Grassroots Champions: Barangay Health Workers Lead the Way to Reduce Adolescent Pregnancy in Lapu-Lapu
Lapu-Lapu City in Central Visayas faced a rising adolescent birth rate (ABR), increasing from 14 births per 1,000 adolescents in 2020 to 23 in 2023. At the same time, modern contraceptive prevalence rate (mCPR) dropped from 31% to 21%. Local health officials saw that, while women continued to seek services, many still relied on short-acting family planning methods. Uptake of long-acting options was growing but needed stronger community support.
To respond to the alarming numbers, the city partnered with The Challenge Initiative (TCI), a global program implemented in the Philippines by the Zuellig Family Foundation that helps local governments scale proven family planning and adolescent and youth sexual and reproductive health (AYSRH) solutions.
Related articles:
- Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health
- Lapu-Lapu City’s Path to Strengthening Family Planning and Adolescent Health
The city formed the Lapu-Lapu City Leadership Team to unite health, education, youth, and social welfare sectors. Barangay nurses and midwives then began integrating meaningful conversations into routine services. They learned that many adolescents lacked parental guidance and reliable reproductive health information, while many adult women feared modern methods because of misconceptions. These issues showed that rising adolescent pregnancies and declining contraceptive use stemmed from the same need: trusted, judgment-free health information within the community.
Lapu-Lapu City placed communities at the center of its strategy. Awareness efforts shifted the conversation from contraceptives alone to responsible parenthood.
Barangay Health Workers (BHWs)—trusted members of each neighborhood—played a central role. Through house-to-house visits, they profiled households, explained family planning options, and corrected myths using simple materials. BHW Coordinator Jovy Alonzo emphasized that all BHWs are trained in adolescent health and development and uphold confidentiality and nonjudgmental support. Their strong performance earned Lapu-Lapu’s BHWs the Performance-Based Incentive (PBI) Award for two consecutive years, making them PBI Champions in Central Visayas. As Nurse Grace Mary Chan-Carunggay shared, “This recognition is a testament to their exceptional service and dedication.”
The city also strengthened its service delivery system by training more providers through Family Planning Competency-Based Training (FPCBT), especially in barangays with limited access. This allowed more health centers to offer long-acting reversible contraceptives (LARC), including the Progestin Subdermal Implant. City leaders supported these improvements by funding BHW incentives and training, conducting regular barangay visits, and ensuring data quality for planning. According to City Health Officer Dr. Agnes Cecilia Realiza, “Adolescent parents are now coming to our health centers. They no longer feel stigmatized, and they seek prenatal care, ensuring the safety of both mother and child during delivery.”
In 2024, the city recorded only one additional adolescent pregnancy case, showing early signs of progress. The drop in mCPR was largely due to data cleaning, which corrected the number of women counted in the program. Lapu-Lapu is also adjusting to the shift in national indicators—from mCPR to “demand satisfied”, or the share of women with a need for family planning who use modern methods. The City Health Office continues to improve staff capacity for accurate data use and coaching.
Lapu-Lapu’s experience shows the power of community-centered, data-driven leadership. By investing in AYSRH and allocating dedicated budgets, the city has strengthened the work of BHWs and sustained community engagement. With a 22% increase in AYSRH budget commitments, based on TCI-Philippines monitoring, Lapu-Lapu demonstrates that empowering frontline workers creates lasting impact—helping young people make informed choices for their health and future.
Lapu-Lapu City’s Path to Strengthening Family Planning and Adolescent Health
On September 18, 2025, the Zuellig Family Foundation, through its The Challenge Initiative (TCI)-Philippines team, met with the Lapu-Lapu City government to discuss family planning and adolescent health. Joining the meeting were City Administrator Atty. Almendras and the City Health Office team, led by nurses Ivy Amistad, Jovy Alonzo, and Leizel Lagtapon. The conversation served as a chance to reflect on the city’s progress, identify ongoing challenges, and consider ways to strengthen impact and sustainability.
Recovery and Resilience after COVID-19
Like many local government units, Lapu-Lapu City experienced major disruptions in reproductive health services during the COVID-19 pandemic. Health workers were diverted to pandemic response, service delivery slowed, and demand for family planning dropped. Now, the City is steadily regaining momentum. With health staff back on the ground, there has been recovery in the uptake of short-acting methods such as pills, injectables, and condoms. Encouragingly, long-acting and permanent methods (LAPMs) like implants, intrauterine devices (IUDs), and sterilization are also increasing in demand.
One area where Lapu-Lapu has exceeded expectations is in postpartum family planning (PPFP). Through sustained training and outreach activities, the city has exceeded its TCI commitment of ensuring that targeted providers are trained on PPFP–demonstrating that with political will and operational focus, service delivery can quickly regain strength.
Related article:
Addressing the Data Gap
Reliable data is critical for decision-making, yet the city continues to face difficulties in capturing a complete picture of family planning performance. Public facilities generally provide regular reports, though private birthing centers and hospitals show variable compliance rates. An ordinance requires reporting, but enforcement is limited without established legal penalties. The City Health Office is considering connecting compliance requirements to business permit processes and incorporating maternal death review procedures as accountability measures.
Another challenge lies in the transition to new Department of Health (DOH) performance indicators. Health staff are still adjusting from measuring modern contraceptive prevalence rate (mCPR) to tracking “demand satisfied”, which looks at the percentage of women with demand for family planning and who are actually using modern methods. Lapu-Lapu currently reports a demand satisfied rate of only 46%, far below the 70% national target. Continued coaching and capacity building will be essential to ensure that data is not only accurate but also used strategically for planning and advocacy.
Investing in Young People
Adolescent health remains a priority in Lapu-Lapu. Several health workers have been trained on adolescent-friendly health services (AFHS), and facilities are starting to offer confidential, youth-centered care. While formal DOH accreditation is still in development for most facilities, efforts are underway to address infrastructure needs, including the establishment of appropriate counseling spaces.
Despite these challenges, peer education is emerging as a promising practice. By mobilizing young people themselves to reach their peers, the city is creating more relatable and effective pathways to information and services. Plans are underway to expand peer education networks through collaboration with the Sangguniang Kabataan (SK) Federation and barangay-level initiatives. For sustainability, the city will need to determine the right peer-to-population ratio to ensure meaningful coverage across communities.
Governance, Financing, and Sustainability
Lapu-Lapu has demonstrated strong commitment to financing reproductive health, earmarking four million pesos in 2024 and five million pesos in 2025 for FP and adolescent health.
Budget execution has been gradual, with 22% of funds utilized by mid 2025, indicating opportunities to accelerate implementation timelines to maintain program momentum. This highlights the potential for strengthening alignment between program objectives and financial planning. For example, advancing demand satisfied rates from 46% to 60% would involve specific resource requirements for peer educators, supplies, and community outreach activities, each with defined costs. Developing such costing frameworks could support city leadership, including the mayor and city council, in making strategic resource allocation decisions for optimal program impact.
In May 2025, the City completed a self-reliance assessment using TCI’s Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) Tool. The results showed strong performance in data management (100%) and leadership (85%). However, areas needing improvement include formalizing policies, ensuring specific line-item allocations for FP and adolescent health, and strengthening supportive supervision systems. These gaps highlight where technical assistance and local leadership need to converge to ensure sustainability.
Moving Ahead
The meeting underscored both the progress and the unfinished work in Lapu-Lapu City’s reproductive health journey. On the one hand, the city has demonstrated resilience, ownership, and momentum—recovering service delivery, expanding postpartum FP, and investing in adolescent-friendly health services. On the other hand, challenges remain: persistent gaps in data reporting, budget execution, and demand satisfied rates reveal the need for stronger systems and sharper strategies.
With committed leadership, available resources, and the support of partners like ZFF and TCI, Lapu-Lapu City is well-positioned to transform these challenges into breakthroughs. By enforcing policies, scaling up peer-led youth programs, and aligning financial investments with program outcomes, the city can not only close its current gaps but also emerge as a model for sustainable, locally-owned family planning and adolescent health programs in the Philippines.