At least 60 percent of Filipino households are experiencing moderate to severe food insecurity amid the pandemic, a 2020 Food and Nutrition Research Institute survey showed. The first 1,000 days (F1KD) population proved to be most at risk, with reported higher food insecurity among households with pregnant women and children (including those below two years).

To address food insecurity in their communities, the provincial governments of Zamboanga del Norte, Northern Samar, and Samar under the Provincial Nutrition Governance Program (PNGP) increased their budget allocation and utilization for integrated health and nutrition programs.

PNGP, a partnership between the Zuellig Family Foundation and the United Nations Children’s Fund, aims to have a comprehensive and integrated nutrition program wherein health and nutrition sectors work with other agencies, including education, agriculture, and social welfare.

Ground-level efforts
In an online executive session titled “Deepening Leadership: Sustaining Gains and Managing Change for F1KD” last July 21, Zamboanga del Norte shared its Enhanced Gasang Bahandianon para sa Umahan (eGBU), an anti-poverty program and social entrepreneurship project that integrates health and nutrition information, services, education, environment, and agriculture.

At the household level, the eGBU operates by distributing starter kits containing seeds, fertilizer, and basic planting equipment. Under this initiative, the participants learn farming, food processing, and marketing to have direct access to food and a source of sustainable income and livelihood.

Produce from the eGBU will also be used for the Bigas Monggo (BiMo) food packs, which will serve as supplementary food for children and pregnant women.

Meanwhile, the provincial government of Samar has an ongoing partnership with the Department of Science and Technology for complimentary food processing. It also plans to implement backyard farming.

Likewise, in Northern Samar, the local government plans to organize province-wide communal gardening to engage the community toward food security.

The Zuellig Family Foundation (ZFF) signed a three-year partnership with the Local Government Academy (LGA), which aims to boost the capacity of local government units (LGUs) to deliver basic services, including health, following the full devolution of such services to the LGUs.

For the LGUs to take on additional functions, the local chief executives must gain new knowledge and skills to better strategize and invest in effective measures that will immediately improve health outcomes and bring about inclusive growth.

During the online signing event held last July 16, Executive Director Austere Panadero represented the ZFF, with Deputy Executive Director Dr. Anthony Faraon acting as a witness to the signing. Their counterparts were LGA Executive Director Thelma Vecina and Director Esmeralda Daphne Purnell.

The partnership will address Universal Health Care (UHC) implementation readiness, nutrition during the first 1,000 days of life (F1KD), adolescent sexual and reproductive health (ASRH), pandemic response, and local health system resiliency.

A recording of the signing ceremony can be found on ZFF’s Facebook Page: https://bit.ly/3iFQArS.

Local government units (LGUs) do not only lack COVID-19 vaccines, but they also do not have enough vaccinators. This concern was echoed among the participants in the webinar “May Bakuna Pero Walang Magbabakuna: What Can LGUs Do?” of the Zuellig Family Foundation (ZFF) and the Philippine Center for Population and Development.

During the webinar held last June 18, Dr. Aleli Annie Grace Sudiacal of the Department of Health assured that the national government would urgently hire needed personnel.

Inadequate human resources
Due to the shortage of personnel, most LGUs rely heavily on volunteers. Some volunteers, however, are not as committed and unwilling to take on other related tasks. Some do not even show up.

Another consideration among LGUs is balancing the team members onsite and doing house to house for the marginalized sector, such as the bedridden senior citizens.

Having inadequate manpower is especially felt in small towns and geographically isolated and disadvantaged areas (GIDA). Rural health units in small towns only have one doctor and two nurses.

Sustainable solutions
The DOH emphasized developing a national deployment vaccination plan for a successful vaccination program toward herd immunity by vaccinating 70% of the population. Further, the plan should be reviewed to employ innovative strategies and mechanisms in addressing emerging challenges.

To stop relying on volunteers, pharmacists and midwives can now administer vaccines in addition to doctors, nurses, and dentists. Administrative and support functions can also be given to non-health care workers. Graduates of health science education courses who are not yet licensed may be part of the vaccination teams provided that they are under the supervision of licensed health professionals. Other health professionals, such as medical technicians, cannot administer the vaccine but can be part of the vaccination team.

Simply adding personnel, however, is not sustainable. For Sudiacal, the national government and private sector should consider regulatory and financing interventions requiring all graduates of health-related courses to render mandatory service as members of the vaccination team and the vaccination to be covered by health and maintenance organizations (HMOs).

A recording of the webinar can be found on ZFF’s Facebook Page: https://bit.ly/2Uhb4id.

At least 495 babies are born every day to Filipino girls aged 10 to 19 years, according to the 2019 data of the Philippine Statistics Authority. To address this, Malacañang declared as a national priority the implementation of measures to prevent teenage pregnancy through Executive Order (EO) No. 141, which further mobilized government agencies, the youth, and the community to work together in addressing the root causes of the problem.

Ahead of the EO signed on June 25, an additional 10 cities already heeded the call of The Challenge Initiative (TCI) in the Philippines to reduce teenage pregnancies. TCI aims to establish adolescent-friendly health facilities that promote positive health-seeking behavior and improve access to family planning programs.

Related story: Establishing adolescent and youth-friendly cities seen to help curb teenage pregnancies

Started in 2020, the TCI in the Philippines is co-managed and co-funded by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health. The five-year project has been implemented in three pilot sites (Dipolog, Cagayan de Oro, and Puerto Princesa cities) in collaboration with the Commission on Population and Development (Popcom).

10 scale-up cities
The 10 scale-up cities are Santiago (Isabela), Baguio, San Jose (Nueva Ecija), Biñan (Laguna), Naga (Camarines Sur), Tacloban, Iloilo, Tagum (Davao del Norte), Tacurong (Sultan Kudarat), and General Santos. These were selected based on high political commitment, available budget and other resources, health system readiness, size of potential impact, and identified stakeholders.

The participating cities will be given technical assistance and guidance on TCI’s proven high-impact approaches on leadership and governance, quality adolescent and youth sexual and reproductive (AYSRH) health services, youth engagement, and demand generation.

Interventions include comprehensive sexuality education, inter-generational dialogue, policy development, and information and service delivery network for adolescent health and development.

Related story: Youth-led participation of religious sector in reducing teenage pregnancies

According to experts, clusters are the main engine transmission of the COVID-19 pandemic. That is why knowing where, when, and why they happen through effective contact tracing could help curb the transmission rate while the COVID-19 vaccine is not yet widely available.

In a series of executive coaching sessions with the provincial governments of Agusan del Sur, Aklan, and Bataan, former Health Secretary Manuel Dayrit highlighted the importance of mapping out contact tracing and utilizing the results as part of risk communication.

Creating visual stories
Dr. Dayrit, also a trustee of the Zuellig Family Foundation (ZFF), pointed out that an effective contact tracing entails testing all contacts, identifying and isolating symptomatic and asymptomatic contacts, locating clusters in the barangays, and understanding the transmission patterns.

Citing a good practice in Taguig City, Dr. Dayrit recommends developing the results of contact tracing into visual stories to warn people of how COVID-19 transmission happens. For example, a gym instructor conducting classes without a mask reportedly infected 21 people (who further infected other people) in three days.

The online sessions held on April 23 and 28, and May 7 were part of ZFF’s Provincial Leadership and Governance Program (PLGP). The program aims to prepare provinces for Universal Health Care systems integration.

Addressing complacency
In all three provinces, people’s complacency in following minimum health standards has resulted in super spreading events and clustering of cases.

Agusan del Sur has eased border controls but is counting on stricter implementation of health protocols as its best defense against COVID-19. The provincial government distributed 85,000 face masks throughout the province and drafted an ordinance penalizing people who do not follow minimum health standards.

A more personal approach to enforce the minimum health standards is needed in Bataan, as the province’s main challenge is the authorized persons outside of residence (APOR) returning on weekends. Dr. Dayrit suggested the governor reach out to each family to make the message more personal and appealing to them. The local leaders are also looking into a policy that will allow residents working outside Bataan to go home only after doing a mandatory quarantine.

Meanwhile, Aklan is already on the right track when it comes to contact tracing. But the province still wants to focus on effective messaging to avoid super spreader events in places such as Boracay. Another challenge is the financing of treatment for COVID-19 patients as reimbursements from PhilHealth are too slow.

In a pandemic, people must receive accurate and timely information so they can make informed choices. To help provincial health leaders in their critical risk communication task, Zuellig Family Foundation (ZFF) co-created a manual with the governments of Agusan del Sur, Aklan, and Bataan.

The manual contains the basic steps, worksheets, templates, and recommended activities in enhancing risk communication plans. It is available here: https://bit.ly/3ft3Bn6.

Webinar on COVID-19 vaccine
ZFF also addressed concerns about the COVID-19 vaccine by holding a webinar on May 17. Safety emerged as a common concern among the participants, particularly to those with comorbidities such as chronic respiratory disease, hypertension, cardiovascular disease, malignancy, diabetes mellitus, obesity, and chronic kidney disease.

Dr. Catherine Chung, ZFF director, reiterated that the COVID-19 vaccine is safe and effective even for those with underlying medical conditions. However, those with autoimmune conditions, (human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or cancer, and those who had a transplant or are bedridden need medical clearance to get the vaccine.

Dr. Anthony Faraon, ZFF deputy executive director, also clarified that the vaccine is not advisable for people with allergies to the ingredients of the vaccine and those who had severe allergic reactions after their first dose. Minors, too, are not yet advised to take the vaccine.

Questions about side effects were also raised. Dr. Ramir Blanco, ZFF director, noted that blood clotting due to the COVID-19 vaccine is rare (about 4 in 1 million). The common side effects are pain, redness, itchiness or swelling on the area of injection, and flu-like symptoms (chills, joint pains, headache) that will all subside in one to three days. These are signs that the body is building immunity to the virus.

The webinar also showed the BIDA BakuNation video of the Department of Health (DOH) on the 10 common questions about the COVID-19 vaccine as narrated by public health expert Dr. Beverly Lorraine Ho. The video highlighted the need to have at least 70 percent of the population be vaccinated to achieve herd community and effectively protect everyone from the COVID-19 virus.

A recording of the webinar can be found on ZFF’s Facebook Page: https://bit.ly/3hCKDNo.

Among the provinces in Eastern Visayas, Samar recorded the highest stunting (impaired growth and development) prevalence among children under two years old at 29.4 percent in 2019. Acknowledging the urgency of addressing malnutrition, the provincial government of Samar launched its “Tatak Tangkad” program to fast-track its efforts in improving nutrition among pregnant and the first 1,000 days (F1KD) population—children 0 to 23 months old.

In his opening remarks during the program launch yesterday, Samar Governor Reynolds Michael Tan highlighted that stunting does not only concern height, but also the overall brain development of the child that could lead to severe consequences later in life if neglected. According to the World Health Organization, the most crucial period to address stunting is during the F1KD of a child’s life because this is a period of rapid physical growth and accelerated mental development.

Improved F1KD numbers
Through the “Tatak Tangkad” program, the provincial government aims to bring down stunting and wasting (too thin for a given height) prevalence among children below two years old by 25 and 10 percent in 2025, respectively. It also aims to reduce the number of nutritionally-at-risk pregnant women and low birth weight infants.

Since July 2020, Samar has been undergoing interventions for improved F1KD nutrition under the Provincial Nutrition Governance Program (PNGP) of the Zuellig Family Foundation and United Nations Children’s Fund. PNGP aims to have a comprehensive and integrated nutrition program that will have health and nutrition sectors working with other agencies, including education, agriculture, and social welfare.

Declaration of commitment
Governor Tan also called on the local leaders, partners, other agencies, and the community to support the “Tangkad Tatak” program: “Help us end the cycle of child malnutrition in Samar. There is no better time to do it but now.”

The Samar community affirmed its collective response in addressing malnutrition with the signing of a declaration, committing themselves to become “champions for the improvement of maternal and child nutrition” in the province.

Tatak Tangkad will be an intersectoral collaboration targeted at the vulnerable and disadvantaged F1KD population. Tracking, monitoring, and referrals of malnutrition cases will be handled by a so-called team of navigators composed of parent leaders, youth representatives, barangay health workers, and barangay nutrition scholars. Identified at-risk individuals will be enrolled in the program.

With disrupted nutrition-related services amid the pandemic, the World Health Organization (WHO) is expecting an increase in the levels of malnutrition among vulnerable households. In the Philippines, one in every five children under two years old is stunted or too short for their age and 7 percent is wasted or too thin for their height, according to a 2019 Food and Nutrition Research Institute (FNRI) survey.

To effectively manage these numbers, studies have shown that community engagement plays an important role. Anchored on this, governors of Basilan and Sarangani are enhancing their capacities toward gaining increased support from the ground level through the Provincial Nutrition Governance Program (PNGP).

Designed based on positive results
A second partnership project of the Zuellig Family Foundation (ZFF) and Kristian Gerhard Jebsen Foundation, PNGP focuses on addressing nutrition problems in the crucial first 1,000 days (F1KD) of life—from conception up to two years of age. Stunting during this stage, in particular, may have is irreversible effects on the cognitive development and growth of children, according to WHO.

These efforts reduced the stunting rate among the municipalities’ 0 to 23-month-old children from 19 percent in 2017 to 15 percent in 2019, lower than the national rate of 21.9 percent, according to FNRI.

Community participation
Among the interventions, executive sessions titled “Nutrition Leadership and Governance: Instituting Change for Co-Ownership and Co-Creation” were held for Governors Jim Hataman-Sallimana (Basilan) and Steve Chiongbian Solon (Sarangani) on March 30 and April 15, respectively.

The sessions highlighted increasing community engagement by transforming into sensitive leaders who can understand the culture and behavior of the community. This will help the leader gain a deeper connection and shared responsibility of improving nutrition security, and eventually, having an integrated nutrition system toward a reduction in stunting and wasting among children.

This strategy includes strengthened leadership, improved messaging, and locally-tailored health and nutrition service design and delivery toward continuous ground-level support. This is especially important amid an increase in food insecurity due to food supply chain disruptions, interrupted market movement due to quarantine restrictions, and higher prices of nutritious foods during the pandemic.

Other tried and tested ZFF strategies in improving the numbers of nutritionally at-risk pregnant women, low birth weight infants, and stunted and wasted children, and ensuring the proper health of pregnant women and infants were also discussed.

The provision of family planning (FP) commodities and counseling takes a back seat during emergencies, posing life-threatening complications to pregnant women and girls. The new program of the Zuellig Family Foundation (ZFF) aims to avoid this scenario by introducing local government units to the Minimum Initial Service Package (MISP) for Sexual Reproductive Health (SRH) training course.

The initiative, a partnership with the United Nations Population Fund (UNFPA) and funded by the Australian Aid, will strengthen the competencies of provincial leaders to implement life-saving SRH information and services during natural disasters and other public health emergencies. The pilot sites are the provinces of Catanduanes, Laguna, and Maguindanao.

Catanduanes
Last July 30, ZFF and UNFPA rolled out the executive course on MISP for SRH to Catanduanes. The provincial leaders will be training until September 2021 to ensure that the province has the funds and an integrated system for the continuous delivery of SRH services and commodities amid disasters, pandemics, and other emergencies.

Known as the “Land of the Howling Winds,” the province of Catanduanes is frequently visited by typhoons. Last year, at least 8,000 pregnant women—20 percent of which are adolescents—lacked access to SRH services after the back-to-back typhoons Rolly and Ulysses amid the COVID-19 pandemic. Women and girls are also at risk of unintended pregnancies, sexual violence, exploitation, and HIV infection during such situations.

MISP for SRH
The executive course uses a blended learning approach through asynchronous sessions and online workshops with participants from the offices of the governor, vice governor, provincial health, provincial disaster risk reduction and management, budget, social welfare and development, planning and development, and administrator.

The MISP for SRH is a set of priority activities during emergencies that prevent and manage SRH issues and help plan for comprehensive SRH services during the recovery and rehabilitation phase of an emergency response. Activities include the continued provision of FP commodities and counseling and establishing women and child-friendly health spaces. Participants will acquire the basic leadership knowledge, skills, and attitude to create a shared change agenda and more responsive plan to address the gaps in their health systems toward increasing access to SRH services.

For inquiries about the MISP for SRH program, email communications@zuelligfoundation.org.