By Renzo Guinto

 

On the basis of the Local Government Code of 1991, the Philippines has developed what is called a devolved health system.

Devolution is a form of “administrative decentralization” wherein functions such as planning, decision-making, financing, and delivery of most health services are transferred from the central government to local government units (LGUs).

Hence, municipalities and provinces are responsible for a wide variety of tasks – from hiring local health workers and purchasing medical supplies, to running barangay health centers and hospitals and implementing disease prevention activities.

In most health policy discussions held in “Imperial Manila,” health system devolution is often deemed as the main reason why our national health system has failed to ensure healthcare access and improve health conditions.

Some argue that devolution led to healthcare fragmentation, lack of accountability, and even rampant corruption. To address these problems, one solution that was suggested was to recentralize healthcare and bring all health system functions back to the Department of Health (DOH).

One needs to be careful in making such sweeping statements and hasty recommendations.

Not a dead-end

Devolution is a complex feature of the health system with many components and dimensions. Unlike a medical intervention, it cannot be simply subjected to a clinical trial or a natural experiment.

Its effects on health system performance and ultimate health outcomes cannot be easily isolated, and attributing health system failure solely to devolution is both irresponsible and dangerous.

This is not to say that devolution cannot be understood and therefore must be treated as a given. Looking for local case studies that either demonstrate good or bad performance helps generate insights on how devolution is not really a dead-end, but rather can be fixed.

Last week, I attended the Health Leadership and Governance Symposium of the Zuellig Family Foundation (ZFF). For the past decade, ZFF, using its Health Change Model, has been training not only municipal and provincial health officers, but also mayors and governors on how to strengthen their local health systems and meet the health needs of their citizens especially the poor.

Engaging local chief executives and not just health professionals is critical, since in a devolved health system, they are the main decision-makers. Rather than countering the devolved system, ZFF instead “swam” with it.

One of ZFF’s sites, the province of Aklan, made huge investments in health – to improve existing hospitals, equip health workers, and strengthen referral systems. In 2018 alone, PhP 748 million or 38% of its entire provincial budget went to the health sector.

The provincial government also partnered with other local stakeholders to identify gaps and design solutions. As a result of these efforts, almost all of the top 10 causes of disease and death have decreased. “I want to make sure even the poor receives VIP treatment in our health facilities,” remarked Aklan Governor Florencio Miraflores during the symposium.

Bataan, another ZFF recipient, has set for itself the goal of becoming the province with the highest Human Development Index – which is a measure that combines health, education, and livelihood indicators.

Its governor, Albert Garcia, understands that to achieve this, the province must not only strengthen its healthcare system but also address the social determinants of health such as drunk driving and public safety. Interventions outside of the traditional health sector that target these factors have already shown decline in vehicular accidents and street crime.

Up to leaders, stakeholders

Unfortunately, despite the adequate decision space that LGUs do enjoy, not every municipality or province takes advantage of it in a way that truly benefits the people.

The problem is not that the decision space is too broad or too narrow, but how decision-makers are making good use of it, if not exploiting it for self-serving interests. And that is why organizations such as ZFF have been working hard to reorient local leaders to develop a genuine concern for health, adopt a broader systems-wide view, and make smart choices that improve health and save lives.

The problems with implementing devolution have a particular relevance to recent discussions around the proposed shift to a federal form of government.

Federalism, like devolution, decentralizes power and gives fiscal autonomy to sub-national units, specifically at the regional level. Because each region will have its own parliament, the decision space for health and other areas expands even further. However, similar to devolution, if the decision-making task goes to the wrong hands, intended health system goals will still not be achieved.

Hence, bigger decision space without the right safeguards such as the proposed Anti-Dynasty Bill will just perpetuate the culture of corruption that steals money away from people’s health.

Another ongoing development that relates to devolution is the proposal to create Service Delivery Networks (SDN).

The revitalized Universal Health Care bill that is currently deliberated in Congress enshrines SDN as an integrated unit of hospitals and primary care clinics convened by the province and covering different municipalities.

In theory, SDN should address health system fragmentation that comes with devolution, strengthen the referral system to ensure no patient falls into the cracks, and pool financial and human resources together for efficient and equitable use. SDN can also help enhance local government accountability – mayors and governors that are part of an SDN can exert pressure on each other to fulfill their commitments to public health.

At present, our devolved health system is characterized by islands of good practice in an archipelago still marked by underperformance and poor health outcomes.

3 recommendations

How can we spread a positive “virus” of good health governance across municipalities and provinces? Here are three general recommendations.

First, we must ensure that good decision makers occupy the “decision space.”

It begins with electing leaders with real concern for the health of their constituents. Citizens must question candidates about their vision for the public’s health even before they get elected. And once these politicians are sitting in power, communities must continue monitoring their actions and holding them accountable. The decision space is strengthened when leaders deliver and citizens participate.

Second, while I argued for keeping devolution and making it work, this is in no way to absolve DOH of its responsibility as the country’s public health steward.

It should rethink its strategy in working with LGUs. During the ZFF Symposium, Governor Adolph Edward Plaza of Agusan del Sur urged the DOH Central Office staff to do a “deep dive” in municipalities so that they can develop national guidelines that are not detached from ground realities.

In addition, DOH can design innovative strategies to nudge municipalities and provinces that don’t deliver without violating local autonomy as enshrined in the Local Government Code. The Philippines can learn from examples from other countries with decentralized health systems.

For instance, in Mexico, Brazil, and South Africa, the federal government, invoking the constitutional right to health, can intervene in provincial and municipal health governance if these subnational units are not achieving national health objectives.

One option within our disposal is to use PhilHealth reimbursements to incentivize LGU-administered clinics and hospitals to provide quality health care and leave no one behind.

Finally, leadership development programs such as ZFF’s must be strengthened, sustained, and scaled up. At present, not all provinces and municipalities in the country are covered by ZFF.

Moreover, while the goal is to institutionalize good governance that defy electoral cycles, the reality is that there is a high turnover of health workers especially in poor areas and culture change in any organization takes time.

Pulling out the program prematurely may reverse progress and even bring back communities to square one.

Renzo Guinto (@RenzoGuinto) is a physician and currently a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. He is also currently establishing PH Lab, a “glocal think-and-do tank” for generating innovative solutions for Philippine health, public health, and planetary health. He can be reached at https://scholar.harvard.edu/renzoguinto.

 

This article was published by Rappler.com on October 3, 2018. 

The Zuellig Family Foundation (ZFF) welcomes Austere Panadero as its new executive vice president effective September 1, 2018. He brings to ZFF his wealth of experience in ensuring local governments have the capacity to effectively deliver public services and become accountable, transparent and results-based.

Panadero worked for close to three decades in various capacities at the Department of the Interior and Local Government (DILG), where he was undersecretary from 2007 until his recent retirement.

An Industrial Engineering graduate of the University of the Philippines, Panadero began working in the government as technical staff of the Development Academy of the Philippines, where he eventually became its vice president.

In the DILG, he ensured the continuity of program and policy implementation amid multiple leadership changes. For being an exemplary public official who has dedicated his life to improving local governance, the Ateneo de Manila University conferred to him the 2016 Government Service Award.

In a span of 10 years, the Zuellig Family Foundation (ZFF) has laid the groundwork in advocating for a leader-centric approach in solving societal inequities, particularly those relating to health.

In those years, ZFF has successfully built a network of Health Bridging Leaders ready to work together to create more responsive health systems for the Filipino people, especially the poor.

To celebrate its 10-year journey, ZFF will recognize individuals who have stood out among the rest, and who have exceptionally manifested Bridging Leadership qualities that resulted in improved health outcomes.

In May this year, the ZFF called for nominations for Outstanding Barangay Leader in Public Health, Outstanding Bridging Leader in Public Health, and LGU Excellence in Public Health Governance.

Nominations for Department of Health officers and local chief executives, health officers, and government units were carefully reviewed. They were evaluated and scored based on their submitted nomination forms, Bridging Leadership Competency Assessment, and LGU scorecards. Below are short profiles of the awardees.

 

LGU Excellence in Public Health Governance

ALILEM, ILOCOS SUR

Region 1

Alilem is a fouth-class municipality in Ilocos Sur located between Benguet and La Union. During rainy season, 11 of its 14 barangays are inaccessible to motor vehicles. This problem with road access, coupled with social norms, cost of maternal services, disproportionate number of midwives to barangays were the reasons women choose to give birth at home and forego the services of skilled birth attendants in the birthing facilities.

Spearheaded by Mayor Mar Ruel Sumabat, the local government unit (LGU) of Alilem worked to improve the women’s health-seeking behavior. A local ordinance was passed to strengthen the LGU’s advocacies to improve the rate of facility-based delivery (FBD). Health expenses of indigent families were sponsored by the LGU.  All indigent pregnant mothers who were non-PhilHealth members, as well as all indigent couples who underwent marriage counselling sessions, were automatically enrolled by the LGU. To ensure access to health services, a midwife was hired for every barangay. An Inter-Barangay Transport Vehicle Referral System was established that utilizes designated point persons to coordinate vehicle use for emergencies.

From only 75% FBD in 2013, this increased to 100% in 2017. Zero maternal death was maintained in the same period.

Outstanding Bridging Leaders in Public Health

MYRNA C. CABOTAJE

OIC-Undersecretary, Public Health Services Team (Present)

Former Director, Regional Office 1 (2012-May 2018)

Department of Health

Dr. Myrna C. Cabotaje is the first Department of Health (DOH) regional director who passed the Health Leadership and Governance Program (HLGP) Institutionalization and Coaching Policy in the country.

As a regional director, she fostered the institutionalization of HLGP in Region 1. She aligned the DOH Region 1 HLGP policy to the Sustainable Development Goals and the country’s health agenda to ensure sustainability and improve coaching protocols in support of the practicums of the governors, chiefs of hospitals, municipal mayors, and provincial and municipal health officers.

She grouped the DOH division chiefs to lead the cluster teams in provinces to improve technical capacities and encourage easier ways to address existing and emerging health issues. She spearheaded mentoring sessions among guiding coalitions and the Provincial DOH Offices to strengthen the Service Delivery Network and improve staff performance and accountability.  She was also the first to train her coalition in systems thinking.

Under her watch, Region 1 reached the DOH targets for maternal mortality ratio and targets/rates for facility-based deliveries, births attended by skilled health personnel, contraceptive prevalence and infant mortalities. The region also achieved the national targets for safe water, sanitation, and hygiene.

Among her recent recognitions are the Diego Silang Award for her contribution in the attainment of the Millennium Development Goal 4 in 2016 and the UP Medical Alumni Society Inc. Outstanding in Community Service/Public Health Award in 2015.

 

 

ANNA BIRTHA I. DATINGUINOO

Health Leadership and Governance Program Coordinator

Department of Health Regional Office IV-B

For over two decades in the Department of Health Regional Office IV-B, Anna Birtha Datinguinoo braved the complexities of government bureaucracy and intricacies of political dynamics and maintained a positive work environment for her team.

Her leadership has fast tracked the improvement of regional health outcomes. Through the region’s participation in the Change Management Program of the Zuellig Family Foundation, she was able to push for the creation and mobilization of a guiding coalition. With this, she influenced her team and even her regional director to think out of the box and explore new arrangements for more responsive program interventions.

Through her Bridging Leadership for Palawan initiative, she was able to co-establish a convergence team in the province composed of provincial health office personnel, the governor and local provincial leaders, and other key stakeholders. She co-facilitated the Health Leadership and Management Program in the provincial government hospitals, as well as the DOH-retained hospitals to effectively surface the internal issues and concerns and efficiently take steps to address them. She has also conducted BL appreciation workshops for partner agencies such as DILG, PhilHealth, DepEd, DSWD and PopCom, taking into account their important roles in creating a more sustainable health system in the community.

 

 

HEIDELIZA V. CHIO

Health Leadership and Governance Program Coordinator

Department of Health Regional Office XII

Working for over a decade now with the Department of Health (DOH) Regional Office XII, Heideliza Chio knows very well the needs and challenges in her region. Complemented by her persistence in communicating and creating strong partnership with local government units (LGUs), non-government organizations, government agencies, and with her colleagues in the DOH, she was able to turn these stakeholders as co-owners of the health problems.

Her hard work paid off when the Health Leadership and Governance Program (HLGP) of the DOH engaged 37 out of 48 municipal LGUs, and 85% of the region’s barangays. As a result, partner municipalities were able to contribute to better maternal health outcomes in the region, particularly the decrease in maternal mortality, from 76 per 100,000 population in 2015 to 58 in 2017.

With the initial results, she continues to uphold her commitment in institutionalizing HLGP in the region. She conducts annual peer learning forums designed to strengthen the capacity of DOH management officers in coaching and mentoring health leaders at the local level. She also pushes for the inclusion of coaching in the Individual Performance Commitment and Review system of the DOH, as well as for the integration of the HLGP in the human resource processes and policies.

 

MAY BERNARDINE T. BELARDO

Development Management Officer IV

Department of Health Regional Office 1

When May Berbardine Belardo completed her Bridging Leadership training in 2014, she immediately applied her learnings in her assigned areas. By being part of the local health board, she was able to convince the local chief executives in three municipalities of Ilocos Sur to enroll in the Municipal Leadership and Governance Program. She then co-owned the challenges in her areas, and was able to coach and mentor effectively the mayors, and the municipal health staff by communicating a sense of urgency that translated into immediate action. Prior to the program, the local government units (LGUs) were non-participative when it comes to health. Health service delivery has been the sole responsibility of the health unit. Using the leadership roadmap as a guide, the LGUs were able to achieve notable milestones in terms of leadership and governance, health financing and health information system. Community leaders were trained on Bridging Leadership under the program, thus, were able to develop responsive action plans included in the Municipal Investment Plan for Health. Further, use of barangay health data boards were sustained and serve as bases for improving health service delivery in every community.

 

ERICSON G. SINGSON

City Mayor

Candon, Ilocos Sur

Dr. Mayor Ericson Singson was at the helm of providing health services in his private clinic when he agreed to run as mayor of Candon, a fourth-class city in Ilocos Sur. A doctor by profession, health, naturally, is one of his many priorities. He knew co-creating solutions to health problems was not only limited between him and his city health officer, so the city’s health board was expanded to include representatives from government hospitals, non-government organizations, and the Association of Barangay Captains. Through the increased cooperation of barangay leaders, the city’s health vision was easily cascaded to the communities: “Healthy families for a healthier community.” Medical and dental missions held in 42 barangays provided a one-stop access to the city’s health programs and services including tax assistance, agricultural support, livelihood, and registries. This also served as platform for the communities to voice their opinion through the open forums. Each of Candon’s 42 barangays has a functional barangay health station and has 5% of its internal revenue alloted for health. Candon has met and surpassed the DOH’s health personnel-to-population ratio. The city has 3 doctors (1:20,658 people), 14 midwives (1:4,423), and 5 nurses (1:12,395). Candon also secured a 6–in-1 accreditation with the Philippine Health Insurance Corp.

 

JEREMY JESUS DP. BUENO III

Municipal Vice Mayor (2016-Present)

Former Municipal Mayor (2007-2016)

Santa, Ilocos Sur

In 2007, Jeremy Jesus DP. Bueno III was 25 when he became the mayor of Santa, Ilocos Sur. Early in his term, Bueno showed interest in health by having it as one of the components in his priority disaster risk program. Realizing the need for more systematic approach in leading and governing, he strived for self-growth and continuous learning, which included a Certificate Course in Community Health Development from the Baguio State University after he completed the Municipal Leadership and Governance Program. From concretizing municipal health plans and expanding local health board, he continued leading change by engaging barangay leaders and seeking their participation in crafting barangay health governance plans. As a result, barangay health governance bodies were formed and a system for barangay health worker recruitment was identified. Municipal health budget from the internal revenue allotment was at 16%, while barangays health budget was at 5% in 2017. Rates for facility-based deliveries and births attended by skilled attendants are both 100% as of second quarter of 2018. The municipality has also maintained zero maternal death from 2015 up to second quarter of 2018. Among the innovative programs under his watch is the Santa SMILES Program that deals with issues in four major groups: health, nutrition, and social services; infrastructure, economy and employment opportunities; governance, peace and order, and environment; and education and capacity building. Bueno finished his third term as mayor in 2016 and now serves as the vice mayor.

 

ENGR. MILLIARD S. VILLANUEVA

Municipal Mayor

Concepcion, Iloilo

Engr. Milliard Villanueva of Concepcion, Iloilo put premium in networking and collaboration for improved health outcomes. Concepcion is a third-class municipality which used to suffer from water-borne diseases and parasitism. In 2013, 208 cases of diarrhea and two deaths were attributed to poor environmental sanitation. Villanueva understood that with only six out of 10 households owning sanitary toilets, ending open defecation is a goal he could not achieve alone.

Upon expanding his municipal health board, Villanueva created task forces to address the open defecation in barangays. He partnered with the Iloilo provincial government and other non-government organizations for toilet bowls provision and construction. Accompanied by his team’s extensive promotion and advocacy during meetings with village leaders and Association of Barangay Captain members, community health summits and municipal gatherings, he was also able to move the whole community to decrease the number of water-borne diseases and parasitism.

In 2017, 90% of households in Concepcion have their own sanitary toilets, water-borne diseases and parasitism dropped by 50%, and no deaths attributed to poor sanitation was recorded. In the first quarter of 2018, 64% of barangays were conferred with the Zero Open Defecation certification.

 

JOSEPH A. EVANGELISTA

City Mayor

Kidapawan, Cotabato

In his bid to improve the health outcomes in Kidapawan City, Joseph Evangelista banked on the participation of the 40 barangays in the city. Upon expanding the barangay health boards, Evangelista sought the voices of the poor through the Kapehan sa Barangay, an informal conference to discuss health concerns. He ensured he intimately knows the status of their health outcomes by being present in the presentations of barangay roadmaps. To further encourage the barangays, he launched the Performance Challenge Fund competition to award outstanding barangays in health service, financial accountability, and transparency, among others. He fostered inter-barangay collaboration through the Big Brother/Big Sister program, a strategy where better performing barangays assist other barangays mimicking how big brothers and sisters help their siblings.  Evangelista addressed technical challenges by providing training opportunities for all midwives in Basic Emergency Obstetric and Newborn Care, equipping barangay health stations medical equipment and supplies, increasing the number of heath personnel, and allocating funds for honoraria and benefits of barangay health workers and nutrition scholars. As a result, Kidapawan City has shown significant health progress in the last five years. Facility- based delivery and skilled birth attended rates have increased to 99% in 2017.  Maternal death was reduced to zero (except for one case in 2015). Its five-year average for infant mortality rate (2.52 deaths per thousand live births) is below the national average of 19.7 deaths per thousand live births.

 

ALFREDO M. CORO II

Municipal Mayor

Del Carmen, Surigao del Norte

When Alfredo M. Coro II took over as mayor of Del Carmen, Surigao del Norte in 2010, health system was poorly established. Malnutrition was present and deaths due to dengue, childbirth, poor sanitation, among others, were on the rise. Coro did not settle for traditional ways of doing things to address the health concerns of his municipality.  He started the Seal of Good Health Governance Program, an initiative for monitoring improvement in health outcomes in barangays, which was later on replicated in other municipalities across the country. This innovation has garnered recognitions from the different government agencies and organizations including Health Governance Award (Kaya Natin Movement- 2015); Galing Pook Award (2015); and Social Innovation for Health Initiative Award 2017. The Seal of Good Health Governance Program ensured health outcomes are checked and health programs are evidenced-based. Furthermore, the barangays are given renewed interest to keep aspiring for improved health because of the incentives under the program.  As a result, in only three years, almost 99% of pregnant women in Del Carmen were given services in all stages of pregnancy.  Sanitary toilets were also present in 88% of households with many barangays achieving 100%. The LGU was also able to provide access to safe water to 87% of its households.

 

JOSELITO Y. ESCUTIN

Municipal Administrator (Present)

Former Municipal Mayor (2007-2016)

Dao, Capiz

Joselito “Bo” Escutin of Dao, Capiz begun his leadership journey believing that health is solely the expertise and responsibility of the municipal health officer. Staying clear of meetings and discussions on health, the 2009 Health Leaders for the Poor (HLP) program was instrumental in changing his perspective and making him realize his crucial role as a Bridging Leader to improve the health outcomes in Dao. With the help of the Office of the Municipal Agriculture and the Municipal Health Office, Escutin spearheaded the program for Indigenous Supplementary Mixture to help combat malnutrition. INSUMIX is a highly nutritious product created by combining ground monggo and sesame. In his flagship program, Nanay Buhay Bata Alagaan, the barangay mobilized their tanods in the masterlisting of pregnant mothers, health education, and referring women in labor and the sick children. Escutin mobilized the barangays under the Leading and Managing Health Innovations, a multi-sectoral and participatory governance initiative aimed at responding to the Millenium Development Goals, namely: to reduce child mortality, to improve maternal health, to combat HIV/AIDS, malaria, and other diseases, and to ensure environmental sustainability.

 

LORETO I. ESLABAN

Municipal Vice Mayor

Dao, Capiz

Dao is a fourth-class municipality in Capiz that relies heavily on internal revenue allocation, support from nongovernment organizations (NGOs), additional funds from national agencies and donations from balikabayan residents.  With limited resources, Vice Mayor Loreto Eslaban underlined the need for solutions that are high impact and will require minimum resources. Since the expansion of the municipal health board was followed by the activation of local school board, the Busog Lusog Talino (BLT) Program was launched in school to target school children with malnutrition. Eslaban oversaw the preliminary roll out of the BLT Program in selected schools, while advocating for improved school attendance. The program, therefore, became a way for the local government unit (LGU) to respond not only to malnutrition but also to children’s education. To further strengthen the LGU’s program in public schools in Dao, Department of Education district supervisor was also invited to be a member of the expanded local health board.  Using the same creative reasoning as BLT Program, Eslaban supported the inititatives that links households to the Food Always in the Home (FAITH) program and the agriculture projects of the town, ensuring that the poor school children never get hungry at home.

 

HELEN B. MINGUEZ

Municipal Health Officer

Concepcion, Iloilo

Out of the 25 barangays in the third-class municipality of Concepcion in Iloilo, 11 are island communities, making health service delivery a great challenge. When Dr. Helen Minguez started as municipal health officer in 2001, maternal health service utilization in Concepcion was very poor, as evidenced by high incidence of home deliveries attended by traditional birthing assistants. She stepped up her efforts to address the challenges, and eventually received Department of Health recognitions for outstanding delivery of maternal and child health services. But even if she has done so much for her hometown, she never stopped improving herself, believing that a good leader must be well equipped and empowered to gain the support and commitment of her staff and other stakeholders.

Minguez believes her journey in the Municipal Leadership and Governance Program, together with her mayor and municipal planning officer, widened her understanding on how the local health system affects the performance of the local government unit. She immediately worked on how to improve the LGU roadmap. Aware that participation of community leaders is poor in some areas and collaborative efforts are needed to make changes in the community, she used the Community Health Summit as a platform to challenge the barangay stakeholders to do their share. She capacitated the community leaders which resulted in increased awareness of barangay health status through their roadmaps. Their increased involvement prompted solutions that led to local health system improvement. Minguez initiated a performance evaluation system by recognizing best barangay performers with certificates and cash awards they can use to augment their budget for health.

 

JOCELYN E. ENCIENZO

City Health Officer

Kidapawan, Cotabato

Dr. Jocleyn Encienzo recognizes the importance of team approach in the delivery of health services, bearing in mind the unique contribution of each member toward improvement of the health system. Her deep concern for the welfare of the health personnel moved her to lobby for the approval and provision of the Magna Carta for their health workers. She has led multiple stakeholders in creating health solutions, like partnering with City Council for the Protection of Children to address increasing number of teenage pregnancies. Inspired by the Municipal Leadership and Governance Program, and having the local government unit roadmap for health as guide, Encienzo challenged herself to improve the health status of Kidapawan City to make it more accessible to the poorest in the community.  One of her notable contributions to bringing health services closer to the barangay people is the conduct of “Buntis Caravan sa Kidapawan City” in clustered barangays, where comprehensive mobile medical consultations were done twice a week, with simultaneous mobile blood donation. This has sustained high maternal health service utilization rates in Kidapawan City since 2015, with no maternal death in the past two years.

 

GILSON L. LASPIÑAS

Municipal Health Officer

Esperanza, Sultan Kudarat

A native of Esperanza, Sultan Kudarat, Dr. Gilson Laspiñas has been serving the municipality for almost 15 years. Under his leadership, the Rural Health Unit is ready to serve the poor with its 7-in-1 Philippine Health Insurance Corp. accreditation, with complete service package for all life stages including mental and adolescent health. To counter the increasing number of teenage pregnancies, he pushed for the establishment of an adolescent-friendly teen health center, the only facility with Level 2 accreditation in the province. Laspiñas acknowledges the importance of team work. He articulates target results, sets parameters, determines support needed, and sets times to conduct progress reviews along the way. He shows sincerity, and communicates face-to-face for both positive and negative performance efforts.

He finds ways to address health challenges by innovating with other stakeholders. He ensures community leaders take part in the solution and are held accountable for health programs by engaging them in dialogues. He made sure community health plans are integrated into the Municipal Health Investment Plan, which was approved and endorsed by the Local Health Board for a 15% budget allocation in 2017. Among the health programs under his leadership is the “Buntis Kilatis” which delivers quality, efficient and free laboratory examinations, classes, service transportation during ultrasound and delivery, birthing home tour, and dental checkups to all pregnant mothers. The municipality was able to maintain zero maternal and infant death and above 90% for facility-based deliveries and births attended by skilled professional from 2013 to 2017.

 

HUMBELYN M. HORNEJA

Municipal Health Officer

Dao, Capiz

Dr. Humblelyn Horneja has been serving Dao, Capiz as municipal health officer for almost 30 years. Among her achievements is the successful adoption of the Wireless Access for Health (WAH) Program which initially proved to be difficult as 70% of midwives and health workers were beyond 50 years old with limited computer skills. To motivate them to learn, she joined in the hands-on training. With a clear vision and committed team, they were able to make the WAH functional in a few months’ time. Horneja always use the community-based approach in implementing health innovations. The Nanay Buhay Bata Alagaan (NBA) is one of the municipality’s flagship innovations. She captured barangay leaders’ passion by working on the vision of better health outcomes for Daonhons through reduction of maternal deaths. She mobilized the barangay health board members as part of NBA teams, including barangay tanods and mothers in barangays.  She capacitated them in the masterlisting of pregnant mothers, conducting health education program and in creating a system of referral, particularly for pregnant mothers and children during times of delivery or sickness.  This initiative has sustained zero maternal death in the town since 2010.

 

HERMERALDO M. CATUBIG JR.

Municipal Health Officer

San Pablo, Zamboanga del Sur

As the municipal health officer of San Pablo, Zamboanga del Sur, Dr. Hermeraldo Catubig Jr.  focused on eliminating maternal deaths, which, in 2009, peaked at 774 per 100,000 population rate. He sought the support of the municipal local government unit officials through the local health board and pushed for health budget increase.  As a result, roads and half-way homes were constructed so expectant mothers from upland communities can have better access to birthing facilities. He advocated for ordinance regulating the trained birth attendants and health workers on Safe Motherhood and Child Health Program. As a result, the municipality maintained zero maternal death since 2014.

 

As a bridging leader, he empowers San Pabloanons by letting them participate in the decision-making and implementation of health programs. In their bid for a national award on sanitation, he saw the need to capacitate community leaders, which he later mobilized as barangay sanitary workers. He implemented the use of sanitary spot maps in each barangay, which was later used and updated by barangay officials to monitor household access to sanitation. Through the concerted efforts of different stakeholders, 14 of 28 barangays in San Pablo are national awardees for best sanitation practices.

 

Outstanding Barangay Leaders in Public Health

JUAN A. SOLIVEN

Barangay Paypayad, Candon, Ilocos Sur

Barangay Captain Juan Soliven was one of the beneficiaries of Candon City’s Barangay Health Leadership and Management Program in 2014 when community leaders were trained to functionalize their health boards. Being the leader of a community from a fourth-class city and cognizant of the challenges it brings, he has been able to strengthen his social capital, which is vital in improving health service delivery in his own barangay. He was very serious in implementing the barangay health system roadmap, a tool which guided his barangay health board in identifying system gaps, and created necessary action steps to address them. He leads in tracking their progress and enjoins critical stakeholders not only in making them cooperate but also in making them accountable for results. He also uses monthly health board meetings and semestral barangay assemblies as an avenue for two-way learning between him and his fellow barangay leaders.

Soliven was also notable for his accomplishment in terms of collaborating with non-government organizations, leading to augmented resources for the delivery of health-related initiatives, particularly targeting pregnant mothers and malnourished children in his community. Up to now, he continues to inspire his co-leaders, as well as other barangay leaders by sharing his good practices, and by underscoring the importance of leadership toward meaningful and strategic collaboration.

 

 

JUDITO T. GAQUIT

Barangay Tambaliza, Concepcion, Iloilo

Recognizing the wisdom in concerted and intersectoral approach to address the health priorities of his community, Barangay Captain Judito Gaquit knew he needed to share his vision with his barangay constituents. He actively participated in the identification of the major health priorities in Barangay Tambaliza, which is composed of two islands in northeastern Concepcion, Iloilo. With more than half of the canine population not vaccinated with anti-rabies, the barangay health board distinguished it as one of the top health issues needed to be addressed.

Under his leadership, budget for community mobilization and for sustainability of the Rabies-Free Zone project was allotted. He created a task force to effectively plan and implement the necessary steps to achieve the shared vision of a rabies-free barangay. He personally supervised mass dog immunization and management of stray dogs. He coached members of the barangay council and volunteer workers in order for them to help in rabies control and prevention. Under his leadership, dog immunization coverage increased to 97% in 2017. An islet named Sombrero Island, a sitio of Tambaliza, was also declared as rabies-free zone in 2018.

 

ENGR. TRINIDAD B. CAÑIZARES

Barangay Calunasan, Mlang, Cotabato

Serving her barangay for three consecutive terms Engr. Trinidad Cañizares has gained the trust of her co-leaders. When she was trained on Barangay Health Leadership and Management, she was able to apply systems thinking and maximize her potential to collaborate and innovate. Soon enough, Barangay Calunasan was able to implement a No Smoking Policy under her leadership and was the recipient of the Barangay Red Orchid Award in 2016. Even with the backlash coming from store owners, she showed persistence in negotiating and enjoining critical stakeholders. She was able to communicate clearly her vision for her community, and uses open dialogue as a platform to engage stakeholders. All these were critical in the successful implementation of the policy in her barangay, which brought down the number of smokers from 177 to 30. Under her watch, Barangay Calunasan has been recognized by the municipal health office as the barangay with the lowest malnutrition rate (2017) and for its best performance in implementation of maternal and child health, non-communicable disease, and nutrition programs in 2016.

 

See related photos here.

FROM THE STANDS – Domini M. Torrevillas

Beset and challenged both, three provincial governors hurdled difficulties in demonstrating genuine concern for the health and well-being of their constituents. In matters of health, they heard complaints of patients being turned away by hospitals for lack of downpayment money, of  relatives being transported from one hospital to a better equipped one and dying along the way, of  not having drinking water and sanitary toilets. It all boiled to one big problem – poverty, so evident and felt in rural areas. At a symposium Tuesday in Makati, the governors – Sharee Ann Tan of Samar, Florentino Miraflores of Aklan, and Adolph Edward Plaza of Agusan del Sur, shared their experiences in improving matters and allowing patients to have better care and at affordable cost.

The three governors have been “pupils’’ under the programs of the Zuellig Family Foundation, whose mission is ‘’to inspire health conditions in rural communities by training programs for local government health leaders to strengthen health leadership and improve governance.’’

The foundation’s focus in improving health systems is rooted in the Zuellig family’s long-standing business in health care. It began when Frederick E. Zuellig came to Manila in 1901 for business opportunities. After World War II, his sons Stephen and Gilbert rebuilt, diversified and expanded the firm internationally. In 1997, the  Zuellig grandsons, Daniel and David, established the Pharmaceutical Health and Family Foundation that catered to the health needs of the communities surrounding  the manufacturing plant of Zuellig’s Interphil  Laboratories Inc. in Canlubang, Laguna, and in 2008, changed the name to Zuellig Family Foundation.

A research paper by scholars noted the “great disparities in access to healthcare, resulting in significant difference in health status between the rich minority and the poor majority of Filipinos.”

ZFF addressed the gap by empowering local leaders with the proper tools and training to systematically implement reforms so their healthcare systems respond to the needs of the underprivileged. The leaders are coached and mentored on effective healthcare systems.

Grandson David told the symposium – attended by a good number of delegates from government and NGOs involved in healthcare services, on the occasion of the 10th year anniversary of ZFF, that the foundation is the vehicle of the family in “giving back to the country of our  birth.”

The foundation focuses on health leadership and governance of local executives since they control the health facilities where the poor go to for services. Over the past 10 years, its health leadership and governance model initially piloted in 72 municipalities is now in over 600 municipalities and 23 provinces. It has also cooperated with the Department of Health and its regional directors and their staff. It has trained 13 academic partners who share the leadership approach to other sectors.

In his remarks, Roberto R. Romulo, ZFF trustees chair, said the foundation developed a Health Change Model, which states that health indicators, especially of the poor, will improve if they have access to health services that are made available by an equitable health system, made possible by a responsive local chief executive and his team.

Romulo made it clear that ZFF president, Ernesto D. Garilao, has kept the foundation on track. For example, the Health Leaders for the Poor program he introduced, also known as the Bridging Leadership process, equipped the mayors with an understanding of the inequities in their health system. Model-tested in two years, its major focus was (and still is) maternal health.

In 2013, former Health Secretary Enrique Ona asked ZFF to adopt the approach and work with priority municipalities of the National Anti-Poverty Commission. All partnership policies, systems and  procedures are co-created with the DOH, with operating costs shouldered by ZFF.

In 2016, ZFF started working with provincial governors and DOH regional directors, the purpose being to let the poor have better access to health services. This mandated provincial governors to exercise direct supervision over the hospitals, where the political officers assigned there carry out the goals and objectives of the municipal health system.

The three governors mentioned above and regional directors spoke at the symposium of the approaches they used to improve their health systems. For one, they visited poor communities. They fixed rundown government and peripheral hospitals, put in more hospital equipment, and constructed toilets and water systems in the houses that had to be fixed, worked for the hastening of PhilHealth assistance, and adding more doctors and personnel to the staff. Results have been good, as indicated by more people going to the hospitals instead of suffering at home in silence, maternal deliveries managed by skilled nurses and hilots, high contraceptive prevalence rates, and very few deaths.

They acknowledged the cooperation and participation of government agencies and members of the community – the latter won over by the executives’ meeting face to face with them, and the core groups they created to help in the achievement of their goals.

Governor Plaza said a lot has yet to be done to improve the systems, but for his part, he is hopeful in time he can leave ‘’a legacy of a quality health system with a high standard of service felt by the people.’’

This article was originally published in Philippine Star on September 27, 2018.

Ten years of work in improving health leadership and governance allowed the Zuellig Family Foundation (ZFF) to tackle challenges not only limited to maternal and child health but other areas of Filipino health as well.

These include primary health care, nutrition, and resiliency, among others.

In those years, some alumni leaders from different partner local government units (LGUs) have re-enrolled in other ZFF leadership and governance programs optimistic that the continued partnership would further improve and sustain their respective health programs.

Such is the case of Gamay, Northern Samar whose local chief executive and members of health core group are now in the second year of ZFF’s nutrition program in partnership with Switzerland-based Kristian Gerhard Jebsen Foundation.

The Nutrition and Health Leadership (NutriHeaL) Program aims to strengthen local nutrition systems to reduce stunting and other forms of malnutrition.

Gamay ranked third highest in the region in terms of under-2 stunting and wasting in 2017.

The LGU representatives were trained to understand the issues concerning nutrition-specific and nutrition-sensitive needs of pregnant women and children 0-23 months old (First 1,000 days population group).

In addressing the nutrition-sensitive needs like food sufficiency, the municipality rallied for an intensified campaign on backyard gardening which was also in line with this year’s nutrition month theme of “Ugaliing Magtanim, Sapat na Nutrisyon Aanihin.”

A result of a multi-sectoral approach involving municipality’s health and agricultural sectors, seedlings were distributed to the barangays to facilitate the planting of vegetables.

Such activity aimed to address challenges not only in nutrition and food sufficiency but also economic incomes. Produce of barangays was sold in a food fair on July 27, a nutrition month culminating activity which the municipality hopes to be sustained in the next years.

Out of the 26 participating barangays, Barangay Malidong was recognized for displaying the most number of varieties of harvests.

To make the initiative more sustainable, the Sangguniang Bayan (Municipal Council) drafted ordinances requiring every household to plant kamalunggay/saluyot and barangays and every household in Gamay to have a backyard garden.

 

 

 

 

This article was published in Philippine Daily Inquirer. 

 

 

Zuellig Family Foundation (ZFF) President Ernesto Garilao was honored last May 8 in New York for his work in building collaborations among local health leaders, resulting in improved health systems in rural communities in the Philippines.

Called the David Rockefeller Bridging Leadership Award, this is given by the Synergos, a global nonprofit organization working to solve complex problems of poverty through trust building and collaboration.

During the awarding ceremony, Synergos founder and executive chairman Peggy Dulany said, “When Synergos began to work in the Philippines, we were fortunate to connect to people like Ernie. People steeped in grassroots activism and social change but who would also learned how to build bridges with institutions in government and business who held significant power.” Dulany is one of the children of the late David Rockefeller, a known philanthropist.

In his acceptance speech, Garilao said, “Bridging Leadership in the Philippines was a seed planted by Synergos in 2001. It fell on fertile ground and bore great fruit shared by many stakeholders and communities in search for equitable outcomes.”

Bridging leadership (BL) is an approach that aims to build trust among multi-stakeholders resulting in effective collaborations to address inequities.

Garilao started his work in BL when he was still with the Asian Institute of Management, focusing on conflicted areas south of the Philippines. By 2008, he started his work with ZFF and developed the Health Change Model (HCM) strategy using the BL framework to help local leaders in poor communities achieve better health for their constituents. Since then, Garilao led ZFF as it grew its reach from just nine rural municipalities to 740 municipalities and 40 provinces in less than a decade primarily through a partnership with the Department of Health. The year 2018 marks the 10^th year ZFF has been using its strategy to improve local health systems.

Former Department of Social Welfare and Development Secretary Corazon “Dinky” Soliman also received the award for championing people-focused development both in the Philippines and internationally.

 

Ernesto Garilao during the awarding ceremony (Photo courtesy of Synergos)

Watch the full speech here.

Four “Municipal Leadership and Governance Program” (MLGP) alumni local government units (LGUs) received “Champion for Health Governance” awards in recognition of their excellent and efficient implementation of local health programs. (more…)