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.

In a bid to bring its health development framework to more rural areas in the Philippines, the Zuellig Family Foundation forged a partnership with the regional government of the Autonomous Region in Muslim Mindanao to accelerate improvements in local health systems.

The partnership will bring ZFF’s health leadership training program to mayors and municipal health officers of 37 municipalities in the region.

Under the agreement, local government units (LGUs) in the program can gain access to the regional government’s health fund—P1 million each LGU—which they can use to address issues on health personnel, medicines and service delivery.

Called “ARMM-ZFF Health Partnership,” the joint undertaking is seen to improve health service delivery systems and health financing capacities through stronger local health leadership and better health-seeking behaviour of residents.

ARMM Governor Mujiv Hataman and DOH-ARMM Secretary Kadil Sinolinding were present during the signing of the partnership agreement last July 7 in Quezon City.

For David Zuellig, trustee of the Zuellig Family Foundation, the decision to focus on health leadership and local governance to improve the health of the rural poor in the Philippines was logical yet counter-intuitive.

Zuellig spoke about the Foundation’s strategy in the session on innovative philanthropy during the Regional World Health Summit in Singapore, the first time the annual meeting was held outside Berlin since it started in 2009.
The summit’s theme, “Health for Sustainable Development in Asia,” underscored the challenge for governments and healthcare providers to meet the increasing demands for better healthcare at lower costs in the region. Amid Asia’s growing economy, public-private collaborations become more vital in coming up with sustainable strategies that will bring quality healthcare even to low-income populations.

According Zuellig, access of the Filipino rural poor is usually limited to those offered in the rural health units. So the Foundation focused on improving local health systems.

Zuellig said their strategy had the municipal mayor as the key element in improving the system. He said this was a logical move since mayors had the power to implement ordinances to improve rural health services. But Zuellig added that local politicians are generally perceived to be unresponsive to health and that is why their strategy also seemed counter-intuitive.

Yet, the Foundation proceeded to work with local chief executives, picking those who show genuine commitment for health reforms. In a relatively short time, their efforts paid off. Since piloting the strategy in 2009, 30 partner-municipalities have brought their maternal mortality ratio closer to the targeted Millennium Development Goal of 52. The MMR, accordingly, is a surrogate indicator of the quality of a health system.

To make sure gains are sustained, Zuellig emphasized the need to have a continuity protocol. “Policies that support the continuation of health programs must be in place. The motivation to improve health must come from leaders and the community itself, with or without external influencers.”

The rapid improvements in health outcomes in the municipalities came as a pleasant surprise to Zuellig himself. “I was pleasantly surprised to realize that health outcomes have improved faster than I thought was possible.” Such positive changes also caught the interest of other groups, including the Philippines’ lead agency in health. Partnership with the Department of Health will bring its health change strategy to 609 priority local government units. There are also existing partnerships with the United Nations Population Fund and global healthcare company Merck Sharp & Dohme.

For Zuellig, a number of lessons learned along the way also served as factors for their success. First, the Foundation focused on health because this was their area of expertise, further refining it to rural health because of serious inequities in rural areas. Then, there was the identification of a strategic intervention, which in this case was working with local health executives. Third lesson was the choice to have a systems approach over short-term interventions that do not address the root causes of problems. Lastly, Zuellig said they realized they had to take a long-term perspective because transforming systems take time.

In closing, Zuellig expressed optimism that for as long as the Foundation’s current crop of leaders hold public office, they will also continue to use its leadership and governance framework to address development challenges beyond health.

More mayors will become more adept in running their local health systems. This is what a newly-launched public-private partnership expects to achieve with the “Health Leadership and Governance Program”(HLGP). The joint undertaking between the Department of Health and the Zuellig Family Foundation will cover 15 regions, 54 provinces, and 609 cities and municipalities all over the country. The 609 local government units (LGUs) were identified as priority areas by the National Anti-Poverty Commission. The program will run from 2013 to 2016.

“The DOH recognizes the importance of good governance and leadership to achieve good health outcomes in the local government units; thus, this joint venture of DOH and ZFF,” said Health Secretary Enrique Ona in his keynote address.

The health chief also expressed optimism the program will help the country achieve its health-related Millennium Development Goals.

“By bringing this intervention to the 609 LGUs, we are optimistic that the country will achieve its health-related MDG targets while at the same time develop empowered leaders to improve not only the health outcomes but also the overall quality of life of all Filipinos.”

The project will adopt ZFF’s “Health Change Model” which according to ZFF chairman Roberto Romulo “is premised on the assumption that local leadership is the key to changing systems and innovating programs that can lead to better health outcomes.”

Romulo, in his response, said that since piloting the strategy in 2009, the foundation’s “97 municipalities have continuously decreased its maternal and infant mortalities.” He added that “while bringing down maternal mortality ratio of the country is proving to be a challenge” most of their municipalities have hit the MDG target of 52 last year.

The program is expected to cost P864 million of which ZFF, along with its partners United Nations Population Fund and MSD (Merck Sharp & Dohme), will fund P125 million. The foundation is currently in talks with other organizations like the UNICEF, USAID and AusAID that have all expressed interest in providing additional resources for the program.

Ona is also looking forward to having the program implemented in areas beyond the 609 priority LGUs.

By Ching Araneta

Three municipalities of Sibuyan Island in Romblon have been making sure every barangay health worker (BHW) is given security of tenure and rightful benefits as a volunteer. And for doing this, the Sibuyan Inter-Local Health Zone (ILHZ) won third place in the Department of Health’s 2013 Inter-Local Health Zone Good Practice. The award came with a P200,000 cash prize.

It was in June 2012 when mayors, BHW federation presidents and village captains in the three municipalities of Cajidiocan, Magdiwang and San Fernando formally agreed to adopt measures preventing the arbitrary removal of BHWs. They also installed a performance management system to protect the rights of BHWs and make sure they receive their benefits under the Barangay Health Worker’s Benefits and Incentives Act.

The measure, called the “Manual of procedures for BHW retention,” was put to test after the October 2013 barangay election. BHWs, who were subject for removal, were subsequently retained after undergoing due process in the municipal local health board.

This innovation of the ILHZ was nominated by DOH Regional Office IV-B. Representatives from the DOH central office conducted the assessment in Sibuyan in December 2013. The criteria for the award included leadership, governance and improvement of service delivery.

Awarding ceremony was held last February in Traders Hotel, Pasay City.

“What this program is showing us now is that public-private partnership is a good strategy toward the achievement of our goals. Together, we must continue to work hand-in-hand. Together we can do it.”

These were the words of Health Secretary Enrique Ona in his speech delivered on his behalf by DOH director Nestor Santiago Jr. during a forum on the DOH-Zuellig Family Foundation partnership program called the “Health Leadership and Governance Program” (HLGP).

The program aims to help the country achieve by 2015 its health targets under the Millennium Development Goals. It is also a program intended to strengthen the government’s Kalusugang Pangkalahatan (Universal Health Care agenda).
During what is called a “Gallery Walk,” in the forum, each regional director presented Ona their region’s maternal mortality ratio and infant mortality rate, and the strategies they have in minimizing mortalities and improving health outcomes in the different municipalities.

The forum, held in Antipolo City last March 26 and 27, discussed the gains made and the challenges encountered in implementing the HLGP, which began in the second half last year.

By Sealdi Gonzales

As aid pours into typhoon Haiyan (local name: Yolanda) affected municipalities, mayors are asking that a well-coordinated system be in place for speedier recovery and rehabilitation.

During a partnership meeting organized by Tabang Visayas and the Zuellig Family Foundation last month, Marabut Mayor Percival Ortillo Jr. noted the lack of a municipal system for donor assistance. “It is important to implement a centralized system at the municipal level to manage donor assistance with municipal priorities.”

Both Ambassador Howard Dee, lead convenor of Tabang Visayas and chairman of Assisi Development Foundation, and ZFF president Ernesto Garilao emphasized the need for partners and local government units to work together. “The role of Tabang Visayas [and its convenors] is to help the local government units harmonize the rehabilitation of their municipalities,” Garilao said.

The meeting aimed to match programs of various organizations with the specific needs of the municipalities. Former Health Secretary Jaime Galvez-Tan presented the Health Futures Foundation Inc. (HFI)’s “Sagip Samar!” (Save Samar) disaster response program and emphasized the need for psychological first aid to communities and local chief executives in the aftermath of major calamities.

Plan International-Philippines presented their six-month Country Strategy Programme, which supports the re-establishment of maternal, newborn, child health, nutrition, and water, sanitation and hygiene (WaSH) programs in affected municipalities in Samar island.

Presenting their respective agricultural, livelihood, micro-finance and enterprise assistance programs were the Philippine Business for Social Progress (PBSP), Hapinoy Sari-Sari Stores, Partnership for Development Assistance in the Philippines, Inc. (PDAP), and the Center for Community Transformation Inc. (CCT).

Stiftung Solarenergie-Solar Energy Foundation chairman Jaime Ayala was also present to discuss solar energy and distribute solar lamps to leaders of the 12 municipalities present.

The meeting that was held in Greenhills, San Juan was attended by the local government officials of Eastern Samar municipalities of Salcedo, Giporlos, Quinapondan, Gen. MacArthur, Balangiga, Balangkayan, Hernani, Lawaan, Mercedes, and Guiuan, and the Samar municipalities of Basey and Marabut.

These municipalities have partnership agreements with ZFF to help in the municipalities’ recovery program, especially in health. ZFF’s 6-month “Recovery Assistance Program for Mothers” (RAP for Mothers) is aimed at protecting women and infants by making sure pregnant and lactating women get proper natal care. Midwives and barangay (village) health workers are also given health kits they can use for delivery of health services. Under the program, mayors and municipal health officers are also required to attend ZFF’s leadership and governance program to arm them with skills to fix their health systems and sustain health gains beyond the 6-month recovery assistance program.

The RAP for Mothers is being implemented with the funding support from the Washington, D.C- based US-Philippines Society.