Despite the high risks of early pregnancy and sexually transmitted infections, adolescent sexual and reproductive health (ASRH) remains overlooked by local governments due to the lack of funding. The Department of Health (DOH) Region 10 office stepped up to start changing this scenario by contributing ₱1 million to supplement the initial ASRH activities in Cagayan de Oro (CDO) city under The Challenge Initiative (TCI) in the Philippines.

TCI in the Philippines, a partnership between the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health, aims to reduce teenage pregnancies by promoting positive health-seeking behavior and improving access to family planning programs.

Region 10 (Northern Mindanao) has the second-highest teenage pregnancy rate in the country, according to the most recent National Demographic and Health Survey conducted in 2017. And in CDO alone, at least 1,800 girls aged 10-19 years are already mothers.

Activities for 2021
With the ₱1 million budget from the DOH regional office, at least 10 ASRH activities have been lined up in CDO this year. But for the continuous implementation of these ASRH initiatives, there should be committed funding from the DOH and other agencies concerned.

The city health personnel will undergo training on Adolescent Health Education and Practical Training (ADEPT), Adolescent Job Aid (AJA) manual, Healthy Young Ones, and Reproduction HEEADSSS (Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, and Safety) forms. These activities will help health workers effectively communicate with adolescents and improve service delivery.

Youth leaders are also enjoined in the health provider training, wherein they undergo deep dive activities. Deep dives are integral in the ZFF training, wherein leaders immerse themselves in unfamiliar environments and different contexts to gain a wider perspective of the real situation and create novel solutions to problems.

Other activities include assessment and mentoring of barangays in establishing adolescent-friendly health facilities, annual implementation reviews, and semi-annual meetings with various technical working groups. Part of the donation will also be used to buy office supplies.

A 4th class municipality in Capiz, Dao was among the Zuellig Family Foundation’s (ZFF) nine pilot sites for its Health Change Model (HCM) in 2009. Up to date, then-mayor and now vice mayor Joselito “Bo” Escutin still credits much of the municipality’s success to its local government’s partnership with ZFF: “Thanks to ZFF, I learned what governance should be.”

Anchored on the Bridging Leadership (BL) framework, the HCM focuses on building local health leadership and governance capacities to address health inequities. Interventions include training, coaching, and mentoring.

Through the years, Dao recognizes the role of multi-stakeholder engagement toward a strong, stable, and resilient community—demonstrating the ownership, co-ownership, and co-creation cycle of the ZFF program. The local government commits to achieving better health outcomes for its more than 38,000 citizens in 20 barangays without any exceptions.

Proof of its consistent and collective efforts, Dao has received several health awards, including the 2017 Purple Ribbon Award for its reproductive health programs and the 2017 Regional Local Health System Award (first place). The municipality was also awarded the Seal of Good Local Governance by the Department of the Interior and Local Government in 2015, 2017, and 2019.

Vice Mayor Escutin, the then-vice mayor and now Sangguniang Bayan member Loreto Eslaban, and municipal health officer Dr. Humbelyn Horneja were all ZFF awardees for being outstanding Bridging Leaders in Public Health. Their BL skills helped propel not just Dao’s health care system but also its overall economic progress.

A feature video of Dao can be found on the municipality’s Facebook Page: https://fb.watch/91FEfLi7Tu/.

Local government units (LGUs) should not let their guard down despite the reported decline in new COVID-19 cases. The season of get-together is once again upon us and that can translate to another spike in COVID-19 cases.

According to Bloomberg’s COVID Resilience Ranking of 53 countries last September, the Philippines is the worst place to be amid the pandemic in terms of virus containment, economy, and opening up. Unless the Philippines wants to stay behind, LGUs should heed the advice of former Health Secretary Manuel Dayrit to have an integrated local COVID-19 response system.

Dayrit, also a trustee of the Zuellig Family Foundation (ZFF), shared some tips on how LGUs can handle COVID-19 more effectively during a webinar with the governors of Agusan del Sur, Aklan, and Bataan. The webinar held last July 30 was part of ZFF’s Provincial Leadership and Governance Program (PLGP), which helps provinces manage the pandemic while preparing them for Universal Health Care systems integration.

Dayrit said that LGUs should enhance their Prevent-Detect-Isolate-Treat-Reintegrate (PDITR) strategy by increasing testing capacity, upgrading hospital and isolation facilities, improving contact tracing, locating clusters in the barangays, and understanding the transmission patterns.

He also highlighted the critical role of data-driven strategies in fast-tracking the containment of the virus. More aggressive testing should be done about 3 to 5 times than normal, especially with the highly infectious Delta variant. Dayrit reiterated using the results of contact tracing as part of ground-level risk communication to help stop transmission, especially within households.

Related story: Effective contact tracing, key in curbing COVID-19 transmission

Best practices of LGUs
Even while under General Community Quarantine (GCQ) status, Agusan del Sur implemented heightened border controls with strict adherence to health protocols. The local government also passed an ordinance penalizing people who do not follow minimum health standards. Further, the One Caraga Shield has laid out unified plans for the region’s COVID-19 response.

In Aklan, all tourism personnel was vaccinated to lessen the transmission among workers. The province also shared its strategies with the other LGUs within Western Visayas.

Meanwhile, Bataan has been concentrating prevention efforts at the barangay level to address super-spreader events. New vaccination sites are also opened weekly to fast-track the vaccination rollout as the province enjoys a fair share of vaccines being near Metro Manila.

Educating and empowering her fellow youth to reduce teenage pregnancies in their barangay is a mission shared by May Ann Jacob in her speech during the “Adolescent and Youth Sexual and Reproductive Health (AYSRH) in Action” webinar held last September 22.

Jacob, 25, a Sangguniang Kabataan (SK) councilor from Canitoan, Cagayan de Oro City, represented the youth leaders who trained under The Challenge Initiative (TCI) in the Philippines during the “Youth in Action: Stories from the front lines of TCI” presentation of the webinar.

Co-managed and co-funded by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health, TCI aims to establish adolescent-friendly health facilities that promote positive health-seeking behavior and improve access to family planning programs.

Behavior change design
Jacob’s experience during the Leadership for Adolescent and Youth Friendly Cities training of TCI and in partnership with the Commission on Population and Development taught her that having informed and empowered youth is vital in making adolescent and youth-friendly cities toward reduced teenage pregnancies.

“[The training] taught me that through behavior change design (BCD), we could help our fellow youth in practicing positive behavior to decrease teenage pregnancies,” Jacob said.

The BCD is a human-centered approach that blends insights and methods to come up with best practices in identifying the desired new behavior. The identified change in behavior will then be reinforced among teenagers through innovative solutions. The 8-step process emphasizes the deep dive, which is Step 2.

Deep dive
The deep dive is integral in ZFF programs and gives leaders an opportunity to immerse themselves in unfamiliar environments and different contexts to gain a wider perspective of the real situation and build relationships with stakeholders. “It was an eye-opener on the major challenge of the high incidence of teenage pregnancies in our barangay and the city,” Jacob shared.

Together with their SK Chairman Jun Nador, Jacob came up with an advocacy campaign dubbed “Project Trese” after a deep dive wherein they learned that teenage mothers and fathers in their community lack information and access to AYSRH programs. The project focuses on information and educational activities. In partnership with their barangay health workers, they plan to conduct skills training and give livelihood opportunities to the youth.

World Contraception Day
Held in celebration of World Contraception Day, the webinar hosted by the Gates Institute also showcased the stories of youth leaders and advocates from other TCI hubs in East Africa, Francophone West Africa, and India. There were also presentations on what works in youth advocacy, and contraceptive dynamics during COVID-19 in Nairobi, Kenya.

Observed every September 26, World Contraception Day aims to raise awareness about contraception and guide couples to an informed decision about family planning so that every pregnancy is wanted. This year’s theme was “Contraception: it’s your life, it’s your responsibility.”

The University of the Philippines-Philippine General Hospital (UP-PGH) now has a state-of-the-art isolation facility ideal for handling COVID-19 cases and other infectious diseases. The inauguration of the “Bayanihan Na! Isolation Unit” held earlier today was attended by donors, including the Zuellig Family Foundation (ZFF), the Bureau of Fire Protection, TikTok Philippines, and St. Luke’s Medical Center.

Project Kaagapay
The Foundation donated ₱21 million for the construction (P15 million) and other medical equipment (P6 million). The $21 million was part of the ZFF’s ₱60-million donation to the Project Kaagapay: Protect our Health Care Heroes, a fundraiser of the Philippine Disaster for Resilience Foundation, Zuellig Pharma Corp., Metro Drug Inc., ABS-CBN, and Go Negosyo. The fundraiser has provided personal protective equipment (PPE), ventilators, and other essential medical equipment to help the government hospitals and their front liners respond to the COVID-19 pandemic.

State of the art
As a COVID-19 referral facility, UP-PGH had to temporarily stop admitting non-COVID-19 patients and walk-ins amid the surge due to the Delta variant. UP-PGH accepts only COVID-19 cases with a referral from a hospital or the local government and emergencies and life-threatening cases.

With the new 570-square meter isolation ward, an additional four wards with a 44-bed capacity, including an Intensive Care Unit (ICU) capable ward with 11 beds, will now be available for COVID-19 patients at UP-PGH. The ICU ward was named Zuellig ICU Ward as UP-PGH’s expression of gratitude.

The COVID-19 isolation ward uses a negative pressure ventilation system that prevents potentially contaminated air or other dangerous particles from inside the room from flowing outside into non-contaminated areas. The ventilation ducts are fitted with ultraviolet (UV) light sterilizers and high-efficiency particulate air (HEPA) filters that clean the air before it is pumped outside and away from the healthcare facility. There are also air pocket chambers that protect the personnel from the virus even without wearing PPE.

Amid the absence of a clear COVID-19 vaccine rollout roadmap at the national level, local government units (LGUs) are left with the responsibility to gear up on their own. For the provincial government of Agusan del Sur, holding a two-day workshop, in partnership with the Zuellig Family Foundation (ZFF), strengthened its microplans for a vaccine rollout.

The microplanning workshop held last February 17 and 18 included a scenario-based activity that encouraged the participants to identify strengths and weaknesses in their respective localities’ supply chain management (SCM) governance and technical capacity.

6 scenarios
The participants were given six possible scenarios to gauge their vaccine rollout preparedness. These are: (1) Determining the “priority in the priority” list based on the degree of threat or exposure should there be a limited supply of vaccines; (2) Contingency plans in the event of more than 24 hours of blackout, fluctuating power, or incompatible electrical capacity; (3) What to do when at least one vaccination team member tested positive; (4) Only 50 percent of the people who pre-registered showed up on vaccination day; (5) Support available in case of flooding in the area; and (6) Protocols for pharmaceutical donations.

No blindspots
The workshop also had a dedicated session for examining the Rural Health Units’ (RHUs) microplans. Guided by a worksheet, and through feedback from the ZFF and Department of Health (DOH) representatives, participants were able to identify existing gaps and possible governance and technical challenges and address them accordingly.

With a bottom-up approach, quantifying the vaccines was among the key concerns addressed. Identifying the critical workforce and population will help the province and the DOH to determine the right quantity of vaccines that the province can handle, store, and administer within rational use, which would include monitoring of adverse events.

Three-year microplan
Agusan del Sur developed a three-year microplan for the provincial vaccine rollout consisting of three phases: pre-vaccination, vaccination, and post-vaccination, including waste management. It aims to vaccinate 70 percent (or 506,194 individuals) of its total population with the COVID-19 vaccine by 2023 to reduce morbidity and mortality due to the virus.

According to the province’s Community Based Monitoring System (CBMS), Agusan del Sur has 723,134 constituents. The target was set considering the eligible population who are aged 17 years and above.

With the strengthened microplans through the workshop, the Provincial Health Office (PHO), the DOH, and especially the constituents of Agusan del Sur will hopefully see through this goal together.

Providing access to the right information on adolescent sexual reproductive health (ASRH), family planning, and education through traditional and cultural approaches to reduce teenage pregnancies—this is the vision of Janifah Unda, 24, a youth leader in Masiu, Lanao del Sur. She takes part in the Zuellig Family Foundation’s (ZFF) Youth Leadership and Governance Program (YLGP), a partnership with the United Nations Population Fund (UNFPA) since 2018.

In 2019, an estimated seven girls aged 10 to 14 gave birth every day in the Philippines–a three-fold increase from 2000–according to the Commission on Population and Development (POPCOM). The YLGP aims to help reduce adolescent pregnancies in 10 rural municipalities of Sarangani, Sultan Kudarat, and Lanao del Sur by molding competent youth leaders who can spearhead and engage their community in youth-related health programs. Interventions include leadership and technical training, practicum, coaching, and mentoring.

Islam-compliant ASRH programs
Sharing during the mid-practicum presentation as part of the two-day YLGP virtual workshop held last February 18 and 19, Unda said that there was a common misconception that using family planning is against the teachings of Islam. Through the deep dive activities, she witnessed how poverty and lack of access to proper ASRH information and education have led to early marriages and teenage pregnancies in their municipality.

Deep dives are integral in the ZFF training, wherein leaders immerse themselves in unfamiliar environments and different contexts to gain a wider perspective of the real situation and build relationships with stakeholders. Unda talked to pregnant adolescents, witnessed their circumstances, and learned the lack of ASRH programs both at the barangay and municipal levels.

Stepping up to her role as Sangguniang Kabataan (SK) vice president in providing and engaging the youth in ASRH programs, Unda—together with the other SK leaders in Masiu—sought the engagement of Muslim Religious Leaders (Ulama Council) in the promotion of SRH to young people, particularly family planning from the Islamic perspective. The youth and their parents as well were able to debunk the notion that family planning equates to killing an unborn child in the mother’s womb, which is forbidden in the practice of Islam. They learned that family planning can be done to prevent conception. This helped them to be more open and understanding of the issues of early marriage and teenage pregnancy.

Related article: ‘Girls Not Brides’ Act Reinforces ZFF’s ASRH Initiatives

Decreased teenage pregnancies
Though limited to the records of pregnant women who visit their health centers, teenage pregnancies in Masiu dropped from 34 in 2018 (start of YLGP) to 25 in 2020. Unda’s team plan to continue the implementation of the Adolescent Pregnancy Tracking and Profiling, which they started in December 2020, to get more accurate data on teenage pregnancies.

Other accomplishments include having a functional Local Youth Development Council, and increased numbers of adolescent- and youth-led activities in SRH and adolescents reached with information and life skills on SRH.

Participating LGUs in the YLGP are guided by a technical roadmap that represents the status of their current system. With the desired impact of reducing pregnancies among adolescents and young people, an array of services should be provided, including health education, life-skills building, health promotion of available services, and provision of actual preventive services.

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

Continued youth engagement and LGU support
Faced with weak participation from other SK leaders and limited funding amid a pandemic, Unda and her team are still determined to achieve “a secure and diverse community that respects, empowers, nurtures, educates, and encourages a healthy and responsible youth population.” They are set to seek local government funding for ASRH programs such as the Peer Education Roll-out, which aims to create more youth leaders who can share the right information on SRH.

The YLGP is ZFF’s pilot program for engaging youth leaders. It was supposed to run for 18 months ending in December 2020, but the pandemic led to its extension until October 2021.

Know more about the ZFF health leadership training programs here: Public Health Leadership Formation.