In 2020, Santiago City faced a serious problem. Its adolescent birth rate was the highest in Region II—47 births per 1,000 girls aged 15–19. That meant too many young lives were being disrupted by unplanned pregnancies. For Population Program Officer Johanna Gabriel, these were not just numbers. She saw dreams put on hold and young futures changed overnight. This crisis unfolded during the COVID-19 pandemic, despite the city having a modern contraceptive prevalence rate (mCPR) of 39%, which was already above the national average of 30%.

 

A Unified Response: Empowering the Whole Community

Mayor Sheena Tan knew that stopping adolescent pregnancy meant involving the whole city. She reached out to The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation and the Bill and Melinda Gates Institute for Population and Reproductive Health. The first step was creating a City Leadership Team (CLT)—not just made up of health officials, but also representatives from education, planning, youth sectors, and even young people themselves.

The city’s response fit perfectly with its KAISAKA Development Strategies, which focuses on four pillars:

• Kabuhayan (Livelihood)
• Kalusugan (Health)
• Karunungan (Education)
• Kaayusan (Good Governance)

This meant adolescent and youth sexual and reproductive health (AYSRH) was addressed alongside other core priorities, and not treated as a separate issue.

Making Healthcare Youth-Friendly

Before the intervention, adolescents often felt judged or misunderstood at health centers. There was a lack of privacy, and services were not designed for youth. Santiago City changed this by building 37 community-based and 22 school-based teen centers—safe, respectful spaces designed with and for young people.

Importantly, these centers are now run by trained youth facilitators with guidance from adult mentors. This gives young people ownership and confidence. In 2023, Ordinance No. 11THCC-089 institutionalized the Information Service Delivery Network (ISDN)—a system to make sure youth services remain accessible, consistent, and effective across the city.

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Training and Expanding Youth Reach

One of Santiago’s biggest challenges was the limited number of trained service providers in family planning. The city responded by using TCI tools to identify root causes of high adolescent pregnancy. It also adopted ZFF’s Bridging Leadership approach, empowering local leaders to work with young people in shaping policy.

The results were powerful:

• 638 Teen Facilitators were trained as peer leaders.
• Health workers received essential training in Family Planning Competency-Based Training (FPCBT 1 and 2), Adolescent Health Education (ADEPT), and Healthy Young Ones (HEYO).

At the same time, the city upgraded all Barangay Health Centers and teen centers to Adolescent-Friendly Health Facilities (AFHFs). These were linked to the broader public health system and supported by the Santiago City Youth Code and the Local Youth Development Plan.

Community Programs and Campaigns

The city knew awareness was just as important as access. It launched a range of youth-centered initiatives including:

• Samahang Teenage Nanay na Dakila (STAND) Project – for adolescent mothers
• Kalalakihang Tapat sa Responsibilidad at Obligasyon sa Pamilya (KATROPA) Program – to involve young men
• Project Developing a Responsive Environment for AYSRH Movement (DREAM)

Outreach strategies included house-to-house campaigns, social media content, and tailored Social and Behavior Change Communication (SBCC) materials to bring the right messages directly to young people and their families.

A Brighter, Healthier Future

Santiago City’s bold moves produced real results:

• Adolescent birth rate dropped from 47 in 2020 to 30 in 2024
• The city’s mCPR stayed strong at 36% in 2024, continuing to exceed the national standard of 30%
• More adolescents are confidently seeking care from health providers and peer facilitators

“KAISAKA namin kayo” (“we are with you”) is the heartbeat of Santiago City’s movement. From teen centers to city ordinances, from peer facilitators to youth awards, every initiative is rooted in a belief that adolescents deserve to be supported, informed, and empowered.

As Gabriel shared, it is about building a future where health-seeking behavior is a way of life, and where every young person has the tools and support they need to thrive. Santiago City’s journey continues—with commitment, compassion, and the confidence that change is not only possible, but is already happening.

Iloilo City, lovingly called the ‘City of Love’, has long been known for its cultural richness and educational institutions. But in recent years, it has also emerged as a national model for adolescent health reform. Faced with rising rates of teen pregnancy and weakened service delivery, the city responded with bold leadership, strong partnerships, and deep youth engagement—changing the story for its young population.

A Crisis in Continuity

In 2019, Iloilo City’s Adolescent Health and Development Program (AHDP) was in crisis. A leadership change at the City Health Office and the retirement of key personnel created disruptions in program continuity. At the time, the city had only one Level 2 Adolescent-Friendly Health Facility (AFHF) based in the Arevalo District. Despite support from the Integrated Service Delivery Network (ISDN) and local ordinances, the program remained fragile.

Even before the pandemic, adolescent health was already at risk. The city recorded an adolescent birth rate (ABR) of 36 per 1,000 girls aged 15–19 in 2019. One particularly alarming case involved a 10-year-old girl, the youngest known to give birth in the city—a clear sign of service gaps and unmet needs. By 2022, adolescents made up more than 18% of the city’s total population, amplifying the urgency.

Then COVID-19 struck, stalling what little progress had been made.

 

A Turning Point: Local Action Meets Global Support

Change began in earnest in 2022, when Iloilo City joined The Challenge Initiative (TCI)—a global program that supports local governments in implementing high-impact, sustainable family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions. Co-managed by the Zuellig Family Foundation and Bill and Melinda Gates Institute for Population and Reproductive Health, TCI helped the city reframe adolescent health as a shared, multisectoral responsibility.

A City Leadership Team (CLT) was formed, expanding the existing Technical Working Group into a powerhouse of cooperation. Members included city government units, the Department of Education (DepEd), the Technical Education and Skills Development Authority (TESDA), local colleges, the Iloilo City Police, the Sangguniang Kabataan (SK) Federation, and community organizations. Using TCI’s assessment tool as a strategic guide, the CLT pinpointed gaps and co-created solutions rooted in local realities.

“Through the Health Leadership and Management Program, our people evolved from support staff into leaders,” said Florence Joy Rubido, AHDP Nurse Coordinator. “We have achieved substantial progress. All district health centers in Iloilo City now have at least one Adolescent-Friendly Health Facility, and all adolescent focal persons from our nine district health centers have been capacitated through the AHDP foundational course in October 2023.”

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Youth Voices at the Center

Iloilo’s new approach centered on empowering adolescents to lead. Programs like KaTEenAran, a teen center at Nabitasan Integrated School, gave marginalized youth a safe, structured space. The NewscasTEENg competition and the AHD Film Advocacy Contest with UP Visayas allowed youth to use media and storytelling as advocacy tools.

The Teen AD Facebook page grew into a vibrant online community, connecting over 2,900 members to health information and services. Meanwhile, the Peer Helpers Training program built a cadre of trained young advocates offering peer-to-peer support.

“Young people were not just reached, they were engaged on their terms, in ways that truly resonate,” said Richard Magullado, Information Officer of Commission on Population and Development (CPD)Region VII. “From film contests and newscasting to vibrant digital platforms, youth voices drove the movement.”

Reaching Every Barangay

The city also strengthened its demand generation workforce. All 224 Barangay Service Point Officers (BSPOs) were re-trained to deliver up-to-date FP information. The city’s grassroots commitment was evident in events like the Adolescent Summits in June and November 2024.

Held in Brgy. Sooc, Mandurriao and Arevalo respectively, these summits reached over 330 adolescents with sessions on teen pregnancy, human immunodeficiency virus (HIV), child labor, and family planning profiling. Parents were also engaged through Parent-Teen Talks and Usapan Sessions, breaking down taboos and building trust.

During Youth Day at Ramon Avanceña National High School, 92 adolescents joined interactive workshops on mental health, HIV, and Violence Against Women and Children (VAWC), reinforcing their agency and access to support.

Policy Backing and Budget Growth

Iloilo’s local policies strengthened these efforts. Ordinance No. 2017-048 institutionalized the ISDN, while Executive Order No. 141 (2021) underscored adolescent pregnancy as a national priority. These enabled a coordinated response, backed by real investment: the city increased its adolescent health budget by 620% from 2024 to 2025.

The results speak volumes. Between 2019 and 2024, ABR dropped from 36 to 24 births per 1,000 girls aged 15–19. Meanwhile, modern contraceptive prevalence rates (mCPR) have consistently exceeded the national benchmark of 30% at 41% in 2024.

A Movement Built to Last

“Iloilo City shows that when local leadership is bold, young people are engaged as partners, and systems are built to last, transformation becomes not just possible but inevitable,” said Magullado.

The city’s journey is far from over—but the foundation is strong. With sustained leadership, empowered communities, and energized youth, Iloilo is not only protecting its adolescents—it is equipping them to thrive.

And in true Iloilo fashion, it is doing so with heart.

For decades, access to reproductive health services in Manila was restricted by policy. Executive Order 003, enacted in 2000, effectively banned modern contraceptives in the city. Though it was eventually repealed, its replacement—EO 030 in 2008—prohibited the use of public funds for contraceptives such as pills, condoms, intrauterine devices (IUDs), and sterilization. These policies were only formally reversed in 2019. 

In 2020, City reports show that Manila’s modern contraceptive prevalence rate (mCPR) was just 6%—30 percentage points below the national target and among the lowest in Metro Manila. The adolescent birth rate (ABR) stood at 50 per 1,000 girls aged 15–19, 20 points higher than the national average of 30.

 

Rising to the Challenge

In 2023, the City Government of Manila joined The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation and the Bill and Melinda Gates Institute for Population and Reproductive Health. A structured roadmap was developed to address systemic issues and restore public confidence in reproductive health services.

Spearheading this transformation was Mayor Honey Lacuna-Pangan, who convened a City Leadership Team (CLT) to institutionalize reforms. The CLT addressed issues such as fragmented service delivery, outdated clinical protocols, weak data systems, low youth engagement, and lingering biases among providers.

Dr. Evelyn Rimando, Family Planning Coordinator at the Manila Health Department, captured the core of the problem: “How can we reach those in need of family planning if there is a shortage of trained staff, few people know that such services exist, and misconceptions about it are widespread?”

From Policy Paralysis to Grassroots Power

To overcome these barriers, the city launched the Bayanihan Outreach Program, modeled after the Filipino tradition of collective community effort. Small teams composed of trained midwives, supervisors, and barangay health workers conducted daily door-to-door visits in low-income communities, providing pills, implants, injectables, and condoms.

Dr. Rimando noted, “The response was overwhelming. For many, this was their first time accessing family planning services. Being met by someone they trust, right at their doorstep, changed everything.”

What began in just ten communities quickly expanded citywide.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
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Training the Frontlines, Transforming the System

In parallel, the city invested in training to boost the quality and reach of reproductive health services. Through Family Planning Competency-Based Trainings (FPCBT):

• 20 midwives were trained in FPCBT Level 1
• 20 more learned to administer progestin-only subdermal implants (PSI)
• 15 health workers were certified as IUD trainers
• Another 15 became PSI mentors

These trainers helped capacitate 38 additional providers, helping Manila build a self-sustaining training network.

To boost demand for services, the Usapan series—structured group discussions—were rolled out in clinics. Midwives were trained to lead these sessions, tackling misinformation, and fostering informed choices.

Supporting Adolescents

Youth-specific interventions were introduced in 2025, starting with a training focused on the Adolescent Sexuality and Reproductive Health – Family Planning Module, grounded in the HEEADSSS or the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidal Ideation, and Safety assessment framework. This globally recognized tool guides providers in addressing adolescents’ psychosocial and reproductive health needs holistically.

The training also featured the Adolescent Job Aid 2.0 (AJA), aligned with the Department of Health’s Omnibus Guidelines. However, a gap surfaced: out of over 50 public doctors in Manila, only four had prior AJA training.

Dr. Anthony Faraon, Chief of Party for TCI-Philippines, stressed, “Adolescent health training is essential, not optional.” He added that care for young people must be developmentally appropriate, respectful, and consistent.

To address training shortfalls, Manila is now seeking to scale adolescent health training locally and strengthen mentorship with ZFF-TCI and partners.

Systemic Reform from the Ground Up

Manila also tackled system-level bottlenecks:

• AYSRH services were made more youth-friendly
• Data-sharing agreements were formalized
• City Ordinance No. 9054 institutionalized the Key Assistance for Developing Adolescents (KADA) program, enabling stronger coordination across departments

The city’s long-neglected reproductive health infrastructure is now being rebuilt with intention and inclusivity.

A City Transformed

From a modern contraceptive prevalence rate of 6% in 2020, Manila surged to 35% in 2024. The adolescent birth rate fell from 50 to 15 per 1,000 in the same period. In recognition of these achievements, Manila was named a Global Self-Reliant City in family planning and adolescent health by ZFF-TCI. During the turnover, Assistant City Health Officer Dr. Gina Pardilla said, “This partnership empowers us to design interventions that truly respond to the evolving realities of families and young people. It is about meeting them where they are.”

Still, the work is far from over. Dr. Pardilla reflected, “If we are to sustain these gains, the commitment must go beyond training or funding. Our local systems must take ownership of reform, backed by national support.”

Where outdated policy once stifled progress, a spirit of bayanihan now fuels Manila’s drive toward equitable reproductive health. Families, adolescents, and providers are no longer sidelined—they are leading the change. This is Manila’s lesson: even the most entrenched public health challenges can be broken—one provider trained, one visit made, and one choice empowered at a time.