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.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

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.

Perseverance—the unwavering will to keep moving forward despite challenges—is what defines the life and service of a 71-year-old Barangay Kagawad from Barangay Mambajao, Maasin City, Southern Leyte. 

Felizardo Ramos is a retired community organizer of the Commission on Population and Development. He dedicated 17 years to grassroots work. Today, even in his retirement, he continues to serve—this time with a deep focus on preventing teenage pregnancy in his barangay.

As the head of the Barangay Health Committee, he sees every learning opportunity as a way to improve himself and his leadership. He completed training under Modules 1 and 2 of Zuellig Family Foundation (ZFF)’s Barangay Expanded Youth Leadership and Governance Program (BEYLGP)—a training series that equips local leaders with innovative strategies to address adolescent health and rights. 

These sessions are part of the Joint Program on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar. The program is supported by the Provincial Government of  Southern Leyte, the City Government of Maasin, the United Nations Population Fund (UNFPA), and the Korea International Cooperation Agency (KOICA). 

In Barangay Mambajao, reported teenage pregnancies among 15- to 19-year-olds rose from zero in 2021 to 3 in 2022. The number slightly declined to 1 in 2023 but increased again to 4 in 2024 and 6 in 2025. These numbers reflect the urgent need for sustained action to protect and empower young people.

To Ramos, making a difference is not about numbers—it is about heart. “Even if we are only two or three, as long as we have the commitment and passion to help others—especially adolescents—we can make a difference,” he shared. Over time, they realized that holding just one symposium was not enough to create real change. This is why Ramos is now planning to allocate funds for the Adolescent Sexual and Reproductive Health and Rights (ASRHR) program in the barangay.

With a renewed sense of purpose, he is determined to carry out the plans created during the program and follow through even beyond the end of the project. His promise is clear: to continue the fight against teenage pregnancy so that every adolescent has a chance at a better future.

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
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

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.

Naga City, the ‘Heart of Bicol’, is known for its rich history, deep religious heritage, and a strong sense of community. With a population of 209,170 as of the 2020 Census of Population and Health, it stands as the second most populous city in the Bicol Region. However, like many growing cities in the Philippines, it grapples with significant social challenges, including the rising concern of adolescent pregnancy, which continues to impact the youth and local development efforts.

Based on city reports, Naga’s adolescent birth rate (ABR) surged dramatically in recent years, climbing from 21 per 1,000 live births in 2020 to 106 in 2021, and even higher in 2022 at 110. This prompted local officials to rethink how they addressed adolescent reproductive health. Mayor Nelson Legacion recognized the urgency of the situation, particularly as young people struggled with limited access to reproductive health services and faced social stigma. The COVID-19 pandemic only made things worse by disrupting outreach programs and services.

 

A Strategic Partnership to Drive Change

In 2021, Naga City partnered with The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health. This partnership led to the creation of a City Leadership Team (CLT), which helped harmonize and scale up family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) efforts.

“We’ve had adolescent-focused initiatives in the past, but they were not well-coordinated or harmonized,” said Joy Macaraig, Assistant Department Head of the City Population and Nutrition Office (CPNO). With 26 years in public service, she explained how the integration of FP and AYSRH under the CPNO helped streamline both outreach and service delivery. The CLT further empowered various departments to incorporate adolescent health into their work.

The results were striking: by 2023, Naga’s ABR had dropped to 71, and by 2024, it had plummeted to 20—well below the national target of 37 .

From Pilot to Full Coverage: Empowering Barangays

Originally launched in three barangays, TCI’s model was soon expanded to six through the mayor’s initiative, and later to all 27 barangays in the city. The backbone of this local effort was the Barangay Service Point Officers (BSPOs), who not only tracked adolescent mothers but also ensured these young families received critical health and nutrition services.

Healthcare workers were also equipped through TCI University, an online platform offering practical tools and real-world examples. Janet Beloro, a midwife at the City Health Office, noted the improvement in her service delivery. “When clients return and tell me they will practice family planning, that’s when I realize I’ve made a difference—that I’ve been an effective provider. I see their health literacy improving, and for young people especially, I notice their growing awareness.”

Institutionalizing the Vision: Naga’s AYSRH Ordinance

In 2023, Naga passed City Ordinance No. 2023-025, also known as the AYSRH Ordinance. Authored by Councilor Gayle Abonal-Gomez, a member of the CLT, the ordinance institutionalized adolescent health initiatives and created a dedicated local budget to fund them.

One key result was the establishment of an Integrated Service Delivery Network (ISDN), which strengthened referral pathways among barangay health stations, hospitals, schools, and NGOs. This made it easier for adolescents to access the care they need, when and where they need it.

Creating Safe Spaces for Teens

Another major achievement of the ordinance was the rollout of teen hubs in schools and barangays. These safe spaces provide young people—including out-of-school youth—with information, counseling, and support.

At Concepcion Pequena National High School, teacher Dessa Bermejo helps manage their school’s Teen Hub. “With teenage pregnancy remaining a pressing concern, young people need a safe space where they can confide in someone they trust—someone who will listen without judgment and provide the guidance and support they need,” she shared.

Teen hubs have already been set up in Barangays Balatas and Calauag, and the goal is to bring these hubs to every school in the city.

Empowering Youth Through Communication

To support a more holistic approach to adolescent well-being, the Commission on Population and Development Region V launched the ‘Hearts and Minds’ campaign, under Director Joyce Dela Paz-Hilvano. This pre-orientation program focuses on emotional well-being and self-awareness, laying the foundation for more informed decision-making in adolescence.

The result? Naga’s modern contraceptive prevalence rate (mCPR) has remained above national targets, signaling sustained progress in FP and AYSRH initiatives.

Funding the Future

Since joining TCI, Naga has grown its investment in AYSRH from Php 2.2 million in 2023 to Php 5.1 million in 2024. This increase supports teen hubs, healthcare worker training, and the continuous delivery of reproductive health services.

Importantly, the city’s general fund and annual investment plan now include AYSRH—securing financial sustainability beyond political cycles.

Naga City’s experience shows that tackling adolescent pregnancy demands leadership, coordination, and sustained investment. Its journey offers a clear message to other local governments: meaningful change is possible when adolescents are placed at the center of public health and development efforts.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

The Zuellig Family Foundation (ZFF) and The Challenge Initiative (TCI)-Philippines concluded a three-day webinar series titled “Sustaining Momentum: Driving Leadership in Building Responsive Systems for Family Planning (FP) and Adolescent Sexual Reproductive Health (ASRH).” Held on May 26, 28, and 30, the series showcased the work of eight local government units (LGUs): Iligan, Naga, Santiago, Biñan, Mandaue, Manila, Iloilo, and Las Piñas.

Kate Graham, Deputy Director of the William H. Gates Sr. Institute for Population and Reproductive Health, co-implementer of the TCI program, framed the event as a new chapter for local leadership: “This event marks not only a culmination, but a new beginning—one where cities take the lead in building stronger, more responsive systems for FP and ASRH.”

Day 1: Cities at the Forefront

Iligan, Naga, and Santiago shared how strong leadership fosters systems change. Mayor Frederick Siao of Iligan treated FP as a governance priority, while Naga Mayor Nelson Legacion institutionalized grassroots collaboration to address teen pregnancy. Santiago Mayor Alyssa Sheena Tan, represented by Population Program Officer Johanna Gabriel, highlighted youth empowerment through peer-led education programs. Adding depth to the discussions, Joyce Dela Paz, Commission on Population and Development (CPD) Region V Director, and Theresa Soriano, CPD Region II Director, served as reactors.

“Our cities aren’t just predicting change; they’re creating it, one policy, one partnership, and one empowered young person at a time,” said Dr. Anthony Faraon, Chief of Party of TCI-Philippines at Zuellig Family Foundation, as he challenged participants to move from “best practices” to “next practices”.

Day 2: Expanding Family Planning Through Outreach

The second day began with opening remarks from Dr. Ann Ysabel Andres, OIC-Division Chief of the Child, Adolescent and Maternal Health Division of the Department of Health (DOH). Biñan Mayor Arman Dimaguila, Jr. emphasized co-ownership in tackling health system weaknesses. Mandaue City Health Officer Dr. Debra Maria Catulong presented their Women’s Health Caravan, which delivers life-stage appropriate services directly to communities. Manila Family Planning Coordinator Dr. Evelyn Rimando explained how they reconnected with women through house-to-house family planning services.

Reacting to these presentations, Marilyn Ogaya, CPD Regional Director for CALABARZON, and Reynaldo Wong, CPD Regional Director for MIMAROPA, highlighted the importance of community outreach, data-driven programming, and integrated strategies that address both demand and service delivery gaps in family planning.

Dr. Manuel Dayrit, ZFF Chairman, identified four drivers of success: strong leadership, technical excellence, adequate resources, and community engagement.

Related articles:

• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations
• Five Cities Celebrate Milestone in Adolescent Health and Family Planning Efforts

Day 3: Reaching Adolescents through Adolescent-Friendly Services

On the final day, Iloilo and Las Piñas presented their adolescent health strategies. Dr. Justine Hernandez, Medical Officer of the Adolescent Health and Development (AHD) Program at Las Piñas City Health Office, shared how a referral network streamlined services among adolescent-serving agencies. Richard Magullado, Information Officer and AHD Focal Person at Commission on Population and Development (CPD) Region VI, described how Iloilo created safe spaces that encouraged youth expression and participation.

“As a continuous commitment to lead and sustain, graduating from TCI is not an end point. It is now your city’s duty to sustain your progress and motivate others to guide, support, and proactively create an efficient and equitable health system,” said Mylin Mirasol Quiray, Division Chief of Knowledge Management and Communications Division at CPD.

Adding further insights, Jackylin Robel, CPD National Capital Region Director, and Harold Alfred Marshall, CPD Region VI Director, responded to the city presentations emphasizing that adolescent-responsive systems must go beyond access—they must provide consistent, youth-friendly engagement that respects the rights and realities of young people.

Celebrating Local Innovation and Ownership

Over the three days, the webinar emphasized local ownership, integration of services, and community-driven change. Dr. Faraon praised the eight cities for their leadership and encouraged others to scale up proven models and build partnerships across sectors.

The eight featured cities—now TCI graduates—will serve as models for other LGUs working to improve family and adolescent health outcomes. Their stories underline a clear message: responsive governance saves lives.

Eight cities will take center stage next week in a three-day webinar series hosted by the Zuellig Family Foundation (ZFF) through The Challenge Initiative (TCI)-Philippines, a global program supporting high-impact practices in family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH).

The event, titled “Sustaining Momentum: Driving Leadership in Building Responsive Systems for Family Planning and Adolescent Sexual Reproductive Health”, aims to showcase how local governments have taken bold, data-driven actions to improve access to reproductive health services. The webinar series will run on May 26, 28, and 30, from 10:00 AM to 1:00 PM, via Zoom.

Launched in 2020, TCI is a five-year global platform co-managed with the William S. Gates Sr. Institute for Population and Reproductive Health. In the Philippines, TCI has worked closely with city governments to support policies and programs that reduce adolescent pregnancies and improve access to FP services. The program encourages cities to adopt self-reliant, gender-responsive strategies that empower women and youth.

The cities of Iligan, Naga, Santiago, Biñan, Mandaue, Manila, Iloilo, and Las Piñas have been recognized as Global Self-Reliant Cities in FP and AYSRH under the program.

Each city’s approach reflects local leadership and innovation:

• Iligan City expanded FP and AYSRH services by empowering women and girls with access to information and health services.
• Naga City focused on youth-centered policies and community mobilization to address teenage pregnancy.
• Santiago City promoted peer education and youth leadership as a tool for reproductive health education.
• Biñan City tailored FP services to meet the real-life needs of women through integrated outreach.
• Mandaue City launched a Women’s Health Caravan to bring services closer to communities.
• Manila City used its Bayanihan Outreach Program to reach underserved areas with FP services.
• Iloilo City created adolescent-friendly healthcare environments using culturally sensitive, gender-aware strategies.
• Las Piñas City developed a multisectoral approach by aligning efforts across health, education, and social services.

The webinar series will allow participants to hear directly from local officials, program leaders, and partners about their experiences in building responsive and sustainable systems. Participants will also gain insights into effective strategies that can be applied to other cities and towns across the country.

Webinar Details:

• Day 1 – May 26: Cities at the Forefront (no CPD units applied)
  Join via Zoom: https://bit.ly/zff-tciwebinar1
• Day 2 – May 28: Expanding Family Planning Services to Priority Populations through Targeted Outreach
  (with accredited CPD units: Medicine: 1; Nursing: 3; Midwifery: 1)
  Register: https://bit.ly/zff-tciwebinar2
• Day 3 – May 30: Expanding Access to Adolescents through Adolescent-friendly Health Services
  (with accredited CPD units: Medicine: 1; Nursing: 2; Midwifery: 1)
  Register: https://bit.ly/zff-tciwebinar3

The webinar marks both a culmination and a new chapter for these cities as they continue to strengthen systems that protect and promote reproductive health. ZFF encourages health workers, local policymakers, advocates, and community leaders to join the discussion and explore how these stories can inspire wider change.

Related article:

• Five Cities Celebrate Milestone in Adolescent Health and Family Planning Efforts

 

Day 1 of the The Challenge Initiative (TCI)-Philippines Webinar Series (May 26, 2025) featured Iligan, Naga, and Santiago Cities showing how strong leadership drives systems change. Mayors prioritized family planning, youth empowerment, and community collaboration to tackle teen pregnancy. “Our cities aren’t just predicting change; they’re creating it,” said Dr. Anthony Faraon, Chief of Party of TCI-Philippines at Zuellig Family Foundation, urging everyone to move beyond BEST practices and toward NEXT practices. 

Read more:

• Eight Cities Share Success in Family Planning and Adolescent Health