Challenges of rural health

Despite improvements in nutrition levels in recent years, malnutrition continues to debilitate very young minds and bodies in many rural communities around the country. National statistics indicate that as many as 3.35 million children suffer from one form of malnutrition or another. The impact of this is staggering, as mortality of children under five is one of the direct consequences of the lack of proper food among poor families. This is an ongoing tragedy that has not been apparent to the public.

This harsh reality confronted me in a recent trip to Padre Burgos – a fourth-class municipality in Quezon Province – where I was informed by a principal that almost one out of every five school-age children in her school is malnourished. Even if they manage to go to school, malnutrition prevents many of them from performing the most basic academic functions, let alone survive an entire school year.

The Zuellig Family Foundation (ZFF), which I chair and the Jollibee Foundation are two organizations that have been working with the national and local government to address this issue.

Jollibee Foundation

While more popularly recognized as the country’s leading fast-food chain, Jollibee has taken upon itself to do something about this problem through its social development arm. In partnership with local government units, the Jollibee Foundation is expanding its school-based feeding program that aims to keep malnourished kids in school. The program covers 16,000 pupils in 444 schools in 90 towns and cities. Jollibee requires LGUs to provide counterpart funds starting on the second year of the partnership, with the local government eventually sustaining the feeding program after three years.

So far, the partnership seems to be working in Padre Burgos, a partner municipality of ZFF since 2009. A midyear assessment of the current feeding cycle showed half of the children under the program have achieved their prescribed Body Mass Index after just a little over two months. Aside from the laudable support of the LGU under Mayor Roger Panganiban, one aspect of the program that is seen to be contributing to the positive results is the involvement of the parents, who are required to attend seminars, to take part in the actual preparation of the daily meals and replicate nutritious recipes in their homes.

The program also got a boost when the LGU introduced INSUMIX – an indigenous supplementary mixture composed of sesame seeds and monggo that is blended with rice – to further enhance the nutritional value of meals served under the feeding program. Padre Burgos got the idea of using INSUMIX from the municipality of Dao in Capiz, another ZFF partner municipality that has successfully addressed its malnutrition problem using local resources.

Microfinancing by CARD

Malnutrition is just one of the many offshoots of poverty. When families simply do not earn enough to put food on the table, children are the most affected. In San Pablo, Laguna I also visited the headquarters of an organization that has made a niche in addressing the need to improve the quality of life of the poor. Since 1986, the Center for Agriculture and Rural Development-Mutually Reinforcing Institutions (CARD) has helped millions of families gain access to affordable loans for micro-enterprises. In 2008, in recognition of its impact on rural communities, CARD under the leadership of Dr. Aristole Alip, was named one of the Ramon Magsaysay Awardees for Public Service.

Disease: Additional financial burden

While microfinance interventions are developing the capacity of poor families to engage in productive activities, the impact of disease and other health burdens usually wipe away whatever modest gains these poor families derive from their small businesses. Ernie Garilao, President of ZFF explained to me how the foundation is working to address this. Two years ago, CARD embarked on a partnership with ZFF to integrate health and microfinance interventions for the poor. The partnership aims to make low-cost loans available to CARD members in ZFF’s 30 partner municipalities. While CARD members have maintained a 99 percent repayment rate on their loans, health expenditures cause delays in amortization of their loans. The credit facility is expected to jumpstart livelihood opportunities for poor families to address their healthcare requirements.

A distinct component of this partnership is the provision of special loan packages for health providers to augment allowances given by LGUs to CARD barangay health workers. The micro-finance facility, established with ZFF, can be tapped for small business enterprises, health-related or otherwise. The health workers also benefit from training programs conducted by ZFF.

To further assist the poor, CARD now operates clinics that provide free consultation services to its members. Medicines prescribed by CARD-MRI member-doctors are delivered to a network of HAPINOY Stores in far-flung barangays at no added cost. To further support this program, CARD-MRI has opened pharmacies to ensure the supply of quality and affordable generic medicines for the poor. 

“5-6” versus Microfinancing

CARD has directly competed with local loan sharks offering usurious rates, commonly known as “5-6”.While the availability of a more reasonable credit facility drove many of these usurers out of business, it has also put the lives of CARD personnel in danger, in some areas, with threats coming from the displaced loan sharks. Rumor has it that the “5-6” business has been enhanced nationally by partnerships with influential local businessmen and officials or their spouses.

Local Leaders: Responsible for health challenges

These insights into the dynamics of local health systems illustrate the need for more responsive, equitable and sustainable health programs and services. The key is getting local health leaders – the mayor and the municipal health officer – to recognize the challenges that they face in terms of health, and assume responsibility for addressing these problems. I am told that effective health leadership should easily provide an additional five percent   to 10 percent in the annual municipal health budget which will fund the construction of a few more facilities like birthing clinics or maternal homes, facilitate the recruitment of another team or two of nurses in rural health units – more than 180,000 of them are currently out of work – and make available a couple of hundred thousand pesos worth of essential medicines for indigent patients. In turn, this will significantly assist in reducing maternal and infant deaths, promote child health and nutrition, and prevent the spread of communicable diseases – all part of our Millennium Development Goals on health that are due by 2015.

DOH APPEAL: PPP’s in health

Obviously, the government will need help to achieve our health MDGs, and the Public-Private Partnership Framework being pursued by the Department of Health is a means to get support from the non-government sector, especially the business community and civil society. To this end, DOH in partnership with the Union of Local Authorities of the Philippines, the Philippine Business for Social Progress and the Zuellig Family Foundation has organized the “Philippine Health Outlook Forum 2011”on Dec. 13, from 8:30 a.m. to 12 noon at the JV del Rosario Conference Rooms of the Asian Institute of Management Conference Center. Secretary Ona will present “Public-Private Partnership Opportunities in Health”. The PPP policy framework will be presented during the Forum. Concerned individuals and institutions will find opportunities to engage in collaborative work that will address national and local health challenges. Details on the Forum can be accessed through 0917-8724468 (Ana Go) and online registration can be done at www.zuelligfoundation.org.