Institutional Partnership for Improved Health Outcomes: The Zamboanga Alliance

(A BRIEFER)

A. The Zamboanga Alliance
In October 2010, a core group from the DSWD, DOH and Zuellig Family Foundation formed the Zamboanga Alliance. The Alliance’s formation was aimed at improving the health conditions in the poorest municipalities of the three provinces of Zamboanga Peninsula by way of convergence of resources, programs and institutional expertise. Later, the objectives evolved to include the improvement of other MDG indicators such as education and livelihood. The Alliance engaged other players to take part in the effort: PhilHealth, Provincial LGUs and the Ateneo de Zamboanga University-School of Medicine. The agencies committed to (a) pursue opportunities for convergence of programs and services; (b) operationalize public-private partnership as a development strategy in local governance; and, (c) utilize the Millennium Development Goals (MDG) as a framework for engagement. In support of the LGUs are three core ZamAll institutions: DOH, DSWD and ZFF. The actual operational commitments of each of these institutions are as follows: 1. DOH 1.1. Technical assistance in the areas of PIPH, HFEP, BnB or ComPack, CHT organizing and training 1.2. Special assistance for small scale water projects 1.3. Committed its DOH reps and provincial health teams 1.4. Participation in ZamAll core group 2. DSWD 2.1. Support to regional / provincial convergence meetings (operational planning sessions, LGU-ZamAll coordination sessions, etc) 2.2. Follow-through of LGU operational plans 2.3. Execution of municipal level multi-agency convergence 2.4. Participation in ZamAll core group 3. ZFF 3.1. Modular training for DSWD, DOH and 14 LGUs 3.2. ZamAll technical coordination lead (HLMP Fellows, ZamAll and LGU convergence) 3.3. Coaching, mentoring to 7 sub-cohort LGUs 3.4. Special technical mentoring on BL for DSWD projects staff -Excerpts from Zamboanga Alliance Status Report, December 2011

Elements of the Partnership:
 Shared vision and mission  Commitment of stakeholders – DOH, DSWD, ZFF  Indicator-driven strategy and response  Monitoring and assessment protocols  Technical assistance  Continuing capacity building 2

 Cost-sharing

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1. Alliance Development Framework How: LGU: Ownership and governance Responsive program

To address:

Health: 6 building blocks What are Poverty: implementation Improved the Social Community MDG CONVERGED drivers? welfare participation Indicators PROGRAMS indicators DOH/DSWD/ Poverty, AND Education PhilHealth/De health and Better ACTIVITIES : pEd education quality of Participatio National indicators life n rate flagship Survival programs 2. Alliance Strategies rate ZFF National Capacity Strategy 1: Indicator driven target setting, planning and monitoring achieveme building Resource As ntresponse to questions on Alliance impact, all ZamAll partner institutions a scores will have its own set oflinkages upon which the Alliance gains can be indicators measured. This will also provide the Alliance partners a highly focused approach to the LGUs. The LGUs on the other hand, by having an indicator driven target setting, planning and monitoring will be more conscious and directed in its approach to development. Strategy 2: Alliance municipal level convergence

The first 10 months saw a convergence of the efforts of ZFF and DOH by way of the Health Leadership and Management for the Poor (HLMP) Program wherein DOH Reps and Provincial Health Offices were brought into the picture in terms of direct engagement with a select group of LGUs for technical assistance starting with training. Scaling up, the field program personnel of DSWD should be brought into the equation, joining the DOH Reps and ZFF ZamAlliance program officer in providing technical assistance in the form of direct trainings, monitoring and coaching/mentoring. Strategy 3: HLMP Capability – building for the institutional partners through the

ZFF needs to provide capability building assistance to DOH and DSWD regional leadership and field personnel specific in the area of adaptive work. 4

This may be in the form of coaching to regional directors, assistant regional directors and other key regional technical officers. Similarly, training assistance and mentoring should also be provided to the DOH, PHO and DSWD field officers on how to engage, coach, mentor and train municipal and barangay officers in the area of adaptive work. Strategy 4: Coaching, mentoring and training

It has been proven that close-in coaching and mentoring of LCEs, MSWDOs and MHOs can directly impact on the poverty and health indicators. Close in coaching and mentoring of LGUs increases the ownership and thus LGU investments in local initiatives. Operationally ZFF, DOH and DSWD can assign themselves to specific LGUs for directed TA. Senior field personnel of DOH, DSWD and ZFF can also address the need for specific municipal level coaching for health leadership teams. Ideally, a cadre of skilled DOH and DSWD field staff can be trained in high-level LCE coaching and mentoring. 3. Alliance Technical Structure REGIONAL STEERING COMMITTEE: RDs, PHOs and ZFF Director/Account Officer

PROVINCIAL CLUSTERS (HLMP/LGUs) Pool of Pool of coaches and trainers mentors MUNICIPAL CONVERGENCE TEAMS DOH Reps, DSWD municipal project officers (Kalahi, 4Ps)

CLIENT LGUs

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CONVERGENCE OF ZFF PROGRAMS FOR CAPACITY BUILDING

These capacity-building programs can be mainstreamed through partnerships with academic institutions in the Zamboanga Peninsula. As LGU health membership teams progress through the leadership development process, coaches and mentors will be needed to guide them and ensure the attainment, as well as the application, of leadership competencies in addressing their health and other social development challenges.

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B. Results
1. Completed Activities 1.1 MLMDGs Module 1 for all 14 LGUs in Batch 1 1.2 MLMDGs Module 2 for 7 ZFF sub-cohort 1.3 HLMP Modules 1 and 2 1.4 Provincial HLMP Clusters 1.5 Provincial Integration Workshops (LGUs/HLMP) 1.6 Capacity Building: CPE-CHTs (BHSSP and MCH) 1.7 Quarterly Data Monitoring 2. Health Indicators Municipality Bayog Dumingag Vincenzo Sagun Siayan Mutia, Gutalac, Kalawit, Total – Zambo Alliance Infant Deaths 2010 2011 0 2 0 0 1 5 1 2 8 3 0 3 0 1 10 16 Maternal Deaths 2010 2011 1 3 1 1 1 0 0 7

0 3 0 1 0 0 0 4

C. Challenges: Moving Forward – Mainstreaming with Partner Institutions

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In partnership with academic institutions

ZFF (MLH/HLMP/CPE) and the Alliance

D. Opportunities: Partnership with Ateneo de Zamboanga University
The Zamboanga Alliance hopes to work with 43 priority municipalities in the Peninsula, all under the DSWD’s 4Ps and Kalahi-CIDSS Program. From the initial batch of 14 in 2011, a new set of 12 municipalities has begun the first cycle of project implementation with the DSWD this year. The last batch of 17 municipalities should be covered by 2013. In the long-term, the availability of capacity building programs in the region, with focus on health leadership and governance, should benefit more LGUs not just in the Zamboanga Peninsula, but in nearby provinces particularly Basilan, Sulu, and Tawi-tawi. 8

As an academic partner of the Foundation, the Ateneo de Zamboanga University can cater to a unique market of local health leaders and public health professionals as well as frontline health workers. Specifically, a stand-alone public course offering for local chief executives and municipal health officers can attract local health leaders who are serious about transforming their health systems and improving their health indicators. The Municipal Leaders for Health-Executive Course (MLH-EC) for LCEs and MHOs is a capacity building program, offered through partner academic institutions such as UP Manila School of Health Sciences in Palo, Leyte and the University of Makati, that is designed to help facilitate partnerships with more municipalities in priority regions. The Executive Course is a one-year training program with two modules, which will be supplemented by coaching and mentoring sessions as participants go through their practicum between modules. Faculty members from academic partners will be tapped as resource persons and coaches for the program. Participants are expected to improve their municipal health indicators as course deliverables (attached please refer to the training cost structure of the MLH-EC). The University can also offer short technical courses – enriched with leadership sessions – for frontline health workers. Under the Continuing Professional Education (CPE) for Frontline Health Workers, the Foundation helps address capacity building requirements for community leaders, midwives and barangay health workers that are crucial for effective service delivery. Together with the University, the Foundation can organize a pool of trainers that will be tasked with the conduct of community-level training activities, including modules on barangay health systems strengthening as well as technical skills training for health human resources. Members of this pool will come from faculty members of academic partners.

D. Opportunities: Partnership with Governors of Zambo Norte, Zambo Sur and Zambo Sibugay
The Zamboanga Alliance hopes to integrate and engage more closely the governors of the three provinces whose mandate is to ensure that there is overall health leadership of the province-wide health system characterized by a well integrated and supported - the network of hospitals and the municipal health sytems – are integrated through functional interlocal health zones and referral systems. One of the crucial mechanism to integration is activating the provincial Local Health Board and integrating the LHB to the steering committee of the Alliance and to the on site operations of the HLMP Fellows.

Two areas for partnership with the governors include 1. Ensuring the governors’ support to present and future partner municipalities of the Alliance and 2. The Alliance responding to specific needs of the provincial government. 1. Support of the Governor to Existing Partner Municipalities and Future Partner Municipalities of the Alliance through 9

a. Ensuring the attendance of participants and their completion of the one-year, twomodule training program;

b. Co-sharing with participating LGUs, course fees to be determined by a partner academic institution, as well as travel, accommodation and other training expenses (per diem) of the participants;

c. Subject to the certification and endorsement of the Foundation allocate financial and technical support for the implementation of identified interventions that will address gaps in the six building blocks of local health systems development in selected LGUs, including but not limited to the construction and/or renovation of health facilities, medical supplies and equipment, medicines and commodities, health financing and regulations, information and communications technology, and human resources; and d. Generating and mobilizing resources from other sectors to ensure continuity and sustainability of program interventions and the achievement of partnership objectives.

2. Support of the Alliance to specific concerns of the provincial government. Based on the initial exploratory talks with the governors, these may include the following: Governor Rolando Yebes a. Team of consultants for the governor b. Designing maternal waiting homes c. Policy on maternal health Governor Antonio Cerriles a. Team of consultants for the governor in support of his vision for re designing and rationalizing the hospital service delivery network in the province and upgrading the Zamboanga del Sur Medical Center. Governor Rommel Jalosjos a. Health leadership course including coaching for the governor which is integrated to the MLH. b. Programs for improving infant and child health in the province c. Improving hospital care through physical ugrading of hospitals, recruitment of more specialists particularly surgeons, OB-Gynes, and anesthesiologists 10

d. PhilHealth accreditation of other RHUs e. Coordination among agencies to ensure universal health care coverage with priority given to the poor

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