THE CHALLENGE Zumarraga is a fifth class island municipality composed of 25 coastal barangays. Access to the municipality from the mainland Samar is through passenger or private boats. The island is one of more than 700 geographically isolated and disadvantaged areas (GIDA) in the country. The lack of circumferential roads makes it challenging to transport high-risk pregnant women in an accredited birthing facility located in Poblacion. It would take about 30 minutes to reach the Poblacion from the nearest catchment barangay while it would take another hour to reach the farthest, on the other side of the island. The municipality failed to meet the national targets for most of the health indicators, especially in terms of facility-based deliveries and skilled birth attendance, which were only about 20% prior to the implementation of the project.

THE SOCIAL INNOVATION The solution is a sea ambulance or a boat referral system that connects remote barangay health stations to the main birthing facility in Poblacion. It also ensures that a designated boat driver and fuel are always available and accessible for timely referral. The birthing facility is accredited by the Philippine Health Insurance Corporation (PhilHealth) to provide basic maternal and newborn package, hence it is entitled with claims Inter-island Health reimbursements for every pregnant woman who delivers at the birthing facility, provided she is an eligible member of Philhealth. The innovation in the project is its financial sustainability model where the facility utilizes the reimbursements from Referral System PhilHealth to fund the operations and maintenance through One Health of the boats. IMPACT ON HEALTH Service Boat Project DELIVERY Significant improvements were noted in key — Zumarraga maternal and child health indicators. Two years after the implementation, Zumarraga improved in its facility-based deliveries from 20% in 2013 to 90% in 2015. In addition, the facility earned more Municipal Health than one million pesos per year from PhilHealth reimbursements from 2015 to 2016. The extra funding allowed the health center to strengthen the implementation of its key priority health programs and provided additional incentives for health care workers. Overall, the project also Office increased trust between the health workers and the community members because of their enhanced capacity to respond to emergencies and disasters through dedicated health service boats.

OPPORTUNITY FOR SCALE

The health service boat is made of timber, typical of the boats used by the local fishermen in the region and other island communities in the country. Since it is made out of local materials, it is easier to maintain by local boat builders. It also consumes a moderate amount of fuel (around 8-10 liters, which is about Php 300-500) for a round-trip transfer. This is in stark contrast with the standard sea ambulance, which can cost millions of pesos to procure and maintain. Funding for maintenance support is anchored in the existing national health insurance scheme. This provides an adequate and steady revenue stream to support other priority health programs that fosters real and systemic change in the locale.

KEY LESSONS

1

Supporting mechanisms—such as dedicated boatmen, tapping local fuel suppliers and boat builders as well as engaging barangay captains for support—should be equally harnessed to ensure sustainability of operations and maintenance.

2  Investing in people is integral to the success A sustainable inter-island of the project. Securing the ownership and referral and financing commitment of the health workers, especially the midwives, is important. As the principal mechanism that improves caretaker of the boats, they should embrace the quality of maternal and the responsibility of ensuring that it is properly newborn care utilized and adequately maintained.

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