Thinkwell Stop The Spread

Good Governance and Multi-Sectoral Synergy for Pandemic Response in Western Visayas, Philippines

15 October 2020

This article originally appeared in Health Systems Governance Collaborative here

Our current situation – living through the COVID-19 pandemic – highlights the critical role of local governments in securing the health of communities. Since the confirmation of the Philippines’ first COVID-19 case last January 30, 2020, the disease has heavily strained the health system of the country. The early stages of the pandemic had local government units (LGUs) and different sectors scrambling to address various concerns with “survival” strategies on their own because of unclear directives from central government. In the Western Visayas region, the provinces imposed border restrictions and requested airlines to temporarily suspend flights coming in from areas with known positive cases. Despite these, COVID 19 entered the region with the first confirmed case on March 20.

As the confirmed COVID-19 cases increased in the region, panic and fear set in. Rising numbers of confirmed positive cases globally and nationally coupled with limited and confusing information about how the virus spreads, and the haphazard implementation of the community quarantine heightened the negative sentiment of the people towards the national government response. In addition, there was widespread news that personal protective equipment (PPE), especially for health workers, were limited. Rural health units and hospitals across the region grappled to put protocols in place, reorganizing patient flows in services and establishing referral protocols for COVID-19 and non-COVID-19 patients. Making matters more problematic was the fact that there was no testing laboratory in the region and all swab samples had to be flown to the central laboratory in Manila. On top of these health concerns was the foreseeable impact of the pandemic to the economy and livelihood of the people.

LGUs became proactive in their campaigns against the COVID-19 pandemic, especially in engaging both public and private stakeholders. Harnessing the combined efforts of the local government, the regional Department of Health (DOH), the academia, and the private sector led the facilitation of the availability of necessary laboratory equipment and supplies. Health human resources were mobilized and capacitated such that within a week time, the first COVID-19 testing laboratory in the region became functional. From big businesses to pooled efforts of groups of friends, food and donation drive initiatives to support front liners overflowed. To augment PPE supplies, science and technology schools produced alcohol, designed and built face shields, aerosol boxes, and even prototyped ventilators. Local fashion designers collaborated and redirected skills to producing hazmat suits with film-inspired designs to bring some positive light amidst uncertainties. When community quarantine prevented the ingress of supplies coming into the region as well as the transport of economic products outside, efforts to save agricultural products were initiated. For example, tons of world-class Guimaras mangoes were in danger of being unsold and wasted but a new market for the mangoes emerged from the neighboring provinces and cities within the region aided by social media marketing and online platforms. This ensured that none of these agricultural products were wasted and provided much needed funds to the farmers.

Power Rangers PPE
Power Rangers-inspired hazmat suits, made by Ilonggo nurse and designer Adrian Pe, were distributed to local hospitals. © Adrian Pe

Local civil society organizations partnered with academia in generating context-specific evidence to inform decision makers and spur action across all sectors for a coordinated and effective COVID-19 response. This effort was initiated by ThinkWell Philippines, through its field-based team that has been providing technical assistance in Western Visayas for the implementation of Universal Health Care (UHC) reforms in the region. Due to COVID-19, most of the UHC reform activities halted, and support was redirected to help in the strengthening of the region’s pandemic response. The team started with a simple contact tracing analysis of the first few COVID-19 cases in the region with data sourced and consolidated from local official bulletins and news articles, and then shared these with networks in the health sector and in academia. This eventually led to a collaboration with public health experts from the University of the Philippines Visayas (UPV) for a series of policy notes (linked below) anchored on the detect-isolate-treat structure with epidemiological analysis of local data supported by various issuances from the national government and the World Health Organization.

With strong collaboration among local leaders who chose to adapt a local and contextualized approach to pandemic response, Western Visayas was recognized as one of model regions in terms of COVID-19 response. ThinkWell and UPV, both well-regarded in their own fields, gained the trust of regional partners and were agents in influencing the COVID-19 response in the region through the endorsement of the policy notes. The regional DOH and LGUs appreciated the analyses, used the findings as talking points in both the national and local arena, and considered the recommendations put forth during task force meetings. Mass media and social media platforms facilitated the sharing of documents to the public, drawing the interest of non-government and private organizations to use these as guides in planning and decision-making.

This experience of LGUs taking charge and stepping up to protect the people emphasizes that deeper trust can indeed be fostered by quick inclusive action of local leaders. The spirit of togetherness is very much alive. This realization is a call to build on local strengths. Moving forward, local health systems should invest in taking stock of capacities, expertise, resources, influence, and networks, keeping in mind that multi-sectoral approaches should not only focus on health challenges but also promote good governance across sectors that impact health.    

Multi-sectoral actions create space for people to come together, breaking down silos to think out of the box and design new interventions or arrangements that could lead to more sustainable and comprehensive results. The UHC Law of 2019 seeks the implementation of province-wide integrated health systems. In Western Visayas these efforts were underway, especially in pushing for strong and independent health systems led at the provincial level. The COVID-19 pandemic highlights the glaring fragmentation of the current health system. This situation is an opportune time to reflect on this experience and harvest learnings to ensure a more prepared local health system as we adjust to the “better normal”. Responding to the COVID-19 crisis is not the sole responsibility of government alone, the Western Visayas experience illustrates that local governments that have the capacity and willingness to proactively engage multi-sectoral partners are a cut above the rest.

Policy notes:

Authors’ Bionote

Written by Helena Marie Lagon Alvior, Mary Camille Samson, and Jemar Anne Sigua. The authors are affiliated with ThinkWell under the Strategic Purchasing for Primary Health Care (SP4PHC) Project in the Philippines. Dr. Helena Alvior, Technical Advisor, and Camille Samson, Program Analyst, are assigned in two provinces in Western Visayas, Philippines to provide technical assistance in the implementation of the Universal Health Care Law. They work together with Jem Sigua, Program Coordinator, who oversees the development of knowledge products and analyses.

The authors would also like to acknowledge Dr. Maria Eufemia Yap and Ian Nuevo of ThinkWell, and Dr. Philip Ian Padilla of the University of the Philippines Visayas for their inputs.

To know more about the project: