Last week I wrote about the National Resilience Council. This column will be devoted to the Zuellig Family Foundation (ZFF) and its work with local governments in delivering better health results faster, considering the improvements in Philippine health indicators have been incremental for decades.
When I assumed the ZFF chairmanship in 2008, I and ZFF president Ernesto Garilao agreed that since ZFF’s mission was to improve the health of the poor, the foundation’s performance will be judged based on improvements in health metrics. In a devolved situation, improvements in the health indicators are influenced by the local chief executive (LCE) as he reforms the health system to be responsive in delivering better and more accessible health services, especially to the marginalized and the disadvantaged. ZFF made the LCE the driver of change.
Maternal Health
This approach was first tested in 2008 with 9 municipal mayors in 2008. After 5 years, ZFF had 72 partner municipalities characterized by poor health indicators, low incomes and multiple geographically isolated villages, but led by mayors committed to better health outcomes. The focus was on reducing maternal deaths, a major challenge at that time.
The result was a significant drop in maternal mortality ratio (MMR) two years after the program’s introduction: from a collective baseline of 167 to 116. In 2014, MMR was 91 versus the country’s 131. Moreover, the number of ZFF municipalities with no maternal death grew from a baseline 31 to 55 by 2015. MMR is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.
Among the LGUs with spotless maternal death record from 2010 to 2021 is the municipality of Dao in Capiz whose mayor was Joselito Escutin, currently vice mayor (2019-2022). Under his leadership, Dao removed barriers to health care access by tracking all pregnant women, supporting their completion of pre- and post-natal checkups, and ensuring delivery in PhilHealth-accredited facilities.
The reduction of the maternal deaths encouraged then Secretary Enrique Ona of the Department of Health (DOH) to share the approach to interested DOH regional offices. Thus, along with trained faculty from partner universities, ZFF’s strategy was introduced to over 600 mayors and municipal health officers nationwide from 2013 to 2018.
Malnutrition and Stunting
The country continues to struggle in bringing down child stunting prevalence. After 16 years it showed no progress. Further, it increased from 21% in 2003 to 22% in 2019.
ZFF’s prototype nutrition intervention to reduce stunting in two rural municipalities (Looc, Romblon and Gamay, Northern Samar) led under-2 (years old) stunting to drop to 15% in 2019 from 19% in 2017, a faster decline than the country’s performance. The improvements showed how stunting can be reduced faster.
Critical interventions included the active participation of the LCE, consolidation of disjointed implementation of nutrition-specific and nutrition-sensitive programs, identification and monitoring of the nutritional status of pregnant women and under-2, and provision of supplementary sources of food.
These learnings were introduced to three cities via partnership with Nutrition International, and five provinces with Kristian Gerhard Jebsen Foundation and UNICEF as partners.
For cities, ZFF focused on activating local nutrition committees, dedicating budgets for nutrition, improving information systems especially on pregnant women and under-2, and training more health and nutrition workers.
Tacurong City, headed by Mayor Lino Montilla, performed well. Its stunting rate declined from eight percent in 2019, seven percent in 2020 and four percent in June 2021. Tracking nutritionally at-risk (NAR) pregnant women led to sharp declines in cases between 2019 and 2020: 32 percent to 6 percent. It stood at 1% by end-June 2021. All these despite the pandemic.
ZFF has made its manuals containing these lessons available to any LGU interested in addressing malnutrition.
Teenage Pregnancies
ZFF’s program with the United Nations Fund for Population Agency (UNFPA) works with Sanggunian Kabataan Federation presidents who have become major actors in engaging local governments to develop adolescent-friendly policies and facilities that have helped reduce teenage pregnancies.
The results from Sarangani’s three municipalities were commendable with overall adolescent birth rate (ABR) dropping from 80 in 2019 to 35 in the third quarter of 2021. Likewise, ABR in two Sultan Kudarat municipalities dropped from 74 to 31. ABR is the annual number of births to women aged 15-19 years per 1,000 women in that age group.
The ZFF-UNFPA work generated support from the Bill and Melinda Gates Institute for Population and Reproductive Health, and led to The Challenge Initiative (TCI), a USD$2M program that will bring ZFF’s approach and TCI best practices to 10 cities in the next three years in partnership with the Population Commission.
Overall Lessons
Improving health indicators is a function of services received on the ground, which are greatly influenced by the leadership actions of local chief executives. Key is understanding the health issue so the mayor must make a systems analysis of what needs to be done. He must empower the internal bureaucracy and the community, and mobilize external stakeholders in co-creating innovative approaches to resolve the issue.
For ZFF, good performance attracts more support. It learns from failures and scales up proven practices. It is by scaling up proven health interventions that better health outcome can be achieved faster.
In 2019, Ernie Garilao assumed the position of chairman in addition to his role as president. I remain chairman emeritus. I believe and many will agree with me that Ernie has been the driving force of ZFF’s excellent performance.