Republic of the Philippines

Department of Health
OFFICE OF THE SBCRETARY

Jtne 6,2017

DEPARTMENT MEMORANDTTM
No.2017- 02q0

FOR : ALL I]NDERSECRETARIES. ASSISTAI\T SECRETARIES.

OFFICE FOR HEALTH OPERATIONS. OFFICE FOR FIELD
IMPLEMENTATION MANAGEMENT. OFFICE DIRECTORS OF
BUREAUS. REGIONAL IIEALTH OFFICES. NATIONAL
NUTRITION COIINCIL" Ai\D CONCERI\ED TECHNICAL STAFF

SUBJECT: Guidelines on the Weeklv lron Folic Acid (WIFA) Supplementation

for Female Adolescent Learners in Public Hish Schools.

I. RATIONALE

The 2013 National Nutrition Survey OINS) conducted by the Food and Nutrition Research
Institute (FNRI) reveal that I out 10 adolescents aged 13-19 years old suffer from anemia.
Learners, especially female adolescents, are vulnerable to anemia because of their menstruation,
rapid growth, increased iron requirement and high prevalence of parasitic infection resulting to
loss of iron in the blood.

The Department of Health's Administrative Order (AO) No. 2010-0010 entitled "Revised
Policy on Micronutrient Supplementation to Support Achievement of 2015 MDG Targets to
Reduce Under-Five and Maternal Deaths and Address Micronutrient Needs of Other Population
Groups'o issued in 2010 has identified iron and folic acid supplementation for women of
reproductive age, including adolescents, as one of the interventions to address IDA and folate
deficiency among women. Likewise, one of the guiding principles of the same AO provides for
the Micronutrient Supplementation provision to take place in the health and non-health sector
settings, particularly in schools, workplaceso malls, and the like.

Considering also that most adolescents are in school and do not usually go to the health
center to access health services, the Department of Health (DOH) partnered with the Department
of Education (DepEd) to implement a school-based Weekly Iron Folic Acid (WIFA)
Supplementation for grades 7 - I0 female learners. Prevention of iron deficiency anemia among
female learners will improve their school performance and reduce absenteeism due to ill health
thus, contributing to the reduction of about 200-500 million school days lost due to absenteeism.

Building 1, San Lazaro Compound, Rizal Avenus Sta. Cruz, 1003 Manila o Trunk Line 651-7800 local I113, I l0S; 1135
Direct Line: 711-9502l'71 I -9503 Fax;743-1829 r URL: http://www.doh.gov.ph; e-mail: officeofsoh@doh.gov.ph
 WIFA will be a component of the Menstrual Health Management Project of DepEd to
address knowledge gaps and support learners many of whom do not have the meansfor self-care
and do not get the support they need when they face problems related to menstruation, including
anemia. Such problems, if not addressed, hinders the female learners' ability to sarry on with
everyday activities and may also establish a foundation for lifeJong disempowerment.

II. OBJECTIVE

To provide guidelines on the Weekly Iron Folic Acid (WIFA) supplementation among
female adolescents enrolled in grades 7 to 10 in public high schools and those adolescents enrolled
in the Alternative Learning System of DepEd.

UI. SCOPE AND COVERAGE

The Weekly Iron Folic Acid (WIFA) supplementation is a nationwide routine activity in
all public high schools targeting Grades 7 to l0 female adolescent learners and those in the
Alternative Learning System (ALS).

IV. DEFINITION OF TERMS

Iron lron is an essential trace mineral that is needed for hemoglobin

formation. Hemoglobin is part of the red blood cells and gives blood
its red color.

Folate Folate is a water-soluble B vitamin. Folate is the form found in foods

while folic acid is a synthetic compound of folate and is the form
available as supplement. Folic acid helps the body make healthy new
cells, helps form red blood cells and helps produce DNA, the building
block of the human bodv. which carries genetic information.
Folate Deficiency Folate deficiency is usually linked or coupled with iron deficiency
anemia. Folate deficiencv is also a known factor to cause certain neural
tube defects
Iron Deficiency It is a disorder resulting from the decrease in the number of red blood
Anemia cells due to lack of iron and/or folate. It is the most common nutritional
deficiency in the world and occurs if the amount of iron and/or folate
absorbed is too little to meet the bodv's needs.

Micronutrient A dietary element essential only in small quantities.

Microruttrient Vitamins and minerals in concentrated form alone or in combinations

Supplement taken to supplement the intake from the normal diet.
 Microruttrient A short to medium term intervention intended to prevent and./or correct
Supplementation high levels of micronutrient deficiencies by providing large doses of
micronutrients immediately until more sustainable food-based
approaches (e.g. food fortification and diet diversification) are put in
place and become effective.

Full Stomach Having just recently eaten to the point of being full

Gastric discomfort
Alternative Learning
Svstem
Any kind of discomfort in the stomach or other organs in the upper
abdomen
A parallel learning system that provides a practical option to the
existing formal instruction. When one does not have or cannot access
formal education in schools, ALS is an altemate or substitute. ALS
includes both the non-formal and infonnal sources of knowledge and
skills.

V. GENERAL GTIIDELINES

1. WIFA Supplementation is a collaborative activity between the Department of Health

and the Department of Education. It shall be a nationwide routine activity to be done
simultaneously for all Grades 7-10 female learners in public high schools and in the
Alternative Learning System (ALS).
2. The DOH shall provide the required iron and folic acid (IFA) tablets to cover all eligible
female leamers in all public high schools nationwide.
3. The DepBd shall implement the WIFA supplementation in all public high schools and
in the ALS.
4. All public high schools and ALS shall secure consent from parents/guardians for WIFA
Supplementation. Only learners with consent shall be administered with IFA. Learners
with no consent will still be included in the masterlist but will not be provided with IFA
tablets.
5. All records and reports generated by DepEd for this activity shall be shared with
concerned local health offices and DOH regional and central offices.

VI. SPECIFIC GTIIDELII{ES

I. Target Population

All Grades 7 to 10 female adolescent learners

inpublic high schools and in the ALS
shall be the recipients of the intermittent WIFA supplementation every July to
September (first round) and January to March (2nd round) of each school year.

2. Drug, Dose and Schedule of Administration

2.1. Iron Folic Acid QFA) Tablet Preparation

 Iron folic acid (IFA) tablets contains 60 mg blemental iron and 400 ug folic acid
with film coating

2.2. Iron folic acid (IFA) tablet administration

2.2.1. Prior to administration of IFA supplement:

- Female learners shall be screened by the school nurse/classroom
adviser if they have been deworrned within the last six months
o If yes, give the IFA tablet
o If not, deworm first then administer the IFA tablet after 2-3
days
- If the leamer was given consent only for WIFA supplementation but
not for deworming, the parents of the female leamer shall be
encouraged by the nurse/classroom teacher to likewise give consent
for deworming as the benefits of WIFA supplementation will be
maximized only if the learner has been dewormed first.

2.2.2. Intermittent WIFA supplementation based on the World Health

Organizatron (WHO) recommendation shall be given as follows:

# of Implementation Schedule Dose per Learner

Rounds
I Julv to Seotember I tablet oer week
II Januarv to March 1 tablet per week

Note: The IFA tablet shall be administered on a full stomach to avoid

gastric discomfort

2.2.3. The school nurse/classroom teacher shall administer IFA tablet every
Monday or the next school day if Monday is declared as holiday or no
school day and shall observe that the learner swallowed the tablet.
2.2.4. If the learner is absent on the day of WIFA scheduled administration, the
IFA for the week shall be given on the day the learner returns to school.
2.2.5. If the learner is absent for the whole week, the IFA tablet for the previous
week shall be given on the day she returns and the current week's IFA
tablet 1-2 days after.
2.2.6. If the leamer is currently taking multiple vitamin, WIFA can still be
administered.
2.2.7. In case the learner has been previously diagnosed with anemia and
receiving therapeutic doses of iron, IFA shall NO longer be given. Once
the therapeutic treatment has been completed, WIFA supplementation
shall be started to prevent reculrence of anemia following the WIFA
recommended schedule.
2.2.8. In case the learner has been screened positive for glucose-6-phosphate
dehydrogenase (G-6-PD), the learner shall be given the IFA tablet as it is
not a contraindication for iron supplementation.
 2.2.9. For ALS, administration of iron folic acid shall be as per agreed schedule
between the ALS coordinator and the learners.

2.3. Expected Drug Reaction

2.3.1 .
Iron folic acid tablet has only minor side effects such as gastric discomfort,
constipation and blackening of stool.
2.3.2. These side effects, if experienced by the learner, may be reported to the
classroom teacher and/or the school nurse for management and provision
of appropriate counseling.
2.3.3. If the learner's symptoms persist, the school nurse may refer the learner to
the Rural Health Unit or Barangay Health Center for further evaluation and
management.

2.4. DrugStorage

2.4.l.lron folic acid tablets are sensitive to heat and shall be stored in a cool dry
place at all times
2.4.2.Once opened, the iron tablets should not be removed from the High Density
Polyethylene (HDPE) bottle to preserve its potency
2.4.3.If possible, opened bottles should be used immediately.

3. Recording and Reporting Forms (Annex A)

Form 1: Recording Form- This form shall be accomplished by the class

adviser, lists all fernale learners provided and not provided with
WIFA and other relevant information about them per class. This form
shall be retained to the class teacher as reference.

Form 2a: Grade Level Report - This form shall be accomplished by the grade
level coordinators, is a consolidation the classroom level reports
submitted by the class advisers and to be submitted to the WIFA
Supplementation point person. The lst round report shall be submitted
every 2nd week of October while the 2nd round report will be submitted
every second week of April. Filled up Forms shall be retained to the
classroom teacher as guide for the 2nd round.

Form 2b: School Level Report- This form shall be accomplished by the school
WIFA Supplementation point person, is the consolidation report of the
Forrn2a signed by the principal and submitted to the district point person
for consolidation within two (2) weeks after the Form 2a Grade Level
Reports are submitted.

Form 3: District Level Report- This form shall be accomplished by the district
point person, to be signed by the district supervisor and to be submitted
to the division point person one week after the due date for School
 Level Report submission. Once approved, a copy shall be furnished to
the Municipal Health Office.

Form 4: Division Level Report-This form shall be accomplished by the division

point person, to be signed by the schools division superintendent and to
be submitted to the regional point person one week after the due date
for District Level Report submission. Once approved, a copy shall be
furnished to the Provincial/City Health Office.

Form 5: Regional Level Report-This form shall be accomplished by the

regional point person, to be signed by the regional director and to
be submitted to the national point person one week after the due date
for Division Level Report submission. Once approved a copy shall also
be furnished to the Regional DOH Office for submission to DOH-CO.

Form 6: National Level Report - This form shall be accomplished by the

national point person, to be signed by the Director of the Bureau of
Learner Support Services (BLSS) and to be submitted to the Office of
the Undersecretary. Once approved a copy shall also be furnished to the
Women, Men and Children's Health Development Division of DOH-CO
before the end of December and June for the first and second round.
respectively.

Flow of recording and reporting

DOH Central Office (DPCB-

DepEd- BLSS
WMCHDD)

DepEd Regional DOH Regional

Coordinator Coordinator

Schools Division PHOiCHO

Superintendent
+

District Supervisor MHO

High School Principal

Grade Level Chairperson

Class Adviser

6
VII. IMPLEMENTING MECHANISM

A. Department of Health

|. Central Office @OH-CO):

a. Formulates guidelines and procedures on the implementation of WIFA

supplementation and disseminate to Regional Offices, LGUs and other
stakeholders
b. Prepares a Memorandum of Agreement in consultation with DepEd
c. Issues a Department Memorandum on the implementation of WIFA
supplementation
d. Prepares a Communication plan and protoq/pe materials for WIFA
supplementation advocacy and promotion in schools
e. Procures, allocates and distributes in a timely manner all required iron with
folic acid tablets to be distributed among Grades 7-10 and ALS female students

2. Regional Office (DOH-RO)

a. The Regional Nutritionist assisted by the Regional Adolescent Health

Development Program Coordinator supervised by the Office of the Regional
Director and the Concerned Cluster Head shall be the focal points for the WIFA
Supplementation implementation.
b. Reproduces and disseminates guidelines and procedures on the implementation
of WIFA Supplementation
c. Reproduces and disseminates communication plan and prototype of IEC
materials
d. Coordinates with DepEd regional counterpart during the pre during and post
WIFA supplementation proj ect implementation
e. Monitors the implementation of WIFA supplementation and submit reports to
DOH-Central Office using the prescribed forms and following the reporting
schedules

3. Rural Health Units/ Barangay Health Centers

a. Provides WIFA to Grades 7 to l0 in private high schools, out-of-school

adolescents and women 10-49 years old not covered by the WIFA
supplementation in public high schools
b. Assists the school health personnel in information dissemination among
parents on the benefits of WIFA Supplemantation
c. Manages referred cases of persistent minor drug reactions like constipation,
gastric discomfort and blackening of stool.
B. Department of Education (CO)

1. Bureau of Learner Support Services-School Health Division (BLSS-SHD)

a. Develops policies and issue memoranda./orders on the concern;

b. Prepares annual targets and documents to support request for commodities
from the Department of Health
c. Collaborates with the DOH and other local and international
institutions/organizations on the development of Operational Guide for WIFA
supplementation for Adolescent Girls in schools, capacity building for the
implementation of the Operational Guide, complimentary school-based
nutrition intervention, behavior change communication activities, recording
reporting and evaluation of the supplementationprogram.
d. Coordinates with the DOH on the delivery of WIFA tablets for distribution to
targeted schools.
e. Consolidates and submits reports to DOH
f. Monitors and provides technical assistance to ROs and SDOs in the
implementation of this policy.

2. Regional Offices (ROs)

a. Determines annual targets of the region and prepare sub-allotment to SDOs or

conduct the actual procurement of iron with folic acid tablets for SY 2017-2018
only
b. Conducts regional orientation, to schools, division / SDOs on the activity
c. Consolidates submitted reports from the SDOs and submit to BLSS-SHD and
DOH-regional counterpart; and
d. Monitors and provide technical assistance to SDOs/Schools on the
implementation of the activity.

3. School Division Offices (SDOs)

a. Determines annual targets of the division and submit the data to the RO;
b. Distributes the iron with folic acid tablets to the schools
c. Conducts information dissemination to school heads PTCA and students: and
d. Consolidates reports of school/district offices and submit to DepED Regional
Office
e. Monitors and provides technical assistance to schools to ensure successful
implementation of WIFA supplementation.
f. Designates WIFA focaVpoint person (WIFA coordinator).

4. Schools

a. The School Head shall develop a protocol on the following:

- Assignment of a WIFA Supplementation point person

 Preparation of the master list of female students in Grades 7-10 and ALS to
be given weekly iron and folic acid supplements
Orientation and coordination with PTA and other stakeholders on the WIFA
supplementation
Administration of IFA tablets every Monday of the week through a school
nurse or a teacher

Storage, inventory and distribution of iron with folic acid tablets.

Collect parent consent together with immunization and deworming

b. Prepares and submit reports on the number of female students who received
supplementation, observations, issues encountered, and recommendations.

VIII. EFFECTIVITY
This policy shall take effect immediately.

BAYUGO, MD, MPH, CESO III

of Health
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