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.

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.”