BYWATER AND BY LAND Porters on the island village of Old Caaluan carry a pregnant woman in a hammock to a boat that will ferry her to the mainland, where a “habal-habal” is waiting to take her to a hospital in Tinambac. PHOTO COURTESY OF ZUELLIG FAMILY FOUNDATION — BY WATER AND BY LAND Porters on the island village of Old Caaluan carry a pregnant woman in a hammock to a boat that will ferry her to the mainland, where a “habal-habal” is waiting to take her to a hospital in Tinambac. PHOTO COURTESY OF ZUELLIG FAMILY FOUNDATION

In the small town of Tinambac in Camarines Sur province, the health of every mother and child is everybody’s affair.

While public health workers are the primary providers of care, ordinary townsfolk—from the midwives going around the villages to the habal-habal drivers plying the town’s steep roads to the priests holding Sunday Masses in the barrios—share in the arduous task of keeping every mother and baby alive and well.

Cultivating this novel synergy in the last two years, the municipality was able to reverse setbacks in its health programs, which worsened in 2011 when nine mothers died in childbirth and 11 infants perished even before they were a month old.

For a town of more than 65,000 residents, the figures were considered alarming as the Philippines worked to meet the Millennium Development Goal (MDG) targets on maternal and infant deaths at 52 women per 100,000 live births and 26.7 per 1,000 live births, respectively, by the end of 2015.

Actual figures show that there were 539 maternal deaths nationwide as of the third quarter of 2015, a 57-percent reduction from the numbers culled in 2012.

Partnerships

“I learned that providing better health for the mothers and children is not just the job of the mayor, the barangay official or the health personnel. We have to create more partners to [achieve this goal],” Tinambac Mayor Ruel Velarde said in an interview with the Inquirer.

A first-class municipality, Tinambac was recently awarded the first Zuellig Family Foundation (ZFF) Excellence Award for Leadership in Public Health for instituting health reforms to help make serious dents in the national figures on maternal and infant mortality.

In 2013, Tinambac has been able to bring down maternal deaths to one and finally to zero in the succeeding two years despite the absence of avant-garde health facilities, complicated by the geographical isolation of majority of its 44 barangays.

“[The award] is given to a municipality whose mayor has displayed commendable ‘Bridging Leadership’ skills in instituting changes. The mayor’s ownership of health issues inspired others to take part in a better vision for health,” Roberto Romulo, ZFF chair, said at the awarding ceremony.

“Together with the municipal health officer, rural health physician and members of the local health board, they took a health reform journey we all can learn from,” he added.

Velarde pioneered many health innovations worthy of replication in other cities when he partnered with ZFF and trained under its Health Leadership and Governance Program in 2012.

Under this program, mayors and municipal health officers take a yearlong, two-module leadership program and are tasked with improving health indicators in their jurisdictions following the World Health Organization’s six building blocks of health: leadership and governance, health care financing, health workforce, medical products and technologies, information and research and service delivery.

In giving the award to Tinambac, ZFF lauded the town’s “breakthrough alliance” with the Archdiocese of Caceres and the local parishes, where priests take to their pulpits the advocacy of responsible parenthood and of safe, planned and wanted pregnancy.

It might have been a difficult partnership if it were implemented elsewhere in the country, but in a town where priests are still highly revered as God’s messengers, the campaign reaped positive results, said Velarde, a devout Catholic.

It also helped that Tinambac has the most number of parishes, seven, under the Archdiocese of Caceres, he said.

“If we just leave it to the local leaders to speak, people may resist the message, especially when it goes against their beliefs and traditions,” Velarde said, explaining the reason for the unusual partnership.

The national government and the Catholic Church have been at odds over the reproductive health law, which gave Filipino couples access to a wide range of birth control methods, particularly artificial ones.

Earlier, ZFF president Ernesto Garilao underscored the importance of family planning, saying family planning services must be made available to Filipino households to curb deaths of mothers during pregnancy.

Effective communicators

“Priests are still effective communicators in our municipality. Our people still believe that the message priests deliver to them is the word of God, so they obey,” Velarde said.

He added, however, that the priests are helping out with the town’s campaign to teach couples the calendar method, which uses past menstrual cycles to estimate the time of ovulation. The “scientific commodities” of family planning are left to the health experts.

Involving priests to help improve and protect the health of mothers and infants has also become handy in communicating often ignored programs and activities like vaccination schedules for infants and free prenatal and postnatal checkups for pregnant women, Velarde said.

“There were times that the priest in my parish would allow me to be by his side and make the announcements myself or lecture about the calendar method before he concluded the Mass,” he said.

To handle the last-minute hospital admissions of laboring mothers and the dismal rate of hospital deliveries, Velarde had to be extra creative in the face of inevitable limitations, such as the distance of coastal and upland villages to the town’s health facilities.

Tinambac has two rural health centers and a municipal hospital manned by five resident doctors, 12 staff nurses and five midwives.

Transportation system

Velarde formed a band of habal-habal drivers in each of the 44 barangays of Tinambac under the Kasurog Program to make sure that every pregnant woman in labor, even in the remotest areas, reaches the hospital on time.

He said one of the major causes of maternal and neonatal death in his town was the failure of pregnant mothers about to give birth or with an emergency medical condition to get prompt help.

Others who are too poor to pay for transportation choose to give birth in their homes with the assistance of a hilot, he added.

“So what we did was, we organized the habal-habal drivers, gave them uniforms and IDs and a record book identifying all the pregnant mothers in their own villages and the mothers’ respective addresses and due dates,” Velarde said.

The record book, regularly updated at the municipal health office, gives the drivers an idea when they are expected to give the mothers a ride to the nearest health center. In return, the drivers are given monetary incentives upon arrival at the hospital.

The construction of a halfway maternal home in 2013, financed by ZFF, provided a more permanent solution. Built right next to the municipal hospital, the halfway house provided pregnant women a refuge while awaiting their delivery date so they no longer needed to travel from far-flung villages.

To dissuade hilot from assisting in home deliveries, Velarde gave them a more stable and lucrative job—the young ones were enlisted as barangay health workers and the older ones as community herbal gardeners.

A safe birthing ordinance has also been passed, which imposes stiffer sanctions on stubborn hilot and couples who seek their assistance rather than get professional care.

Continuity

Velarde, now serving his last term, said he worked hard over the last two years to build a better health system that involved all sectors so that after he stepped down in June, the people would know what the municipal government owed them and would continue to demand better services from whoever was at the helm.

“This way, continuity is ensured even if I am no longer the mayor,” he said.

In her speech at the awarding ceremony, Health Secretary Janette Garin underscored the importance of accountability among local leaders to achieve better health services in their communities.

Various sectors must work together to deal with post-2015 challenges and social barriers facing the country’s health care system, she said.

“Local government[s] must have strong capacities as the front-line planners, resource programmers and implementers of policies and programs at the grassroots level,” she said.

Garin also said ZFF’s health change model had been proven to be an impetus for harnessing the “energies, talents and commitment” of mayors, municipal health officers and community leaders to improve health services.

Expanding this model on the national level will help the Department of Health enhance further its programs and initiatives toward meeting the country’s MDG targets, she added.