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Difficult but Not Impossible PAGE 14 Annual Report 2012 Progress Highlights Contents Crossing Rivers to Get Pre-Natal Care PAGE ii The First Five Years: Testing the Health Change Model PAGE 4 Leadership Transformation and Health Reforms PAGE 8 End Goal is Sustainability of Good Health Outcomes PAGE 22 Health Challenges in Isolated and Disadvantaged Areas: Difficult But Not Impossible PAGE 14 Annual Report 2012 Progress Highlights Contents 1 Message from the Board of Trustees 4 The First Five Years: P198.1m Testing the Health Change Model ZFF Expenditures 8 Leadership Transformation and Health Reforms 14 Health Challenges in Isolated and Disadvantaged Areas: 95 Difficult but Not Impossible 16 Samar Provinces: Partner-Municipalities 849 Poverty, Governance Health Leaders and Health Trained 22 End Goal is Sustainability of Good Health Outcomes 2.7m 27 Financial Highlights Persons Benefitting from ZFF Programs 2,751 Frontline Health Workers Trained 51 Health Facilities Funded 933,182 Crossing Rivers Residents Benifitting from 51 ZFF-sponsored to Get Pre-Natal Care Health Facilities in 30 Municipalities For some, getting healthcare requires literally going the extra mile – taking hours of boat rides, long walks, lengthy land travels or a combination of these. Such is the case of these three pregnant women who are boarding a boat with the help of midwife Elmer Estudillo. They need to cross the river that separates their village from the poblacion where the Rural Health Unit is located. The short one-way ride costs P5 a person. They can also use a hanging bridge but that is a longer and riskier alternative, especially for these expectant mothers. Daram, Samar Location: Barangay Calingnan, Catubig in Northern Samar B ZUELLIG FAMILY FOUNDATION A Message from the Zuellig Family Committed to Rural Health government units in programs to build disadvantaged areas, and continuous specific capacities in health leadership efforts will be required to ensure and health governance. sustained improvement through the long-term adherence to good ZFF Health Change Model health practices. To guide us in our work, we developed a matrix we call the “ZFF Health Change Partnerships for Health Model.” The modular syllabus of this Good results have attracted good program identifies major interventions partners. The relevance and scope of to enable local health leadership and the ZFF Health Change Model have Daniel Zuellig David Zuellig to institute good health governance, been reinforced and expanded by a as well as a framework for improving partnership with the United Nations No social endeavor can be all things to all critical elements of the local health Population Fund for nine provinces men and women. Without the dedicated system, primarily in terms of access and and a co-operation with Merck Sharp focus on a well-defined field of action, effectiveness. & Dohme in 21 municipalities on charities and philanthropic organizations Samar Island. are at risk of wasting good intentions It took us four years, from 2009 to 2012, and squandering both money and time. to pilot the ZFF Health Change Model in We are particularly encouraged by Given our long-standing engagement five cohorts of 46 municipalities. Three an unprecedented Public-Private in the Philippine health sector, we cohorts have already completed their Partnership (PPP): the Department decided to focus our family foundation two-year partnership program with us. of Health (DOH) has committed to on health, and more specifically, on the We are continuing our work with them mainstream the ZFF Health Change improvement of health conditions in along with 49 other municipalities. Model to 609 priority municipalities, disadvantaged rural areas. as well as to regional DOH officials who Measuring Health Outcomes will provide both health leadership Primary Health System in Rural Areas The function of the ZFF Health Change and technical assistance to mayors and When we reframed our foundation’s Model is based on systematic data municipal health officers. mission in 2008, we found that great collection and measurement of health inequities persisted in all health outcomes. The results of our initial In the next ten years, especially with indicators between rural and urban cohorts of partner-municipalities show the DOH-ZFF PPP, we will continue to areas. Even more than in cities, the that, within two years, the maternal focus on rural health. We have realized rural poor depend on the services and mortality ratio (MMR), one of the that improving health outcomes amenities of the municipal health units. sentinel indicators for the performance requires a long-term engagement. of primary health systems, could Founded on mutual trust, we have Typically, primary health facilities are be significantly reduced in most established solid relationships with our ill-equipped, inaccessible or offer only municipalities. Our findings give us the partners and health leaders throughout very limited services. We could have confidence that the achievement of the the country. built hospitals, sponsored equipment government’s target for the reduction and doled out medicine, but we were of maternal mortality is within reach. We will use this experience as we not convinced that such donations In line with the UN Millennium accompany many more mayors would have a lasting effect and address Development Goals, the Philippines is and local health officials through the systemic root causes of the deficient committed to bring the MMR below 52 the transformation of their health provision of primary healthcare. maternal deaths per 100,000 live births systems towards the achievement by 2015, from 221 in 2011. of sustainable and measurable We realized that sustainable improvements of health outcomes in improvements can be achieved only The positive results in our partner- their communities. We will go forward with the full engagement of the leaders municipalities were achieved through on this journey with our partners to of the local public health system, deliberate efforts of local health give rise to a better quality of life for headed by the mayor. Therefore, we leaders. Still, many challenges remain, Filipinos in disadvantaged rural areas. chose to engage the leaders of local especially in geographically isolated and 2012 ANNUAL REPORT 1 Message from the Board of Trustees • Francisco R. Billano • Alberto G. Romualdez, MD • Esperanza I. Cabral, MD • Daniel Zuellig • Roberto R. Romulo Chairman • David Zuellig • Ernesto D. Garilao President • Reiner W. Gloor • Washington Z. SyCip • Kasigod V. Jamias Treasurer Challenging Health Inequities Dear partners and fellow health reservations among health experts, Five years after our start with a workers: even within the inner circle of our pilot set of nine municipalities, we foundation. Concerns were raised about now have worked with a total of 95 Back in 2008, the decision to change the strategic necessity of working with municipalities, primarily in regions the focus of the Zuellig Family local political executives, specifically facing the most challenging health Foundation (ZFF) to the health of the the mayors of rural municipalities, issues – Mimaropa, Bicol, Eastern rural poor came at a critical, but also who were generally perceived to be Visayas, Zamboanga Peninsula and opportune time. unresponsive and oblivious to health the Autonomous Region in Muslim matters. However, a consensus evolved Mindanao (ARMM). While Philippine health indicators that, as a result of the enactment of the showed gradual improvements, a Local Government Code in 1991, which When we began our work, we were closer look revealed a disturbing reality: devolved the responsibility for primary confronted with a daunting task. In growing health inequities between public healthcare to the local level, line with the Philippine government’s income classes, and among the richer the mayor of each municipality holds commitment to reaching the UN and the poorer regions. For the poor, the key and the power to oversee and Millennium Development Goals (MDGs) life expectancy was 60 years – 20 years effect changes in the provision of basic by 2015, we focused on improving shorter than for the rich. The incidence primary healthcare on which the rural maternal health, in line with the MDG of maternal deaths was ten times poor depend. Rather than intervening in of reducing the country’s maternal higher among the poor than among specific health programs and projects, mortality ratio (MMR) to 52 maternal the rich. And infants in poor areas were or addressing short-term needs with deaths per 100,000 live births by nine times more likely to die than those a series of one-time donations, we set 2015. The United Nations Population born in rich areas. In short, the poor, out to tackle the bigger challenge of Fund (UNFPA) projected that, in the especially in rural areas, were being left system change to build sustainable absence of drastic interventions, the out of the country’s progress in health. and inclusive public healthcare Philippines could meet its MMR target system in rural areas. We realized no earlier than in 2043, or 28 years after Strategic work with local political that this approach to “health change” the 2015 MDG deadline. Contrary to leaders necessitates a long-term and replicative such predictions, the experience with To address these inequities, we put involvement with local government our partner-municipalities, however, forward a health change strategy that units in our target regions. showed that the MMR can be reduced initially drew mixed reactions and some to meet the target within two years. 2 ZUELLIG
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