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Q&A Reading Time: 9 minutes

Spotlight on People-Planet Connection: Dr. Joan Castro, PFPI

Dr. Joan L. Castro, M.D., is not just a medical professional but a visionary leader on a mission to transform public health in the Philippines and beyond. As the Executive Vice-President of PATH Foundation Philippines Inc., an organization renowned for its dedication to advancing health equity and innovation, her journey is a testament to her commitment to improving healthcare access and community well-being.

Her role at PATH Foundation Philippines Inc. is nothing short of transformative. As the Executive Vice-President, she has consistently demonstrated exceptional leadership, a deep commitment to the organization’s mission, and a vision for a healthier future. Dr. Castro’s expertise and advocacy have been instrumental in driving initiatives aimed at enhancing healthcare accessibility and quality. 

Dr. Castro has championed healthcare solutions to address pressing health challenges in the Philippines, particularly those affecting underserved populations. Her innovative approaches and collaborative efforts have brought about significant positive change, ensuring that the organization’s mission resonates with the needs of the communities it serves. Her innovative strategies and collaborative efforts have made a significant difference in maternal and child health, disease prevention, health education, and community engagement. 

She is not only a healthcare practitioner but an inspiring figure who motivates others to join the pursuit of healthier societies. Her dedication to PATH Foundation Philippines Inc.’s mission serves as a guiding light, inspiring others to work collectively for meaningful change. Her vision, expertise, and unwavering commitment continue to pave the way for healthier, more promising communities in the Philippines and beyond. We’ve interviewed Dr. Joan L. Castro, M.D. as a transformative leader and healthcare professional dedicated to reshaping public health. Here is transcript of the interview discussion:

Can you briefly introduce yourself, including your position and organization?

Joan Castro: I am a medical doctor by profession and currently hold the position of Executive Vice-President at PATH Foundation Philippines Incorporated (PFPI). PFPI is a Philippines-based organization that initially started as an affiliate of the Program for Appropriate Technology in Health in 1992. We focused on implementing a 10-year HIV/AIDS program at that time. In 2004, we became an independent organization and have since been implementing our own programs. Our mission at PFPI is to improve health, alleviate poverty, and promote environmentally sustainable development. We implement programs within and across sectors, such as the pioneering integrated population and coastal resource management initiative in the Philippines.

Woman conservation farmer walking through ankle-deep water carrying plants in the Philippines.
Female conservation farmer wading through ankle-deep water carrying conservation plants in the Philippines.

What has steered you and your organization towards this cross sectoral approach to health and environment and development?

We started as an organization that implemented health programs in particular the AIDS Surveillance and Education Project to prevent and control HIV/AIDS for 10 years. And then we looked into other root problems. Asked questions like what are the social and economic issues experienced with the populations we work with, men who have sex with men and sex workers, for example? And what is happening with the changes from migrating from the rural environment where the populations came from? What are the difficulties with the dwindling sources of income they depend upon for food and livelihood?  In their search for a better life, they come to the city. We met them in programs that worked on educating and preventing HIV/AIDS in major cities.

This is how we transitioned from sectoral implementation of sectoral projects like health programs, to integrating sectors by looking deeper into the root factors. We were able to address other issues besides HIV/AIDS, family planning and reproductive health, such as coastal resource management initiatives in particularly rich biodiverse areas.

Being a non-profit 5013c organization registered with the US, was part of a capacity and mechanisms development initiative that we had as an affiliate of PATH. The non-profit status allowed private funding agencies, like Packard Foundation and other organizations, to support our integrated work.

Regarding cross-sector work, currently we are implementing a fisheries management initiative which allows us to apply the population health and environment (PHE) approach when we can. We were able to widen our network and broaden our funding base, which allowed us to do work in both the health sector and in the coastal resource management area. Our fisheries management initiative is on its sixth year.  We have an extended scope for a couple more years to reach other areas. You may have heard that the Vice President of the United States came to the Philippines last November. The site that she visited was one of our sites! Because we work with women, we organized an opportunity for her to visit and talk with the women fishers who were doing the fisheries work and selling the dried fish. It was a special experience.

You have a background in health. You’re a medical doctor. Can you say more about how your own passions, learnings, and vision for your work expanded to include the environment and conservation areas. What was influential to you?

My pre-medical course was in biology, which provided me with a foundation in natural resources. My medical career began as a Medical Officer in a hospital, and later, I shifted my focus to HIV and AIDS, specializing in public health. This shift allowed me to view healthcare from a different perspective. Public health examines broader factors that can prevent and control diseases, particularly among marginalized populations. It offered a different kind of satisfaction, as it emphasized addressing the underlying factors that contribute to health and well-being. This holistic approach appealed to me and led me to explore other sectors beyond clinical medicine.

When the opportunity to integrate sectors arose in the early 2000s, I was well-prepared to contribute. I realized that the health of people and ecosystems is intertwined. The PHE approach, which we use in our fisheries and community initiatives, mitigates threats to biodiversity and addresses food insecurity, leading to improved community health and nutrition. We also address gender-related issues by working with women on health, family planning, and sexual and reproductive health.

My health background has allowed me to offer added value in sectors like fisheries and conservation. For instance, we recently published a paper that examines the broader marine resources’ value in the West Philippines Sea, as well as food security and nutrition. The PHE approach provides a broad and comprehensive perspective that makes logical and conceptual sense. I hope more people will start to apply it as it aligns with the interconnectedness of health and the environment.

Can you speak about the importance of partnership in your work and describe what the process of working with partners looks like?

The governance system in the Philippines is decentralized, involving work at both national and subnational levels, and a considerable portion of this work requires partnerships with government entities, the private sector, and CSOs. PFPI has consistently collaborated with local government institutions, with local government units serving as the basic governance unit in the country. Our engagement involves working with local leadership. As an organization, we recognize that our presence is not for the long term, but rather a short period. Therefore, we prioritize sustainability right from the planning phase of our work and always aim for local ownership of the initiatives introduced. This is where partnerships at the community level come into play. We collaborate closely with local government units, CSOs, and relevant stakeholders, enhancing their capacities—both technical and operational—for tasks such as assessment, planning, implementation, and monitoring.

A similar approach applies to our partnerships with people’s organizations, such as fisher-folk, youth, and women’s organizations. We build on the existing community structures, a crucial aspect of achieving community empowerment and sustaining the gains of our partnerships.

When implementing our programs, establishing trust within the community is immensely valuable. In cases where we are new to an area, we initiate partnerships with organizations that the community already trusts and is familiar with. These partnerships have enabled us to effectively influence policies through advocacy work, particularly with local government units, creating an environment conducive to behavior change among individuals and communities.

We also collaborate with various sectors. For instance, in our coastal and marine conservation work, we partner and leverage contributions from national agencies that are already active in the communities. Given that funding is often insufficient to address deep-rooted issues, we recognize the critical role that partnerships and collaboration play. It’s a clear realization for program implementers that partnerships provide advantages in terms of consolidating and synergizing efforts, irrespective of whether the programs are short-term or long-term, or the funding is substantial or limited. Aligning with the vision of local leadership is another vital component. It’s evident that everyone shares the goal of alleviating poverty, improving well-being, and enhancing systems to provide all community members with access to ecosystem services that a healthy natural resource can offer. This shared vision makes collaboration easier, as all stakeholders contribute to the same goals and aspirations of communities and households.

We typically approach well-being at the household level as the basic unit of partnership, alongside individuals. For instance, when working with women, we often hear them express the desire for their partners and husbands to have similar opportunities for livelihood when offered. Households are tightly-knit units, and when working with youth, they often influence their parents to alter their behaviors or provide support to maintain positive changes. Working with households is inevitable because the dynamics of the family structure, relationships, and networks play a crucial role. By reaching out to households, we also connect with the broader networks of youth and women.

An important lesson I’ve learned from working across various sectors is that certain basic principles are universally applicable. The peer education approach that proved effective in our HIV/AIDS program also yields positive results in conservation programs. Peer education capitalizes on the existing networks within each family unit. In our programs, we consider both formal and informal structures and work with existing government systems to promote sustainability and influence policy changes. As we implement our programs, we aim to enhance structures with new technology and learning. Our programs essentially serve as catalysts for the aspirations of governments and households. They empower existing institutions, households, and individuals to operate independently, equipped with knowledge, technology, and tools provided through project support and donor contributions. This approach results in a win-win situation for all involved.

Woman conservation farmer in ankle-deep water planting conservation plants.
Woman in ankle-deep water planting conservation plants in the Philippines.

What are some of the most significant challenges you’ve faced in your work on integrated health and environment programs, and how has PFPI addressed these challenges?

My response to this challenge is not unique; it revolves around the issue of stove-piped funding and programming systems. The challenge lies in influencing the thinking, planning, and budgeting processes to consider the conceptual linkages between sectors. This extends to operational strategies for integrating sectors effectively. The Population, Health, and Environment (PHE) approach operates at the intersection of science and art. We seize every available opportunity to integrate across programs, plans, and policies.

Another major challenge is building and maintaining a community of practice for PHE, as well as nurturing champions across various sectors. This intergenerational approach is essential to harness the strengths of different sectors and to build upon existing knowledge while acquiring new insights.

A significant challenge in integrating sectors is the need to combine evidence-based approaches with practical measures that reflect the community’s way of life. This amalgamation of science and art is vital for effective implementation.

Regarding innovative work in the field of integrated health and environment, one project under the USAID FISH Right Program is noteworthy. We supported women in an indigenous community to manage a specific bivalve species and its habitat. Typically, marine protected area management is dominated by men,

and when women are involved, their roles often revolve around secretarial tasks within committees. However, our gender analysis revealed that women’s contributions to the fisheries sector are often hidden, despite the fact that they play pivotal roles such as drying and selling fish and managing activities once the fishermen return home. While the focus tends to be on fishermen, women are more comfortable working in nearshore environments, like mangroves, seagrasses, and mudflats, as they can easily respond to issues at home.

This project with indigenous peoples began when women expressed their interest in managing the resource themselves due to the dwindling availability of bivalves and mollusks. We worked together with the USAID FISH Right Program, where PFPI serves as the lead implementer in the Calamianes Island Group. This collaboration led to the establishment of the first indigenous women-managed coastal area, aimed at safeguarding the bivalves and the associated habitat that supports their food and livelihood. The initiative has since expanded, and we now have 11 women-managed areas within our program sites.

In addition to our conservation work with women, PFPI facilitated the formation of a gender network that addresses various issues, including health, food security, unmet family planning needs, and the challenges faced by larger families in coping with issues like climate change and reduced fish resources.

Another innovative practice within our organization was inspired by a team member’s family tradition. Her father, a dentist and environmentalist, had a unique tradition of planting a tree every time a child was born into the family. We adopted this practice in our programs. Women in our program areas protect designated areas where each family, upon the birth of a child, plants a tree. This practice allows us to physically monitor the number of children born in the area while instilling the values of stewardship from a very young age. It symbolizes life, health, and conservation, and we refer to it as a “twin mangrove.” This practice is an example of how we naturally incorporate the perspectives of health and population dynamics into our existing fisheries projects.

What are some of PFPI’s accomplishments over the years that you are most proud of?

One accomplishment that stands out is the pioneering project in integrated population and coastal resource management. This project laid the groundwork for integrated approaches, not only within the country but also in other regions. The lessons and strategies we developed during this project have continued to guide our work and have sparked interest from more projects, countries, and sectors. Initially planned as a seven-year project, it ended up running much longer than anticipated due to its significance. Through this endeavor, we have seen increased enthusiasm and engagement with integrated approaches in diverse areas.

What are some important lessons you’ve learned through your experiences in cross sectoral work?

One major challenge is the stove-piped funding and programming systems that can limit cross-sectoral integration. Influencing planning, budgeting, and operational processes to consider sectoral linkages and intersectoral integration remains challenging. However, the PHE approach effectively addresses these challenges, but it requires continuous advocacy and action to implement cross-sectoral solutions.

Another challenge is the need to build a community of practice and champions for PHE from various sectors. Developing intergenerational leadership that harnesses the strengths of different sectors is crucial for effective cross-sectoral work.

Moreover, integrating sectors should consider a balance between evidence-based approaches and practical measures that align with the community’s way of life. This integration is both science and art.

Adaptation and flexibility in approaches are also vital, especially in the context of the COVID-19 pandemic and climate change. We have learned that we need to be responsive and adapt to changing circumstances while maintaining a focus on the well-being of communities.

Finally, I would like to highlight the upcoming PHE conference organized by the PHE network in the Philippines in October this year. This conference brings together the PHE community of practice every two years, providing an opportunity to collaborate and learn from each other. Even during the pandemic, we successfully held an online PHE conference with over a hundred participants. The PHE community continues to grow and evolve as a loose network of various sectors, providing valuable opportunities for collaboration and learning.

Kirsten Krueger

Research Utilization Technical Advisor, FHI 360

Kirsten Krueger is a Research Utilization Technical Advisor for the Global Health, Population and Nutrition Group at FHI 360. She specializes in designing and conducting evidence utilization activities globally to accelerate adoption of evidence-based practices through close partnerships with donors, researchers, health policy makers, and program managers. Her areas of expertise include family planning/reproductive health, community-based access to family planning, population, health, and environment, policy change and advocacy, and capacity building.

Kiya Myers, MPS

Managing Editor, Knowledge SUCCESS

Kiya Myers is the Managing Editor of Knowledge SUCCESS’ website. She was previously the Managing Editor of CHEST journals at American College of Chest Physicians where she worked to transition the manuscript submission platforms and launched two new online-only journals. She was the Assistant Managing Editor at the American Society of Anesthesiologists, responsible for copyediting the column “Science, Medicine, and Anesthesiology” published monthly in Anesthesiology and ensuring adherence to peer review policies by reviewers, associate editors, and editorial staff. She facilitated the successful launch of Blood Podcast in 2020. Serving as the Podcast Subcommittee Chair of the Professional Development Committee for the Council of Science Editors, she managed the successful launch of CSE S.P.E.A.K. Podcast in 2021.