the SHF], the province will also give its share, which is greater than your share, so hindi kayo lugi,” Dr. Ismael said in his discussion. 

A resolution on the distribution of the funds for SHF is set to be issued. The mechanism, sum, or percentages will be considered for the distribution to the respective health districts. The signing of the  agreement will also be held for the 1% sharing of the Provincial Development Fund and 1% Municipal Development Fund.

One key to the success of the program is the support shown by Aklan Governor Jose Enrique Miraflores in accelerating health initiatives.  According to Dr. Ismael, this was vital in materializing the shared vision of an excellent and responsive healthcare system powered by UHC through #OneAklan. He also expressed gratitude for the recent Municipal Leadership and Development Program Module 2 training of ZFF, which aided in initial planning. Majority of MHOs and mayors were present and expressed support for the initiative during this activity.

As mentioned by Dr. Manuel Dayrit, ZFF Trustee and former Secretary of the Department of Health, and one of the invited reactors: “Change is happening before our very eyes; the presentations are a glimpse of the future.” Through the narratives told  during the program, one could see how the steps taken towards the betterment of the implementation of UHC in the country can serve as a reminder that the goal of equitable and quality healthcare for the Filipinos is within our reach. With proper mechanisms and support from the people and the government, we will be able to achieve better health outcomes. The future of UHC is bright and through collective leadership and learning, we can forge healthier and better communities for the Filipinos. 

“I aspire to be remembered as a leader who genuinely cared about the well-being of every member of our community. This is not just a position for me; it is my heartfelt passion to create a positive impact in your lives.”

At 24, Arcam Istarul became Mayor of Tipo-Tipo, inheriting a legacy of public service from his father and accomplished siblings. His father, Ingatun “Tong” Istarul, was a respected three-term mayor, while his siblings held prominent positions in the community. Despite being the fourth of nine siblings and facing societal expectations, Arcam embraced his role, starting as a youth council member and eventually becoming the youngest municipal councilor. He took on the mayoral seat at 24, defying norms and leveraging his family’s achievements to lead Tipo-Tipo to new heights, particularly in nutrition initiatives.

Tipo-Tipo, a third-class municipality in Basilan, has a population of 25,531 as of 2020. Historically plagued by conflict, Mayor Tong during his last term, played a pivotal role in supporting Governor Jim Hataman-Salliman’ peace efforts to counter violent extremism, paving the way for progress in the municipality.

Long-time relationship with ZFF

The Zuellig Family Foundation (ZFF) initially partnered with Tipo-Tipo in late 2014 through the Health Leaders for the Poor-Municipal Leadership and Governance Program (HLP-MLGP). Mayor Tong Istarul spearheaded initiatives such as obtaining PhilHealth accreditation for the Rural Health Unit, establishing a 24/7 Birthing Facility, recruiting more Barangay Health Workers (BHWs), providing additional benefits for BHWs, and enhancing the functionality of the Local Health Board. These efforts led to significant improvements in health indicators, particularly in Facility-Based Delivery (FBD) rates, which rose from 0% in 2014 to 21% by 2016.

Mayor Arcam, the second local chief executive (LCE) engaged by ZFF-KGJF (Kristian Gerhard Jebsen Foundation), joined the Partnership for Nutrition Governance Program (PNGP) after expressing his commitment to participate. The program, which aimed to strengthen nutrition governance, launched the Municipal Nutrition Governance Program (MNGP) approximately one year later. In January 2022, Tipo-Tipo, along with Maluso, Sumisip, Isabela City and Lamitan City, joined Batch 1 of the MNGP.

Nutrition situation before the MNGP

Dr. Nurkhan Istarul, the Municipal Health Officer (MHO) of Tipo-Tipo and brother of Mayor Arcam, was among the first group of trainees in the Philippine Integrated Management of Acute Malnutrition (PIMAM) program in the now defunct Autonomous Region in Muslim Mindanao (ARMM). Attended medical school to serve his community, Dr. Nurkhan remains the MHO of Tipo-Tipo despite several job offers, including a post at the Ministry of Health-Bangsamoro ARMM. During Mayor Tong’s term, only two municipalities in Basilan have a doctor; one of these is Dr. Nurkhan.

His exposure to the nutrition situation in Tipo-Tipo, particularly rehabilitating a Severely Acute Malnourished (SAM) child, ignited his determination to enhance nutrition efforts. Although nutrition work was established, it primarily focused on service delivery, neglecting crucial building blocks.

In 2021, the stunting prevalence in Tipo-Tipo was at 32.1%. When it comes to healthcare accessibility, all key indicators remain low due to the geographical makeup of the municipality. The diverse ethnic population, presence of geographically isolated and disadvantaged areas (GIDA) barangays, sporadic armed encounters, and the proximity of large barangays to Lamitan City, where residents often prefer to access health services, contribute to the limited coverage. The complex nature of the problem of malnutrition, coupled with limited resources, means that finding a solution is not straightforward.

Deepening understanding of nutrition gaps through the MNGP

The MNGP aims to empower the Municipal Nutrition Committee (MNC) to tackle malnutrition effectively through comprehensive service delivery. Mayor Arcam identified key gaps contributing to high stunting prevalence, including unemployment, limited access to family planning, poor health-seeking behavior, and inadequate financial support. These issues are influenced by factors like early marriages, misconceptions about stunting, fragmented programs, and security concerns. Mayor Arcam advocates for a multi-sectoral approach to address these challenges.

Drawing on his accounting background (as a BS Accountancy graduate from Western Mindanao State University), Mayor Arcam envisions improved fiscal management, sustainable food supply, and enhanced quality of life for Tipo-tipo. He aims to achieve these goals by focusing on fiscal management for health and nutrition, access to basic services, and food security. Priority actions include activating the MNC, issuing relevant policies, formulating a comprehensive action plan, hiring additional nutrition-focused staff, targeting poverty reduction, engaging barangays, and masterlisting vulnerable populations. These actions aim to strengthen nutrition governance, enhance service delivery, and uplift the community’s well-being, particularly for vulnerable groups.

Leadership acts in a snapshot

Mayor Arcam spearheaded the expansion of the MNC in Tipo-Tipo, benefiting from strong legislative support due to his father’s role as vice mayor. Regular MNC meetings lead to the issuance of supportive policies, including the groundbreaking Municipal Ordinance No. 23-04, s. 2023, which serves as a model for addressing malnutrition in Basilan.

Recognizing the importance of nutrition, the Sanggunian significantly increased the nutrition budget from Php 1 million in 2022 to Php 10 million in 2023. This reflects their commitment to effective programs and interventions.

In August 2022, the expanded MNC core team formulated a three-year Comprehensive Nutrition Action Plan (CNAP), making Tipo-tipo the first LGU with an approved Local Nutrition Action Plan (LNAP). This achievement underscores Mayor Arcam’s dedication and strategic planning.

Under Mayor Arcam’s leadership, Barangay Nutrition Committees (BNCs) were organized in a significant number of barangays by the end of 2022, promoting community involvement and ownership of nutrition programs. The BNCs collaborate with the core team to address issues like teenage pregnancies, enhancing community support for comprehensive nutrition initiatives.

Deep Dive

Mayor Arcam’s understanding of nutrition issues, influenced by his brother’s expertise and his own experiences, was deepened through a firsthand Deep Dive experience in December 2022. Originally planned for remote areas, security concerns redirected the Deep Dive to Barangay Tipo-tipo Proper, uncovering the additional challenge of teenage pregnancies.

In this barangay, Mayor Arcam encountered a young couple struggling with multiple births and severe malnutrition, residing in challenging family circumstances. This encounter underscored the harsh realities faced by vulnerable constituents.

This experience prompted Mayor Arcam to reevaluate nutrition strategies, leading to the revitalization of the Sanyang Collaborative Action for Mobilization (CAM) initiative. Combining experiential insights with data analysis, Mayor Arcam refined Sanyang CAM to address specific community needs effectively.

Notably, there was a considerable reduction in stunting prevalence, from 28.18% in 2022 to 19.45% in 2023. Wasting prevalence decreased from 4.82% to 2.20% during the same period. These achievements highlight the effectiveness of the implemented strategies and the dedication of Mayor Arcam and his team in addressing the nutritional challenges faced by the municipality of Tipo-tipo.

Mayor Alexander Bryan Reganit, Jr., son of former Mayor Reganit, Sr. of Maitum, Sarangani, did not imagine a life of public service. Growing up, he lived life for himself, with no purpose and direction. 

He once wrote about himself: “[My father] made me enter a convent school so I can get an education, but I went to Notre Dame. I got kicked out of school. I took up Civil Engineering but I did not finish it. I finished something else: my marriage. I was embarrassed to face my father, so I left home. I handled jobs during that time, like being a taxi driver. In between, I became a driver for Uber/Grab.”

In his narrative, the younger Reganit shared that shortly after his marriage ended, he went back home to Maitum with his son. It was then that his relationship with his father saw a dramatic turn for the better, especially when he landed a job under the administration of President Arroyo. Sadly, in 2008, the older Reganit died, devastating the family. 

“I thought we could never recover; I had no intention of entering politics,” Mayor Reganit, Jr. wrote.

In April of 2009, he met Senator Manny Pacquiao who convinced him to help the sports legend run for a seat in congress. Senator Pacquiao offered him a good salary, which allowed him to pay for his siblings’ education. 

In 2019, the younger Reganit did what a decade ago was unthinkable. He ran for mayor in his town of Maitum—and won. 

Of his win, he wrote: “I won because of my surname.”

While acknowledging the family name as the reason for winning, Mayor Reganit made sure to show he deserved the people’s trust. He vowed to his family and his constituents to serve his fellow Maitumians well, having finally learned upon the birth of his son what having a “sense of duty” entailed. 

A town rich in heritage

Maitum, known for its anthropomorphic burial jars found in historical caves, is a second-class municipality in Sarangani province, bordered by Kiamba to the east, Lake Sebu to the north, and Palimbang to the west. It boasts a diverse population, including Ilocanos and T’bolis from South Cotabato, and faces challenges as a coastal town with several Geographically Isolated and Disadvantaged Areas (GIDA) among its 19 barangays, leading to a high migration rate.

Mayor Reganit Jr.’s leadership was enhanced with progress in Maitum’s health governance, thanks to its participation in the Health Leadership and Governance Program (HLGP) initiated by the Department of Health (DOH) Region XII and Zuellig Family Foundation (ZFF) in 2016. This partnership resulted in notable improvements in leadership, health service delivery, and the implementation of a robust Health Information System (HIS) with essential technological upgrades for barangay health stations and midwives.

The municipality’s success in health governance, particularly in maternal and child health interventions, earned recognition from the DOH as the best Maternal, Newborn, and Child Health and Nutrition (MNCHN) project implementer in the province by December 2019, achieving over 95% coverage. Despite these achievements, nutrition remains a challenge, with a stunting prevalence rate of 12.86% among children aged 0-5 years old, highlighting the ongoing need for targeted nutritional interventions.

Municipal Nutrition Governance Program

In June 2022, Mayor Reganit, Jr. and his core team participated in ZFF’s Municipal Nutrition Governance Program (MNGP) aimed at enhancing health and nutrition outcomes in Sarangani’s municipalities. The program provided valuable insights into the importance of nutrition, particularly focusing on the critical first one thousand days (FK1D) of a child’s life.

During this period, Mayor Reganit appointed Ms. Marife Cambel as the new Municipal Nutrition Action Officer (MNAO) for Maitum. With her background as a registered Nutritionist-Dietician and experience in community nutrition work, Ms. Cambel brought expertise and leadership to the role.

Despite being new, Ms. Cambel’s coordination skills and understanding of local government processes led to improvements in Maitum’s nutrition system. She collaborated with key stakeholders such as the Social Welfare Development Officer, Agriculturist, Budget Officer, Health Officer, and others to streamline efforts.

Participation in MNGP Module 1 training further empowered Mayor Reganit, Jr. and the MNAO to revitalize the Municipal Nutrition Council. This revitalization focused on implementing targeted interventions for vulnerable groups, including families with malnourished children and nutritionally-at-risk pregnant mothers. These efforts aimed to address nutrition challenges comprehensively and improve health outcomes in Maitum.

Information management and communication strategy for nutrition

Mayor Reganit, Jr. effectively utilized limited resources in Maitum by leveraging existing platforms to promote quality interventions in nutrition. One such platform was “Radyo Kasaganaan”, a mainstream media program broadcasted on DXNI-FM 99.7, reaching 15 out of 19 barangays in Maitum. This Nutriskwela Community Radio Network Program, in partnership with the National Nutrition Council (NNC) Region XII and the DOH Region XII, helped in improvements in health and nutrition outcomes since its launch in 2017, notably reducing stunting prevalence by almost 6% in the 2018 Operation Timbang Plus results.

Mayor Reganit Jr. employed various strategies through the radio program to influence positive health and nutrition behaviors, such as promoting the “10 Kumainments”, preparing nutritious meals for families, sharing local nutrition news, and discussing legislated policies. Live broadcasts engaged local listeners, fostering conversations on healthy lifestyles.

Recognizing the program’s effectiveness, Mayor Reganit Jr. increased investment in its operations, prioritizing funding under the municipality’s Annual Investment Plan. This led to expanded personnel, equipment upgrades, and technical training to ensure quality production. The MNAO now oversees the station’s management, conducting regular content quality checks and team evaluations.

By 2022, signal mapping confirmed the station’s reach in 15 out of 19 barangays, despite some weak radio signals in four barangays, mitigated by satisfactory internet signals. Daily feedback from listeners and online followers guides program improvements, reflecting a desired behavioral change. Stunting and wasting numbers were reduced from 19.59% in 2017 to 5.1% in 2022.

Through this dedicated platform, Maitum’s Community Radio has become a success story, delivering context-specific interventions, healthy conversations, and active information campaigns for maternal, newborn, and child health initiatives, making it a proud achievement for the municipality.

Resource mobilization and forging partnerships for food security and nutrition 

Despite Maitum’s status as the “rice granary” of Sarangani, it faces shortages in essential food groups crucial for the nutritionally at-risk, particularly children and vulnerable groups. Recognizing these challenges alongside limited resources, Mayor Reganit Jr. forged key partnerships to enhance nutrition and food security.

These partnerships span national agencies, non-governmental organizations, private sector entities, and community organizations. Collaborating with the Department of Agriculture, programs were tailored to support nutritionally at-risk pregnant women and families with malnourished children. Mayor Reganit also leveraged his co-founded volunteer group, the Eagle’s Organization, to distribute egg-laying chickens at his own expense to families in need.

A Memorandum of Understanding was also established with the Philippine Carabao Center (PCC) to set up a “Dairy Box” in Maitum, providing dairy products to the local market. This initiative involved distributing 50 carabaos to farmers within the Pangi Multipurpose Cooperative (PAMULCO), enhancing agricultural productivity and economic well-being. The PCC buys milk from these carabaos, which are processed into various dairy products for sale. This venture has been profitable, with daily sales reaching up to P10,000 during municipal events, benefiting cooperative members.

Under the guidance of the new MNAO, Maitum incorporated food fortification and salt iodization processes into its nutrition program. Collaborations with government agencies such as the Department of Science and Technology-Food and Nutrition Research Institute, NNC, and DOH facilitated these initiatives, including salt-testing in local markets to ensure adequate iodine content in food items. 

Deep Dive in an indigenous community

In February 2023, Mayor Reganit, Jr. embarked on ZFF’s Deep Dive, a guided community immersion, in Barangay Kalaneg, a T’boli community located about 20 minutes from Maitum. This barangay is among the top 10 in Maitum with the most malnourished cases. Joining the Mayor and his Nutrition Team was Sangguniang Bayan member Frediman Wanan, formerly an Indigenous Person Mandatory Representative (IPMR).

During the visit, they met “Francis”, a malnourished child born with an abdominal defect called “omphalocele”. Despite being advised to undergo surgery, Francis remained untreated due to concerns about the operation’s success and post-operative costs. Mayor Reganit Jr. discovered this and realized there were deep-seated trust issues among the T’boli community, especially concerning healthcare workers from outside their group.

To address this, the municipality enhanced a program training and deploying T’boli women as healthcare providers, which improved health-seeking behavior among pregnant T’boli women. This initiative led to a remarkable increase in prenatal check-ups from 70% in 2019 to 100% in 2022. These efforts resulted in a steady decline in malnutrition rates, with stunting dropping from 9.10% in 2020 to 4.81% in 2022, and wasting decreasing from 2.10% to 0.85% during the same period. These outcomes reflect the success of the municipality’s targeted interventions and community engagement strategies.

Behavior-centered designing workshop 

In March 2023, Mayor Reganit and his team took part in Module 2 of the MNGP, leveraging their insights from the Deep Dive. This module focused on adopting a behavior-centered approach to health and nutrition.

During this workshop, the team reviewed Maitum’s ongoing challenges despite progress in reducing malnutrition, highlighting issues like rising teenage pregnancies and early marriages among the T’boli community. They recognized arranged marriage among teenage IPs as a problem.

In response, they outlined interventions as part of their Behavior-Centered Design (BCD) project named “OPLAN ISULONG”, including providing health kits and check-ups for pregnant women, rewarding traditional birth attendants who refer patients to facilities, conducting weekly sessions for teenagers on health education, launching an information, education, and communication (IEC) campaign and health services in a selected barangay, and supporting the establishment of a community garden.

Additionally, they planned to establish a community assembly for dialogues on teenage pregnancies, draft a municipal ordinance against early child marriage, reward barangays with no teenage pregnancy cases, and recognize tribal leaders discouraging early child marriage.

Moreover, Maitum is looking to further enhance their nutrition interventions by forging active partnerships externally and internally. Mayor Reganit Jr. understands that in order to expand the nutrition program and attain their goal of “no new stunting by 2025,” he has to actively engage all sectors, especially community leaders and volunteers, including the private sector. In fact, he and his team already forged partnerships with San Miguel Corporation to expand the reach of his livelihood and food production initiatives (e.g., carabao and poultry farming to help parents with malnourished children).

Indeed, Mayor Reganit, Jr. may have envisioned a different path for himself as a young man, but having eventually chosen to become a leader, he has been keen on showing that he has what it takes to respond to the needs of his constituents. 

He believes that together with his core team, they will be able to make their vision come true—that is, Maitum becoming a “fully-empowered municipality where the peace-loving people are nutritionally resilient, healthy, and living abundantly.”

“Improving nutrition outcomes is important to me, because I dream of an Isabela cradled in strong, competent, and nurturing arms of future Isabeleños.”

Determined to improve health and nutrition, Isabela City Mayor Sitti Djalia “Dadah” Turabin-Hataman, decided to participate in the Municipal Nutrition Governance Program (MNGP) by the Zuellig Family Foundation (ZFF).

Born in Manila and married to Representative Mujiv Hataman, a prominent figure in Basilan, Mayor Dadah brings a wealth of experience in human rights and governance. After serving two terms in Congress, she returned to Isabela City, driven by a desire for grassroots impact and community service.

Isabela City, nestled in the southern Philippines, is a vibrant hub of diverse cultures and traditions, home to various ethnic groups living harmoniously alongside Christianity and Islam. Despite its classification as a fourth-class city with a population of 130,379, Isabela City is vital to the commerce and industry of Basilan Province. Distinguishing it from the province of Isabela located in northern Luzon, Isabela City has become known colloquially as Isabela de Basilan.

Improved transportation links have reduced travel time to neighboring Zamboanga City, fostering economic growth and cooperation between the two regions. Despite these advancements, challenges persist, especially in remote areas like Malamawi Island, where health services and nutrition education require targeted interventions.

Persistent malnutrition problem

While Isabela City saw a notable reduction in poverty rates from 53% in 2018 to 23.7% by 2021, malnutrition persists, largely stemming from poverty. First-time mothers often lack essential knowledge about proper nutrition, resulting in harmful feeding practices like early introduction of solid food or inappropriate bottle feeding. 

Mayor Dadah emphasized the importance of Local Chief Executive (LCEs) like her, stating: “The support of LCEs plays a major role in strengthening our programs, particularly when it comes to addressing nutrition.” She continued, “When the focus is solely on the compliance with the program, the true essence and importance of nutrition is somehow compromised.”

Realizing the vision

Governor Jim Hataman-Salliman recommended Isabela City to be part of ZFF’s Nutrition Governance Program. Mayor Dadah was invited through a network of ZFF’s development workers in Basilan, who often spoke highly of the Mayor’s abilities and leadership skills.

Initially, Mayor Dadah was content with Isabela City’s ongoing feeding program and was surprised by the invitation. Reflecting on her administration’s efforts, she realized that while their feeding program had merit, it fell short in addressing the multifaceted challenges of malnutrition comprehensively. She admitted that nutrition had been a blind spot and that malnutrition encompasses more than just children being underweight or had stunted growth. Participating in ZFF’s MNGP workshop was eye-opening, especially in identifying the need for a nutrition expert, which led to the prompt hiring of a Registered Nutritionist-Dietitian (ND) for the city.

The MNGP experience highlighted the intricate dynamics of nutrition issues and the pivotal role of leaders in effecting change, particularly for malnourished children and at-risk pregnant women. Mayor Dadah now aims to expand the program to barangays through their Local Government Units (LGUs), recognizing their crucial role in promoting the health of vulnerable populations.

Forward-looking initiatives

Under Mayor Dadah’s leadership, the City Nutrition Committee Technical Working Group (CNC TWG) was established to closely monitor program implementations such as the Operation Timbang (OPT) program,  Maternal, Early Childhood, and Learning Program Intervention, and supplemental feeding for nutritionally at-risk and malnourished children.

The collaboration extended beyond the CNC, with departments like the City Social Welfare and Development Office contributing to feeding programs and cash assistance initiatives. The City Agriculture Office (CAO) promoted food security through backyard gardening programs, while the City Health Office focused on delivering quality Maternal, Newborn, Child Health, and Nutrition services, leading to successful outcomes such as exceeding antenatal care targets in 2022.

Further, nutrition interventions have been strategically integrated into the approved annual investment plans and the Disaster Risk Reduction and Management – Health (DRRM-H) plan for 2023 in Isabela City. This integration encompasses crucial aspects such as procuring nutrition commodities and equipment, promoting breastfeeding, and managing malnutrition. Health workers diligently educate mothers about the significance of breastfeeding during prenatal checkups, emphasizing its role in preventing malnutrition.

In addition to hiring an ND, the City Population Commission Office also employed four more ND Job Order personnel. These personnel are crucial in implementing the 90 and 120-day supplementary feeding programs in selected barangays identified during OPT. Their efforts have significantly increased the OPT coverage in the city, nearing the national target of 90%.

Partnerships with educational institutions and organizations like Basilan State College and the National Nutrition Council (NNC) of Region IX have been strengthened. Collaborative programs such as the “Tutok Kainan” Program and partnerships with NGOs like ASA PHILIPPINES aim to improve food and nutrient intake for vulnerable populations, including pregnant women and malnourished children.

Acknowledging the needs of marginalized sectors, Isabela City supports initiatives for youth, provides assistance to solo parents, promotes women’s participation in local bodies, and celebrates Women’s Month annually to empower women and recognize their achievements. These efforts collectively contribute to a more holistic and impactful approach to address health and nutrition challenges in Isabela City.

The path ahead

In the last quarter of 2023, Isabela City initiated the development of its City Nutrition Action Plan covering 2023 to 2025. This comprehensive plan involved collaboration with the LGUs to ensure the inclusion of all necessary resources for demand generation and nutrition commodities. The agriculture sector also aligned its interventions, focusing on improving food security programs.

“Nutrition has always been a top priority for our administration,” Mayor Dadah affirmed. “We have implemented effective interventions backed by research and development to tackle persistent malnutrition issues. With our substantial budget allocation of 10,959,813.63 pesos for nutrition, we stand as a capable agent of change at the community level. Our efforts have borne fruit, as evidenced by the recent decline in stunting and overweight cases in 2022.”

Looking ahead, the City Nutrition Council aims to progressively eliminate malnutrition and achieve a zero-case target. Mayor Dadah said, “We will work vigorously to achieve scale-up inclusive nutrition interventions and build resilience among our target sectors with an emphasis on the vulnerable ones. I will continually express my solidarity together with our partners and stakeholders in building food and nutrition security for a happy and dignified life for all Isabeleños.”

Mayor Dadah emphasized the importance of unity and commitment, stating, “Coming together is just the beginning, but it is the right beginning. From this point forward, we commit to delivering what is expected from us, going above and beyond.”