Philippines Sustainable Health Improvements through Empowerment and Local Development

(SHIELD)
IN!E"SIN# "ESS $% HE"L$H SE!&IES
In the Autonomous Region of Muslim Mindanao (ARMM), in southern Philippines, less than
half of pregnant women were receiving prenatal care or delivery assistance from a doctor,
nurse or midwife. The infant mortality rate hovered around ! percent and the under"#
mortality rate was $% percent.
In this conte&t, A'(I)*+'A helped implement the ,-AI("funded ARMM .ealth Pro/ect, or
-ustaina0le .ealth Improvements through 1mpowerment and 2ocal (evelopment (-.I12().
This was a comprehensive maternal and child health pro/ect that focused on incorporating
all sectors of society in promoting good health practices and 0etter services. A'(I)*+'A
wor3ed in con/unction with .elen 4eller International (.4I), which served as prime
implementer on the pro/ect, to mo0ili5e communities, health professionals and the
government to improve health services delivery and coverage. The pro/ect focused its
e6orts on maternal, new0orn and child health, family planning, tu0erculosis, malaria,
.I*)AI(- and avian in7uen5a. A'(I)*+'A led these activities in two of the four targeted
ARMM provinces, Maguindanao and Tawi Tawi, and headed two regionwide technical
components8local government unit (29,) support and communication for 0ehavior change
(':').
As part of the pro/ect;s primary activities, A'(I)*+'A conducted trainings and wor3shops for
community mem0ers, health professionals and government o<cials. These included
trainings in improved health practices= community organi5ing and outreach for community
leaders= and communication s3ills and lo00ying for sta3eholders and health professionals to
0etter advocate for improved health services and delivery. These trainings used a training"
of"trainers methodology to increase the capacity of local e&perts to educate community
organi5ations, health professionals, leaders and advocates long after the pro/ect has
>nished.
A'(I)*+'A also provided direct humanitarian assistance 0y supporting health campaigns
such as the ?4noc3 +ut Measles@ vaccination campaign and ?9arantisadong Pam0ata,@ an
annual campaign that promoted 0reastfeeding and provided immuni5ations and vitamin A
supplements to families.
The geography of ARMM posed some uniAue logistical pro0lems. Bor e&ample, Tawi Tawi is
an isolated archipelago of CD$ islands and islets= its inha0itants have little access to proper
health care and reaching them is di<cult. A'(I)*+'A addressed this challenge through the
?Bloating 'linic@8a 0oat eAuipped with an on0oard health clinic that delivered health
services and professionals to hard"to"reach islands.
To achieve long"term improved health services and delivery, -.I12( wor3ed closely with
regional and provincial governments, health 0oards and o<cials on o<cial government
health plans and policies. In the >rst year, the pro/ect facilitated the development of
provincial investment plans for health in each province. In the second year, the pro/ect
wor3ed with regional government to esta0lish a contraceptive self"reliance policy.
+ne of the most innovative and important components of -.I12( was the incorporation of
religious leaders and culturally appropriate messages to encourage healthy living and
counter stigmas against health practices such as family planning. This approach 0uilt upon
the success of A'(I)*+'A;s 1nhanced and Rapid Improvement of 'ommunity .ealth
(1nRI'.) pro/ect, the precursor to -.I12(. 1nRI'. facilitated the release 0y local Muslim
leaders of three fatwa, or legal statements, that countered the common misconception that
Islam is opposed to family planning. As part of -.I12(, A'(I)*+'A 0uilds partnerships with
local Muslim and traditional leaders throughout Maguindanao and Tawi Tawi. A'(I)*+'A
conducted trainings on health, facilitated the leaders; integration into community health
activities, and provided them with the s3ills and 3nowledge needed to get local government
to provide and fund 0etter health services.
Health and Nutrition
!'I"L IN&ES$(EN$S )%! S$"*ILI$+, E%N%(I #!%-$H
.ealth and nutrition programs are a 3eystone of A'(I)*+'A;s mission"driven wor3 to
enhance people;s 3nowledge, opportunities and choices. At A'(I)*+'A, we 0elieve that the
health and nutrition of individuals and families is crucial to ensuring food security, creating
sustaina0le livelihoods and empowering people to sei5e opportunities for 0etter lives.
'onsider these factsE
Today more than ! 0illion people are chronically undernourished and food insecure.
,ndernourishment compromises immune systems, which leads to a higher
incidence of illness and disease that in turn contri0ute to lower productivity and life
e&pectancies.
Poor nutrition undermines economic growth. According to ,FI'1B, !G# million
children younger than # are chronically malnourished. 'hronic undernourishment in
children creates a vicious cycle of compromised physical and cognitive development
that reduces their economic productivity when they 0ecome adults, miring people in
poverty that, in turn, leads to chronic undernourishment and poor health in the ne&t
generation.
A'(I)*+'A customi5es our health and nutrition approaches and methodologies to speci>c
country and regional environments to create the greatest impact and ensure sustaina0ility.
+ur wor3 0uilds on local strengths and cultural values in a holistic and conte&t"driven way as
part of our integrated, multi"sector programming. He also have found that household" and
community"driven approaches for health improvements in fragile or disrupted environments
contri0ute to sta0ili5ation e6orts and collective action.
Health and Nutrition for the Most Vulnerable
Many of our programs are in con7ict, post"con7ict or other fragile states where we are
tas3ed with meeting people;s most 0asic food and health care needs. These needs are
greatest among the most vulnera0le populations, including young children and pregnant and
lactating women.
In .aiti, A'(I)*+'A used the preventing malnutrition in children under % approach (PM%A)
developed 0y ,-AI(;s Bood and Futrition Technical Assistance II Pro/ect (BAFTA"%). To
prevent malnutrition our sta6 com0ined conditional food rations with a suite of health care
and education services including ante and postnatal care, treatment of childhood illness,
immuni5ation, growth monitoring and promotion, and care groups to reduce malnutrition in
implementation areas.
A'(I)*+'A;s programming in the Philippines; Autonomous Region of Muslim
Mindanao (ARMM) also focused on vulnera0le women and children. The region;s hundreds of
islands and islets ma3e access to health care di<cult. A'(I)*+'A addressed this challenge
through our ?Bloating 'linic@8a 0oat eAuipped with an on0oard health clinic that delivers
mother" and child"centric health services to hard"to"reach islands.
From Meeting Acute Health Needs to Making Long-term Gains
Hhether wor3ing in an emergency setting or one of chronic hunger and poverty,
A'(I)*+'A;s programs always 3eep the long"view in sightE sustained health and economic
growth for communities and people.
A'(I)*+'A health and nutrition programs use training, technical assistance and pu0lic
information campaigns to promote positive health and 0ehavior change environments so
that even once a program ends, people will consume more nutritious foods and practice
0etter health and hygiene ha0its to maintain their health.
Bor e&ample, our sta6 in .aiti taught smallholder farmers8many who were part of our PM%A
program8new farming techniAues which helped them revitali5e their farm plots to feed their
families and earn money. In addition, we trained hundreds of health sta6 in .aiti and formed
care groups and water and sanitation committees.
To achieve long"term improved health services and delivery in the Philippines, our program
wor3ed closely with regional and provincial governments, health 0oards, and other o<cials
on pu0lic health plans and policies. In its >rst year, the pro/ect facilitated the development of
provincial investment plans for health in each province. In the second year, the pro/ect
esta0lished a contraceptive self"reliance policy.
Gender and Cultural Approaches Optimie Health! Nutrition "rograms
A'(I)*+'A;s health programming re7ects sensitivity to local gender, intra"household
resource dynamics and cultural traditions and practices. These considerations are essential
to design activities that result in improved health and nutrition for everyone in the
household.
Ta3e gender approaches as an e&ample. .ealth and nutrition programs traditionally single
out women as recipients 0ecause of their careta3er and food preparer roles (and sometimes,
primary farmers). .owever, in several communities the social norms that determine these
gender roles for women may limit their a0ility to change 0ehavior and community practices.
,sing gender analysis and assessments, A'(I)*+'A devises integrated strategies to address
asymmetric intra"household dynamics and to 0uild programs that provide a strong
foundation for food security and household"level health and nutrition. He train 0oth women
and men on the importance of nutrition, maternal and child health, hygiene, family planning
and livelihoods so they will mutually support decisions and household resource allocation.
In ,ganda A'(I)*+'A reAuired men to attend the health and nutrition training 0efore they
could receive additional agriculture production training. As a result, participating men
adopted the new 0ehaviors they learned, which resulted in improved nutrition, health and
hygiene practices within their own households8as well as the 0roader community.
A'(I)*+'A similarly has facilitated positive inroads through applying cultural approaches. In
the Philippines, pro/ect sta6 employed the ?Islamic Approach to .ealth 'are@ 0ased on the
essential aspects of Islamic society8solidarity, cooperation, self"su<ciency and perfection8
to encourage people to adopt healthy living 0ehaviors and counter cultural stigmas opposed
to 0irth spacing and modern health practices.
#ustainable Health! Nutrition "rograms $uild Local Capacit%
,ltimately, our health and nutrition programs promote long"term sustaina0ility and growth
0y investing in local partners and the people we serve through e6orts that 0uild local
capacity.
A'(I)*+'A wor3s with local and regional government 0odies to improve their technical
capacities and outreach services to improve people;s access to and Auality of health
services. Bor e&ample, in .aiti, the Philippines and ,ganda, A'(I)*+'A partnered with
governments to improve people;s access to health insurance= develop laws, regulations and
guidelines for health initiatives= train health care wor3ers= support pu0lic health promotion
activities= and improve lin3ages 0etween communities and local health units.
A'(I)*+'A also facilitates the construction and reha0ilitation of health infrastructure
through community"driven development approaches under which local communities
participate in decision ma3ing. Initiatives include constructing hospitals and clinics and
supplying needed health eAuipmentIfrom emergency room eAuipment to training materials
for rural health wor3ers to motor0oats to access remote island communities to training in
the design and manufacture of prosthetics.
In 4a5a3hstan, 4yrgy5stan, IraA and -er0ia, A'(I)*+'A 0rought together local communities
through voluntary 0oards to esta0lish community health goals and action plans to directly
improve the lives of local citi5ens. ,sing participatory processes, communities identi>ed
priority health needs and were fully engaged throughout the planning and implementation of
the health pro/ects (e.g., constructing and reha0ilitating health units, supplying eAuipment,
training health wor3ers, introducing reproductive health curriculum in schools, and
supporting manufacturers of prosthetics).