Pitching in for the health of Filipinos
Thirteen mayors and nine Department of Health officials were recently awarded for displaying excellence in leadership that led to health system reforms and, for mayors, zero maternal death for two straight years.
These health leaders were among those introduced to the “bridging leadership” framework during training programs under the DOH- Zuellig Family Foundation program.
“What you have done is you have opened the minds of the people that health is not just about infra and equipment,” said former Health Secretary Janette Garin, in acknowledging the advantages of the program for mayors.
The training is part of the DOH-ZFF’s “Health Leadership and Governance Program” (HLGP) initiative intended to turn mayors into pro-active health system reformists. This means not just building health facilities but also improving governance, health financing, information system, service delivery, access to medicines, and health workforce.
Key to being a “bridging leader” is the ability to be fully accountable to the health of one’s people, and work collaboratively with different people to co-create health solutions and innovations.
As Health Secretary Paulyn Ubial said during the HLGP Colloquium, “Health is everyone’s concern. Nobody is exempted. We should all pitch in. Nobody’s exempted from making health a priority.”
The three-year DOH-ZFF partnership program began in May 2013 under then Secretary Enrique Ona, who appealed for a continuity and support for the program.
The partnership was extended by Garin until November 2017. While Ubial, who has worked under 13 health secretaries, said she plans to continue the program, especially since, according to her, one of her strengths is building on the best practices of past DOH heads.
Photo caption: Health leadership excellency awards were handed out to outstanding mayors and health officials recently by the Zuellig Family Foundation (ZFF). Present during the ceremony were (from left) Health Secretary Paulyn Ubial, former health secretaries Janette Garin, Enrique Ona and Esperanza Cabral (also a Zuellig Family Foundation trustee) with one of the awardees, Region 1 DOH Director Myrna Cabotaje, David Zuellig (trustee), Roberto Romulo (ZFF chairman) and Ernesto Garilao (ZFF president).
ZFF/DOH: Model PPP
By Roberto Romulo, The Philippine Star
The Zuellig Family Foundation, in partnership with the Department of Health, just held the First National Colloquium of the Health Leadership and Governance Program or HLGP. My personal journey with HLGP started in 2008 when I was appointed chairman of ZFF and, in turn, I appointed Ernesto Garilao as its president.
Ernie developed the Health Change Model (HCM) which is founded on theconviction that health is a right for all people and that the poor must have equitable access to basic health services. What is unique about the HCM approach is that it is anchored on health leadership and governance. The attainment of health outcomes was predicated on the leader’s recognition of his purpose as a public leader, and the recognition that better health outcomes is the result of the leader’s passion and deliberate acts of leadership.
Since the ZFF vision is to improve the health outcomes of the poor, then our mission became capacitating local chief executives (mayors) so that they can make theirlocal health systems equitable since the poor go primarily to public health facilities. We have been piloting the HCM through ZFF’s own Community Health Partnership for the Poor (CHPP) program since 2009. At present we have 72 fourth and fifth-class municipalities under our pilot program.
The pilot health teams went through a two-year, training cum practicum intervention, using bridging leadership as the leadership approach and the World Health Organization’s (WHO) six building blocks of health. ZFF also provided coaching and technical assistance, as well as built birthing clinics and maternal halfway homes.
The focus was on improving maternal health, because in 2009, the Philippines was lagging behind its Millennium Development Goal for Maternal Mortality Ratio (MMR). Moreover, maternal health is a sentinel indicator on the quality of the local health system. In 2012, after three to four years of piloting HCM in 29 municipalities from cohorts one to three, we observed dramatic improvements in the local health systems and health outcomes.
Specifically, MMR went down from 177 (37 deaths) to 44 (nine deaths) deaths per 100,000 livebirths and infant mortality rates went down from 4.9 (101 deaths) to 4.1 (85 deaths) deaths per 1,000 livebirths.
In 2015, we commissioned an impact evaluation study of the first 29 pilot LGUs. The study concluded that there is a positive connection between the health-related decisions of the mayor, or what we call acts of leadership, to the improvements in the health systems. These eventually made a difference in reducing inequities in the health system, especially in access to health services of the poor. The study concluded the program should be replicated or scaled-up.
In 2013, we were asked by then Health Secretary Dr. Enrique Ona to replicate our approach in the DOH, and we signed a three-year partnership with the department from May 2013 to May 2016. The same agreement has since been extended by then Health Secretary Janette Loreto-Garin until November 2017.
Personally, I am pleased to inform what ZFF has accomplished:
• Reached a total of 543 municipalities, 20 cities, and 32 provinces; of these 375 municipalities, eight cities, and one province have already completed the program
• Engaged 12 regional academic partners, and trained more than 200 faculty members of these academic partners
• Trained more than 600 DOH officers and staff from 16 regional offices.
We were gratified by the kind words of Secretary Garin in her speech:
“You (ZFF) have opened the minds of the people (local chief executives) that health is not just about infrastructure and equipment… (Through HCM we learned that) as bridging leaders, we start with ourselves by owning the challenge… Ownership has been created, commitment has been enhanced.”
“We have seen the (HCM as the) perfect formula in making things work in enhancing (the health of) our people.” ZFF would also like to express our gratitude for the support and guidance of the former Secretaries (Drs.) Enrique Ona, Esperanza Cabral (ZFF trustee) and Manuel Dayrit (ZFF trustee). We assure incoming Secretary Paulyn Ubial our continued support. We take great pride in the ZFF-DOH partnership which is a successful model of public-private partnership (PPP).
I want to thank the ZFF staff’s professional commitment and dedication. Lastly, I would like to thank and honor our president Ernie Garilao, whose wisdom and leadership made it happen.
The Photo (from left): Health Secretary Paulyn Ubial, former Secretaries Janette Garin, Enrique Ona and Esperanza Cabral (also a ZFF trustee), Health Leadership and Governance Excellence awardee DOH Regional Director Abdullah Dumama Jr., David Zuellig (ZFF trustee), Roberto Romulo (ZFF chairman) and Ernesto Garilao (ZFF president)
This column can also be viewed at http://www.philstar.com/business/2016/07/01/1598226/zff/doh-model-ppp.
More than a motherhood statement
By Jocelyn R. Uy (Philippine Daily Inquirer)
As a young boy, Alih Sali would hear stories of mothers and their babies dying during childbirth “because of poverty, the lack of knowledge on health issues and the need to endure long travel on rough roads to get to the nearest hospital in town,” the former police inspector and now vice mayor of Akbar, Basilan, recalled.
But going around the province as a police officer made Sali realize how other towns had grappled with the same problem and made their health systems work.
“I asked myself, ‘If they can do it, why can’t I?’” Sali said at recent rites that honored a growing number of local chiefs who have become health champions in the conflict-stricken Autonomous Region in Muslim Mindanao (ARMM).
Under the program, mayors and municipal health officers were trained on leadership and service delivery and were expected to improve health indicators in their areas using as roadmap the World Health Organization’s six building blocks of health. These are: leadership and governance; health-care financing; health workforce; medical products and technologies; information and research, and service delivery.
Illustration by Rene Elevera
Also recognized for wielding their power to save the lives of pregnant mothers and newborn babies were Mayor Rahiema Salih of Tandubas, a third-class municipality in Tawi-Tawi, and Rauf Talib Mastura of Sultan Mastura in Maguindanao.
The Philippines has one of the highest maternal mortality rates in Southeast Asia. In 2015, there were roughly 114 mothers dying in childbirth per 100,000 live births in the country, way beyond the Millennium Development Goal target of 52 women per 100,000 live births.
A new target has been set under the Sustainable Development Goal, which has countries committing to reduce global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
Folk healers
Sali recalled how, in the early years following the creation of Akbar, the nearest public and private hospitals in Lamitan were almost two hours away, which often discouraged residents from seeking proper medical treatment. Their only option, he added, were folk healers for the sick, and the “panday” and “hilot” for women who prefer to give birth at home.
In 2013, an incident that had a mother and her newborn dying 24 hours apart jolted Sali enough to ask religious leaders to use their Friday sermons to convince mothers to go to health facilities for childbirth.
Traditional healers and panday and hilot were also recruited as barangay health workers who were given a P1,000-incentive for every pregnant mother they bring to the birthing clinic. Mothers who seek professional medical help were compensated as well with a free birth certificate. At the same time, Sali enacted an ordinance to mete out stiff penalties to traditional healers who stubbornly practice their trade.
The first to be chastised by the ordinance was his own grandmother who was summoned to the police precinct to pay a P1,000-fine for initial offense. Sali said his poor grandmother had to ask money from him for the penalty.
“I gave her the money in exchange for her promise not to assist pregnant women at home anymore,” recounted Sali, who was appointed mayor in 2006 of the then newly created and impoverished municipality of Akbar.
At first, it was hard to convince traditional healers to stop the practice that put many mothers and babies in danger. But a monthly gathering with the municipal health officer slowly reshaped their beliefs and habits and made them well-informed barangay health workers, said Sali.
No IRA
Since 2014, Akbar has managed to achieve zero maternal and newborn deaths and improve facility-based deliveries from a dismal five percent in 2013, to 94 percent this year.
This, without having a share in the Internal Revenue Allotment (IRA) for nearly a decade now, the mayor pointed out.
Salih has a similar story of reversing the chronic health problems of Tandubas, but only after she overcame the rift between her and the municipal health officer, and realized that collaboration between them was important.
“It was not because we were fighting,” Salih said in a speech. “We just didn’t have enough reason to collaborate except on occasions when the rural health unit needed extra money or I needed to address an event as mayor,” she added.
“I also heard things about the municipal health officer that I didn’t like,” Salih said. But the frosty relations thawed when the leadership program brought them together.
In 2014, the two officials sat down for the first time to map out an action plan to address maternal and infant deaths and other health issues in this town located northeast of Tawi-Tawi.
The renewed alliance resulted in zero maternal deaths in Tandubas since last year and a surge in facility-based deliveries from 85 percent in 2015 to 90 percent this year.
Mastura meanwhile worked to sustain the gains made by his predecessor, his father Armando, in eliminating maternal deaths and fixing poor health-seeking behavior among pregnant mothers in Sultan Mastura.
Despite the absence of a municipal health officer and public health nurses, the small town of less than 5,000 households has been recognized as one of the first two ARMM municipalities to have reached the national target of 90 percent in facility-based deliveries and skilled birth attendance.
To stem the persistent problem of women’s preference for home births, Mastura worked with his health team on a program that gave pregnant women priority coverage under the Philippine Health Insurance Corp. (PhilHealth), on condition that they complete four prenatal checkups.
“Among Muslims, mothers weigh three times more than fathers. It only goes to show how important mothers are in our society,” said Mastura.
The strategy raised the rate of facility-based deliveries and skilled birth attendance to 91 percent middle of last year.
“We achieved these results through dedication, teamwork, proper programs, tight coordination and right incentives,” Mastura said, referring to the midwives’ share in incentives under PhilHealth’s maternal care package.
Good governance
“We celebrate because we have more Moro health champions whose good governance practices will reduce health inequities in their region, which is the poorest in the country,” said ZFF chair Roberto Romulo at the culmination of the health leadership and governance program.
Romulo said the ratio of births assisted by skilled birth attendants in the 19 ARMM towns rose from 54 percent in 2013 to 75 percent on the first half of 2016.
The rate of facility-based deliveries also surged from a dismal 23 percent in 2013 to 60 percent in the first half of 2016, he added.
The municipalities that reached the 90-percent target were Taraka and Masiu in Lanao del Sur; Sultan Mastura in Maguindanao; Sibutu in South Ubian; Tandubas in Tawi-Tawi; Kalingalan Caluang in Sulu, and Akbar in Basilan.
This story can also be viewed at http://newsinfo.inquirer.net/866281/more-than-a-motherhood-statement.
Dr. Stephen Zuellig
He was born in Intramuros, Manila on May 4, 1917. He died on January 8 four months before his 100th birthday. Much can be written about this businessman, who unlike trading houses of yesterday, successfully transformed his business into a regional multinational of today. Two presidents recognized him for his outstanding advocacies abroad: former president Fidel V. Ramos decorated him twice, including the Order of Sikatuna, rank of Datu in 1998. President Gloria Macapagal-Arroyo decorated him with the Order of Lakandula – Grand Cross (Bayani) in 2007.
I have been associated with Stephen Zuellig for almost a quarter century. A memorial was held for him yesterday at The Peninsula Manila. Allow me to reprint my remarks.
“Adversity shapes a man’s life as much as opportunity. In the case of Dr. Stephen Zuellig, both were crucial factors in forming the values that he lived by and that animated the Zuellig Group of Companies. From his early days in school and university, throughout his career as a successful businessman and discreet diplomat, Stephen exemplified qualities that set him apart. He was a classic gentleman who lived in modern times, a discerning citizen of the world who blended European mode of thought with Asian sensibilities.
In business, Stephen – employing his determination, his sense of balance and his innate business acumen, combined with foresight – transformed a Manila-based trading house into an international group of industry-leading companies. In looking at the reasons for the Zuellig Group’s success and longevity, it would be instructive to quote what Stephen had to say to explain his achievement: ‘In my case, being successful has had a variety of causes – good education, a good set of ethics, a good family name, and a degree of flexibility that was up to the challenge of Asia at this time of extraordinary development. This flexibility he further amplifies when he said, ‘It is ultimately what I want to achieve that governs how I act. At all times though, within a set of ethics.’
After Christmas, I decided to write Stephen my new year’s letter which I believe is appropriate to express the same sentiments today in this memorial:
“Dear Stephen: Wishing you prosperity and even longevity seems a bit bizarre when you consider how you have achieved both “summa cum laude.”
I salute your modus vivendi of approaching whatever confronts you objectively and always striving to arrive at a conclusion with a “sense of balance.” The iconic Zuellig Building is a case in point. Many consider its construction as a testament to the success of your personal enterprise, and yet it is at the same time the institutionalization of the Zuellig brand.
Your “sense of balance” manifests also in your philanthropic endeavors. There is a Chinese adage that says: ‘Give a man a fish, you feed him for a day; teach a man to fish, you feed him for a life time.’ You have done so in multiple ways.
You have been a strong supporter of the endeavors of the Asian Institute of Management, particularly in the field of development management for the ASEAN region.
You have also been a generous supporter of the Virlanie Foundation which helps bring back the smile to the street children through its various programs, including education and skills training – that help empower them to live life to the fullest.
And most of all, the Zuellig Family Foundation has had a transformative impact on healthcare for the rural poor. To be precise, 634 municipalities and 32 provinces, representing almost half of our population have been impacted by the foundation’s endeavors. The foundation’s health leadership and governance program has been adopted by mayors and governors and the regional offices of the health department.”
In 2017, Dr. Zuellig approved a donation for the UP Manila College of Public Health for the construction of a new building. Unfortunately the papers were not finalized. Hopefully, the legal procedures in Europe, on estate matters, will be finalized in the near future.
Personally, I take great pride in having been part of Dr. Zuellig’s noble ventures. I wish to express my profound gratitude for his friendship, wisdom and unstinting support.
My wife Olivia and I wish to express our deepest sympathy and condolences to the Zuellig Family.”
This column can also be viewed at http://www.philstar.com/business/2017/01/27/1665753/dr-stephen-zuellig.
Innovative health competition wins popular support
Would you like a program that wins support of community leaders and members? Would you like to sustain your health programs?
Know about the “Seal of Health Governance.”
Implemented in Del Carmen, Surigao del Norte, this innovative program has encouraged all villages in this fifth-class municipality to work and innovate so they can reach different health targets.
Read about our Policy Brief in our “Publications.”
A SHARED RESPONSIBILITY
United Nations Population Fund (UNFPA) country representative Klaus Beck (left) and Zuellig Family Foundation (ZFF) president Ernesto Garilao (right) hand over training modules to the Department of Health (DOH) leaders in a symbolic handover ceremony during the ZFF-UNFPA Colloquium on November 10. The colloquium is the culminating activity of a four-and-a-half-year leadership and governance training program of the DOH, ZFF and UNFPA. Inclusion of indigenous peoples and Bangasmoro-sensitive indicators in the health roadmaps are among the innovations in its nine partner provinces including Mountain Province, Camarines Norte, Sarangani, Eastern Samar, Albay, Surigao del Sur, Ifugao, Compostella Valley and Sultan Kudarat. Present to receive the modules are (from left) DOH Director Dr. Enrique Tayag, Assistant Secretary of Health-Mindanao Cluster Dr. Abdullah Dumama, Region 8 Assistant Regional Director (RD) Dr. Paula Sydiongco, Cordillera Administrative Region RD Dr. Lakshmi Legazpi, Provincial DOH Officer Dr. Jocelyn Iraola, Region 12 (Soccsksargen) RD Dr. Francisco Mateo, and Region 13 (Caraga) RD Dr. Jose Llacuna.
Health: Everybody’s concern
By Roberto R. Romulo, The Philippine Star
The Autonomous Region in Muslim Mindanao (ARMM) continues to face economic and social development challenges and has one of the country’s worst health indicators. The Zuellig Family Foundation’s (ZFF) work in the ARMM started with four municipalities in 2008. Significant improvements in maternal and child health were achieved in these municipalities. This experience laid the groundwork for ushering in more partners and LGUs in the region. Under a partnership agreement with the US Agency for International Development (USAID), ZFF expanded to 24 more municipalities.
Last Oct. 14, ZFF jointly organized with the DOH, USAID and DOH-ARMM a Colloquium that marked the culmination of a two-year Health Leaders for the Poor Program participated in by leaders from the 19 municipalities in ARMM.
ZFF chairman Romulo and ARMM Health Secretary Sinolinding presented a certificate of appreciation for USAID and as a token of gratitude and farewell, a Bayanihan sculpture, to Ambassador Goldberg.
Despite the challenges, there were six LGUs who achieved the Philippine target of 90 percent in skilled birth attendance and facility based deliveries. These municipalities were recognized during the Colloquium: Taraka and Masiu in Lanao del Sur; Sultan Mastura in Maguindanao; Tandubas in Tawi-Tawi; Kalingalan Caluang in Sulu and Akbar from Basilan.
ZFF chairman Romulo and ARMM Health Secretary Sinolinding presented a certificate of appreciation for USAID and as a token of gratitude and farewell, a Bayanihan sculpture, to Ambassador Goldberg.
While there have been marked improvements in maternal health and tuberculosis outcomes, program results also show the continued need for interventions in the ARMM.
DOH Secretary Paulyn Ubial said “the Department cannot do this alone, we need partners, and we need you to be able to help us meet the challenges.” This perfectly coincides with American Ambassador Philip Goldberg’s message, wherein he cited that from “2012 to 2017, USAID is contributing more than three billion pesos to Mindanao and ARMM, with 500 million pesos specifically allocated for health activities.”
Vice-President Leni Robredo stressed in her keynote speech that “the key to ARMM’S progress is good governance, strong and honest leadership, transparency and accountability….. I believe that is why Zuellig’s and USAID’s health program is working so well.
“We all know that when mayors first get elected, they have no idea about the intensity of public health challenges they will face. More so the solutions that are urgently needed. Programs like yours (DOH) and partners like Zuellig and USAID allow mayors to quickly understand the problem and become a catalyst for change. The mayor understands that he needs to go beyond medical missions or paying for the medicine and hospital bills of his constituents, establish a clear vision for health change and be a health ambassador, so that his constituents develop co-ownership of health programs…. Ultimately, he must be committed to providing health services to all, especially the poor.”
On behalf of the Zuellig Family Foundation, we wish to thank the DOH, USAID and ARMM for their sustained support of our Health Leadership and Governance program.
This column can also be viewed at http://www.philstar.com/business/2016/10/21/1635639/health-everybodys-concern.
ARMM health gets support from government heads, US
“The keys to ARMM’s progress are good governance, strong and honest leadership, transparency and accountability, and an ability to love its history,” Vice President Leni Robredo said in a colloquium of Autonomous Region in Muslim Mindanao (ARMM) health leaders.
“Programs like yours and partners like Zuellig and USAID allow mayors to quickly understand the problem and become a catalyst for change,” Robredo added, pertaining to the Zuellig Family Foundation’s multi-modular training for local leaders that seeks to improve their understanding of the public health system to effectively provide programs that would address their constituents’ health needs.
She said the mayors need to go beyond medical missions or paying for the medicine and hospital bills of his constituents, establish a clear vision for health change, so that his constituents develop co-ownership of health programs.
The program is supported by the Department of Health (DOH) and the United States Agency for International Development, and at the event DOH Secretary Pauline Ubial stressed the government’s thrust for an inclusive healthcare. She said, “The Philippine Health Agenda is for everyone including our Muslim leaders, our Moro leaders and our Moro people, so our battle cry is All for Health towards Health for All.” She added the new health agenda includes financial risk protection and the “best possible health outcomes for all Filipinos with very little disparities across social economic class, race, ethnicity and geographic situation.”
Among the 19 ARMM municipalities recognized for finishing the program were Akbar, Albarka, Lamitan, Lantawan, Simisip, Tabuan Lasa, Tipo-Tipo, Tuburanand Ungkaya Pukan in Basilan; Kalingalan Caluang in Sulu; Sibutu, South Ubian and Tandubas in Tawi-Tawi; Masiu, Piagapo, Pualas and Taraka in Lanao del Sur; and Sultan Mastura and Sultan Sa Barongis in Maguindanao.
In 2009, ZFF began its health intervention program in select municipalities in ARMM using its Health Change Model as strategy. By 2013 it expanded its reach to 39 municipalities, or 34 percent of all ARMM municipalities.
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In photo are (from left) USIAD Director for Office of Health Karen Klimowski, ZFF President Ernesto Garilao, Tandubas’ Mayor Rahiema Salih and municipal health officer Dr. Allahminda Uriben and DOH-ARMM Secretary Khadil Sinolinding. Tandubas received a special citation for reaching the national target of 90 percent for facility-based delivery during the ARMM Colloquium on October 14.
Leadership program to improve nutrition of poor mothers and children
Two fourth-class geographically isolated and disadvantaged municipalities are the pilot areas for a nutrition project to reduce prevalence of low birthweight, stunting, wasting, underweight children and underweight expectant mothers.
Gamay, Northern Samar and Looc, Romblon are sites of the Zuellig Family Foundation’s (ZFF) three-year project supported by Switzerland-based Kristian Gerhard Jebsen Foundation, which provided $300,000, or over P14 million worth of grants.
Using the bridging leadership framework as key strategy for health leadership transformation of local chief executives, it will document a change strategy to promote healthy eating behavior and address poor maternal and child nutrition.
Latest 2015 data show malnutrition rate of Gamay and Looc are at 9 percent and 7 percent, respectively. The accuracy of numbers still has to be determined considering factors such as underreporting, availability and functionality of assessment equipment, as well as the competence of staff.
Thus, the project involves capacitating barangay nutrition scholars (BNS) on community-based nutrition promotion and counselling. ZFF tapped the University of the Philippines Los Baños-Institute of Human Nutrition and Food for training BNS and for coming up with a training module.
This project is also aligned with the Sustainable Development Goal 2, or “End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.”
In photo are Gamay Mayor Mayor Timoteo Capoquian and Looc Mayor Leila Arboleda (center left and center right, respectively) during the official launch of the project St. Giles Hotel in Makati. The two leaders led the commitment signing declaring their support to the First 100 Days Initiative, which aims to promote and protect welfare of mothers and their children.