Davao de Oro joined Aklan, Dinagat Islands, and Kalinga in celebrating a key achievement last March 2025—the successful completion of the Roberto R. Romulo (RRR) Fellowship for Public Health Leadership and Governance, a program led by the Zuellig Family Foundation (ZFF) in partnership with the University of the Philippines (UP) College of Public Health and the UP National College of Public Administration and Governance.

For Davao de Oro Governor Dorothy Gonzaga, the year-long fellowship was a transformational journey. “Coming from the judiciary and only entering politics in 2022, I never imagined how complex the health system really is,” she said. “This program helped me understand the power of leadership in turning health challenges into opportunities.”

Davao de Oro faced five key health concerns:

1. Child immunization coverage remains critically low. Only 63% of children were fully immunized in 2024—far below the national target of 95%. This gap leaves many children vulnerable to preventable diseases.
2. Teenage pregnancy continues to rise. In 2024, the rate reached 51 per 1,000 adolescents, which is significantly higher than both national and global benchmarks. 
3. The province’s hospitals are overwhelmed. The four provincial hospitals have a 315% occupancy rate, far above the ideal 80–85%, putting strain on both patients and health workers.
4. The province struggles with limited funding to properly manage its hospital system. To address this, the provincial government has proposed the renationalization of one hospital to improve funding and governance. 
5. Enrollment in the PhilHealth Konsulta program is still low. Only 8.4% of residents have had their first patient encounter, showing the need for stronger public awareness and engagement.

Despite the gaps, the province has made important strides. It tapped Barangay Volunteer Sanitation Inspectors to improve sanitation monitoring and prevent disease outbreaks at the community level. An information system was also developed that profiles and helps track Barangay Health Workers. 

The KoboCollect digital tool is being used to collect and manage data on water, sanitation, and hygiene. A provincial communication plan was also rolled out to improve field registration for primary health services.

In terms of services, the province exceeded national targets in prenatal care coverage, skilled birth attendance, and family planning. “These wins give us confidence that we’re on the right path,” she said.

The RRR Fellowship emphasized Bridging Leadership—the idea that real change happens when leaders bring people together. “I learned I can’t do it alone,” Governor Gonzaga reflected. “We need our mayors, health workers, and citizens to co-create solutions.”

Governor Gonzaga credits the Fellowship for sharpening her sense of purpose as a public servant. “I now see health not just as a service, but as a platform for empowerment and equity.”

Iloilo City, lovingly called the ‘City of Love’, has long been known for its cultural richness and educational institutions. But in recent years, it has also emerged as a national model for adolescent health reform. Faced with rising rates of teen pregnancy and weakened service delivery, the city responded with bold leadership, strong partnerships, and deep youth engagement—changing the story for its young population.

A Crisis in Continuity

In 2019, Iloilo City’s Adolescent Health and Development Program (AHDP) was in crisis. A leadership change at the City Health Office and the retirement of key personnel created disruptions in program continuity. At the time, the city had only one Level 2 Adolescent-Friendly Health Facility (AFHF) based in the Arevalo District. Despite support from the Integrated Service Delivery Network (ISDN) and local ordinances, the program remained fragile.

Even before the pandemic, adolescent health was already at risk. The city recorded an adolescent birth rate (ABR) of 36 per 1,000 girls aged 15–19 in 2019. One particularly alarming case involved a 10-year-old girl, the youngest known to give birth in the city—a clear sign of service gaps and unmet needs. By 2022, adolescents made up more than 18% of the city’s total population, amplifying the urgency.

Then COVID-19 struck, stalling what little progress had been made.

 

A Turning Point: Local Action Meets Global Support

Change began in earnest in 2022, when Iloilo City joined The Challenge Initiative (TCI)—a global program that supports local governments in implementing high-impact, sustainable family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions. Co-managed by the Zuellig Family Foundation and Bill and Melinda Gates Institute for Population and Reproductive Health, TCI helped the city reframe adolescent health as a shared, multisectoral responsibility.

A City Leadership Team (CLT) was formed, expanding the existing Technical Working Group into a powerhouse of cooperation. Members included city government units, the Department of Education (DepEd), the Technical Education and Skills Development Authority (TESDA), local colleges, the Iloilo City Police, the Sangguniang Kabataan (SK) Federation, and community organizations. Using TCI’s assessment tool as a strategic guide, the CLT pinpointed gaps and co-created solutions rooted in local realities.

“Through the Health Leadership and Management Program, our people evolved from support staff into leaders,” said Florence Joy Rubido, AHDP Nurse Coordinator. “We have achieved substantial progress. All district health centers in Iloilo City now have at least one Adolescent-Friendly Health Facility, and all adolescent focal persons from our nine district health centers have been capacitated through the AHDP foundational course in October 2023.”

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

Youth Voices at the Center

Iloilo’s new approach centered on empowering adolescents to lead. Programs like KaTEenAran, a teen center at Nabitasan Integrated School, gave marginalized youth a safe, structured space. The NewscasTEENg competition and the AHD Film Advocacy Contest with UP Visayas allowed youth to use media and storytelling as advocacy tools.

The Teen AD Facebook page grew into a vibrant online community, connecting over 2,900 members to health information and services. Meanwhile, the Peer Helpers Training program built a cadre of trained young advocates offering peer-to-peer support.

“Young people were not just reached, they were engaged on their terms, in ways that truly resonate,” said Richard Magullado, Information Officer of Commission on Population and Development (CPD)Region VII. “From film contests and newscasting to vibrant digital platforms, youth voices drove the movement.”

Reaching Every Barangay

The city also strengthened its demand generation workforce. All 224 Barangay Service Point Officers (BSPOs) were re-trained to deliver up-to-date FP information. The city’s grassroots commitment was evident in events like the Adolescent Summits in June and November 2024.

Held in Brgy. Sooc, Mandurriao and Arevalo respectively, these summits reached over 330 adolescents with sessions on teen pregnancy, human immunodeficiency virus (HIV), child labor, and family planning profiling. Parents were also engaged through Parent-Teen Talks and Usapan Sessions, breaking down taboos and building trust.

During Youth Day at Ramon Avanceña National High School, 92 adolescents joined interactive workshops on mental health, HIV, and Violence Against Women and Children (VAWC), reinforcing their agency and access to support.

Policy Backing and Budget Growth

Iloilo’s local policies strengthened these efforts. Ordinance No. 2017-048 institutionalized the ISDN, while Executive Order No. 141 (2021) underscored adolescent pregnancy as a national priority. These enabled a coordinated response, backed by real investment: the city increased its adolescent health budget by 620% from 2024 to 2025.

The results speak volumes. Between 2019 and 2024, ABR dropped from 36 to 24 births per 1,000 girls aged 15–19. Meanwhile, modern contraceptive prevalence rates (mCPR) have consistently exceeded the national benchmark of 30% at 41% in 2024.

A Movement Built to Last

“Iloilo City shows that when local leadership is bold, young people are engaged as partners, and systems are built to last, transformation becomes not just possible but inevitable,” said Magullado.

The city’s journey is far from over—but the foundation is strong. With sustained leadership, empowered communities, and energized youth, Iloilo is not only protecting its adolescents—it is equipping them to thrive.

And in true Iloilo fashion, it is doing so with heart.

Aklan proudly marked the end of a transformative journey. Alongside Davao de Oro, Dinagat Islands, and Kalinga, the province graduated from the Zuellig Family Foundation’s (ZFF) Roberto R. Romulo (RRR) Fellowship for Public Health Leadership and Governance in March 2025.

The RRR Fellowship, named after ZFF’s founding chair and in partnership with the University of the Philippines (UP) College of Public Health and the UP National College of Public Administration and Governance, aimed to equip governors and local health leaders with skills to solve real-life health problems.

For Aklan Governor Jose Enrique Miraflores, this was a year of action, collaboration, and meaningful progress for the province. The Fellowship builds on the province’s involvement in ZFF’s other health leadership programs, which helped strengthen the local health system and prepared Aklan’s leaders for deeper, systems-oriented reform.

 

From the start, Governor Miraflores made it clear: implementing Universal Health Care (UHC) was his top priority. As one of the pilot areas for the Healthcare Provider Network (HCPN), Aklan was determined to improve health services for every Aklanon. All 18 primary care facilities in the province are now fully licensed by the Department of Health (DOH)—a first in Western Visayas.

This success came from strong local unity. “All the mayors of the 17 municipalities, kahit ‘kalaban’ pa namin na mayors, they grasped what we need to do,” he remarked. “It’s not only my job to implement UHC. Dapat sama-sama kaming lahat.”

Governor Miraflores also shared the province’s top health challenges. These included:

• Delays in PhilHealth contracting: Even with all the preparation and local budget support, national delays in PhilHealth’s processes held back fund releases and service contracting.

• Slow first patient encounter (FPE) rates: Although 400,000 Aklanons are registered with PhilHealth, only 12% have completed their first patient encounter—still far from the target of 50%.

• Digital health systems: While many primary care facilities now use electronic medical records (EMRs), Aklan’s hospitals still lack full digital systems.

• Lack of health workers: Aklan needs more doctors, nurses, and midwives. The province is now drafting a plan to address this.
• Rising mental health cases: Aklan has the highest suicide rate in Western Visayas. Mental health became Governor Miraflores’ focus during his Deep Dive, a guided community immersion, under the Fellowship.

Despite the challenges, Aklan has achieved impressive results:

• Successfully negotiated with PhilHealth to become an HCPN demonstration site.
• All LGUs contribute 1% of their development fund to the Special Health Fund.
• Six district health managers hired to lead health services in identified clusters.
• Strong partnership with the Sangguniang Panlalawigan, which passed the Aklan HCPN ordinance.
• Digital health partnerships that led to an increase in PhilHealth reimbursements—from Php 104,000 in 2022 to Php 66 million in 2024.
• For mental health, Aklan passed a provincial ordinance and encouraged municipalities to adopt it. In one inspiring case, a troubled child received help and is now serving as a barangay health worker.

Governor Miraflores emphasized the value of data in decision-making: “Kailangan talaga data-driven. Before we decide on things, we need to see the data first so we can learn what we need to do.”

He also credited his training under ZFF’s Bridging Leadership approach, which focuses on personal ownership, co-ownership with stakeholders, and co-creation of solutions. “Hindi ako doktor, but I have to understand what’s happening in our health issues. I shared this mindset with our mayors. That’s why it wasn’t hard to convince them to collaborate.”

As he closed his RRR Fellowship journey, Governor Miraflores reflected on the long-term impact of their work: “Since I became a leader, this is what I always say: ‘What we do in life echoes in eternity.’ This is not only about legacy. It’s about what we do now that will benefit future generations.”

Mandaue City, a bustling center in Central Visayas, is proving that when reproductive health becomes a priority, women’s empowerment follows. For years, reproductive health services in the city were sparse—available only once a week, with just five trained providers serving thousands. Women, especially working mothers and adolescents, struggled to access timely and respectful care.

Cultural stigma and logistical barriers only deepened the gaps. That began to change in 2023, when Mandaue City joined The Challenge Initiative (TCI)-Philippines, a global platform, co-managed by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health, that helps cities implement evidence-based, high-impact practices for reproductive health. The city faced a wake-up call: city reports revealed that adolescent birth rates had jumped from 14 per 1,000 girls in 2021 to 35 per 1,000 in 2023—more than double in just two years.

 

From Problem to Purpose

To respond, Mayor Jonas Cortes mobilized a City Leadership Team (CLT) composed of healthcare professionals, barangay officials, NGO partners, and youth advocates. With TCI’s technical coaching, Mandaue began scaling up its family planning and adolescent and youth sexual and reproductive health (AYSRH) programs, embedding rights-based, client-centered care into the city’s health system.

One major innovation: the Women’s Health Caravan (WHC)—a mobile outreach program designed to bring care directly to women in their communities. Launched in March 2024, the WHC is rooted in a simple but powerful belief: healthcare should be accessible, convenient, and empowering.

Services under the caravan include:

• Free consultations and pre/postnatal care
• Contraceptive services including implants and intrauterine devices (IUDs)
• Cervical and breast cancer screenings
• Human Immunodeficiency virus (HIV)/ sexually transmitted infection (STI) testing and counseling
• Adolescent-friendly, age-appropriate health services
• Health education on mental health, body image, and informed choice

At each site, the caravan begins with open discussions on reproductive rights and agency. Women are not only given access to services—they are encouraged to understand and assert their right to choose.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
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Results That Matter

Since the caravan’s launch, Mandaue has seen promising results. According to City reports:

• The modern Contraceptive Prevalence Rate (mCPR) rose from 27% in 2023 to 30% in 2024, meeting the national target for the first time.
• The adolescent birth rate (ABR) decreased from 35 to 29 per 1,000 girls, signaling improved access to youth-responsive services.

To complement mobile outreach, Mandaue also opened the ‘Pink Corner’ at Parkmall—a permanent, woman-focused health space offering services such as breast check-up, pap smear, mental health consultation, and HIV testing in a welcoming environment.

Investing in Long-Term Impact

The city’s commitment isn’t just about short-term wins. From 2024 to 2025, Mandaue increased its local budget for reproductive health by 381%—a bold statement of political will. These funds support operations, training, outreach, and continued innovation in service delivery.

All 27 family planning providers across city health facilities have undergone Family Planning Competency-Based Training (FPCBT), focusing not only on clinical expertise but also on client dignity and respect. The Department of Health (DOH)-Central Visayas provided oversight to ensure quality and alignment with national health policies.

A Network of Support

Mandaue’s progress stems from strong partnerships:

• DOH-Central Visayas guided the city in integrating the ‘Life Stage Approach’ for UHC.
• Commission on Population and Development Region VII helped align services with population and development planning.
• Local women’s groups and schools extended outreach to underserved communities and young people.

Together, they created a system grounded in local realities, but aligned with national goals.

Looking Ahead

As Mandaue continues its journey, the Women’s Health Caravan is more than just a program. It is a declaration: that every woman, no matter her age, location, or income, deserves the right to make informed decisions about her health.

As City Health Officer Dr. Debra Catulong affirms, “this is what happens when healthcare is made human. When services are local, consistent, and rooted in trust, behavior change becomes possible—and lives are changed in the process.”

In Mandaue, the future of reproductive health is mobile, inclusive, and driven by choice.

Perseverance—the unwavering will to keep moving forward despite challenges—is what defines the life and service of a 71-year-old Barangay Kagawad from Barangay Mambajao, Maasin City, Southern Leyte. 

Felizardo Ramos is a retired community organizer of the Commission on Population and Development. He dedicated 17 years to grassroots work. Today, even in his retirement, he continues to serve—this time with a deep focus on preventing teenage pregnancy in his barangay.

As the head of the Barangay Health Committee, he sees every learning opportunity as a way to improve himself and his leadership. He completed training under Modules 1 and 2 of Zuellig Family Foundation (ZFF)’s Barangay Expanded Youth Leadership and Governance Program (BEYLGP)—a training series that equips local leaders with innovative strategies to address adolescent health and rights. 

These sessions are part of the Joint Program on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar. The program is supported by the Provincial Government of  Southern Leyte, the City Government of Maasin, the United Nations Population Fund (UNFPA), and the Korea International Cooperation Agency (KOICA). 

In Barangay Mambajao, reported teenage pregnancies among 15- to 19-year-olds rose from zero in 2021 to 3 in 2022. The number slightly declined to 1 in 2023 but increased again to 4 in 2024 and 6 in 2025. These numbers reflect the urgent need for sustained action to protect and empower young people.

To Ramos, making a difference is not about numbers—it is about heart. “Even if we are only two or three, as long as we have the commitment and passion to help others—especially adolescents—we can make a difference,” he shared. Over time, they realized that holding just one symposium was not enough to create real change. This is why Ramos is now planning to allocate funds for the Adolescent Sexual and Reproductive Health and Rights (ASRHR) program in the barangay.

With a renewed sense of purpose, he is determined to carry out the plans created during the program and follow through even beyond the end of the project. His promise is clear: to continue the fight against teenage pregnancy so that every adolescent has a chance at a better future.

Biñan City is proving that local government leadership, when paired with youth empowerment and data-driven strategies, can lead to measurable improvements in reproductive health. Once among the top 20 cities in the Calabarzon region for teenage pregnancies, Biñan has since emerged as a frontrunner in youth-focused family planning (FP) outreach, increasing its modern contraceptive prevalence rate (mCPR) from 71.3% in 2021 to 83.12% in 2024.

This progress did not happen overnight. Between 2016 and 2020, the Commission on Population and Development (CPD)-Calabarzon recorded 4,896 cases of teenage pregnancy in Biñan. In 2021 alone, there were 945 cases, with an Adolescent Birth Rate (ABR) of 47 per 1,000 girls aged 15 to 19—well above the national target of 30. These figures alarmed local leaders, prompting a full-scale response that combined service delivery improvements with strong demand generation.

 

Strategic Shift through Partnership

This urgent situation prompted Mayor Atty. Walfredo “Arman” Dimaguila Jr. and the local government to pursue a bolder, more integrated approach to reproductive health. A staunch advocate of youth development and a consistent champion for health equity, Mayor Dimaguila led the city in forming a partnership with the Zuellig Family Foundation (ZFF) under The Challenge Initiative (TCI)-Philippines in 2021. Through a formal Memorandum of Understanding, Biñan established a City Leadership Team (CLT) composed of representatives from the City Population Office, Department of Health (DOH), CPD, and ZFF. The CLT broke down previously fragmented programming and created a coordinated structure for adolescent health planning and implementation.

A key part of Biñan’s approach was the deliberate combination of supply-side improvements with demand generation strategies. The city knew that simply offering services was not enough—people needed to understand and trust them. To create demand, Biñan mobilized community actors, trained peer educators, and conducted sustained information campaigns. This was particularly important for youth, whose needs are often overlooked or misunderstood in reproductive health programming.

Engaging the Youth as Partners

Recognizing young people as equal partners rather than passive recipients, Biñan prioritized their active involvement. Through partnerships with the Department of Education, school leaders, and parents, the city supported peer education, values formation, and comprehensive sexuality education. Atty. Nora Pangan, Acting Department Head of the City Population Office, shared that the team began with school administrators to earn their trust, gradually involving parents and students in the process. 

Despite the onset of the COVID-19 pandemic, the city quickly pivoted to virtual platforms, ensuring continuity through online activities such as teenage pregnancy symposiums and adolescent health film dissemination. Once in-person activities resumed, Biñan organized blended, community-based events including the Pinsenya and Bunti’s Party, which used interactive learning to deliver maternal and reproductive health messages.

Teen centers became a cornerstone of the city’s youth strategy. School-based and community-based centers were designed to be safe, non-judgmental spaces for young people to access services, information, and mental health support. Formalized through Memoranda of Agreement with CPD-Calabarzon and educational institutions, three school-based teen centers were established across public and private schools. These centers also served as referral hubs under the Information Service Delivery Network (ISDN), linking adolescents to health providers and social support systems. Mental health, in particular, emerged as a recurring concern. Population Program Officer Hilario Pantua Jr. noted that the centers helped change how youth viewed mental health services, moving away from punitive associations with guidance offices and toward a model grounded in care and trust.

To expand reach and reinforce behavior change, Biñan trained peer facilitators and implemented youth-led sessions such as Breaking the Barrier Sessions (BTBS), Bunteens, Teenzania, U4U Teen Trail, and Parent-Teen Talks. These initiatives supported conversations on responsible parenthood, gender equality, and family planning—meeting adolescents where they were and speaking their language.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

Building Demand, Strengthening Systems

Alongside youth engagement, Biñan strengthened its health service delivery system. Barangay health stations were upgraded and certified as Level 1 adolescent-friendly health facilities, while City Health Office I and II attained Level 2 certification. These facilities were staffed by adolescent health specialists and peer educators, ensuring services were accessible, inclusive, and age-appropriate.

At the core of these improvements was a commitment to data-driven planning. Through the Field Health Service and Information System (FHSIS) and the e-Plano platform, Biñan monitored service quality, contraceptive uptake, and teen pregnancy rates across all barangays. This digital infrastructure allowed for real-time tracking and responsive strategy adjustments, making program management more precise and impactful.

Complementing these efforts was the Serbisyong Arman Caravan, a mobile initiative delivering family planning and health services directly to barangays. The Caravan advanced the city’s rights-based FP messaging, promoting informed choice and correcting misconceptions about contraceptives. Rooted in grassroots engagement, the Caravan was instrumental in building community trust and addressing barriers to FP access.

Results and Sustainability

The results have been significant. City reports revealed that from an ABR of 47 per 1,000 in 2021, Biñan saw a sharp and steady decline: 22 in 2022, 16 in 2023, and 15 in 2024. This drop demonstrates the impact of the city’s combined efforts to build awareness, improve access, and nurture community support. Moreover, the rise in mCPR from 71.3 percent in 2021 to 83.12 percent in 2024 reflects not just improved availability of contraceptives, but also growing public confidence in family planning services.

To support this sustained progress, Biñan significantly increased its local investment in adolescent health. The city’s AYSRH budget rose from 625 thousand pesos in 2023 to 3.3 million pesos in 2024, and then more than doubled to 6.5 million pesos in 2025. These figures reflect the strong political will of Mayor Dimaguila and the City Council to institutionalize AYSRH programs and ensure that adolescent-friendly services are adequately funded across all barangays.

Biñan’s transformation is a testament to what is possible when leadership, data, and community action converge. Through its youth-led, multi-sectoral, and evidence-based approach, Biñan is building a future where every young person can access the services, information, and support they need to thrive—today and in the years to come.

For decades, access to reproductive health services in Manila was restricted by policy. Executive Order 003, enacted in 2000, effectively banned modern contraceptives in the city. Though it was eventually repealed, its replacement—EO 030 in 2008—prohibited the use of public funds for contraceptives such as pills, condoms, intrauterine devices (IUDs), and sterilization. These policies were only formally reversed in 2019. 

In 2020, City reports show that Manila’s modern contraceptive prevalence rate (mCPR) was just 6%—30 percentage points below the national target and among the lowest in Metro Manila. The adolescent birth rate (ABR) stood at 50 per 1,000 girls aged 15–19, 20 points higher than the national average of 30.

 

Rising to the Challenge

In 2023, the City Government of Manila joined The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation and the Bill and Melinda Gates Institute for Population and Reproductive Health. A structured roadmap was developed to address systemic issues and restore public confidence in reproductive health services.

Spearheading this transformation was Mayor Honey Lacuna-Pangan, who convened a City Leadership Team (CLT) to institutionalize reforms. The CLT addressed issues such as fragmented service delivery, outdated clinical protocols, weak data systems, low youth engagement, and lingering biases among providers.

Dr. Evelyn Rimando, Family Planning Coordinator at the Manila Health Department, captured the core of the problem: “How can we reach those in need of family planning if there is a shortage of trained staff, few people know that such services exist, and misconceptions about it are widespread?”

From Policy Paralysis to Grassroots Power

To overcome these barriers, the city launched the Bayanihan Outreach Program, modeled after the Filipino tradition of collective community effort. Small teams composed of trained midwives, supervisors, and barangay health workers conducted daily door-to-door visits in low-income communities, providing pills, implants, injectables, and condoms.

Dr. Rimando noted, “The response was overwhelming. For many, this was their first time accessing family planning services. Being met by someone they trust, right at their doorstep, changed everything.”

What began in just ten communities quickly expanded citywide.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

Training the Frontlines, Transforming the System

In parallel, the city invested in training to boost the quality and reach of reproductive health services. Through Family Planning Competency-Based Trainings (FPCBT):

• 20 midwives were trained in FPCBT Level 1
• 20 more learned to administer progestin-only subdermal implants (PSI)
• 15 health workers were certified as IUD trainers
• Another 15 became PSI mentors

These trainers helped capacitate 38 additional providers, helping Manila build a self-sustaining training network.

To boost demand for services, the Usapan series—structured group discussions—were rolled out in clinics. Midwives were trained to lead these sessions, tackling misinformation, and fostering informed choices.

Supporting Adolescents

Youth-specific interventions were introduced in 2025, starting with a training focused on the Adolescent Sexuality and Reproductive Health – Family Planning Module, grounded in the HEEADSSS or the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidal Ideation, and Safety assessment framework. This globally recognized tool guides providers in addressing adolescents’ psychosocial and reproductive health needs holistically.

The training also featured the Adolescent Job Aid 2.0 (AJA), aligned with the Department of Health’s Omnibus Guidelines. However, a gap surfaced: out of over 50 public doctors in Manila, only four had prior AJA training.

Dr. Anthony Faraon, Chief of Party for TCI-Philippines, stressed, “Adolescent health training is essential, not optional.” He added that care for young people must be developmentally appropriate, respectful, and consistent.

To address training shortfalls, Manila is now seeking to scale adolescent health training locally and strengthen mentorship with ZFF-TCI and partners.

Systemic Reform from the Ground Up

Manila also tackled system-level bottlenecks:

• AYSRH services were made more youth-friendly
• Data-sharing agreements were formalized
• City Ordinance No. 9054 institutionalized the Key Assistance for Developing Adolescents (KADA) program, enabling stronger coordination across departments

The city’s long-neglected reproductive health infrastructure is now being rebuilt with intention and inclusivity.

A City Transformed

From a modern contraceptive prevalence rate of 6% in 2020, Manila surged to 35% in 2024. The adolescent birth rate fell from 50 to 15 per 1,000 in the same period. In recognition of these achievements, Manila was named a Global Self-Reliant City in family planning and adolescent health by ZFF-TCI. During the turnover, Assistant City Health Officer Dr. Gina Pardilla said, “This partnership empowers us to design interventions that truly respond to the evolving realities of families and young people. It is about meeting them where they are.”

Still, the work is far from over. Dr. Pardilla reflected, “If we are to sustain these gains, the commitment must go beyond training or funding. Our local systems must take ownership of reform, backed by national support.”

Where outdated policy once stifled progress, a spirit of bayanihan now fuels Manila’s drive toward equitable reproductive health. Families, adolescents, and providers are no longer sidelined—they are leading the change. This is Manila’s lesson: even the most entrenched public health challenges can be broken—one provider trained, one visit made, and one choice empowered at a time.

Naga City, the ‘Heart of Bicol’, is known for its rich history, deep religious heritage, and a strong sense of community. With a population of 209,170 as of the 2020 Census of Population and Health, it stands as the second most populous city in the Bicol Region. However, like many growing cities in the Philippines, it grapples with significant social challenges, including the rising concern of adolescent pregnancy, which continues to impact the youth and local development efforts.

Based on city reports, Naga’s adolescent birth rate (ABR) surged dramatically in recent years, climbing from 21 per 1,000 live births in 2020 to 106 in 2021, and even higher in 2022 at 110. This prompted local officials to rethink how they addressed adolescent reproductive health. Mayor Nelson Legacion recognized the urgency of the situation, particularly as young people struggled with limited access to reproductive health services and faced social stigma. The COVID-19 pandemic only made things worse by disrupting outreach programs and services.

 

A Strategic Partnership to Drive Change

In 2021, Naga City partnered with The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health. This partnership led to the creation of a City Leadership Team (CLT), which helped harmonize and scale up family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) efforts.

“We’ve had adolescent-focused initiatives in the past, but they were not well-coordinated or harmonized,” said Joy Macaraig, Assistant Department Head of the City Population and Nutrition Office (CPNO). With 26 years in public service, she explained how the integration of FP and AYSRH under the CPNO helped streamline both outreach and service delivery. The CLT further empowered various departments to incorporate adolescent health into their work.

The results were striking: by 2023, Naga’s ABR had dropped to 71, and by 2024, it had plummeted to 20—well below the national target of 37 .

From Pilot to Full Coverage: Empowering Barangays

Originally launched in three barangays, TCI’s model was soon expanded to six through the mayor’s initiative, and later to all 27 barangays in the city. The backbone of this local effort was the Barangay Service Point Officers (BSPOs), who not only tracked adolescent mothers but also ensured these young families received critical health and nutrition services.

Healthcare workers were also equipped through TCI University, an online platform offering practical tools and real-world examples. Janet Beloro, a midwife at the City Health Office, noted the improvement in her service delivery. “When clients return and tell me they will practice family planning, that’s when I realize I’ve made a difference—that I’ve been an effective provider. I see their health literacy improving, and for young people especially, I notice their growing awareness.”

Institutionalizing the Vision: Naga’s AYSRH Ordinance

In 2023, Naga passed City Ordinance No. 2023-025, also known as the AYSRH Ordinance. Authored by Councilor Gayle Abonal-Gomez, a member of the CLT, the ordinance institutionalized adolescent health initiatives and created a dedicated local budget to fund them.

One key result was the establishment of an Integrated Service Delivery Network (ISDN), which strengthened referral pathways among barangay health stations, hospitals, schools, and NGOs. This made it easier for adolescents to access the care they need, when and where they need it.

Creating Safe Spaces for Teens

Another major achievement of the ordinance was the rollout of teen hubs in schools and barangays. These safe spaces provide young people—including out-of-school youth—with information, counseling, and support.

At Concepcion Pequena National High School, teacher Dessa Bermejo helps manage their school’s Teen Hub. “With teenage pregnancy remaining a pressing concern, young people need a safe space where they can confide in someone they trust—someone who will listen without judgment and provide the guidance and support they need,” she shared.

Teen hubs have already been set up in Barangays Balatas and Calauag, and the goal is to bring these hubs to every school in the city.

Empowering Youth Through Communication

To support a more holistic approach to adolescent well-being, the Commission on Population and Development Region V launched the ‘Hearts and Minds’ campaign, under Director Joyce Dela Paz-Hilvano. This pre-orientation program focuses on emotional well-being and self-awareness, laying the foundation for more informed decision-making in adolescence.

The result? Naga’s modern contraceptive prevalence rate (mCPR) has remained above national targets, signaling sustained progress in FP and AYSRH initiatives.

Funding the Future

Since joining TCI, Naga has grown its investment in AYSRH from Php 2.2 million in 2023 to Php 5.1 million in 2024. This increase supports teen hubs, healthcare worker training, and the continuous delivery of reproductive health services.

Importantly, the city’s general fund and annual investment plan now include AYSRH—securing financial sustainability beyond political cycles.

Naga City’s experience shows that tackling adolescent pregnancy demands leadership, coordination, and sustained investment. Its journey offers a clear message to other local governments: meaningful change is possible when adolescents are placed at the center of public health and development efforts.

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Nestled in Northern Mindanao, Iligan City has long wrestled with challenges in providing effective family planning (FP) and adolescent sexual and reproductive health (ASRH) services. The COVID-19 pandemic amplified these hurdles, leading to a 30% decline in facility-based deliveries and a rise in home births attended by traditional birth attendants or hilots. These shifts strained health workers’ efforts to promote hospital-based care—especially in remote and coastal barangays.

More troubling was the spike in adolescent births. In Iligan City, the adolescent birth rate (ABR) among 15–19-year-olds was 29 per 1,000 live births in 2021. This jumped sharply to 42 per 1,000 in 2022. This steep rise pointed to how lockdowns and limited access to health education and services had disrupted the lives of Iligan’s youth.

 

Inclusive Leadership Driving Change

In 2023, Mayor Frederick Siao led Iligan City’s official participation in The Challenge Initiative (TCI)—a global partnership co-managed by the Zuellig Family Foundation, the William H. Gates Sr. Institute for Population and Reproductive Health, and Bayer International. The program focuses on supporting local governments to scale up evidence-based and sustainable FP and ASRH solutions.

Mayor Siao championed an inclusive leadership style, formalized through Executive Order No. 28, s. 2023, which created the City Leadership Team (CLT)—a coalition composed of representatives from the City Health Office, Planning, Population, Gender and Development (GAD) Office, Youth Council, Social Services, and national agencies, including the Department of Health (DOH) and the Commission on Population and Development (CPD).

“The collaboration and ownership of the problem and its solution is a key contribution of the TCI program,” said Dr. Glenn Manarpaac, City Health Officer. “Before, our programs were fragmented. Now, we have a strategic, unified approach.”

Data-Driven Solutions for Better Health

Central to Iligan’s transformation is its commitment to accurate and timely data. In March 2024, the City Health Office, TCI, and DOH conducted a three-day reorientation on the Family Planning Field Health Service Information System (FHSIS). This training equipped 44 health centers with updated knowledge on FP data recording and reporting.

“Incorrect data entry leads to inaccurate reporting,” explained Rhona Sumugat, Family Planning Coordinator. “This is our first reorientation in 15 years. We’re now better equipped to deliver quality care.”

With more accurate data, Iligan has been able to provide better services and advocate for greater investments in health infrastructure and training.

Youth-Friendly and Inclusive Services

In partnership with the Local Youth Development Council, Iligan City has scaled up youth-friendly health services. As of 2024, there are nineteen Level 1 Adolescent-Friendly Health Facilities offering services such as mental health counseling, human papillomavirus (HPV) immunization, and family planning for teens.

“Young people are more willing to seek help when they feel heard and respected,” said Nora Fe Escorial, Local Youth Development Officer. “We’re making sure they have access to the information and services they need.”

The city institutionalized this commitment with the passage of Resolution No. 25-210, establishing the Iligan City Youth Development Office (ICYDO). The office will lead youth programs and ensure sustained adolescent participation in governance and service planning.

Teenager Maria Santos shared how meaningful this shift has been: “Having our voices heard in these discussions makes me feel empowered. We need services that understand our needs.”

Respecting Culture While Promoting Choice

Recognizing the importance of cultural and religious sensitivities, Iligan City has adopted inclusive strategies to bridge gaps in FP access. Forty-five trained Barangay Population Volunteers (BPVs) now serve as cultural navigators, offering accurate and respectful reproductive health information in underserved areas.

The city has also started peer learning with nearby Cagayan de Oro, exchanging best practices in patient-centered counseling and health service delivery.

A major breakthrough in 2024 was the city’s first-ever dedicated budget for Long-Acting Reversible Contraceptives (LARCs). This move will ensure consistent access to implants and other modern methods, especially for low-income families.

Efforts are guided by GAD principles: disaggregated data, inclusive consultations, services for persons with disabilities, and mobile outreach to marginalized groups.

Sustaining the Gains

Sustainability is embedded in Iligan City’s long-term health strategy. With increased health budgets, the creation of permanent plantilla positions, and plans for two Family Planning Stand-Alone Clinics, the city is ensuring continuity and expansion of essential services.

“Collaboration is the key lesson here,” noted Dr. Manarpaac. “We learned that we can’t do this alone—and we’re committed to sustaining what we’ve started.”

These sustained investments and strategic interventions are already showing promising results. After peaking at 42 adolescent births per 1,000 live births in 2022, the adolescent birth rate (ABR) among 15–19-year-olds declined to 38 in 2023 and dropped further to 25 in 2024.

Empowered by data, united by shared leadership, and driven by the needs of its people, Iligan City is shaping a health system that is inclusive, resilient, and future-ready.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations