Tuesday, August 05, 2014

[Vital Signs Column] A Hope for Nanay

Nurse’s Notes
By: Alvin Cloyd Dakis, RN

In my return to writing for Vital Signs, after a long hiatus due to a lot of rollercoaster events, I’ll share about a story which I got so inspired – the story of Lapuyan.

Recently, I joined the formidable Zuellig Family Foundation (ZFF) – a 17-year-old foundation that aims to be the catalyst for the achievement of better health outcomes for the poor through sustainable programs and services in partnership with the government and other key stakeholders in the health sector. I have heard of this foundation and how well they implement their programs in the ground but not until today that I officially joined them do I know of how dedicated they are in fulfilling their vision and mission for health in the Philippines.

Lapuyan and the MLGP
I saw the story of Lapuyan (fourth-class municipality in Zamboanga Del Sur) in our orientation at ZFF. The Foundation highlighted its programs and how they work with local chief executives through their Community Health Partnership Program (CHPP) and later through their Health Governance and Leadership Program (HLGP). HLGP aims to create an immediate impact on achieving the Millennium Development Goals (MDGs) especially the health-related goals 4, 5, and 6 (also including Goals 1 and 7) by improving local health systems through an empowered and efficient leadership and governance of their local chief executives (LCEs). HLGP gave birth to three programs focusing on Provinces (PLGP), Municipalities (MLGP) and the most recent in the Cities (CLGP). This program engages LCEs and their local health offices in two years, training and coaching them together with the Department of Health.

Going back to Lapuyan, it is one of the first municipalities that tied up with ZFF for their CHPP in 2010 under the leadership of Mayor Daylinda Sulong.  Lapuyan is distinct with the large presence of the Subanen Tribe which has a culture and tradition on birthing. The Tribe has a lot of rituals and beliefs related to birthing and pregnancy which at times may contradict knowledge of modern medicine. This poses a great challenge for the leadership of Mayor Sulong who is also a Subanen herself – but partnership with ZFF enabled her to compromise culture and modern medicine, a skill learned by LCEs in the Bridging Leadership Program which is offered as part of the training in MLGP.

ZFF and DOH MOU Signing on MLGP, 2013
Mayor Sulong believed that a compromise should be made to both cultural practice and modern medicine because her municipality is experiencing maternal and infant deaths due to risky home deliveries and deliveries which were not attended by skilled birth attendants. She then consulted the tribal and religious leaders in her municipality and presented the problem to them.

“I realized that there is no need for culture and medicine to clash if we just try to understand each other…” Lapuyan Mayor Daylinda Sulong

Numbers don’t lie in Lapuyan
Would you know how many mothers and infants are dying or are dead in Lapuyan?
Since 2011, after their engagement in ZFF for 2 years

So how would a fourth-class municipality in southern Philippines achieve a zero maternal and neonatal death? ZFF believed in empowering and equipping LCEs to impact local health systems. Bridging Leadership capacitates LCEs to ‘own the problem’; identify ways to solve the problem with the stakeholders ‘co-owning’ the issues; and by creating new, innovative, and meaningful solutions and approaches to societal health problems through ‘co-creation’. ZFF Vice President Ramon Derige believes that “adaptive skills are necessary because inaction leads to death.”

Lapuyan’s performance was a remarkable success!

Facility-based deliveries shoot from 3% to 60% from 2009 to 2012.

P500,000 was allotted to increase enrollment in PhilHealth.

The local government allocated budget for health more than what is recommended. Amazing!

These can be seen with Lapuyan’s maternal and infant health indicators turning from unsatisfactory to very satisfactory in most areas; zero maternal and infant deaths; high percentage of facility-based deliveries; improvement and creation of new birthing clinics with maternal shelters guaranteeing the safety of mothers and infants after delivery; a fully operational 24/7 Rural Health Unit; and on-call health human resources (nurses and midwives) who are stationed in the centers as well.

Lapuyan continued to arm it health workforce by continuing education and training and continue to educate and empower their public through their Buntis Congress – an annual event gathering local women and men, pregnant and expectant mothers to discuss about the importance of pregnancy, pre-natal care and post-natal follow-up.

A change of mindset, a change of heart
Lapuyan is not the only municipality that ZFF partnered for this program. Lapuyan’s success is only one of the many astonishing and remarkable feats the MLGP has done.

A key institutional reform in Daram, Samar was when they did a “bottom-up” approach in responding to their health challenges by implementing a performance management system which allowed the municipal health office to clearly outline roles and targets and identify gaps in health care delivery. This system boosted their facility-based deliveries from 4% to 65%. Too many a time, policies are directed from top to bottom, and Daram is an example that an opposite approach may work, and work well.

Perhaps many would be critical in looking into the effectiveness of Zuellig’s Health Leadership and Governance Program and how it can be sustained after the training of its local chief executives and health officers. Some would ask how initiatives and programs can be sustained should the trained mayor or governor end his/her term, and some would wonder how this training can translate to sustainable policies and programs?

I for one was critical of this and saw it as a challenge that might be too large for DOH, UNICEF, and ZFF to handle – but the reports from their partner municipalities tell the otherwise. Theirs are stories of successes and real life transformations that they may appreciate better than I am. Numbers may be manipulated but stories of mothers whose lives were changed cannot. The triumphant stories of leaders shaping better communities and achieving societal goals not just for theirs but for the entire country gave me hope that ZFF’s initiatives together with DOH, UNICEF, UNFPA, DAP, other co-implementing partners, and most especially to every local government partners will succeed, prosper, and sustain.

But let us be reminded that reports will remain words, graphs, tables, and numbers but shall never translate to genuine societal change should the people not feel these changes positively impacting their lives – that no Filipina will ever die while giving life, no child shall be left orphan, and no family shall die from diseases we can prevent.

Finally, know that in those numbers are stories of countless ‘nanay’, ‘ate’, ‘tita’, and Filipina dying. Let us continue to encourage our leaders to pursue their good efforts in saving the lives of our dear ones and together, let us do our share of the solution.

There is hope for ‘nanay’ after all. 

To see what ZFF has been doing in their partner municipalities, and to witness Lapuyan's experience, see this video.

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