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Nutrition Intervention Programs in the Philippines 1.

Millennium Development Goal Achievement Fund 2030: Ensuring Food Security and Nutrition for Children 0-24 Months in the Philippines MDG-F 2030 or Ensuring Food Security and Nutrition Among Children 024 Months Old in the Philippines is one of the programmes approved for funding through the Millennium Development Goals Fund (MDG-F) established by the Spanish government in the United Nations through its development agency (AECID) to accelerate actions to achieve the MDGs. The joint programme (JP) contributes to the achievement of the Millennium Development Goals (MDG) on reducing malnutrition among 0-5 yearold children (MDG 1 eradicate extreme poverty and hunger) and reducing child mortality rate (MDG 4), by complementing governments efforts to refocus on children 0-24 months of age to improve breastfeeding and complementary feeding practices. The JP targets activities that are highlighted as national priorities. The goal is to create an enabling environment where breastfeeding and appropriate complementary feeding are practiced, promoted, supported and protected by communities and the nation as a whole. This three-year programme is expected to 1) increase exclusive breastfeeding rates in the project areas by 20% annually, 2) reduce the prevalence of undernutrition by at least 3% by 2011, and 3) improve the capacities of national and local governments and stakeholders to promote and implement policies and programmes on infant and young child feeding (IYCF).

The JP is designed to work on two levels: 1) upstream at national level to influence policy and programmes through lessons learnt from local implementation and evaluation using data from the nutrition information system; and 2) at the local level to work through existing local nutrition committees, composed of offices of the local chief executive, local line departments or office, local non-government organizations, and community groups for nutrition programme coordination. Activities at the local level aim to create an enabling environment where pregnant and lactating women and mothers/caregivers of infants and young children receive appropriate nutrition messages and support for IYCF from multi-sectoral stakeholders, i.e. government agencies, administrative/legislative stakeholders, community/church groups that come in contact with them. To ensure synergy and complementation of efforts, the JP activities will be implemented in the same JP areas. Three urban and three rural sites were selected with national government agencies on the basis of the magnitude of poverty and subsistence incidence as well as undernutrition in young children and covering each of the countrys main islands. These areas include Naga City and Pasacao in Camarines Sur of the Bicol Region, Iloilo City and Carles in Iloilo Province of the Western Visayas Region, and Aurora, Zamboanga and Zamboanga City for the Zamboanga Peninsula. In addition, selected cities of Central Luzon, CALABARZON, Central Visayas, Eastern Visayas, and Central Mindanao will be covered by the promotion of exclusive breastfeeding through a behavior-based communication strategy.

Local leaders and health managers have been and will continue to be involved in project planning, development, implementation and evaluation in partnership with the participating UN agencies as well as implementing partners from the national government. 2. Barangay Program of Action for Nutrition (BPAN) Every Filipino dreams of delicious, nutritious and affordable foods served on their table each meal. The Nutrition Center of the Philippines (NCP), a nongovernment organization, aims to make this dream a reality through the Barangay Program of Action for Nutrition (BPAN). In this program, the mayors, barangay captains and barangay-based cooperators can work hand-in-hand with NCP to implement feasible nutrition interventions to prevent and control malnutrition in their respective barangays. The action program involves nutrition information education, home food security, Vitamin A, iron and iodine supplementation, food fortification, and growth monitoring under the cooperation and leadership of local officials. NCP believes that people can fight malnutrition through education, thus the implementation of the Project Bayang Mayaman sa Iron, Iodine at Bitamina A (BIDA). BIDA is the centerpiece of the nutrition information education program that integrates nutrition concepts in the classroom by making nutrition education part of the school curriculum and by holding nutrition special events such as quiz, poster-making, and cooking contests. BIDA promotes nutrition education among pregnant and lactating women, mothers of preschoolers, school children and malnourished children through the Pabasa sa Nutrisyon Program. In this

program, portions of the Nutri-Guide are read aloud and personal experiences are shared. To elicit participation and strengthen nutrition messages, Pabasa includes fun learning activities like games, exercises, and demonstrations. After 10 sessions, the participants receive certificates of achievement during the graduation ceremonies. The main thrust of the Home Food Security component of BPAN is food production. Growing of crops and raising of small animals to meet the family's daily needs are encouraged so that, "not a single Filipino goes to bed hungry." The LGUs and barangay-based cooperators can help organize committees for the project's implementation and advocacy, allocate budget for seeds and seedlings, establish gardens and nurseries, and monitor the project. This can be done in the school and day care centers, in the community, and at homes. Vitamin A, iron, and iodine supplementation in barangays are done to improve child survival, help pregnant women, develop educational performance, and increase labor productivity. During the Garantisadong Pambata, (a micronutrient supplementation activity) Vitamin A capsules are given to lactating women, infants, and pre-schoolers while iron tablets and iodized oils are given to pregnant women and women of child-bearing age. The Filipino diet lacks iron, vitamin A, thiamine, riboflavin, and iodine. Due to these nutrient deficiencies, the Department of Health (DOH) is intensifying its campaign on food fortification to make these micronutrients available in processed foods sold in the market. The DOH introduced the Sangkap Pinoy Seal Program to encourage food manufacturers to fortify their products. Sangkap

Pinoy is a seal given by the DOH signifying that the product is fortified properly. With this seal, the consumers are aided in making intelligent decision and proper food choices when buying food products. The LGUs are mandated to sell these nutritious foods, iodized salt, and fortified foods to increase the availability of these products. Health and nutrition workers (with LGUs) campaign for selling and consumption of these foods containing the needed micronutrients while sarisari storeowners are encouraged to sell these at affordable prices. To have an indication of the status of a child's health, Operation Timbang is conducted to monitor his/her weight. Community health and nutrition workers conduct regular weighing and plotting of weight in the growth chart to measure children's physical growth and development. Nutrition counseling is conducted to help mothers detect early stages of malnutrition (indicated by weight loss) and advise them on what kind and how much food a child needs to maintain normal growth. BPAN is a translation of the NCP Philippine Plan of Action for Nutrition (PPAN) into a program of action at the barangay level. The NCP represents the private sector to the governing board of the National Nutrition Council. The introduction of BPAN and relating of its experiences in the approaches to nutrition improvement and home food security in the barangays is part of the BAR Seminar Series held on June 5, 2002 in cooperation with the Postharvest, Food Science and Nutrition RDE Network. This seminar highlighted communitybased approaches that addressed sustainability and political viability of nutrition

programs. It also explored possible applications of these approaches to RDE programs of the Department of Agriculture. 3. Food Always in the Home (FAITH) It is a home and school gardening program that NCP advocates. FAITH focuses on home food security making food always available, accessible and affordable for the family. Training is provided to scientifically learn how to plant fruits and vegetables without the use of pesticides and using limited space. By promoting fruits and vegetables, the NCP encourages dietary diversity which is associated with better health outcomes. The NCP can provide training and materials for local government units and NGOs that plan to implement FAITH. 4. Nutripan sa Eskwelahan Vitamin A deficiency and anemia affliction in the Philippines continue. A significant proportion of vulnerable Filipino children and women is affected. The Nutrition Center of the Philippines, through its Food Fortification Study Group led by Dr Florentino Solon, developed a technology for the fortification of foods with vitamin A and iron. The NutriPan sa Eskwelahan (Fortified Bread in School) was conceptualized to make fortified bread always available in schools at an affordable price. Thirty-six (36) bakeries have been established in over 30 schools in the National Capital Region, Cebu, Negros, Quezon Province, Pangasinan, Cagayan de Oro City and Batangas.

NCP sets up the bakeries and provides training for operation and management. Bakers are trained in food safety and operation of the ovens and dough kneaders. This program emerged as the winner in the Health Services Research category of the 2006 Outstanding Health Research Award given by the Philippine Council for Health Research and Development (PCHRD DOST). With this, schoolchildren now have access to affordable and nutritious bread products, preventing vitamin A deficiency, anemia, and underweight incidence. 5. Monitoring and Evaluation of Local Level Plan Implementation (MELLPI) Background The National Nutrition Council, the countrys policy making body on nutrition, is mandated among others, to monitor and evaluate the implementation of the countrys food and nutrition program, the Philippine Plan of Action for Nutrition (PPAN). Toward this mandate, the interagency NNC annually conducts the Monitoring and Evaluation of Local Level Pla n Implementation or MELLPI since 1978. It aims to assess the efficiency and effectiveness of local governments in planning and implementing local nutrition programs. Likewise, in conjunction with the MELLPI, the NNC also evaluates the performance of the Barangay Nutrition Scholars (BNS). The BNSs are the barangay-based volunteers tasked to coordinate the delivery of basic nutrition and related services in their respective area of assigments. Both the MELLPI and BNS evaluation are institutionalized activities since 1979 of the national and local nutrition committees.

Recognition and Incentives System The MELLPI and BNS Evaluation culminate with the recognition of LGUs and BNSs with exemplary performance in nutrition program management and delivery of nutrition services, respectively. Recognition comes in the form of incentives/awards such as the Green Banner Award, Consistent Regional Outstanding Winner in Nutrition (CROWN), Nutrition Hon or Award (NHA) and the National Outstanding BNS. The Green Banner Award is given to a municipality, city or province, which has shown very satisfactory performance i n implementing its nutrition program. An area awarded the Green Banner for 3 consecutive years as outstanding regional winner automatically qualifies for the CROWN Award. The CROWN awardees are then visited by a National Evaluation Team for three years to check whether their efforts in maintaining a downward trend of malnutrition are sustained through a well-coordinated plan implementation. CROWN areas qualify to vie for the Nutrition Honor Award, the highest award given by NNC to outstanding achievers in nutrition program implementation for another 3 consecutive years. Trophies and cash prizes are granted to the winners. Cash awards in the amount of P 250,000, P 500,000 and P100,000 are granted to CROWN, NHA, and NOBNS, respectively. The Council has awarded to date, the CROWN award to 127 LGUs and the NHA to 43 LGUs. The cash awards provided to the winners plowed back to

the nutrition funds as LGUs used the cash incentives for nutrition activities. On the other hand, 16 BNSs have been proclaimed NOBNS since 1997.