21 October 2012, Business World Online
First of three parts
IN THE third-class municipality of Minalabac, one of the hard-to-reach towns in Camarines Sur, everyone knows who gets pregnant.
Leovegildo Gil Basmayor, a former radio announcer now serving his last term as mayor, has made it his business to know. His administration not only keeps the most vital information on his constituents and agriculture (the main source of livelihood in the area), but also on maternal health.
The local government unit is even proud of a program called Project MAMA (short for Maternal Assistance Monitoring Activity), which provides efficient, cost-effective and sustainable maternal health care with the help of community members and the private sector.
Through the program, barangay health teams conduct a periodic house-to-house pregnancy inventory to identify the women who need maternal health care. Once identified, these women were given pregnancy information data cards to accomplish. This record contains the pregnant womanâs name, date of birth, age, barangay, zone, last menstrual period, expected date of delivery, number of previous pregnancies or deliveries and the specific place where she wants to deliver her child. A midwife is assigned and submits the data to the Municipal Health Office (MHO).
Project MAMA has successfully weaned away pregnant mothers from traditional birth attendants (hilot) and kept Minalabacâs track record of maternal mortality ratio to zero for the past two years since the town entered into a Community Health Partnership program with Zuellig Family Foundation (ZFF) and its partners in the private sector, NGO community, civil society and the academe.
Mr. Basmayor said health concerns, especially maternal health, used to take a backseat in his administration. After undergoing a two-year fellowship that includes training and mentoring to address issues in governance, community participation, systems change and learning ways to achieve the United Nations Millennium Development Goals (UN-MDG) on health under the Community Health Partnership program, he started realizing that local chief executives play a pivotal role as health leaders.
He said he now has a newfound sense of responsibility for the health of his constituents, especially ensuring that Minalabac mothers do not die giving life. He made it his business to know individual pregnancy cases by requiring midwives to personally report to him. The municipality also passed an ordinance to reduce home births and deliveries by traditional hilots.
Minalabac is just one of the more than 50 municipalities that have been witnessing dramatic improvements in health indicators — specifically the UN-MDGs on maternal mortality ratio (MMR) and infant mortality rate (IMR) — since undergoing health leadership and governance partnership programs with ZFF.
ZFF serves as a catalyst in transforming the local health system in rural municipalities in the Philippines to attain the MDGs on health. The nonprofit organizationâs partnership with the municipalities opens the door for other like-minded organizations to provide health leadership training, programs, technology and infrastructure, among other things.
Due to their varying health needs and situations, different models of program partnerships were used for poor municipalities (4th and 5th class), the Autonomous Region in Muslim Mindanao, and geographically isolated and disadvantaged areas.
Collectively, the 30 municipalities started with a MMR of 167 in 2008, which has been reduced to 88 by 2011. By the middle of 2013, this is expected to further decrease to 52.2 — a year ahead of the countryâs MDG target in 2015.
On the other hand, the national performance in meeting the MDG targets is severely wanting. Earlier estimates of the United Nations Population Fund (UNFPA) show that the Philippines will meet its MMR target in 2043, or 28 years after the MDG deadline, said ZFF President Ernesto D. Garilao.
While the national government, through the Department of Health, has already allocated funds for the construction of more birthing facilities and the training of community health teams, especially in areas with high concentration of maternal deaths, âthis supply-side approach needs to be complemented by work on the demand side,â Mr. Garilao said.
âWe need to improve local health leadership and influence traditional health-seeking behavior to ensure that people, especially the poor, actually use health facilities and services,â he stressed.
22 October 2012, Business World Online
Second of three parts
On Oct. 25, 2012, health leaders from among the 12 poorest and far-flung towns in the country will be recognized for their efforts in dramatically turning their health situations around — in particular, saving the lives of mothers and their newborns.
The 12 municipalities are: Cajidiocan, Magdiwang and San Fernando in Romblon; Pilar and Prieto Diaz in Sorsogon; Minalabac in Camarines Sur; Daram and Pinabacdao in Samar; Lapuyan and San Pablo in Zamboanga del Sur; Leon Postigo in Zamboanga del Norte; and Tungawan in Zamboanga Sibugay. They comprise the second batch of municipalities that have undergone health leadership training and other support initiatives under Zuellig Family Foundationâs (ZFF) Community Health Partnership program.
Starting with a maternal mortality ratio (the number of women who die during pregnancy and childbirth per 100,000 live births or MMR) of 193, the collective MMR of the municipalities dropped to 139 in 2010 and even drastically to 44 in 2011. By the end of the first half 2012, the ratio went down to 22 — way below the Philippinesâ Millennium Development Goal target of 52 with still three years to go before the United Nationsâ deadline.
The improvement in maternal health is not isloated to the 12 municipalities. There are now more than 50 other municipalities where mothers are giving birth safely and communities are reporting health gains. These municipalities started under the ZFF partnership program in 2009.
What makes these municipalities succeed while the rest of the population still struggle meeting the MDG targets on health?
The experiences of the municipalities show that it takes more than providing infrastructure such as birthing facilities and health clinics to save the lives of pregnant mothers and their babies. And one family foundation, even with its focused health interventions, simply cannot do it alone.
Through ZFF, partner-municipalities not only benefit from training and mentoring, gaining access to various innovative programs and best practices on health, as well as health infrastructure and equipment support. They also derive support from ZFFâs network of partners, composed of private companies, civil society and nongovernment organizations that share the health advocacy.
These partners include: Synergeia Foundation for education, CARD-MRI for livelihood, corporate foundations such as Jollibee Foundation for nutrition programs, and academic institutions such as the University of Makati, and the University of the Philippines-School of Health Sciences in Palo, Leyte, and Davao Medical School Foundation that can provide LGUs with capacity-building and technical assistance in health governance.
In addition, ZFF has also forged strategic alliances with the departments of Health and Social Welfare and Development to address health problems in the Zamboanga Peninsula and the Autonomous Region in Muslim Mindanao (ARMM) in the case of Maguindanao.
In addition to the construction of more birthing clinics with modern equipment to assist pregnant and mothers, such as in the case of Minalabac, Camarines Sur with the help of Pfizer Philippines, other forms of PPP are also making an impact in the municipalities.
Six partner-municipalities (Dao, Capiz; Don Salvador Benedicto in Negros Occidental; Ipil, Zamboanga Sibugay; and the Romblon towns of Cajidiocan, Magdiwang and San Fernando) are now serving as pilot sites for ZFF and the Wireless Access for Health Initiativeâs partnership aimed at improving health care service delivery through the use of information technology platforms like 3G connectivity technology and electronic medical records.
The project will aim to modernize the health information system such as having electronic medical records, synchronized patient alerts via SMS, real-time health data from the field and inter-connectivity for reporting and consolidation of health data.
Along with this is an initiative using mobile phone technology to give pregnant women 24-hour access to medical advice. Women can call or text the municipal doctor about pregnancy-related question and they have the rural health unit hotline to call an ambulance.
By 2013, the system will also be introduced to ten more ZFF partner-municipalities in the ARMM.
âWe hold no illusion that we can do it alone. We must be able to mainstream our Health Change Model and encourage more PPP among government agencies, local government units, and private development organizations. Not only is this critical in meeting the countryâs MDGs on health, but also in sustaining equitable and responsive health systems well beyond 2015,â said ZFF Chairman Roberto R. Romulo, who is also a former ambassador and Foreign Affairs secretary under the Ramos administration. — contributed by Sheila S. Pesayco
23 October 2012, Business World Online
Last of three parts
BEFORE DR. Heidee Exconde came to Cajidiocan in Romblon under the âDoctors to the Barrioâ program of the Department of Health (DoH) in 2008, the fourth-class municipality had 12 non-functioning barangay health stations and was badly meeting government health standards.
How the municipality turned from being the âsick man of Romblonâ to being recognized by the DoH-Center for Health Development IV-B as a regional model in attaining the UN Millennium Development Goals (MDGs) in barely three years is a powerful testament to the role of health leaders.
Through a three-pronged strategy called Kabarangay para sa Kauswagan ng Kalusugan, the young doctor was able to engage village leaders in initiating health programs, improving health facilities, and running training programs for barangay health workers. The townâs PhilHealth-accredited Rural Health Unit also became the provinceâs first â3-in-1â facility, which means it offers a maternal care package, anti-tuberculosis treatment, and outpatient benefits.
Ms. Exconde is one of the health leaders from among the 12 poorest and far-flung towns in the country who will be recognized tomorrow at a colloquium sponsored by Zuellig Family Foundation (ZFF) for their efforts in turning their communitiesâ health situations around. The municipalities also serve as successful public-private partnership (PPP) models that could help the country attain health-related MDGs by 2015.
HEALTH CHANGE MODEL
Even the DoH, under Secretary Enrique T. Ona, recognizes that it takes strong partnerships for the government to attain its vision of providing universal health care for all Filipinos.
âThe government cannot achieve this dream alone. Universal Health Care will not be realized without the peopleâs commitment and partnership. We ask the private sector to continue working with us with the same enthusiasm and drive to help uplift the lives of the poorest members of our society,â he said.
ZFFâs Community Health Partnership program, which provides health leadership training and other support initiatives to municipalities like Cajidiocan where health burdens are heaviest, is one such vehicle for PPP.
In 2009, ZFF piloted its Health Change Model in nine municipalities. Their combined maternal mortality ratio (MMR) the year before was 167. This came down to 148 after a year, and continued to drop even after the two-year formal partnership program has ended. In 2011, their MMR was at 60 and now stood at only 40 as of the first half of 2012 — meeting the countryâs MDG target three years ahead of the deadline.
The successful implementation of the health change model emboldened ZFF to expand the partnership program in more than 50 other municipalities. Now on its sixth batch of towns, the PPP model has led to drastic improvements in health outcomes and the achievement of the MDGs on health ahead of the 2015 deadline.
While it has already made tremendous strides in reducing the townsâ MMR, ZFF Chairman Roberto R. Romulo said: âSuch interventions were made after the pregnancy, which leaves out a component that needs to be enhanced: reproductive health.â
It is for this reason that ZFF recently forged a partnership with the United Nations Population Fund (UNFPA) to expand the health leadership and governance model to 10 more provinces. It also linked up with the multinational pharmaceutical company Merck Sharp & Dohme (MSD) to provide reproductive education and programs to 21 municipalities in three Samar provinces.
In addition, ZFF has entered into various other forms of partnership in an urgent bid to beat the 2015 MDG deadline and make lasting impact on rural health beyond 2015.
It recently signed a memorandum of agreement with PhilHealth to provide quality health insurance benefits and services to poor Filipinos, especially in underserved rural areas.
The foundation also recently partnered with the nonprofit Peace and Equity Foundation for the creation of 10-million financing facility that would support the growth and development of social enterprises in the health sector. By mounting an aggressive campaign for more private sector investments, the partnership hopes to improve local health systems and eventually address health inequities in the rural areas.
Another partnership model is with the microfinance group CARD MRI to improve access to affordable medicines, especially in far-flung communities, and the extension of loans to health workers. As of last April, ZFF partner-municipalities have already availed of 1.84 million worth of loans, benefiting 86 health workers from six towns.
Addressing the needs of children, ZFF also brings the Jollibee Foundationâs Busog-Lusog-Talino nutritional program and Synergeia Foundationâs basic education program in some of its partner-municipalities.
HEALTH AND PEACE
The successful PPP model is also expected to bring lasting outcomes in the Autonomous Region in Muslim Mindanao (ARMM), where health burdens are considered among the highest in the country because of years of armed conflict.
When the ZFF partnership started in 2010 in ARMM, the collective MMR of the municipalities was at 141. This dropped to 68 after just a year and now stood at only 47 as of the first half of 2012.
A recently forged partnership with the regional government of ARMM will provide health leadership and governance programs to 50 municipalities, comprising 40% of the regionâs total municipalities.
âThis is relevant in the light of the MILF-Philippine peace agreement and road map,â said Mr. Romulo. âDuring the transition of ARMM to Bangsamoro by 2016, it is essential for local governments to immediately be able to reap the benefits of peace and development dividends.â
With a successful PPP model leading to better health and âby having committed local executivesâ in the Bangsamoro, Mr. Romulo said âimprovements will be made and dividends can be maximized.â This way, lasting peace could also lead to lasting health outcomes, attaining the governmentâs vision of universal health care for all Filipinos. — contributed by Sheila S. Pesayco