ILOILO – In 2019, hypertensive cardiovascular disease was the second leading cause of death, and hypertension was the third leading cause of diseases in this province.
These were “silent killers” that needed to be addressed with urgency because they could “lead to catastrophic events and place a huge burden not just on the patient, but also on their family, workplace, and community,” according to Dr. Maria Socorro Colmenares-Quiñon, head of the IPHO.
Fast forward to 2025, what started as a province-wide initiative for “healthy hearts” that has saved thousands of lives and millions in resources has become a model for other provinces in Western Visayas (WV).
Originally implemented in the First District of Iloilo, the “Puso Para sa Puso: Movement for Healthy Hearts” has been expanded across the province. It is also currently being replicated in the region’s provinces of Aklan, Antique, and Capiz.
Its success has also attracted interest from the Department of Health (DOH) – Central Office and all its regional offices, and even the faraway Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) for cross-learning visits.
Under the leadership of Governor Arthur Defensor Jr., the Iloilo provincial government spearheaded the “Puso Para sa Puso” to tackle the high prevalence of cardiovascular diseases by focusing on disease prevention as a fundamental strategy for addressing health issues in the province through effective governance.
The program is a key part of the administration’s development mantra, MoRProGRes, which stands for Movement for a Robust, Progressive, Globally Competitive, and Resilient Iloilo. The implementation has involved partnerships with various government agencies, development partners — especially the World Health Organization (WHO) — private organizations, and civil society organizations.
How it Started
According to Dr. Quiñon, the program is committed to reducing mortality from non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancer, diabetes, and chronic respiratory diseases by strengthening the implementation of a comprehensive service package for the prevention and control of hypertension. Efforts include promoting healthy lifestyles, implementing evidence-based treatment protocols, ensuring access to essential medicines for NCDs, and deploying monitoring systems.
The objectives of the program are to improve the community’s access to quality health services; enhance screening, diagnosis, and management of hypertension; strengthen community participation and stakeholder engagement; and promote behavior change toward healthier lifestyles.
By the end of 2023, the program aimed to achieve the following targets:
* increase in the proportion of the eligible population screened for hypertension
* increase in the blood pressure control rate
* reduction in cardiovascular disease-related deaths
In collaboration with local government units (LGUs), the program initially rolled out in February 2020, starting in the First District, covering the towns of Oton, Tigbauan, Guimbal, Miag-ao, San Joaquin, Igbaras, and Tubungan.
Since then, the program has expanded to four other districts, specifically in the towns of Ajuy, Anilao, Alimodian, Badiangan, Banate, Batad, Carles, Concepcion, Dueñas, Janiuay, Lambunao, Lemery, Mina, New Lucena, San Enrique, Zarraga, Balasan, Dingle, Maasin, Barotac Viejo, Dumangas, San Dionisio, Bingawan, Leganes, San Miguel, Cabatuan, Leon, and Sta Barbara.
The initiative plans to extend its reach to four more towns — Sara, San Rafael, Estancia, and Calinog — by the end of this year.
Program Strategies for Enhancing Cardiovascular Disease Prevention and Control
According to Dr. Quiñon, the program employs four main strategies to ensure effectiveness.
First, the program focuses on strengthening CVD prevention and control through a comprehensive package for quality hypertension care. This includes equipping health workers with the necessary tools such as blood pressure apparatuses and medicines.
“We capacitate health workers by providing job aids such as Blood Pressure apparatuses, medicines, and offering supportive supervision and monitoring. The program integrates with other health and non-health services using an opportunistic screening approach, especially in hard-to-reach areas and for special population groups like senior citizens,” Dr. Quiñon added.
Second, the strategy involves mobilizing community-based health workers and “force multipliers” to focus on monitoring target individuals. Activities include distributing medicines, conducting house-to-house blood pressure monitoring, treatment monitoring, defaulter tracking, and health education across all barangays.
Third, the program empowers patients as partners in its implementation, which includes conducting promotions for healthy lifestyles.
Fourth, it establishes a hypertension information system through the Healthy Heart Program (HHP)-e Registry. This system is utilized by LGUs to track the status of enrolled clients and generate timely reports. The e-Registry helps produce reports on clients with controlled and uncontrolled blood pressure, and lists defaulters for immediate action and evidence-based decision-making like medicine forecasting.
Positive Results and Impact
According to Governor Defensor, the “Puso Para sa Puso” has made significant strides, directly benefiting over 95,000 individuals with screenings and indirectly aiding nearly 400,000 people in the First District of Iloilo.
In terms of treatment and monitoring: in 2021, about 5,788 individuals were diagnosed and enrolled; in 2022, this number rose to 22,354; and in 2023, it reached 24,499.
Since its inception, the program has shown encouraging outcomes in managing hypertension. It successfully controlled the blood pressure of 418 individuals in 2021; 17,182 in 2022; and 20,483 in 2023, representing 84% of those diagnosed and enrolled that year.
Furthermore, the initiative has significantly reduced cardiovascular disease-related mortality in the province by 30%: from 499 deaths in 2021 to 402 in 2022, and down to 351 in 2023.
With an impressive blood pressure control rate of 84%, the program has saved approximately P370 million in potential healthcare costs from hospitalizations.
“Ultimately, the most significant impact of the program has been its contribution to reducing deaths related to cardiovascular diseases by 30%, from nearly 500 in 2021 to only 351 in 2023,” said Governor Defensor.
He noted that the high blood control rate has also boosted productivity, saving more than 200,000 days that were redirected towards productive activities, thus enhancing quality of life and contributing to economic growth.
“With the Healthy Hearts Program, Ilonggos living with hypertension have been given the opportunity to lead productive and quality lives,” said Defensor.
The “Puso Para sa Puso” initiative has also earned Iloilo province distinct honors and recognitions, including being named as finalists for the 2024 Galing Pook Awards. Notably, Iloilo was the first local government unit (LGU) in the Philippines to adopt the World Health Organization (WHO) Healthy Hearts Program.
Sustainability
To ensure the sustainability of the Healthy Hearts program, Governor Defensor issued Executive Order No. 183, titled “An Order Institutionalizing the Healthy Hearts Program in the Province of Iloilo.”
The Healthy Hearts Program Management Team was organized to lead the initiative province-wide. Local chief executives (LCEs) and legislative officials were engaged in participatory policy formulation, resulting in the passage of supportive policies for the program.
Additionally, the Provincial Health Board issued a resolution endorsing the Healthy Hearts Program to the Sangguniang Panlalawigan.
The program has been integrated into the provincially mandated plans, with a budget allocation exceeding P12 million annually. This funding is crucial for maintaining the program’s momentum and ensuring its ongoing success in improving cardiovascular health across Iloilo.
DOH, Other Provinces Replicate Program
Following the successful implementation of the Healthy Hearts Program in the First District Iloilo, the Department of Health (DOH) moved to extend this initiative to other parts of the province and across Western Visayas.
“We would like to see it implemented regionwide,” stated then DOH regional director Dr. Adriano P. Suba-an.
Director Suba-an praised Iloilo for its best practices in project execution, citing the use of forecasting tools for medicine procurement, which helps LGUs plan their budgets effectively.
He also commended the efforts in empowering barangay health workers by providing them with necessary tools, including educational information and communication materials for health education and teaching.
According to Director Suba-an, 2019 data revealed that hypertension was the third leading cause of morbidity in Western Visayas, with 29,331 hypertensive individuals seeking consultation in health facilities for screening and medication refills.
Complications from hypertension, such as hypertensive cardiovascular diseases and cerebrovascular diseases, were the second and third leading causes of mortality in the region, accounting for a total of 12,893 deaths in 2019.
Furthermore, 2020 data from DOH Region 6 indicated that the number of screened and newly identified hypertensive patients in the region increased to 60,947 individuals. In the same year, 44,020 patients sought consultation at health facilities.
“This is an increase of approximately 133 percent and may be attributed to increased screening and detection of hypertension even during the pandemic,” explained Suba-an.
To address this, the DOH has been enhancing the capabilities of its partner health workers in LGUs to conduct screenings to detect hypertension. This is carried out through the PhilPEN risk assessment of the Philippine Package for Essential NCD Services, where all adults aged 20 years and above should be screened.
Antique – First Province in WV to Adopt
Following the successful implementation of the “Puso Para sa Puso: Movement for Healthy Hearts” in Iloilo, the provincial government of Antique, led by Governor Rhodora Cadiao, promptly replicated the initiative.
The launch of the program, also known as “Project Kasing Kasing”, took place on June 20, 2024, in partnership with the World Health Organization (WHO) and the DOH.
Dr. Rui Paulo de Jesus, the Country Representative of WHO Philippines, led the launching ceremony alongside Director Suba-an and Governor Cadiao. Nine towns in Antique are beneficiaries of this program, including Pandan, Barbaza, Sibalom, Culasi, Bugasong, Hamtic, Tibiao, Patnongon, and Tobias Fornier.
According to the 2022 Antique Field Health Service Information System Report, cardiovascular diseases, including hypertension, rank as the fourth leading cause of death and the third leading cause of morbidity in the province.
In response to these alarming statistics, the Healthy Hearts Program aims to enhance hypertension detection and control at the primary healthcare level. It also focuses on promoting healthy diets through government programs and policies and implementing a communications campaign to raise awareness.
Governor Cadiao, a nurse by profession and a strong advocate for health initiatives, delivered a speech at the launch expressing her full support for the program. She emphasized the commitment of the provincial government and the Antique Provincial Health Office to bolster the health sector, including the allocation of over P55 million for the prevention and control of non-communicable diseases.
Contributory Factors for Cardiovascular Diseases: The Role of Cholesterol
Low-density lipoprotein (LDL), or “bad cholesterol”, is the primary transporter of cholesterol to the vascular artery wall.
According to Dr. Maria Socorro Colmenares-Quiñon of the Iloilo Provincial Health Office, an increase in “bad cholesterol” is a key factor in dyslipidemia and is associated with an elevated risk of cardiovascular diseases, particularly atherosclerotic cardiovascular disease (ASCVD).
Numerous studies have pinpointed the roles of LDL cholesterol and its oxidized form as the main drivers of atherosclerosis progression. This can lead to reduced blood flow in an artery or an obstruction caused by a dislodged atherosclerotic plaque or thrombus, which is evident in conditions such as stroke, myocardial infarction (heart attack), and peripheral artery disease. Consequently, reducing LDL cholesterol levels is crucial for treating and preventing ASCVD in clinical practice.
During the “Unblock Your Heart, Unfriend Your Bad Cholesterol” seminar-workshop held on October 21-22, 2024, organized by the Philippine Press Institute (PPI) and supported by Novartis, health experts explained to media practitioners the roles of both bad and good cholesterol in developing cardiovascular diseases, including stroke and heart attacks.
Dr. Lourdes Ella Santos, a Preventive Cardiologist and Clinical Lipidologist at Cardinal Santos Medical Center, discussed the impact of bad cholesterol. High levels of cholesterol are a leading cause of ASCVD.
There are two types of cholesterol:
* HDL (High-Density Lipoprotein) – Known as “good” cholesterol, HDL helps remove cholesterol from your body.
* LDL (Low-Density Lipoprotein) – Known as “bad” cholesterol, LDL contributes to the buildup of cholesterol in your arteries.
The primary causes for high LDL or bad cholesterol levels can be acquired, such as through various diseases, certain medications, and lifestyle patterns like diet, or genetic, such as inherited conditions like familial hypercholesterolemia.
Managing Bad Cholesterol: Strategies to Reduce Health Risks
According to Dr. Raul Lapitan, an Adult Clinical Cardiologist and Echocardiographer at Makati Medical Center, bad cholesterol (LDL-C) is a modifiable risk factor that can be managed through lifestyle changes, dietary adjustments, and medication. By making appropriate changes, individuals can lower their LDL-C levels, reducing their risk of cardiovascular diseases.
Key strategies to manage and reduce bad cholesterol include:
1. Adopt a Heart-Healthy Diet – Focus on eating fruits, vegetables, whole grains, legumes (such as beans and lentils), nuts, fish and seafood, and poultry. It is also important to limit sugary drinks and full-fat dairy products.
2. Manage Your Weight – Maintain a healthy weight through a balanced diet and regular exercise. This helps not only in managing cholesterol but also in overall cardiovascular health.
3. Regular Exercise – Aim for at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous exercise each week. Always consult with your doctor before starting a new exercise program, especially if you have not been active for a while or have chronic health conditions like heart disease, diabetes, or arthritis.
4. Manage Underlying Conditions – Your doctor may prescribe medications to help achieve target levels of blood cholesterol, sugar, and/or blood pressure, or to manage any other conditions that increase your risk of cardiovascular disease. It is crucial never to stop or adjust the dosage of cholesterol-lowering medication without consulting your doctor, even if you have reached your cholesterol targets.
Dr. Lapitan emphasizes the importance of lowering and maintaining cholesterol levels, especially for individuals who have experienced a cardiovascular event such as a heart attack or stroke. He notes that in some cases, lifestyle changes alone may not be sufficient, and medication might be necessary to achieve cholesterol targets. Consulting with a healthcare professional is essential to evaluate individual risk factors and determine the most appropriate treatment plan.
Call to action – ACT NOW!
* A – ASCVD is a top killer in the Philippines
* C – Cholesterol is a key risk but can be managed
* T – Take action to lower it fast
* NOW – The next heart attack or stroke could be worse — act now to stay protected.
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This article is part of the “Unblock Your Heart Health Reporting” initiative, supported by the Philippine Press Institute and Novartis, to improve health literacy on cardiovascular diseases. Know your numbers, understand your risks, and consult your doctor — so no Filipino heart is lost too soon.
Take control of your heart health today. Visit unblockedmovement.ph for more information./PN
