Cagayan de Oro (CDO) City Mayor Oscar Moreno has prioritized health throughout his extensive political career. Even as congressman (1998-2004) and governor (2004-2013) of Misamis Oriental, he strived to improve health services, with the province’s enrolment in the Philippine Health Insurance Company (PhilHealth) among his achievements.

Under Moreno’s leadership, CDO became a partner in two cycles of the Zuellig Family Foundation’s (ZFF) partnership program with the United States Agency for International Development (2013-2020). Since then, ZFF’s interventions, including regular coaching, enhanced Moreno’s and the local health officers’ capacities to improve their health system and address priority health issues.

Despite a reduced budget, the mayor transformed the ill-equipped Justiniano R. Borja General Hospital (JRBGH) into a premier hospital on its way to a Level II hospital accreditation–meaning it will have specialists for gynecology and pediatric services and additional facilities such as intensive care unit. He also modernized 19 other urban health centers that needed PhilHealth accreditation as maternal and child care facilities or birthing homes.

In 2019, the DOH selected CDO as one of the pilot sites for Universal Health Care (UHC) integration because of its outstanding implementation of PhilHealth’s Sponsorship Program (SP). The city spent ₱160 million to enroll 80,000 individuals in PhilHealth’s SP that year. Moreno also pledged a ₱2-billion budget to improve the city’s health services, including plans to build four mega health centers.

Adolescent-friendly city
The city had a high adolescent birth rate—the highest in Northern Mindanao (Region 10) at 57.8% in 2019. In November 2020, Moreno committed to reducing teenage pregnancy in the city through The Challenge Initiative (TCI) in the Philippines. Co-funded and co-managed by ZFF and the Bill and Melinda Gates Institute for Population and Reproductive Health, TCI promotes positive health-seeking behavior and improves access to family planning programs. CDO allotted P6.5 million for TCI’s 2021 implementation.

Among the high-impact approaches adopted by TCI was the Youth Leadership and Governance Program (YLGP) of ZFF. Following this approach, Moreno formed the CDO’s Oro Youth Development Council (OYDC) with representatives from student bodies, out-of-school youths, faith-based and community-based sectors, and other advocacy groups. He also spearheaded the Technical Education, Skills Development, and Employment Committee to offer skills development and employment facilitation to fresh graduates, out-of-school youth, recovering drug dependents, and other disadvantaged groups.

By adopting various proven ways to address youth-related challenges, the adolescent birth rate in CDO decreased to 33% in 2021. The city will also have an adolescent and youth sexual and reproductive plan fully integrated with its UHC program.

Malnutrition remains serious in the Philippines, where according to a 2018 survey, 15 percent of children 0-23 months were underweight, 25.5 percent were stunted, and 7 percent were wasted.

The 2018 Expanded National Nutrition Survey by the Food and Nutrition Research Institute of the Department to Science and Technology also showed that iron-deficiency anemia, which can increase risks of infection and dying among pregnant and lactating women, as well as infants, affected 26 percent of pregnant women, 14 percent of lactating women, and 39 percent of 0-23 months old children.

Left unchecked, malnourished babies—especially the poor—could become poor learners in school, and have limited employment opportunities and low productivity. Undernourished girls, according to the Department of Health and National Nutrition Council, “are likely to be undernourished through adolescence up to adulthood, including the period of pregnancy.”

Through the enactment of the Republic Act 11148 or the First 1,000 Days Law, this cycle of producing malnourished Filipinos will hopefully be prevented. Signed into law late in 2018, it envisions to give the marginalized families easier access to health and nutrition programs in the first 1,000 days i.e. conception until two years of age.

With the intent of helping the country improve F1KD nutritional outcomes, the Nutrition International and Zuellig Family Foundation forged a partnership to improve capacities of mayors and other health leaders in delivering better nutrition services in the cities of Puerto Princesa headed by Mayor Lucilo Bayron, Tacurong led by former Mayor Lina Montilla and Mayor Angelo Montilla and Tagum led by Mayor Allan Rellon. These LGUs had undergone other health leadership and governance programs of the ZFF.

Launched last July 10, the Urban Nutrition Governance project will strengthen capacities of mayors and local governments to plan, finance, and govern integrated nutrition service delivery networks. The project will coach and mentor city and village governments on systems-approach for nutrition through enabling policies and participatory governance, multi-sectoral collaboration, and improvements in technical capacities of health and nutrition workers.

The project aims to reduce undernutrition in the F1KD and specifically targets adolescent mothers, indigenous women and children, urban poor women with young children, and transient families in the three cities.

During the launch, F1KD law co-author Senator Rissa Hontiveros said, “…partnerships with the private sector… and even with other nations like Canada, which has generously supported these worthwhile endeavors, form a cornerstone to achieving our goal of better nutrition and health outcomes for all Filipinos.”

Likewise, DOH Assistant Secretary Maria Rosario Vergeire, M.D. said of the nutrition governance project, “It will bring together the respective expertise, experience, and strengths in governance and program management of the government, Nutrition International, and the Zuellig Family Foundation-and leverage these for tangible results on improving health and nutrition outcomes.”

By Jaykee Rodriguez, M.D.

It is not statistically significant but something has to be done about it. In Health Secretary Enrique Ona’s keynote message delivered on his behalf by Health Undersecretary David Lozada Jr., the secretary said that they received statistical explanation saying the increase in the ratio of maternal mortality from 162 in 2006 to 221 in 2011 is “statistically insignificant.” But Ona goes on to say, “the fact remains that the figures are there and we have to do something to make it come down as we near the countdown to the 2015 Millennium Development Goals.”

The message was delivered during the launch of a public-private partnership for the improvement of maternal health in 21 poor Samar Island municipalities. Called the “MSD for Mothers and ZFF Community Health Partnership: The Joint Development Initiative,” this is a partnership between global healthcare company Merck Sharp and Dohme (MSD) and the Zuellig Family Foundation (ZFF), with the support of the DOH.

“In the Philippines, the grim reality is that the maternal mortality ratio (MMR) is quite alarming, wherein the country is expected to fall behind the MDG 5 target. From current statistics, the maternal mortality ratio is 221, a far cry from the United Nation’s goal of 52,” said MSD Asia Pacific President Patrick Bergstedt.

That women continue to die due to preventable pregnancy or childbirth complications is what made MSD and ZFF decide to work together in one of the country’s poorest provinces. Aside from being poor, chosen municipalities for this project are also considered geographically isolated and disadvantaged areas (GIDAs).

According to ZFF chairman Roberto Romulo, “GIDA municipalities pose unique and more difficult challenges to improving healthcare. Defined as communities with marginalized population physically and economically separated from the mainstream society, these areas are usually isolated due to distance, weather conditions, and transportation difficulties and are characterized by poor health outcomes.”

Romulo also noted that in 2010, the collective MMR of the Samar provinces was 111 while the MMR of GIDA municipalities in the province was 392.

Under the partnership, 63 local chief executives, municipal health officers and community leaders from the 21 LGUs will be trained and mentored on leadership and governance, and local health systems development. At least 34 health leaders and professionals from the region and provinces will be trained to give technical assistance to the 21 LGUs. Using the Essential Intrapartum and Newborn Care Initiative of the WHO, 102 midwives and 1,862 BHW’s will be trained and supervised to increase community participation and improve health-seeking behaviour of locals.

Through the project, these municipalities are expected to eventually have upgraded and certified health facilities, equipment & transport service for antenatal & obstetric care, and policy, program and budgetary support for obstetric and ante-natal care.

This initiative is under the “MSD for Mothers” global project launched in September 2011 at the United Nations in New York. The aim is “to help create a world in which no woman has to die from pregnancy and childbirth, and to help reduce the burden of maternal mortality globally.” This is one of only two grants given so far by MSD (Merck) in the Asia Pacific. The other one is in Indonesia.

By Ellen Licup, M.D.

Two years after expressing their commitment to improve health outcomes in their communities, health champions of 12 partner-municipalities from the second cohort of the Zuellig Family Foundation (ZFF) showcased their achievements through a colloquium held last October 25 in Dusit Thani, Makati City.

With the theme, “Local Leaders Championing Health of the Poor,” the colloquium began with a press conference that had in attendance Health Secretary Enrique Ona, ZFF chairman Roberto Romulo, ZFF President Ernesto Garilao and mayors of the 12 municipalities.

Over the past two years, the mayors, municipal health officers and selected community leaders from the 12 municipalities worked to establish and strengthen the health systems within their localities. Anchored on the World Health Organization’s six building blocks for health systems, they implemented reforms, innovations and strategies to ensure people receive the adequate and appropriate healthcare that they rightfully deserve.

“Local executives need an insight into their people’s real health needs and possible solutions, an insight that the Zuellig Family Foundation provides with this program,” said Secretary Ona in a speech delivered by DOH Director Eduardo Janairo on Ona’s behalf. He added that, “Mayors, as leaders of their local health systems, need to share this insight with their local health personnel and the DOH which is the agency which can possibly provide the additional investments—technical and financial—needed to make local health system flourish.”

Collectively, skilled birth attendant assisted deliveries in the 12 municipalities rose to 69% in 2011 from 51% in 2009. In the same period, facility-based deliveries increased to 64% from 36%. As a result, maternal mortality ratio fell from 193 in 2009 to 44 in 2011. As of the first nine months of the year, it stood at 22.
“The improved health indicators may be attributed to a committed public leadership,” Garilao said as he relayed the story of Cohort 2 by introducing ZFF’s strategic framework called the Health Change Model.

To further advocate for local health systems strengthening, success stories and innovations acquired over the span of two years were gathered and crafted into videos shown during the colloquium. The videos featured stories on health financing and medicines, health service delivery, health human resource and health information systems. Each film showing was followed by a question and answer segment that allowed the mayors to share with the audience their insights on the issues and challenges they encountered.

During the event, ZFF trustee and former Health Secretary Alberto Romualdez Jr. also emphasized the importance of building strategic partnerships between government and the private sector to attain better health outcomes for the poor. As a response, Sanjiv Navangul, Managing Director of Merck Sharp & Dohme (MSD) Philippines, presented its partnership project with ZFF which is aimed at improving maternal and child health outcomes.

In his closing remarks, ZFF trustee Daniel Zuellig said, “There is now real momentum towards the reform of our public health system. We are witnessing this in all our ZFF-partner municipalities. And as ZFF continues to cooperate with the government…with private companies, funding agencies and other development organizations, we are confident that we will see continuity and further innovations in the health programs that have been producing better health outcomes.”

Zuellig also added that the Foundation “will continue to help make sustainable healthcare reforms possible, because we want to, and because we know that we are able to.”

Each of the 12 municipalities received a Plaque of Appreciation from ZFF in acknowledgment of their accomplishments. The 12 are: Romblon’s Cajidiocan, Magdiwang, and San Fernando, Minalabac in Camarines Sur, Sorsogon’s Pilar and Prieto Diaz, Samar’s Daram and Pinabacdao, Leon Postigo in Zamboanga del Norte, Zamboanga del Sur’s Lapuyan and San Pablo, and Tungawan in Zamboanga Sibugay.

Booths were also set up to showcase objects of pride from each of the municipalities.

Last September 28, Philippine Ambassador to Switzerland and Liechtenstein Leslie Baja handed over 5,000 Swiss francs (approximately P223,500) to Zuellig Family Foundation (ZFF) president Ernesto Garilao.

The money was raised by Filipinos living in Switzerland during a charity event held as part of their Philippine Independence Day celebration in Berne last June 9.

The donation will be used for ZFF’s Health Leaders for the Poor (HLP) program which gives leadership and governance training to mayors, municipal health officers and community leaders in ZFF’s Samar Island partner-municipalities.

Of ZFF’s 54 municipalities participating in the HLP program, five are in Samar while three are in Northern Samar.
This program has so far led to improvements in the welfare of poor Filipinos living in rural areas. As health leaders began implementing health policies and programs targeted to the needs of their people, the ZFF also saw improvements in their health statistics, particularly in their maternal health indicators. With the money donated, the Foundation hopes to replicate the same success to more municipalities in the Samar Island.

To update the Filipino community on the use of the funds, the Foundation will regularly report to the Office of the Philippine Ambassador to Switzerland.

Following this fund raising activity, the Foundation hopes to have more overseas Filipinos support their communities of origin.

By Jovito Dy

Electronic medical records, synchronized patient alerts via SMS, real-time health data from the field and inter-connectivity for reporting and consolidation of health data. These are the advantages of a health information system built through the support of several companies and organizations.

The Wireless Access for Health (WAH) Initiative is “aimed at improving healthcare service delivery through the use of information technology platforms like 3G connectivity technology and electronic medical record.”

Piloted in Tarlac, the recent partnership of the Zuellig Family Foundation with the WAH will bring the system to its six partner-local government units (LGU) of Dao (Capiz), Don Salvador Benedicto (Negros Occidental), Ipil (Zamboanga Sibugay) and the Romblon towns of Cajidiocan, Magdiwang and San Fernando. In 2013, the system will also be introduced to ten more ZFF partner-LGUs in the Autonomous Region in Muslim Mindanao.

The WAH Initiative has four main components. First is doing away with paper and having electronic medical records to promote real-time, data-driven planning for municipal health officers and local chief executives. Second is the sending of mobile text messages to remind patients of their scheduled consultations as well as to inform public about health promotion and programs.

The third component, “Mobile Midwife” aims to increase the productivity of rural health workers by capturing real-time data they gather from their field visits and synching it to the rural health unit central database using internet connectivity and smart phones.

The fourth component is the inter-connectivity of LGUs within a province for the electronic reporting and consolidation of health data. This allows having real-time and accurate health information.

Data in the WAH system can also be used for the DOH’s Field Health Service Information System. In the pipeline is enabling the use of WAH system information into the Philhealth system.

The partnership between ZFF and WAH was formalized with the signing of a Memorandum of Agreement last September 26 at the Holiday Inn Clark Pampanga during the North Luzon Health Information Systems Forum. Present during the signing were Tarlac Governor Victor Yap, Tarlac Provincial Health Officer (PHO) II and President PHO of the Philippines Ricardo Ramos M.D. and ZFF Vice President Ramon Derige.

The pioneering supporters of the WAH initiative are the United States Agency for International Development, Smart Communications Inc., Qualcomm Inc., RTI International, Department of Health (DOH)-Center for Health Development Region III, DOH-National Epidemiology Center, DOH-Information Management Service, Tarlac Provincial Government through its Provincial Health Office, University of the Philippines Manila-National Telehealth Center, and Tarlac State University.