Health and hope for mothers

MANILA, Philippines - In the fourth-class municipality of Lapuyan in Zamboanga del Sur, about 80 percent of the residents belong to the Subanen tribe. The Subanen practice various birthing rituals and hold a lot of pregnancy-related beliefs. Sometimes, these rituals go against what modern science dictates, resulting in poor maternal health and placing a lot of new mothers and infants at risk.

Mayor Daylinda Sulong, a Subanen herself, knows only too well that culture has to be a factor in formulating the health policy in her municipality.

In 2010, the local government partnered with the Zuellig Family Foundation (ZFF) as part of its Community Health Partnership Program. Over the past two years, it has made headway in the health outcomes of more than 50 municipalities nationwide.

Lapuyan is just one of the 12 rural municipalities that belong to the second batch of ZFF’s partners. Collectively, the 12 towns’ health indicators, such as maternal and infant mortality ratios, facility-based deliveries and malnutrition rates, have improved dramatically in just a span of two years under the partnership.

In Lapuyan, one of the key reforms this partnership has made possible is the compromise between culture and modern medicine. While the idea of giving birth outside their homes goes against traditional beliefs, maternal and infant deaths have been blamed on risky home deliveries without the supervision of skilled birth attendants, says Sulong.

She consulted with tribal and religious leaders and explained to them the risks involved. “I realized that there is no need for culture and medicine to clash if we just try to understand each other,” she says.

Maternal shelters were also built beside birthing clinics to guarantee the safety of new mothers and babies right after delivery. This has been especially helpful to those who live in remote areas.

To further boost maternal health, the Rural Health Unit was made operational 24/7. An additional two birthing units were built in far-flung villages. Midwives and nurses, who live at or near these centers, are stationed at the clinics during the day and remain on call at night.

As a result, facility-based deliveries have gone up from three percent in 2009 to 60 percent. Both maternal and infant deaths have been zero since 2011. Allocation for health had surpassed the 15 percent recommended level, and every year, P500,000 is allotted to increase enrollment in PhilHealth.

In Daram, Samar, another ZFF partner municipality, the mayor worked from the ground up, empowering his barangay health workers with key institutional and legal reforms.

Double-digit infant deaths due to sepsis alarmed the town’s local leadership, says Mayor Lucia Astorga. Partly to blame was the town’s rough terrain, Astorga adds. Going from one community to the next requires boat rides or long hikes around a mountain, a task that had dampened the resolve of some health workers.

In partnership with ZFF, Daram implemented a performance management system, which would clearly outline roles and targets for all municipal health personnel. This had allowed leaders, such as municipal health officer Khrystina Mabutin, to pinpoint gaps in health service delivery and address them.

This monitoring and evaluation process inspired the health team to step up their efforts. Midwives worked closely with barangay captains and health workers. While the challenging terrain is still a challenge, the health team of Daram now know where to direct their limited resources. Facility-based deliveries have increased from a mere four percent in 2009 to 65 percent.

In the fourth-class municipality of Minalabac, Camarines Sur, Mayor Gil Basmayor admitted that he would rather build roads and bridges than invest in health. This was until he got initiated into ZFF’s Community Partnership Program.  

But Minalabac’s grim health picture was already difficult to ignore. In its worst year, the agricultural town recorded the worst malnourishment rate in the entire Bicol region, owing to the string of typhoons that hit the town and paralyzed its rice and coconut production. Residents used to rely on themselves for health-related services, and allocation for health was a dismal four percent of the budget, way below the ideal 15 percent.

Today, Basmayor can be seen going around the town’s seven birthing clinics to personally talk to new mothers. “If you want to solve the problem, you have to know what the problem is,” he said. Basmayor adds he was surprised that the municipality actually had a lot of unused health-related data.

“We had a community-based monitoring system that was put in place to determine where government needs to focus its efforts. We had data on maternal deaths, tuberculosis, malnourishment, pregnancy-related deaths, and more. It was just a matter of making use of those data,” he said.

The response of the community was overwhelming. When he needed to beef up the health budget and consequently cut other departments, he heard no complaints. In less than a year, the clinics that used to be just empty are now crowded with people even before they open at 7 a.m. From two birthing facilities, the town now has seven strategically located and equipped units.

Facility-based deliveries went from 15 percent in 2009 to 78 percent. No maternal deaths had been recorded in Minalabac since 2010. Pregnant women have 24-hour access to medical advice and an ambulance in case of emergency.

These mayors, together with ZFF, prove that even in the most remote areas, enduring partnerships between the private and public sectors ensure that more lives will be saved.