Zuellig Family Foundation’s “Bridging Leadership” (BL) Framework for health has now reached Indonesia thanks to a partnership among the United Nations Population Fund’s offices in the Philippines and Indonesia, the Philippine Commission on Population (PopCom) and the Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN-National Population and Family Planning Board).

Seeing BL’s value to the Indonesian health system, which is also devolved, PopCom invited ZFF to make a presentation of its strategic intervention in leadership and governance before an audience of Indonesians during their program in General Santos City in Mindanao. From that short session, ZFF found itself collaborating with PopCom for an internship program for its Indonesian partners involved in reproductive health (RH) and family planning (FP) programs.

The six-day “Internship of Indonesian Implementer on Decentralization and Family Planning and Reproductive Health Program” included a two-day training workshop and an educational trip to ZFF’s partner-municipality of Hinatuan in Surigao del Sur. In all, 14 Indonesians attended the program.

Working in the provincial offices of the BKKBN, the participants’ learning from the internship program is intended to make them the bridging leaders who will serve as the link between the national and provincial offices and the local government units or the districts, much like the responsibilities of the Filipino DOH representatives (DOH Reps), whom ZFF has been training to become effective “coaches” to mayors when it comes to improving local health systems.

Despite differences in languages, the Indonesian participants expressed appreciation for the program with one of them, Samidjo, UNFPA Indonesia programme officer, asking for more reference materials they can read so they can have more in-depth knowledge of ZFF’s teachings.

For Dr. Djoko Sulasno Nimpuno, head of the Family Welfare Office in Bantul district, the short course on BL improved his “self-esteem” and taught him “how to implement the program” he was in charge of in his country. And having heard the leadership journey narration of Santol, La Union mayor Daisy Sayangda, who underwent ZFF’s program in 2012, Sustra Dewi of Bangka Belitung district, another training participant, was also “inspired by what ZFF has done to municipalities” and hopes to be able to implement the same in her area in Indonesia.

At the closing of the internship program following their trip to Surigao del Sur province, where they also heard provincial governor Johnny Pimentel and Hinatuan mayor Candelario Viola Jr. share their leadership stories, the trainees gained greater appreciation for the importance of making RH and FP programs not only the responsibility of their leaders and district health officers but more importantly, of the community. They presented specific action plans integrating their new learning to strengthen their program implementation in Indonesia.

Country representative of UNFPA Philippines Klaus Beck, at his closing speech, also emphasized that its partnership program with the Philippines and Indonesia is aligned with the Sustainable Development Goal 17, which is on strengthening global partnerships for development.

Since 2009, ZFF has been using the BL framework to transform local health leaders—mayors, municipal health officers and relevant regional health officers like the DOH Reps in the hopes of improving the health outcomes of the Filipino poor.

Facilitating the two-day training workshop in Manila were members of ZFF’s Community Health Partnership Program team led by its director Bien Nillos, M.D., Romulo Nieva, Michael San Roque and ZFF’s partnership associate Sealdi Calo-Gonzales.

Good marketing campaign is needed to popularize and sustain health programs.

For over six years, the Zuellig Family Foundation has been giving health leadership and governance capability-building programs to mayors and municipal health officers (MHOs) of its partner municipalities. The training has led local governments to come up with innovative health programs meant to improve health outcomes.

The challenge is in communicating the programs and making them sustainable. So ZFF decided to include a session to respond to mayors’ expressed need for assistance in ensuring their health and other social programs gain traction in their communities and become sustainable beyond their terms in office.

For the session entitled “How to Communicate the Vision?” ZFF invited veteran advertising executive and FCB general manager Ellen Samano, who gave the basic pointers on how to create and execute sustainable marketing campaigns. She also pointed out that running successful campaigns does not entail big budgets for as long as local leaders can identify a small core group composed of people who believe in the program objective, can do research, has creative ideas and lead the group.

Lessons learned from Samano’s talk were also applied during the next session, which was on “Diffusing Change in the Community and Sustaining Gains.” This was facilitated by University of the Philippines-Manila Assistant Professor Anthony Cordero M.D., who also reiterated some of the points given by Samano.

The seven municipalities included in the training module belong to ZFF’s “alumni” municipalities or those whose mayors and MHOs have completed ZFF’s program.

On the opening day of the three-day colloquium of academic institutions involved in a capacity-building program for mayors and public doctors, former Health Secretary Jaime Galvez Tan underscored health as being a fundamental right of all individuals. Unfortunately, Galvez said, “It is also the most vulnerable and one of the most denied.”
Such health inequity continues to persist in the country, worsening the health outcomes of the poor as well as preventing the country from achieving its Millennium Development Goals on health.

Given the complexity of health challenges, several stakeholders have come together to overcome these. Among them are the academic institutions that were tapped to deliver health leadership and governance capability-building program to mayors and municipal health officers of different municipalities.

These academic partners are part of the Department of Health’s program with the Zuellig Family Foundation. The partnership program follows ZFF’s strategy, the “Health Change Model,” which posits that leadership is the key to jumpstarting health system reforms needed to reduce inequities and improve health indicators.

The joint initiative, called “Health Leadership and Governance Program,” began in 2013 now counts 12 academic partners that have provided training to mayors and MHOs from over 500 municipalities.

Last Wednesday, representatives of the 12 came together for the first time to deepen their appreciation for “Bridging Leadership” (BL), which is the principal framework used in turning each mayor and MHO into a leader capable of bringing people together, bridging societal divides and working towards common health goals.
Aside from Galvez Tan, participants heard the leadership journeys of individuals who were among the first to get the bridging leadership training in the Asian Institute of Management.

Brig. Gen. Carlito Galvez Jr. spoke about the difficulty of shifting military strategy from enemy-oriented to people centered in solving conflicts and insurgency. His efforts would eventually lead to the creation of the Civil Military Operations battalions unit in the Armed Forces of the Philippines.

Miriam Suacito talked about how her faith-based, Christian NGO Nagdilaam Foundation continues to thrive in the predominantly Muslim province of Basilan despite setbacks, which included having had two of her staff personnel kidnapped. Her leadership has earned the trust of the community—the military, common townsfolk and even the More rebels.

Leadership that understands and respects culture allowed Easterluna Canoy to fix the serious misunderstanding between the military and indigenous people in Mindanao.

Theirs and five others’ stories showed how strong and collaborative leadership solved complex problems and won popular support. They showed how leaders who accept ownership of a problem and work with their people could possibly fix health system failures and minimize inequities.

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).

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.

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.

This column can also be viewed at http://www.philstar.com/business/2017/01/27/1665753/dr-stephen-zuellig.

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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.