In southern Philippines, a test for WHO's unconventional venture

The World Health Organization has often worked with countries’ national health agencies or departments to provide technical advice and guidance on policies and programs.

But in the city of Tagum in Davao, located in the southern Philippine region of Mindanao, the WHO is playing a rather unconventional role: Working with local actors to improve maternal, newborn and child health. It is one of the two areas across the Western Pacific region — the other one is in several municipalities in China — where the health aid agency has taken the decision to work with local authorities and development partners at the subnational level. Such initiatives, the agency notes, are “carried out in full consultation with national authorities.”

Devex was on the ground Thursday, May 11, in Tagum city, to witness the signing of the WHO and the Philippine government’s new country cooperation strategy, essentially areas where the two entities plan to explore opportunities to work together to move a step closer to the common agenda of achieving health for all, which forms today’s global health battle cry in the pursuit of the Sustainable Development Goals.

The new strategy places a bigger emphasis on results, according to Dr. Gundo Weiler, the WHO’s country representative in the Philippines, who, together with the WHO Regional Director for the Western Pacific Dr. Shin Young-soo and Philippine Secretary of Health Dr. Paulyn Ubial, was among the delegates who descended on Davao for the event. The strategy’s five key priorities are to save lives by using and expanding existing interventions; promote people’s well-being; help them protect their health against disasters and other public health threats; optimize the Philippines’ health architecture, which is largely fragmented; and use different platforms to promote the health agenda beyond the health sector.

The signing took place at the Davao Regional Medical Center, one of the hospitals in the country that have adopted the practice of Kangaroo Mother Care, a technique or method of care for preterm and low birth-weight infants  adopted by health professionals in resource-poor settings where incubators may be limited or aren’t often available. It allows mothers — or fathers — to help regulate their newborn’s temperature through skin-to-skin contact.

Prior to that, the delegation visited a WHO-supported birthing facility in La Filipina, a municipality in Tagum with an estimated population size of 15,000 people. The facility started operations in 2013; the WHO helped provide training as well as seed funding for medical equipment in the facility through the support of the Korea International Cooperation Agency, the South Korean government’s foreign aid agency.

“The mandate of WHO is of course to work with the country as a whole, introducing what’s good for the population, not just a small part of the population. But in order to do so, what we try to do is develop good approaches that can be applied across the country, but to develop them first locally and test them,” Weiler told Devex.

He said the concept is founded on the realization that innovation often takes root somewhere and is tried in a “small place” before it gets scaled up at the regional or national level. This is how the practice of Kangaroo Mother Care found its way in many parts of Asia, including the Philippines, where it is now part of the standard of care in several hospitals in the country.

“This is a practical example of having a global concept that is then adopted in a local place, and once it works it can be scaled up. So we’re doing something locally, but then we are also working with the Department of Health at the national level to make sure this experience can be extended to other parts of the country,” he said.

The initiative is an example of how the organization is trying to provide linkages between what it does in country to the global level, and vice versa.

But the WHO’s engagement at the subnational level offered the organization an opportunity to delve deeper into what occurs at the ground level, in remote areas, where despite the presence of well-crafted national programs, local politics can often determine what gets prioritized and what not, program implementation can suffer due to system fragmentation, and local capacity isn’t always sufficient to diagnose the root causes of problems.

In the municipality of Malita, in Davao city, for example, the WHO, through its subnational initiative, helped assess and provide technical assistance to local officials and government health units in the region to address the unusually high maternal mortality rates there. Apart from being one of the poorest municipalities in the region, families live distances from health facilities, particularly members of indigenous communities living in mountainous terrains.

In Devex’s conversations with local WHO staff and some health officials in Davao, the feeling shared was that working on the ground, closer to communities, should be the future direction for the WHO — one perhaps that the next director-general of the organization should ponder on, although a tough sell given the organization’s financial and human resource limitations.

While the U.N. health aid agency is trying to boost its local presence on the ground, the WHO’s country representative in the Philippines cautioned against losing sight of the health aid agency’s main mandate.

“Yes it’s true we’re trying to be more active on the ground, to be closer on the ground. I think it’s extremely important for us to have a good grounding in the field and be present. But, at the end of the day … our main role is to work with the country as a whole,” he said, adding that the objective of working at the local level is to be able to lift and replicate the experience in other areas of the country.

“There’s also a bit of danger with these local projects. Having pilot projects that go on and on, and that maybe have a micro impact, but never lifted up and the experience can never be applied in other settings either because there is no mechanism to … scale them up in other places, or because in the first place the pilots are done in a way that they are somehow creating an artificially successful environment,” he said.

The reporter traveled to Davao City, Philippines for the signing of the WHO-Philippines new cooperation strategy, funded by WHO. Devex retains full editorial independence and responsibility for this content.

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