UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING

COMPETENCY APPRAISAL II
IN COMMUNITY HEALTH NURSING

CHILD HEALTH: MALNUTRITION

4NUR2 - RLE 2

MEMBERS:

CAYTON, Janelle Irish Eunice

GOLEZ, Steffi Gabrielle
LIANG, Fan
MANUEL, Shaina
MENDOZA, Patricia Jane
ORDINARIO, Jolo
PASCUAL, Cathleen Keith
PEROLINO, Philip Job

Asst. Prof. Ritzmond F. Loa, MAN, RN, PhD

Data and Statistics
Every day, 95 children in the Philippines die from malnutrition. Twenty-seven out of 1,000
Filipino children do not get past their fifth birthday. A third of Filipino children are stunted, or
short for their age. Stunting after 2 years of age can be permanent, irreversible and even fatal.
Malnutrition is known as the 3rd leading health problem in the Philippines. Among the 175
countries in the global ranking of best and worst countries for children to grow up, the Philippines
ranks at the 104th spot. According to UNICEF's report in 2019, 1 in 3 children who are age 12 -
23 month old suffer from anemia while 1 in 3 children are irreversibly stunted at the age of 2.
Hence, the Philippine government recognizes malnutrition as a significant public health concern
in the country, and stunting is now seen as one of the major impediments to human development
as well as an established marker for poor child development.

In the Philippines, malnutrition is most prevalent among infants and children through age
four. Infancy and early childhood years are critical periods wherein children need adequate
nutrition to reach their full potential. According to the National Nutrition Survey (NNS),
malnutrition rates increased between 6 and 24 months old children. This is a vulnerable period
when breastfeeding is no longer sufficient to meet the nutritional requirements of the child, hence,
complementary feeding. In response, the Department of Science and Technology (DOST),
through Food and Nutrition Research Institute (FNRI), devised nutrition intervention strategies
aimed to address malnutrition.

Based on the 2015 Census of population, the Philippine population went up from 92 million
in 2010 to 101 million in 2015, which translated to an average population growth area of 1.7
percent annually. In the figure 1.1, it shows that the Philippine population in 2015 was young -
with children aged 0 - 4 years old and 5 - 9 years old which comprises the largest age groups, each
making up 5.2% of the household population.

Based on PSA 2000 Census-based projections, the average life expectancy improved
from 67.1 years in 2000-2005 to 71.6 years in 2015-2020. Modest gains were also achieved in
infant and under - 5 years old mortalities as shown by mortality data from 5 demographic surveys
conducted from 1993 to 2013. Infant mortality rate decreased from 34 per 1,000 live births to 23
per 1,000 live births and under-five mortality rate went down from 54 per 1,000 live births to
31 per 1,000 live births. The rates of decline, however, slowed down over the period. In terms
of nutrition, the 8th National Nutrition Survey showed that stunting remained almost unchanged
from 33.1 percent in 2005 to 33.4 percent in 2015. (Figure 1.2) Stunting was observed to be
high among those residing in rural areas (38.1 percent) and those belonging to the poorest
quintiles (49.7 percent).

The leading cause of mortality in the Philippines in 2016 consisted of non-

communicable diseases (NCDs) like ischemic heart disease, neoplasms or cancer,
cerebrovascular diseases or stroke, hypertensive diseases, diabetes and other heart diseases, and
communicable diseases like pneumonia, respiratory tuberculosis and chronic lower respiratory
infections. Several NCDs share common lifestyle-related risk factors: cigarette smoking,
hypertension, hyperglycemia, dyslipidemia, obesity, physical inactivity and poor nutrition (Asena
et al., 2015).
Social Determinants of Health
● Economic Stability
○ This includes poverty, employment, food insecurity and housing instability. The
documentary setting was in Maguindanao which is known to be one of the poorest
islands in the Philippines. Family of Di doesn´t have any stable job that will cater
to all the daily needs of the family. There is lack of availability of job opportunities
in South Upi, Maguindanao.
● Social & Community Context
○ There is lack of social support from the Local Government and there is no direct
financial support for the health care facilities.
● Neighborhood & Environment
○ Family of Di from South Upi, Maguindanao doesn't have any access to food that
supports healthy eating of the citizens who is sick with malnutrition. He is a 5 year
old boy that only weighs 7kg which is classified underweight and not appropriate
for his age. It was said that the weight of Di is like for a 9-month-old baby. This is
just because they don't have sufficient food; they will just eat sweet potato
(kamote), corn (mais) and rice (kanin) for two times a day.
● Health Care
○ It was seen that there is still currently a lack of accessible health stations to locations
far from commercial areas. In the documentary, it can be seen that people would
have to rent a boat or travel hours through walking to far places in order to get help
from health care providers. And upon reaching the centers, they are then faced with
the news that there is either no health care professional on duty, no available
medication, facility and equipment available or both
● Education
○ It was seen in the documentary that Di, a 5 year old boy who doesn't go to school.
At his age, he should be in a day care center or in a kindergarten. But apparently
due to his condition he wasn't able to go to school and the school is not accessible
from their house.
Programs and their policies regarding nutrition

1. MALNUTRITION REDUCTION PROGRAM or “Package for Improvement of

Nutrition of Young Children”

The Malnutrition Reduction Program (MRP) of the DOST-FNRI addresses the undernutrition
problem among young children. The DOST PINOY strategy under the MRP is a package of
intervention which involves direct feeding of rice-mongo based complementary foods for 6 months
to below 3 years old children and nutrition education among mothers and caregivers. The
complementary food technology and the intervention strategy is being rolled-out to the countryside
as part of the solutions to the malnutrition problem among our Filipino young children.

Objectives:
The project expanded and sustained the implementation and adoption of the DOST PINOY
strategy by the local government units (LGUs) to address the problem of undernutrition among the
Filipino young children under three years old.

Materials and Methods:

The DOST PINOY strategy primarily focused on science and technology (S&T) activities which
composed of advocacy to LGUs and local chief executives (LCEs) and capacity building of local
program implementers.

Policies:
1. Identified malnourished children in the community must be aged 6 months to 3 years old.
2. Malnourished children ages 6 months to 3 years old will undergo supplementary feeding
for 120 days, whereas they will be eating the developed complementary food that they will
receive from the FNRI – DOST for twice a day for 4 months.
3. The mothers and guardians will undergo nutrition education on basic nutrition,
breastfeeding, complementary feeding, meal planning, safe food handling preparation, and
backyard vegetable garden – all in place to free children from malnutrition and equip
mothers/caregivers in raising healthy, thriving children.
 4. The participating family are obliged to seek consultation at least once a week to the health
care unit in order to monitor the nutritional status of the child.
5. An approved budget of Php 324, 620.00 is given to the LGU/s to purchase DOST – FNRI’s
complementary food blends that include Rice – mongo-based commodities rich in energy
and protein for one cycle program.
6. The target community is mandated by the Statistics of the FNRI in accordance to the cities
with high prevalence of malnutrition, especially Antique, Iloilo, Occidental Mindoro, and
Leyte.
Limitation of the Program:
The problem may come at the end of the program, “What happens to the children then?”

Pillars
1) Active Participation
The community itself is needed for this program to be implemented. The parents of the
children in the community are required to attend a 2 - day seminar on the first month
regarding the basic knowledge of nutrition and strategies that they can utilize to supplement
the nutritional needs of their child/children. The mothers, together with their child must
seek consultation to the barangay health unit at least once a week to closely monitor the
development. The parents and children are also taught to do backyard and school gardening
in order to supply the crops needed to produce the food to be distributed in the program.
2) Inter – sectoral Linkages
- The LGU’s are the primary sector that helps in implementing this program. The LCE’s
are the ones who leads the program and is to report to the DOST and FNRI of the status
of the program being conducted in their municipality, also they are assigned to provide
the Capacity Building of Local Program Implementers. The DepEd provides the
addition of the Basic Nutrition to the curriculum. The department of Agriculture
provides knowledge on the families of the techniques to grow the crops needed as an
ingredient to the food distributed in the program. The DOST and FNRI are the ones
who implements and conduct the program to the community.
3) Intra – sectoral Linkages
- Long Live Pharma (a private entrepreneur) started to produce the complementary foods
with a brand name of RIMOTM (rice-mongo). The Long Research and Development
Live Pharma sought the technical assistance of the FNRI-DOST for the training on how
to implement the DOST PINOY among selected community workers in Sta. Barbara,
Pangasinan.
- UNICEF provides additional funds to the FNRI and DOST in implementing the
program.
4) Support Mechanism of the DOH
 -DOH supports the financial needs of the DOST (Department of Science and
Technology) and the FNRI (Food and Nutrition Research Institute) to further
implement and explore the strategy of the program.
5) Technology Used
- Agriculture is the most and foremost technology used in this program. The machineries
used to create the food is funded by the private sectors whereas the crops needed are
supplied from the plantation.

2. Masustansyang Pagkain Para sa Batang Pilipino Act or Republic Act No. 11037

Republic Act No. 11037 or the “Masustansyang Pagkain Para sa Batang Pilipino Act” of 2018
⁃ Mandates the Department of Social Welfare and Development and the Department of
Education to implement the Supplementary Feeding Program (SFP) and the School-Based
Feeding Program respectively to address undernutrition among Filipino children

Objectives:
1. To address the current issues and gaps in the implementation of the SFP;
2. To contribute to a more efficient implementation of the SFP; and,
3. To provide specific options for the procurement of goods for the program

Policy:

The state recognizes the vital role of the youth in nation-building and shall promote and protect
their physical, moral, spiritual, intellectual, and social well-being. In recognition of the
demonstrated relationship between food and nutrition, and the capacity of students to develop and
learn, the State shall establish a comprehensive national feeding program that will address the
problem of undernutrition among Filipino children.

1. The Field Office (FO) will act as the Procuring Entity on the items based on set categories,
such as but not limited to, welfare goods (viand and rice), cooking and eating utensils, location of
delivery, volume of request and availability in the market;
2. The FO may tap organized groups such as the Sustainable Livelihood Program Association
(SLPA) and Agrarian Reform Beneficiaries Organizations (ARBOs) as partner/ service providers.

Legal Bases:
1. Section 3, item 2, Article XV of the 1987 Philippine Constitution
2. RA No. 10410. Early Years Act (EYA) of 2013
3. ECCD Act (RA 8980) EARLY CHILD CARE & DEVELOPMENT

4. Special Protection of Children Against Abuse, Exploitation and Discrimination Act (RA
7610)
5. Local Government Code of the Philippines (RA 7160)
6. Nutrition Act of the Philippines (PD 491)
7. Section 53.12 of the Revised Implementing Rules and Regulations (IRR) of RA 9184
8. Philippine Plan of Action for Nutrition 2017-2022
9. Resolution No. 09-2014
10. Resolution No. 28-2016

Analysis:
The program can be really helpful in solving malnutrition because of the numerous components
and coverage it has. The DSWD, in coordination with the LGUs concerned, will implement a
supplemental feeding program for under nourished children with ages three to five years while the
DepED will implement a school-based feeding program for undernourished public school children
from kindergarten to grade six. The NGAs, in coordination with the DOH and LGUs concerned,
will conduct simultaneous health examinations including, but not limited to deworming and
vaccination. However, there is no update yet whether the program was successful or not.

4 Pillars of Public Health

1. Active participation:
The NGAs shall encourage their respective component units to devote a portion of their land or
space for the cultivation of vegetables and other nutrient-rich plants. Parents shall also be
encouraged to maintain a similar program in their own backyards.

2. Intra and Inter-sectoral linkages:

The NGAs shall encourage the participation of the private sector in the Program which shall
include, among others, PTAs, private corporations, peoples and nongovernment organizations
and such other groups or organizations, both foreign and local, that may want to be partner in
whole or in part with the implementation of the Program.
3. Appropriate technology:
The Program shall have the following components and coverage:
1. Supplemental Feeding Program for Day Care Children
2. School-Based Feeding Program
3. Milk Feeding Program
4. Micronutrient Supplements
5. Health Examination, Vaccination and Deworming
6. Gulalayan sa Paaralan
7. Water, Sanitation, and Hygiene (WASH)
8. Integrated Nutrition Education, Behavioral Transformation, and Social Mobilization

4. Support of local government:

LGUs shall assist the NGAs in the efficient and effective implementation of the Program in
accordance with Section 4 of this Act and shall be authorized to use a portion of the Special
Education Fund (SEF) and/or their twenty percent (20%) development fund as provided for in
Republic Act No. 7160, otherwise known as the "Local Government Code of 1991", as amended
to augment the appropriations available under the General Appropriations Act (GAA)

5A’s
It is appropriate and acceptable because the policies of the program address the problem of
malnutrition. The program addresses the current issues and gaps in the implementation of the SFP
and contribute to a more efficient implementation of the SFP. It is available and accessible for day
care children, a school-based feeding program for public school children from kinder to Grade 6.
It is affordable because the amount necessary to carry out the initial implementation of this Act
shall be sourced from the current appropriations of the NGAs. Thereafter, such sums as may be
necessary for the continuous implementation of this Act shall be included in the annual GAA under
the respective budgets of the NGAs.

3. Barangay Nutrition Scholar (BNS) Program

Barangay Nutrition Scholar (BNS) Program
This program aims to deliver nutrition and nutrition-related services to the barangay by caring for
the malnourished and the nutritionally vulnerable, mobilizing the community, and linkage
building.

Policy
● Presidential Decree No. 1569, “Strengthening the Barangay Nutrition Program by
providing for a barangay nutrition scholar in every barangay, providing funds therefore,
and for other purposes”
● NNC Memorandum No. 2017-011, “Guidelines for providing medical and survivorship
assistance to Barangay Nutrition Scholars (BNS)

4 Pillars of Health Care

1) Active Participation
In this program it has a survey that involves weighing all preschoolers and interviewing mothers
to determine how the child is cared for, and the resources available in the family for their
participation in nutrition and related interventions.

2) Intra-Inter sectoral Linkages

In this program, the BNS also moves the community to organize into networks of 20-25
households, or into community-based organizations working for the improvement of their nutrition
situation. In the presence of other barangay-based development workers, the BNS may not
necessarily deliver direct nutrition services to the community but serve as linkage-builder, to
ensure that members of the community, especially those with underweight children, avail of
nutrition and related services.

The Barangay Nutrition Scholar (BNS) are linked with the other outreach programs as several of
them are also the designated BHWs

3) Use of appropriate technology

In this program, The BNScholar assisting in delivering nutrition and other related services which
include:
 ● organizing caregiver’s class or community nutrition education
● providing nutrition counseling services, especially on exclusive breastfeeding and
appropriate complementary feeding, through home visits.
● Managing community-based feeding programs under the supervision of a
nutritionist-dietitian
● Distributing seeds, seedlings, and small animals from the local agriculture office
and other government organizations and non-government organizations to promote
home or community food gardens; and
● Informing the community on scheduled immunization and other health activities

4) Support Mechanism
For the implementation of this project, it will be the total responsibility of a Provincial/City
Nutrition Committee and Municipal Nutrition Committee.

The National Nutrition Council (NNC) allocates the funds for this project to the various provinces
and/or agencies, for disbursement in accordance with the financial plan of the Barangay Nutrition
Scholars Project. At present, The NNC is attached to the Department of Health (DOH).

Analysis:
By implementing this program in every barangay here in the Philippines, it will have a great impact
to the community by reducing malnutrition and it can also help by preventing unnecessary child
death in each family. In some rural areas like in the documentary shown, even there are health
centers available the parents ignore the malnutrition problem due to lack of knowledge. And in
some areas, it is not accessible for them to go to the health center and access the health care
facilities. So the Barangay Nutrition Scholar (BNS) program will be the answer for this kind of
situation.

But despite the beauty of this program implemented in 1978, there are still places not having
BNScholar in their barangays. Across all municipalities, the BNS shared similar program inputs
and processes that they perceived can contribute to improved Barangay Nutrition Action Plan
(BNAP) implementation. Political support to ensure funding of BNAP, functional BNC,
continuous guidance from their supervisors, continuous BNS capacity building to enhance their
program management skills and to enable them to effectively promote inter-agency collaboration
and sustained advocacy at the national level for the passage of the Magna Carta for BNS that will
increase their allowance and provide them with opportunities to upgrade technical capability to
efficiently plan and manage local nutrition programs.

4. LAKASS (Lalakas ang Katawang Sapat sa Sustansiya) Program

Objective:
The program aims to improve the nutrition situation in all identified nutritionally depressed
municipalities; and provide effective and sustainable services for the community to improve their
nutritional status.

Laws and Policies of the program:

The Philippine Nutrition Program is premised on a nutrition-in-development perspective. It
adheres to the principle that a healthy well-nourished population is a prerequisite to attaining
national development goals. Health and nutritional well-being is considered an integral part of
national socio-economic development, guided by the following policy directions:
1. Focus public resources toward the implementation of community-based nutrition interventions
and poverty-alleviation measures in identified nutritionally depressed areas targeting
nutritionally at-risk families and individuals
2. Promote a supportive policy environment across development sectors to ensure nutritional
improvement
3. Integrate nutrition considerations in sectoral development plans and programs that pursue the
reduction of poverty and address its causes, increased food availability, improved environment,
better health, and increased productivity and economic growth
4. Strengthening local government units and community capability to plan, implement, monitor,
and evaluate sustainable and integrated nutrition programs.
5. Improve and strengthen existing mechanisms for nutrition planning, policy formulation,
implementation, monitoring, evaluation, surveillance and advocacy at all levels.
6. Conduct basic, applied, and operations research on nutrition; strengthen research utilization
and technology transfer; and regularly assess plan implementation
7. Increase the emphasis on the vital role of information and development communication in
promoting good nutrition
8. Involve NGOs including people’s organizations and the business sector more systematically in
plan implementation

Services provided:
A. Food assistance: 4. Communities
1. Preschoolers -Portable water system construction
2. School children - Toiler construction
B. Nutrition related health servies: C. Nutrition Information and Education
1. Preschoolers: 1. Father’s class

- Micronutrient supplements 2. Mother’s class

- Deworming D. Incremental Food Production
- Immunization 1. Families
2. Mothers -Bio-intensive Gardeming
- Micronutrient supplements -Animal raising
3. Families/ Household Livelihood/ IGPs
- Portable water system construction 1. Household/ families
-Toiler Construction 2. Communities

Deficiencies
While the program has seen success in many years in addressing nutrition among Nutritionally
Depressed Municipalities (NDM), the program is not specifically exclusive to addressing child
malnutrition. This leads to the program not focused on a single problem which leaves some
resources not utilized in a singles objective. Rather, the entire program is aimed at a broader
spectrum or target group instead of just children, the program includes the entire family structure
along with the communities surrounding it.

1) Organization’s active participation

Member agencies of the NNC are represented at the local level team as members of various
nutrition committees together with the representatives of various line agencies.

National Nutrition Council (NNC)

Chair- Department of Health (DOH)
Vice-chair- Department of Agriculture (DA)
Department of Interior and Local Government (DILG)

2) Inter-sectoral Coordination
The core of program implementation is at the municipal and barangay levels. At the
municipal level, the MNC directs and manages the implementation of the LAKASS Program. It
reviews project proposals for LAKASS funding and packages these into the municipal LAKASS
proposal for submission to the NNC. The MNC also generates additional funds for LAKASS
projects. It likewise assists barangays in implementing LAKASS projects. Thus, the municipal
mayor, as chairman of the MNC, is accountable to the NNC for the full implementation of the
program.

At the barangay level, LAKASS projects are implemented and managed by community-based
organizations or LAKASS core groups, with the guidance of the Barangay Nutrition Committee
(BNC). Provincial and municipal LAKASS officers, hired or designated by the governor or mayor,
attend to the day-to-day operations of the program at their respective levels. Other departments
that also supports this program includes the following: Department of Social Welfare and
Development (DSWD); Department of Education (DepEd); Department of Science and
Technology; National Economic and Development Authority; Department of Labor and
Employment (DOLE); Department of Trade and Industry (DTI); Department of Budget and
Management

3) Use of Mechanism
The DOH is the overall chair of the said program. They are the main support that funds the
program and also implemented the program nationwide.

4) Appropriate Technology
 - Being an area-based nutrition action program, requires mobilization of people and
communities, to bring together as many individuals and groups as possible whose
capabilities and resources can be harnessed in order to improve the nutritional status of
the population.

5. Mother-Baby Friendly Philippines

This is a 2 year project that seeks to improve the implementation of Executive Order no. 51 and
Republic Act No. 10028 through the use of innovative reporting application, and stimulate
monitoring through crowd-sourcing by increasing awareness and knowledge among health
professionals and the general public about the laws and how these promote and support breast
feeding.
Data: In the Philippines only 52.3% of children 0-6 months of age are exclusively breast fed
despite the legal instruments supportive of breast feeding.

Policies and Laws

• Executive Order no. 51

• Republic Act no. 10028

4 Pillars of Public health

• Active participation
-The active participation of the community specially the mothers must empower
themselves on giving adequate nutrition to their newborns exclusively to 6 months by
breastfeeding. The mothers who have extra milk should also do volunteer work by
sharing some of their breastfeed milk to those who do not have or those who lack on
having breastfeed milk.

• Inter-sectorial Linkages
-DOH
-World Vision Development Foundation
• Intra-sectorial Linkages
-Health disease Prevention and Control Bureau
-Knowledge management and Information services
-Health Promotion and Community Service
-DOH-National Capital Region
The Intra Agency Community (IAC)
• Technology
 -There are available breast pump for the manual pumping of those lactating
mothers and also there is an available milk bank that are available in some hospitals
where milk donations are stored to be given to those who are in need but the breaks for
working mothers are not that well implemented or flexible for their work.

• Support system

LGU made policies and laws that help support programs addressing the problem with
breast feeding liken the Executive Order no. 51 and Republic Act no.10028. DOH
implemented the Philippine Milk Code EO 51 and RA 11148 and implemented the
crowd-based monitoring Milk Code Compliance which covers Malabon, Manila and
Quezon City.

6. Republic Act No. 11148 or Kalusugan at Nutrisyon ng Mag-Nanay Act ( Health and
Nutrition of Mothers and their Children Acts)

An Act Scaling up the National and Local Health and Nutrition Programs through a strengthened
integrated strategy for Maternal, Neonatal, Child Health and Nutrition in the First one thousand
(1000) days of life, appropriating funds therefor and for other purposes.

The Health and Nutrition of Mothers and their Children Acts of the DOH seeks to scale up
government programs addressing nutrition through a more comprehensive and sustainable
strategy in the first 1,000 days of life. As it is signed on November 23, 2018. The NNC Strategy
under the RA Act No. 11148 is a package of intervention which involves the pregnant and
lactating women, particularly teenage mothers, women of reproductive age, adolescent and all
filipino children who are newly born up to 24 months to address the immediate determinants of
maternal, fetal, infants and child nutrition and development, adequate food and nutrient intake,
feeding, caregiving and parenting practices and low burden of infectious disease.

OBJECTIVES:

The program declares its determination to eliminate hunger and reduce all forms of malnutrition.
The program further maintains that ensuring healthy lives, promoting well-being, ending hunger
and food insecurity, and achieving good nutrition for all ages are essential to attainment of
sustainable development.

Policies:

1. The right to health is a fundamental principle guaranteed by the state. It should protect and
promote the right to health of people and instill health consciousness among others. They adheres
the right to adequate food, care, and nutrition to pregnant and lactating women, including
adolescents females, women of reproductive age, and especially children from zero to two years
old.

2. the program adopts in the universal health care (UHC) principles such as strengthening the
primary health care, health service delivery packages, health care provider networks, population-
based and individual-based health serviced, the use of health technology assessment and
harmonized financial plans to support the implementation of the program first one thousand (1000)
days strategy.

3. the program is determined to eliminate hunger and reduce all forms of malnutrition. As the
program maintains and ensures healthy lives, promoting well-being, ending hunger and food
insecurity, and achieving good nutrition for all at all ages are essential to attained of sustainable
development.

4. the program priorities the nutrition’s for adolescents females, pregnant and lactating women,
infants and young children, to be implemented in an integrated manner by all branches of
government and other collaborations.

5. in the program they scales up nutrition intervention programs in the first one thousand (1,000)
days of child’s life, and allocates resources in a sustainable manner to improve the nutritional status
and to address the malnutrition of infants and young children from zero to two years old as it is
the critical period in which they are at risk for irreversible damage to cognitive and physical
development, the adolescent females, pregnant and lactating women as well to ensure the growth
and development of infants and young children, and to prevent the intergenerational effects of
stunning.

Laws:

• Executive Order no. 51- Milk Code

• Republic Act no. 10028- Expanded breastfeeding Promotion Act of 2009

• Republic Act no. 10354- the Responsible Parenthood and Reproductive Health Act of
2012

• AO No. 2010-0010: revised Policy on Micronutrient Supplementation to support

achievement of 2015 MDG Targets to reduce under-five and maternal deaths and micronutrient
needs of other population groups

• AO No. 2007-0045: Zinc Supplementation and reformulated Oral rehydration salt in the
Management of diarrhea among children

• ASIN Law- R.A. 8172, “An act promoting salt iodization nationwide and for other
purposes”, signed into law on Dec. 20, 1995

• Food fortification law, R.A. 8976- “An act establishing the Philippine Food Fortification
Program and for other purposes” mandating fortification of flour, oil and sugar with Vit A and
flour and rice with iron by November 7, 2004 and promoting voluntary fortification through the
SPSP, signed into law on November 7, 2000
• Department Memorandum No. 2011-0303 -Micronutrient powder supplementation for
children 6-23 months

Active participation:

As the community itself is needed with this program to be implemented. The pregnant
women need be in well condition state to help her to have a healthy child. As it is a cycle that the
mother is healthy the child is also healthy as they are as one. The adolescent females, pregnant
and lactating women will have a counseling on proper nutrient needed when being pregnant and
what will be the child must be eating. As the LGUs integrated maternal, neonatal, child and
adolescent health nutrition programs in the local nutrition plans. They will have assessment and
counseling on maternal nutrition, appropriate infant and young child feeding practice, mental
health, avoidance of risk-taking behaviors, smoking and adoption of healthy lifestyle practice
and family health.

Inter-sectoral participation:

The DOH, in coordination with the NNC, DA, LGUs, and key NGAs shall be responsible for the
implantation of the program. The municipal government will supervise the program together
LGU’s as it they will be the implementor together with the barangay health worker and barangay
nutrition scholars and child development workers shall provide the resources and benefits to
carry out the task.

Support Mechanism of the Government

DOH supports to this program by ensuring the supply of health facilities, health and nutrition
services.

7. Pantawid Pamilyang Pilipino Program

The Pantawid Pamilyang Pilipino Program (4Ps) is a human development measure of the national
government that provides conditional cash grants to the poorest of the poor, to improve the health,
nutrition, and the education of children aged 0-18. It is patterned after the conditional cash transfer
(CCT) schemes in Latin American and African countries, which have lifted millions of people
around the world from poverty.

The Department of Social Welfare and Development (DSWD) is the lead government agency of
the 4Ps.

Objectives:

1. social assistance, giving monetary support to extremely poor families to respond to their
immediate needs; and
 2. social development, breaking the intergenerational poverty cycle by investing in the health
and education of poor children through programs such as:
o health check-ups for pregnant women and children aged 0 to 5;
o deworming of schoolchildren aged 6 to 14;
o enrollment of children in daycare, elementary, and secondary schools; and
o family development sessions.

The 4Ps also helps the Philippine government fulfill its commitment to the Millennium
Development Goals (MDGs)—specifically in eradicating extreme poverty and hunger, in
achieving universal primary education, in promoting gender equality, in reducing child mortality,
and in improving maternal health care.

Eligibility:

The poorest among poor families as identified by 2003 Small Area Estimate (SAE) survey
of National Statistical Coordination Board (NSCB) are eligible. The poorest among poor are
selected through a proxy-means test. Economic indicators such as ownership of assets, type of
housing, education of the household head, livelihood of the family and access to water and
sanitation facilities are proxy variables to indicate the family economic category. Additional
qualification is a household that has children 0–14 years old and/or have pregnant women during
the assessment and shall agree on all the conditions set by the government to enter the program.

Policies:

• The congress shall give highest priority to the enactment of measures that protect and
enhance the right of the people the right of the people to human dignity, reduce social,
economic and political inequalities an remove cultural inequities by equitably diffusing
wealth and political power for the coming good;
• The promotion of social justice shall include the commitment to create economic
opportunities based on freedom of initiative and self-reliance;
• Break the intergenerational cycle of poverty through investment in human capital and
improved access and delivery of basic services to the poor, particularly education, health,
nutrition and early childhood care and development and employment as social services
• Promote gender equality and empowerment of women and protection of children’s rights
• Achieve universal primary education
• Reduce child mortality, morbidity, malnutrition and hunger.
• Improve maternal health and reduce maternal mortality and
• Ensure healthy lives and promote well-being for all.
Pillars:
1. Active Participation
One of the conditionalities of this program is that the parents are mandatory to attend
Family Development Sessions (FDS). FDS is one of the key activities in implementation of
the Pantawid Pamilyang Pilipino Program. It was established to social needs of the family. It
is also an important intervention to fulfill the family development thrust of the program
particularly: to serve as an arm to strengthen the program’s capacity to fulfill its role of
investing into human capital of families and children 0-14 years old; strengthen the capacities
of the family members particularly the parents to become more responsive to the needs of the
family and their children; to become more socially aware; and be involved and participative in
community development activities.

2. Inter-sectoral linkages
DSWD, chair; DOH, DepEd, NAPC, NNC, DILG and NEDA, members (NAC)

3. Intra-sectoral linkages
In implementing this program the inter-sectoral linkages of 4 P’s are Municipal Advisory
Committees (MAC) and barangays. They are the one who supply side availability and
monitoring of beneficiaries’ compliance with conditionalities and community assemblies.

4. Support Mechanism of the Government

DOH supports to this program by ensuring the supply of health facilities, health and
nutrition services.

5. Technology Used
Beneficiaries and households were provided the capital seed fund as part of strengthening
the sustainable livelihood program through Self-Employment Assistance- Kaunlaran
(SEA-K).
8. Accelerated Hunger Mitigation Program (AHMP)

Objectives
To decrease hunger incidence by 50% within 1 year.

Laws and Policies

Every individual has the right to adequate food. It is the state’s responsibility to ensure the food
security of its people. As where hunger is prevalent, there is also a development issue hindering
economic growth and keeping millions trapped in poverty. The Philippine government is
committed to eradicate all forms of human deprivation, including hunger and poverty by 2015
under the Millennium Development Goals (MDGs)

Hunger must be addressed in a holistic manner. On the supply side, measures are along
producing more food and efficient delivery of food to whom and where it is needed. These are
done through programs of the DA and DENR, among others.

1. On the demand side, measures are along putting more money in poor peoples’ pockets,
promoting good nutrition and managing population levels.
2. AHMP is in turn, a component of the pump-priming strategy of government which seeks to:

generate investments;
create jobs; and
provide basic services to poor families

Under Executive Order 606 (EO 616), the Anti-Hunger Task Force (AHTF) was created. This
composed of 29 national agencies working to implement the component programs of AHMP.
The Secretary of Health Being the chair of the NNC is also the lead of the anti-hunger task force.
Under the Executive Order 825 (EO 825), is the creation of the Local Anti-Hunger Task Force.
They will facilitate the implementation of the AHMP at the local level

How does the program contribute to addressing malnutrition?

The Hunger Mitigation Program (HMP) is initially composed of 2 main programs:
 1. Food for school program- involves the provision of 1 kilo of iron-fortified rice daily for
120 days to families who suffer from severe hunger through preschool and elementary
school children and children in day care centers.
2. Tinahan natin- ensures availability of basic commodities (e.g. rice and instant noodles) at
lower prices for poor families.
These measures of the Accelerated Hunger Mitigation Program (AHMP) can be summarized as:
1. Increase in food production- Productivity programs inclusing livestock, crops, marine
generation (mangrove and coastal fishery development), farm family (Gulayan ng Masa)
and irrigation – DA, DENR, NIA
2. Enhance efficiency of logistics and food delivery-
a. Barangay Food Terminal and Tindahan Natin – DA, NFA, DSWD
b. Ports (RORO), maximum use of private ports- DOTC/PPA
c. Far to market roads – DPWH, DA, DAR, AFP
d. Efficient local transport – LGUs/Leagues of P/C/M/B, DILG, PNP
e. Food for School Program (FSP) – DepED, DSWD, NFA
f. Creation of NGO network to support feeding – DSWD
3. Put more money in poor people’s pockets (repharse)
a. Improve productivity in coconut areas (coconut coir, virgin coconut & other
value-adding, coconet production) – DA, PCA/CIIF
b. More aggressive micro financing- Microfinance Program Committee
c. Maximize employment opportunities in construction and maintenance of farm-to-
market roads, irrigation and roadside maintenance- DPWH, MMDA, PNP, NIA,
DAR, DA, AFP, DOLE
d. Aggressive training – TESDA, DOLE, DSWD, CHED
e. Upland land distribution (4M ha for jatropha, rubber) – DAR, DENR
4. Promote good nutrition
a. Conduct social marketing – DOH, NNC/LGUs
b. Promote exclusive breastfeeding, appropriate complementary feeding and
increased consumption of vegetables – DOH, NNC, LGUs
c. Nutrition Education in schools- DepED
5. Manage population
a. Responsible Parenthood- DOH, LGUs/ULAP

1. Community’s active participation

The community is the one who will be doing most of the interventions, whereas the parents
will help in preparing and cooking the dishes to be served to the children, the children and
parents will also do home and school gardening whereas the barangay health workers will
undergo training to learn the basic nutrition which they will disseminate to the community.

2. Inter-sectoral Coordination
 The National Nutrition Council (NNC) was given the oversight function to ensure the
implementation of programs and projects within the AHMP framework. With E.O. 616, the Anti-
Hunger Task Force was created, with the Secretary of Health, as chair of the NNC which will lead
the ATHF. Under the Executive Order 825 (EO 825), the Local AHTF, will implement the
programs created by the National AHTF.

• Department of Agrarian Reform (DAR)

§ Presidential Agrarian Reform Council
• Department of Agriculture (DA)
§ Bureau of Animal Industry
§ Bureau of Fisheries and Aquatic Resources
§ Bureau of Plant Industry
§ Coconut Industry Investment Fund
§ National Food Authority
§ National Irrigation Administration
§ Philippine Coconut Authority
• Department of Budget and Management (DBM)
• Department of Environment and Natural Resources (DENR)
§ · Philippine Forest Corporation
• Department of Education (DepED)
• Department of Health (DOH)
§ Commission on Population
§ National Nutrition Council
• Department of the Interior and Local Government (DILG)
§ Philippine National Police (PNP)
• Department of Labor and Employment (DOLE)
§ Technical Education and Skills Development Authority
• Department of Public Works and Highways (DPWH)
• Department of Social Welfare and Development (DSWD)
• Department of Transportation and Communication (DTI)
§ Philippine Ports Authority (PPA)
• National Economic and Development Authority
• Office of the President
§ Commission on Higher Education
§ National Anti-Poverty Commission
§ Metro Manila Development Authority (MMDA)
• People’s Credit and Finance Corporation
• Armed Forces of the Philippines (AFP)
• Catholic Bishops Conference of the Philippines/National Secretariat for Social Action

3. Appropriate Technology
The program utilizes some of the resources of the community. This includes the Gulayan ng Masa
program which helps by providing rural communities with integrated backyard gardening, along
with provision of seeds and planting materials, distribution of poultry, small ruminants, livestock,
and fingerlings.
There have also been programs to promote nutrition, such as promoting exclusive breast feeding,
appropriate complementary feeding and increased consumption of vegetables, as well as having
nutrition education in schools.
However, most interventions are focused on improving economic management and distribution of
resources. There is no emphasis on empowering families to become independent on the support of
government agencies. Rather, the intervention only provides immediate alleviation from hunger.
Therefore, it does not provide a sufficient long term effect on nutrition.

4. Use of Mechanism
The DOH provides the budget that will be distributed to the LGU;s in order to implement the
program to the community that needs the implementation of this program, especially those
that are high prevalence in malnutrition. Seminars and training for the health workers that
will conduct the program is also trained by the DOH themselves.

9. Integrated Management of Acute Malnutrition

This program aims to support the children who suffer from severe and acute form of malnutrition

Policy and Rules

Laws related to the program:
Integrated Management of Childhood Illnesses(IMCI)
Philippine Infant and Young Child Feeding Strategic Plan of Action National Policies on Infant
and Young Child Feeding
Draft National Guidelines on the Management of Moderate Acute Malnutrition

How could this program contribute to the child nutrition problem?

The word integrated means that this program is a combined of the programs and action to
address the children malnutrition problem. The programs above are all target in improve children
health but the integrated management of acute malnutrition gathered all the advantages of them
and established a complete system in addressing the children malnutrition problem.
In some rural areas, even there is health care facilities available the parents might ignore the
malnutrition problem due to lack of knowledge. And in some area, it is not available for them to
approach any health care facilities. So, the Integrated Management of Acute Malnutrition program
will the thing called community mobilization which the health care providers will learn the
expressions of malnutrition and find the key member of the community to develop the community
sensitization which is the activities that prevent the children malnutrition from happening.
Community sensitization will start with the health teaching after gathered all the data of
factors of malnutrition and talk with the local health care providers so they can proceed to the next
step and prepare for the necessary materials. During this program, more and more outreach workers
will be trained to help in community mobilization in order to get more accurate case findings.
After the find the cases, the children will be referred to the OTC or ITC according to the
severity of the malnutrition which is the same with the IMCI protocol. The health care facilities
will then follow the guidelines of management of malnutrition strictly. The program will have
follow up and case finding continuously to cover most of the children population in most of the
areas and minimize the recurrent of malnutrition to reach the sustainable development goal of “no
hunger”.
The program also included infant with no breastfeeding. First is coordinate with local milk
bank, if it is not available the therapeutic milk F100 will be provided to the baby for 3 phases and
reach the ideal weight for age eventually.

Deficiency
Although this program have a complete system for malnutrition children,but the coverage is
only under 5 years old. We cannot ensure that the children above 5 years old will not develop
malnutrition because they also need more nutrition for their growth and development so RUTF
cannot fully satisfy the needs of all the children.

Food Always in The Home project then might be the possible solution for the families. It is
aim to increase the food diversity of the children to decrease the occurrence of malnutrition. It will
not only increase the knowledge of the family but also provide them the necessary skills to
gardening commonly eaten nutritious vegetables and fruits as well as small animal husbandry to
urban and rural poor families.

1) Active Participation
The barangay health workers will be conducting a home visit in the community to
give a one – on – one lecture with the post - partum and breastfeeding mothers on the basic
knowledge of the proper way of breastfeeding and how they can help the community, especially
those postpartum mother who are not able to produce breastmilk.

2) Intra-sectoral Coordinations
The City/Municipal Health Offices will oversees all the nutrition programs and then the
Provincial Health Offices will update and adjust these programs according to their own provincial
needs to make sure it will be effective.And the Regional Offices for Health will not only update
the plans,policies but also develop capacities of health and nutrition human resources and they are
the one in charge of the referral system of OTC and ITC which also need the coordination the
RHU and HOSPITALS. And the OTC is consist of the Barangay Health worker, the midwife
and Public Health Nurse. For the NGOs, they will provide support for the management of SAM
through training, coordination, IT support, advocacy when there is requirement of help from the
regional offices for health and they will usually help in identification of severity of malnutrition
and distribution of materials.

3) Intersectoral Linkages
- DOST – FNRI
- DWSD
- Phil - health

4) Appropriate Technology
Technical support from National PMT, Nutrition Committees, Nutrition Clusters
Adherence to National Guidelines
Provision of certified RUTF which adheres to international CODEX standards
Adequate support and supervision systems
Systematic screening of MUAC and edema for all children aged less than five years at every visit
to a health facility to promote high service coverage
Addition of screening for MUAC and edema to OPT, GP and other community based services to
promote high service coverage
Allocation of assigned tasks to staff at LGU level to promote timely interventions and high service
coverage

5) Support of local government

Management of Funds get from the Philhealth.LGUs shall set aside funds for the emergency
procurement of sufficient quantities of drugs and nutrition supplies in times of impending
shortage to ensure continuous availability of SAM treatment commodities at their service
delivery points
LGUs are primarily responsible for the provision of basic services to their constituents.
Each LGU must be able to mobilize and establish financing schemes to support integrated
management of SAM interventions in their respective localities.Which means they will evaluate
the effectiveness of the programs and have feedback to the DOH.
Other responsibilities of LGUs:
a. Institutionalize health emergency management in their responsible areas.
b. Formulate plans, procedures and protocols to implement their policy and guidelines c.
c. Enforce existing local policies and guidelines.
d. Consider the principles set in this policy in their respective health and nutrition plans and
systems.
e. Identify, develop and enhance capacity of the members of the health and nutrition sector.
f. Plan for and manage supplies efficiently and effectively. g. With support from the Regional
Offices for Health, develop/improve and sustain a safe and efficient referral system of children
with acute malnutrition in their respective LGUs.
5 A’s

CONCEPT OF 5 A’S PROGRAMS

APPROPRIATE Malnutrition Reduction Program,
Mother and Child Friendly,
BNS,
Integrated Management for Acute
Malnutrition,
Masustansyang Pagkain para sa Batang
Pilipino,
4 P’s,
LAKASS,
Kalusugan at Nutrisyon ng Magnanay Act
ACCEPTABLE Malnutrition Reduction Program,
Mother and Child Friendly,
BNS,
Integrated Management for Acute
Malnutrition,
Masustansyang Pagkain para sa Batang
Pilipino,
4 P’s,
LAKASS,
Kalusugan at Nutrisyon ng Magnanay Act
AVAILABILITY Malnutrition Reduction Program,
Mother and Child Friendly,
BNS,
Integrated Management for Acute
Malnutrition,
Masustansyang Pagkain para sa Batang
Pilipino,
4 P’s,
Kalusugan at Nutrisyon ng Magnanay Act
 ACCESSIBLE Malnutrition Reduction Program,
Mother and Child Friendly,
BNS,
Integrated Management for Acute
Malnutrition,
Masustansyang Pagkain para sa Batang
Pilipino,
4 P’s,
LAKASS,
Kalusugan at Nutrisyon ng Magnanay Act
AFFORDABLE Malnutrition Reduction Program,
Mother and Child Friendly,
BNS,
Integrated Management for Acute
Malnutrition,
Masustansyang Pagkain para sa Batang
Pilipino,
4 P’s,
LAKASS,
Kalusugan at Nutrisyon ng Magnanay Act

ANALYSIS:
Appropriate
- The following programs all address the decrease of malnutrition in the country and
community that occurs from infancy to 5 years of age, whereas according to the study
is the most prevalent age for a child to become malnourished.
Acceptable
- The following programs are considered acceptable as all of this aims to reduce
malnutrition. Moreover, the resources are not difficult to gather to implement the
program in the community.
Availability
 - The resources needed for the programs to be implemented are readily available in the
community. However, there are some of the programs that is not implemented in the
community due to the limitation of its settings.
Accessible

- The programs are accessible because of the readily available resources that is needed
to implement the program, which most likely includes milk and crops that will be used
to create a garden that will uphold the availability of the nutrients needed in reducing
the prevalence of malnutrition.
Affordable

- The resources are made readily available. Especially the breastmilk is readily available
to maternal clients. Land that will be used to plant the crops are also available within
the community, the only lacking is that the volunteers or those people who will be
conducting trainings and seminars in order to facilitate the following programs.

SDG

Goal 2: Zero Hunger

● By 2030, end hunger and ensure access by all people, in particular the poor and people in
vulnerable situations, including infants, to safe, nutritious and sufficient food all year
round.
● By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally
agreed targets on stunting and wasting in children under 5 years of age, and address the
nutritional needs of adolescent girls, pregnant and lactating women and older persons.
● By 2030, double the agricultural productivity and incomes of small-scale food producers,
in particular women, indigenous peoples, family farmers, pastoralists and fishers, including
through secure and equal access to land, other productive resources and inputs, knowledge,
financial services, markets and opportunities for value addition and non-farm employment
● By 2030, ensure sustainable food production systems and implement resilient agricultural
practices that increase productivity and production, that help maintain ecosystems, that
strengthen capacity for adaptation to climate change, extreme weather, drought, flooding
and other disasters and that progressively improve land and soil quality
● By 2020, maintain the genetic diversity of seeds, cultivated plants and farmed and
domesticated animals and their related wild species, including through soundly managed
and diversified seed and plant banks at the national, regional and international levels, and
promote access to and fair and equitable sharing of benefits arising from the utilization of
genetic resources and associated traditional knowledge, as internationally agreed
 1. Increase investment, including through enhanced international cooperation, in rural
infrastructure, agricultural research and extension services, technology development and
plant and livestock gene banks in order to enhance agricultural productive capacity in
developing countries, in particular least developed countries. Correct and prevent trade
restrictions and distortions in world agricultural markets, including through the parallel
elimination of all forms of agricultural export subsidies and all export measures with
equivalent effect, in accordance with the mandate of the Doha Development Round
● Adopt measures to ensure the proper functioning of food commodity markets and their
derivatives and facilitate timely access to market information, including on food reserves,
in order to help limit extreme food price volatility

Goal 3: Good Health and Well being

● By 2030, end preventable deaths of newborns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births
and under-5 mortality to at least as low as 25 per 1,000 live births.

● By 2030, reduce by one third premature mortality from non-communicable diseases

through prevention and treatment and promote mental health and well-being.
● Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol.
● By 2030, ensure universal access to sexual and reproductive health-care services, including
for family planning, information and education, and the integration of reproductive health
into national strategies and programmes.
● Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
● By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals
and air, water and soil pollution and contamination.
○ Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate.
○ Support the research and development of vaccines and medicines for the
communicable and noncommunicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in
 the Agreement on Trade Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines
for all.
○ Substantially increase health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing States.
○ Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks.

RA.11223 Universal Health Care Act

An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the
Health Care System, and Appropriating Funds Therefor

CHAPTER 1. General Provisions

Section 1.Declaration of Principles and Policies.
“Ensure that all Filipinos are guaranteed equitable access to quality and affordable
health care goods and services, and protected against financial risk.”
The policy of RA.11223 Stated that it is for all Filipinos which means children is
included in the Universal Health Care Act.So this act is appropriate for our target population
which is the Filipino children.

CHAPTER 2.Universal health care

Section 6. Service Coverage.
(c): “The DOH and the local government units (LGUs) shall endeavor to provide a health care
delivery system that will afford every Filipino a primary care provider that would act as the
navigator, coordinator, and initial and continuing point of contact in the health care delivery
system: Provided, That except in emergency or serious cases and when proximity is a concern,
access to higher levels of care shall be coordinated by the primary care provider.”

(d): “Every Filipino shall register with a public or private primary care provider of choice. The
DOH shall promulgate the guidelines on the licensing of primary care providers and the
registration of every Filipino to a primary care provider.”
Section 7. Financial Coverage.

(a): “Population-based health services shall be financed by the National Government through the
DOH and provided free of charge at point of service for all Filipinos.”

Part of the reason that the child have malnutrition is because of the low education level of
their parents.So they usually ignore the condition of their children or they do not know what to do
during that condition.The act stated that there will be a primary health care provider register with
every Filipino so the necessary health teaching and health care will be provided on time.The
primary health care provider will do basic check up and refer the child to OTC or ITC.This is the
population base health service and will be financed by the National Government so it will not
cause any financial issues to the family at all.

CHAPTER 3. NATIONAL HEALTH INSURANCE PROGRAM

Chapter 2. Section 5:“Every Filipino citizen shall be automatically included into the NHIP,
hereinafter referred to as the Program.”

Section 9. Entitlement to Benefits.

“Every member shall be granted immediate eligibility for health benefit package under the
Program: Provided, That PhilHealth Identification Card shall not be required in the availment of
any health service: Provided, further, That no co-payment shall be charged for services rendered
in basic or ward accommodation.”

When the child is malnutrition and admit in any health care facilities, they can enjoy the
benefits as a member of Philhealth and no need other charges or complicated application
process.Although the NIHP cannot give 100% discount but it will definitely reduce the
malnutrition problem of children cause by poverty.

CHAPTER 5. ORGANIZATION OF LOCAL HEALTH SYSTEMS

Section 19. Integration of Local Health Systems into Province-wide and City-wide Health System.

“The DOH, Department of the Interior and Local Government (DILG), PhilHealth and the
LGUs shall endeavor to integrate health systems into province-wide and city-wide health systems.
The Provincial and City Health Boards shall oversee and coordinate the integration of health
services for province-wide and city-wide health systems, to be composed of municipal and
component city health systems, and city-wide health systems in highly urbanized and independent
component cities, respectively. The Provincial and City Health Boards shall manage the Special
Health Fund referred to in Section 20 of this Act and shall exercise administrative and technical
supervision over health facilities and health human resources within their respective territorial
jurisdiction: Provided, That municipalities and cities included in the province-wide and city-wide
health systems shall be entitled to a representative in the Provincial or City Health Board, as the
case may be.”

Separate the local health care system to city and provincial will increase the efficiency of
the health care delivery and easier to monitor.Special fund will be given to the 2 systems to
improve the health services so more family will be benefit within 2 years.Better health services
will improve the individual health and the children will be benefit during this period of time.

CHAPTER 6. HUMAN RESOURCES FOR HEALTH

Section 25. Scholarship and Training Program. -

(a) :“The Commission on Higher Education (CHED), Technical Education and Skills
Development Authority (TESDA), Professional Regulation Commission (PRC) and the DOH shall
develop and plan the expansion of existing and new allied and health-related degree and training
programs including those for community-based health care workers and regulate the number of
enrollees in each program based on the health needs of the population especially those in
underserved areas.”

Implementation of the whole act cannot leave the support of health care providers.
Inadequate number of health care providers will definitely cause the family have difficulty solve
the problem or continue to ignore the malnutrition problem of their children.

In the implementation of rules and regulations stated: provider a stable job status for each
health care provider working in the system and offer a competitive salary.And for those graduates
like to enroll in any program, the ones who have willing to serve the GIAs will be the priority.More
science and medical schools will be established in these areas.More programs offer scholarship
will be provided to make more health care providers serve the underserved areas.So more and
more area will soon have adequate health care giver and the malnutrition will be reduced then.

CHAPTER 7.REGULATION

Section 28. Affordability.

(a) : “DOH-owned health care providers shall procure drugs and devices guided by price reference
indices, following centrally negotiated prices, sell them following the prescribed maximum mark-
ups, and submit to DOH a price list of all drugs and devices procured and sold by the health care
provider.”
 Disease like parasite might be the cause of malnutrition so the child not only need affordable
health service but also affordable medications.This will provide everyone a clear price.In the
implementation of rules and regulations, it also stated that there should offer fairly priced at all
times.So it will further close the financial burdens of the family.

Section 29. Equity.

(a) “The DOH shall annually update its list of underserved areas, which shall be the basis for
preferential licensing of health facilities and contracting of health services. The DOH shall develop
the framework and guidelines to determine the appropriate bed capacity and number of health care
professionals of public health facilities.”

(b) “The government shall guarantee that the distribution of health services and benefits provided
for in this Act shall be equitable by prioritizing GIDAs in the provision of assistance and support.”

There is situations that the family cannot do anything to change their children’ status because
of the location.For children live in Geographically isolated and disadvantaged areas, they
experience malnutrition because there is no adequate resources and the family cannot find a proper
job to support the family as well.So to update the list of GIAs and let these area receive the priority
supports like food and medication will improve the nutritional status of the children there.

CHAPTER 8. GOVERNANCE AND ACCOUNTABILITY

Section 30. Health Promotion.

“The DOH, as the overall steward for health care, shall strengthen national efforts in providing a
comprehensive and coordinated approach to health development with emphasis on scaling up
health promotion and preventive care.The DOH shall transform its existing Healthy Promotion
and Communication Service into a full-fledged Bureau, to be named as the Health Promotion
Bureau, to improve health literacy and mainstream health promotion and protection.”

MAIN ISSUES IN THE DOCUMENTARY:

1. The lack of available and functional local health stations in a barangay

Having no resources available puts the healthcare team at a disadvantage in assessing and
assisting clients to their needs. This will then lead to more suffering and higher possibilities
of mortality.

In the documentary Kalusugan, it was shown there are many people who need certain
equipment and medication, but upon reaching the station, they are told that they are out of
stock of medication.

Contributing factors may be fault from the lack of available functional equipment, medication,
and facilities in respect to the number of barangays in need of its service. It as well incudes
availability of safe land, undocumented or improper documentation of the demographics of an
area and improper allotment of a budget to establish such a facility. A manner of solving this
problem is first establishing a baseline of medications, equipment, and facilities needed to be
present in every health care station. After establishing a baseline of essential commodities, this
should be modified in respect to the population it is handling whereas larger communities need
larger amounts of supply for their increased number of residences.

SOLUTION:
Authorities should work closely together to ensure that the established barangay
health stations are utilized, coordinate funding resources, build health centers
designated in a specific area, allocate local and national health spending, functional
network of health facilities that will cater to Filipinos and enforce standards

2. The scarcity of health workers present in the unit. - A lack of manpower would lead to
overwork, less efficiency, and decrease in accuracy in providing quality care.

A problem encountered were the lack of health care professionals. In the documentary
Kalusugan, it was shown that there is no nurse in the health center. There is only one who’s
on duty which is a midwife. According to Dr. Janette Garin, former Secretary of the
Department of Health, there should be one health worker per barangay and it is hard to
monitor the presence. The Secretary General of Health Alliance for Democracy mentioned
that ”kadalasang walang doctor; May doctor, o may nurse o kaya may midwife wala ring
naman gamot.”.
Contributing factors may come from the lack of support of the government for local health
workers, low involvement of the residencies in informing their local government in their need
for healthcare professionals and proper allotment of health care professionals in respect to the
population to be handled. A manner of solving this situation is to allocate healthcare teams,
functional regarding the size of the community, to support the existing health care system.

SOLUTION:
Elicit multi-sectoral and multi-stakeholder support for health, registered nurses for
health enhancement and local service, establish a schedule of when the health care
team is available and inform the community about it.

3. Monetary allotment for the embitterment of the health station

Allotment is the amount of something, especially money, that is given to a particular person,
institution for a particular purpose.

A problem that was mentioned at the start of the documentary and mentioned as well
throughout it was the lack of funds or budget for the establishment or the further development
of a current health care station. The Kaptain of a barangay mentioned that they have no
allocation for the development or maintenance of their health station. According to Former
Secretary of the Department Of Health, Dr. Janette Garin, “Dun sa record namin ipinakita na
meron 19,489 barangay health station, pero nung aming pong vinalidate at inikot
unfortunately merong pong ibang budget ng barangay health station na naging barangay hall
dahil parang pinaghalo ng ibang barangay, lalo na kapag walang lupa” this then lead to only
having 17,549 health stations left to serve 42,029 barangays.

Contributing factors may include improper segregation on the budget of what is for the other
sectors of the barangay and that of the health station, and another is the documentation of
what is needed for the health stations improvement.

SOLUTION:
Harness and align the private sector in planning supply side investments. Should be
inclusive of the private medical sector and NGOs involved in the provision of
community-based health care.
NURSES

· Leader / Manager

o We may do our part as nurse leaders and managers in simple ways such as
working in a health center every day. We do not necessarily need a high
position to be able to do these roles. A leader is described as someone who
is influential. We can become leaders in simple ways by influencing people
to improve their health practices or become compliant with their treatment.
It can go hand in hand with being an educator to be able to become
influential. While with being a manager, we must be able to plan, organize,
direct, and control. With planning we can simply conduct budgeting to be
able to be resourceful with the equipment and materials used in centers.
Organizing and directing can be done by assigning members of the health
care team, including barangay health centers to different duties and
responsibilities to be able to maximize their skills and be able to provide
service to more people. It can also be done by providing basic training of
skills appropriate to members such as barangay health workers to improve
their skills and maximize manpower.

· Care Provider

o One of our main roles as nurses is to provide care. In situations featured in the
documentary, with the lack of healthcare professionals in the barangay health
centers, what we can do to intervene is to provide in sectors needed. Although
the employment of healthcare professionals in BHCs are over our control, we
can offer ourselves as volunteers to be able to provide service to these
institutions.

· Advocate

o One example of what we can perform as nurses is to be an advocate. Common

examples of being a nurse advocate is to promote health and prevention of
diseases. Another is by being a patient advocate. We can be an advocate to
the community by not only promoting health but also encouraging these
people to properly voice out their concerns regarding the needed
improvements. By encouraging people, it is possible for the government or
the involved officials (barangay captain, mayor, etc.) to be able to create an
appropriate intervention for these issues or forward it to higher authorities.
 · Researcher

o Our roles as nurses are not only limited to the bed side. We can also maximize
our capacity as nurses by conducting, participating, and supporting research that
will aid in the improvement of practices. A way we can intervene using our role
as researchers is to search about trends and improvements in practices that will
improve our skill. A simpler way is by adhering to standard procedures. We do
our role as researchers because by adhering to the optimal standards, we are
ensuring that our practice is tested and evidenced based, not merely done out of
convenience.

· Educator

• Another role of nurses is to educate. Considering the issues presented, it is only expected
and evident that people will be lacking knowledge with regards to their health. What we
can do as nurses is to disseminate correct and accurate information, not only to our patients
but also to the people around our community. An example is by simply educating relatives
or neighbors, there is a possibility to improve incorrect health practices and belief, improve
health seeking behavior, and increase compliance in existing treatments or improve
lifestyle.

IMPLEMENTATION

The programs are made readily available. After analyzing its policies, laws and concepts, we can
conclude that these are cost – effective to the community. The limitation of these programs is that
there are inadequate health workers and facilities that will accommodate the needs of the families.
Therefore, the government must also increase the allotted budget to these programs in order for it
to be effective. As nurses, we can provide unconditional health teaching to help the community
have basic knowledge regarding the importance of nutrition and techniques to implement these
interventions to lessen the cases of malnutrition in the community. We must conduct a one – on -
one interview to each parents in order to supply them the sufficient basic knowledge and other
independent measures that they can take in order to implement and validate the effectivity of the
problem that causes malnutrition.