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. 

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• 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.

The Zuellig Family Foundation (ZFF) conducted field monitoring and assessment visits in Lamitan City, Maluso, Ungkaya Pukan, Hadji Mohammad Ajul, and Al-Barka, five of the ten Local Government Units (LGUs) as part of the Municipal Nutrition Governance Program (MNGP) under ZFF’s Basilan Assistance Program (BAP). The visits aimed to check the LGUs’ practicum implementation, track accomplishments based on their plans, and identify areas where they need additional support to strengthen local nutrition governance.

LGU nutrition core teams shared their experiences, challenges, and learnings. Their reflections offered a clearer picture of their progress and the guidance they still need. The visit also allowed them to plan for the upcoming Operation Timbang, validate performance milestones, and make sure their strategies align with their nutrition goals.

Across all sites, local leaders are taking concrete actions to place nutrition at the center of development. LGUs strengthened their systems by issuing policies and ordinances that encourage multi-sectoral work and formalize support for community workers. Increased budget allocations now reinforce these policy gains and reflect a more stable commitment to reducing malnutrition.

At the barangay level, improvements continue to take shape. Many barangays formed Barangay Nutrition Committees and drafted Barangay Nutrition Action Plans to guide nutrition initiatives. Barangay Nutrition Workers—including former combatants now serving as community frontliners—received training and built confidence in their roles. They now reach more families and deliver essential services more consistently, which supports more timely management of moderate and severe acute malnutrition cases.

The following key developments across LGUs were observed:

• LGUs issued policies and ordinances that strengthen multi-sectoral nutrition work.
• LGUs now have dedicated and prioritized budgets covering more comprehensive nutrition programs and services.
• Barangays formed Barangay Nutrition Committees to organize community actions.
• Selected barangays developed Barangay Nutrition Action Plans to guide interventions.
• Barangay Nutrition Workers received training on Nutrition Assessment and Basic Management of Acute Malnutrition and now work more confidently and effectively.
• Communities observed more responsive management of acute malnutrition cases. In Lamitan City, the local government hired additional IT support to strengthen the implementation of the Health and Nutrition Information System (HNIS). 
• Improved community access by ensuring regular deployment of medical personnel in strategic barangay posts beyond the barangay health stations.

When LGUs invest in nutrition, they help build a healthier foundation for the next generation. The progress in Basilan shows that prioritizing nutrition is not only a health response, but a long-term investment in peace, stability, and human development.

Author: Rio Fe Del Valle, ZFF Nutrition Monitoring, Evaluation and Learning Expert

Advancing Universal Health Coverage in the Philippines

This presentation summarizes early lessons from financial integration in Batangas and Quezon, Philippines, focusing on advancing Universal Health Coverage (UHC) through the establishment of a Special Health Fund (SHF). It highlights the experiences of local government units, national agencies, and partner organizations in operationalizing the SHF, including key processes, enabling factors, challenges, and practical recommendations for sustainable and coordinated health financing. By sharing these insights, the presentation aims to inform strategies that support equitable access to quality health care across provinces.

The Zuellig Family Foundation (ZFF) shared these early lessons at the 18th Association of Pacific Rim Universities (APRU) Global Health Conference, held at Universiti Malaya, Kuala Lumpur, Malaysia, on October 28–31, 2025, contributing to regional dialogue on strengthening health systems and advancing UHC.

Presentation_APRU-LHS

This poster presented at the Evidence and Implementation Summit 2025, held October 27–29, 2025 at the Melbourne Convention and Exhibition Centre, Australia, showcases the First 1,000 Days (F1KD) Nutrition Roadmap. The roadmap guides local governments in strengthening maternal and child nutrition by applying the World Health Organization (WHO)’s health system building blocks and the Zuellig Family Foundation’s Eight Critical Knobs of Nutrition Governance.

From 2019–2022, the roadmap improved governance, planning, financing, data use, and service delivery across five priority provinces under the Philippine Plan of Action for Nutrition (PPAN) through a structured systems review and adaptive learning tools. It enabled local governments to act more cohesively, use evidence effectively, and integrate stronger strategies into their Provincial Nutrition Action Plans (PNAPs). While the country reduced stunting rates nationally, ongoing malnutrition and food insecurity underscore the need to further strengthen multisectoral and locally driven nutrition systems.

Read more:

• From Evidence to Action: Strengthening Nutrition Governance through the First 1,000 Days Roadmap

ZFF Poster_F1KD Nutrition Roadmap

The Zuellig Family Foundation (ZFF), through the Pook Malusog Community of Practice (CoP), gathered partners to confront one of the toughest issues in nutrition governance: financing. 

Nutrition governance core teams from the provinces of Sarangani, Samar, Northern Samar, Basilan, and Zamboanga del Norte joined the webinar, together with municipal cohort graduates under these provinces. AHON Siargao municipalities and the Manila Health Department also shared their experiences from the ground.

The National Nutrition Council’s Regional Nutrition Program Coordinators and technical staff added their expertise, while consultants Dr. Esmeralda Silva-Javier and Dr. Cecilia Cristina Acuin provided evidence and analysis. ZFF Chairman Dr. Manuel Dayrit offered guidance and reflection. Their participation underscored the Community’s role as a space where local leaders, national agencies, and research partners learn and collaborate to strengthen nutrition systems.

Understanding the Financing Challenge

Dr. Silva-Javier presented findings from a ZFF Case Study on Investments for Nutrition in Sarangani and Northern Samar. The research revealed a persistent mismatch between nutrition responsibilities and the fiscal capacity of local governments. Even with higher budgets—rising from 1 million to 2.75 million pesos annually—up to 90% of Local Nutrition Action Plan activities remain unfunded. Most of the money goes to salaries, leaving little for programs, supplies, and monitoring.

Yet the study confirmed that even modest increases in spending produce measurable improvements. For instance, Northern Samar would need just 250 pesos per capita annually to cut wasting by one percentage point. Sarangani would need 204 pesos. These findings echo global evidence: well-targeted, consistent investments at the frontline can significantly reduce stunting and wasting.

The study also highlighted the role of “enterprising” local chief executives who bridge gaps through creativity and partnerships. Examples include Alabel’s Nutri-bun bakery, Kiamba’s egg distribution, and Gamay’s nutrition trust fund. While promising, Dr. Silva-Javier cautioned that these remain small-scale. Closing the financing gap will require bolder arrangements such as revenue earmarking, trust funds, and strategic purchasing.

Lessons from the Community of Practice

Discussions from the webinar brought out several key insights:

1. The Community of Practice Framework Works. By centering on Purpose, People, and Practice, the Community helps LGUs sustain and expand gains through continuous learning and application.
2. Critical Knobs in Action. Field stories showed how ZFF’s 8 Critical Knobs for Nutrition Governance provide a practical guide for strengthening systems, from institutionalizing nutrition staff to forging cross-sector partnerships.
3. Local Innovations Matter. Enterprising leaders have piloted food processing plants, Nutri-bakeries, egg production, and trust funds, proving that creative solutions can fill gaps.
4. Financing Gaps Remain. Despite local allocations, most plans remain underfunded. Evidence shows, however, that even small but steady investments pay off in nutrition outcomes.
5. Other Factors Count. Socio-economic conditions, maternal education, water and sanitation, disasters, and household income also shape nutrition outcomes. This underlines the need for nutrition-sensitive programs alongside nutrition-specific ones.

Breakout group discussions shed more light on what is working and where challenges remain. Strong leadership from local chief executives, adoption of national policies, and partnerships with communities and donors emerged as effective practices. However, LGUs struggle with unclear budget guidance, limited fiscal space, and the lack of permanent positions for nutrition staff.

Participants emphasized the need for better budget-tagging tools, clearer allocation guidelines, and stronger multi-sectoral planning. They also called for peer-to-peer exchanges to spread successful innovations, from donor-supported feeding programs to local bakeries financing nutrition.

Implications for Nutrition Governance

The webinar made clear that:

1. Provinces must integrate systems, while municipalities deliver services on the ground.
2. Evidence-based decisions strengthen the case for nutrition in fiscal planning.
3. Community ownership and partnerships keep programs sustainable.
4. Clearer financing pathways and national policy guidance are essential.
5. Local leaders must be empowered to design innovative financing strategies.

The Pook Malusog Community of Practice must now focus on sustaining momentum and scaling innovations. Empowering local chief executives to design and advocate new financing arrangements will be crucial, as will expanding peer-to-peer learning that highlights adaptive practices, smart data use, and cross-sectoral collaboration. Providing technical support to help LGUs maximize fiscal space and mobilize resources can ensure that nutrition programs are not only launched but also sustained over time. The Community should also act as a channel for scaling up proven practices from pioneering LGUs to more provinces and municipalities, ensuring that lessons learned do not remain isolated. Finally, engaging national agencies and policy actors is essential to institutionalize sustainable financing pathways, while maintaining spaces for local solutions to flourish.

By linking research, local innovations, and strong leadership, it demonstrates how LGUs can move from scattered efforts to collective strategies. The future of nutrition governance in the Philippines depends not only on increased funding, but also on smarter, evidence-informed, and community-driven use of resources.

Authors: Samantha Morales, ZFF Nutrition Knowledge Management and Communications Associate; Krizzia Esperanza, Corporate Communications Associate

This paper looks at how provinces working with the Zuellig Family Foundation (ZFF) performed in health-related areas compared to other provinces in the country, using data from the Department of the Interior and Local Government’s Seal of Good Local Governance (SGLG) Health Compliance and Responsiveness assessment from 2022 to 2024.

By comparing results, ZFF can better understand how its leadership and governance programs are influencing local health systems and identify areas where support is working or still needed. The findings offer insights that can guide improvements in ZFF’s strategies and partnerships with local governments.

ZFF Technical Paper_Benchmarking Provincial Sites with SGLG Health Performance Assessment 2022-2024