BARANGAY NUTRITION SCHOLAR

ACTION PLAN
CY _____

____________________________________________
BARANGAY NUTRITION SCHOLAR

______________________________________________
DATE PREPARED

__________________________ ____________________________
Barangay Municipality

_____________________________________________________
Province/City

Region I
 BNS FORM NO. I

FAMILY PROFILE

HOUSE NO. OF NAME OF OCCUPATION CHECK IF TYPE OF TOILET (Pls. check) CHECK IF WATER SOURCE CHECK FOOD PRODUCTION
HOLD HOUSE HOUSEHOLD MOTHER MOTHER PRACTICE WATER ANTIPOLO OT HERS NONE PIPE DEEP SPRING NONE VEG POULT RY FISH Using
NO. HOLD HEAD IS PREG. IS FAMILY SEALED OPEN PIT (Specify) WELL GARDEN POND Iodized
TYPE MEMBER NURSING PLANNING Salt

Legend:
A- Concrete C- Nipa/ Bamboo E- Barong-Barong
B- Semi-Concrete D- Wood F- Others (Specify)
BNS Form No. 1B
BASELINE WEIGHT AND IMMUNIZATION RECORDS OR PRESCHOOL CHILDREN

Barangay: ____________________________
Household Name of Household Name of Child Date of DATE OF IMMUNIZATION WEIGHING
No. Birth BCG DPT Polio Hepatitis B Measles Date of Age in Weight Weight
1 2 3 1 2 3 1 2 3 weighing Months (KG) Status
BNS FORM No. 1C

BARANGAY SITUATIONAL ANALYSIS, 20_______

Region: I City/Municipality______________ Province__________________ Date Prepared_________

ITEM NUMBERS
1. Total Number of Households
2. Total Number of Families
3. Total Number of Infants
4. Total number of Women who are:
a. Pregnant
b. Nursing/Lactating
c. Practice Family Planning
5. Total Number of Preschoolers
6. Total Number of Preschoolers weighed
7. Weight status of Preschoolers
a. Number of Severely Underweight (SEV)
b. Number of underweight (UW)
c. Number of Normal
d. Number of Overweight (OW)
e. Number of Children with Cleft Palate/Harelip
8. Number of Preschoolers Immunized:
a. BCG
b. DPT I
c. DPT II
d. DPT III
e. POLIO I
f. POLIO II
g. POLIO III
h. MEASLES
i. OTHERS
9. Number of Households with:
a. Water sealed Toilets
b. Antipolo/Open Pit
c. Others Specify
d. None
10. Number of Household getting potable Water from:
a. Pipe / Waterworks/ Refilling Station
b. Deep Well
c. Spring
d. None
11. Number of Household with Backyard
a. Vegetable Garden
b. Livestocks
c. Poultry
d. Fish
12. Number of Household w/ Type/Kind of Dwelling Unit
a. Concrete
b. Semi-Concrete
c. Nipa/Bamboo
d. Wood
e. Barong-Barong
f. Others (Specify)
13. Using Iodized Salt
 BNSP Form No. 2
BARANGAY NUTRITION SCHOLAR ACTION PLAN
Fro m________________to_______________, 20_____________

_____________________________________ ____________________________
Barangay Nutrition Scholar Barangay

Intervention/Activities Target Group Cooperator Time Period of Imp lementation

Table J F M A M J J A S O N D
A. Identifying & locating Targets All
1. Full Weighing Preschoolers
a. 0-23 mos
2. Monthly Reweighing b. SEV
c. UW
3. Semestral Reweighing 24-71 mos
4. Harelip/Cleft Palate PS
5. Family Profile Survey All Families
B. Referrals
1. To feeding center SEV PS
UW PS
Pregnant/
Lactating
Others
(Specify)
2. To health center
SEV PS
UW PS
Pregnant/
Lactating
Others
(Specify)
3. To Municipal/ City Families w/
Agriculturist for UW and SEV
distribution of PS
seeds/seedlings Others
(Specify)
4. Ind ividual/ Group Mothers w/ UW
Counseling or Mothers and SEV PS
Class Pregnant/
Lactating
Others
(Specify)
C. Other Activities
1. Organizat ion/Reactivation BNC Members
of the BNC
2. Attendance to Meetings BNS
-BNS Meet ings
- BNC Meetings
3. Inco me Generating Families w/
Activit ies/ Resource UW and SEV
Generation for Nutrition PS
Others
(Specify)
4. Assistance to health center PS
activities such as SEV PS
immun izat ion deworming, UW PS
micronutrient SC
supplementation and etc. Others
(Specify)
5. Pro motion of San itary Families w/
Waste Disposal, Clean UW and SEV
Environment and PS
Sanitation Other Families
Households
Intervention/Activities Target Group Cooperator Time Period of Imp lementation
Table J F M A M J J A S O N D
6. Campaign for Household Families w/
Selective Food Production UW and SEV
Other Families
Households
7. Establishment of Backyard Families w/
Gardening/Innovative UW and SEV
Gardening Other Families
Households
8. Pro motion/Distribution/ Households
Ensuring Availability of Storeowners
Fo rtified Foods such as Eatery Owners
Iod ized Salt and Others Others
(Specify)
9. Other Projects to be
imp lemented

Prepared by:

_______________________________________________
Barangay Nutrition Scholar

Approved by:_________________________________
Punong Barangay

Noted by:__________________________________________________
City/Municipal Nutrition Action Officer
 BNS Form #4

Philippine Plan of Action for Nutrition

MONTHLY ACCOMPLISHMENT REPORT
For the Month of ______________________________

Province:_______________ City:____________ Municipality:____________ Name of BNS:_____________

ACTIVITY TARGET Nu mber Reached This Month LAST THIS
NUMBER Old Cases New Cases MONTHS MONTHS
(As stated in (Cases reached (Cases reached TOTAL (Add
the BNS on the previous for the first (Write the Column 4
Action Plan) month who time) entry from the and 6)
were reached column 6 of
again this the last month
month) report)
1 2 3 4 5 6
A. WEIGHING ACTIVITIES
1. Full Weighing
- Preschoolers
2. Monthly Reweighing
- 0-23 months
- UW PS
- SEV PS
3. Semestral Reweighing
- 24-71 mos.
4. Harelip/ Cleft Palate
5. Family Profile Survey
B. RFERRA LS
1. To feeding Center
- Underweight PS
- Severely Underweight PS
- Pregnant/Lactating Mothers
- Others (Specify )
2. To Health Center
- Underweight PS
- SEV/ UW PS
- Pregnant/Lactating Mothers
- Others (Specify )
3. To Municipal/ City/Agriculturist for distribution
of seeds/seedlings
- Families w/ UW including SEV PS
- Others (Specify )
4. Individual/ Group Counseling
- Mothers w/ UW and SEV PS
- Pregnant and Lactating
- Others (Specify )
C. OTHER A CTIVITIES
1. Organization/Reactivation of the BNC
- BNC Members
2. Attendance to Meetings
- BNS Meetings
- BNC Meetings
- Others (Specify )
3. Income Generating Activities/Resource
Generation for Nutrition
- Families w/ UW & SEV PS
- Others (Specify)
 4. Assistance to Health Center activities such
as Immunization, Deworming,
Micronutrient Supplementation and etc.
- PS
- Severely Underweight PS
- Underweight PS
- SC
- Others (Specify)
5. Promotion of Sanitary Waste Disposal,
Clean Environment and Sanitation
- Families w/ UW & SEV PS
- Other Families
- Households
6. Campaign for Household Selective Food
Production
- Families w/ UW & SEV PS
- Other Families
- Households
7. Establishment of Backyard
Gardening/innovative Gardening
- Families w/ UW & SEV PS
- Other Families
- Households
8. Promotion/Distribution/Ensuring
Availability of Fortified Foods Such as
Iodized Salt and Others
- Households
- Storeowners
- Eatery Owners
- Other Families
9. Other Projects to be implemented

D. RESULTS OF FOLLOW-UP WEIGHING

Particulars SEV UW 0-23 months 24-71 months
NUMBER WEIGHED
No. Normal (N)
No. Severely Underweight (SEV)
N. Underweight (UW)
No. Overweight (OW)
No. improved in Nutritional Status

NUMBER NOT WEIGHED

No. Normal
No. Moved Out
No. Dead
Prepared by: Approved by:

___________________________________ ____________________________________
Barangay Nutrition Scholar Punong Barangay

Noted by: ___________________________________

City/Municipal Nutrition Action Officer
BNS Form No. 5

HIGHLIGHTS OF THE MINUTES OF THE BNC MEETING

Held at ________________________________ on __________________________ at _______________

(Place) (Date) (Time)

Present:

Absent:

Minutes:

Agenda Item Matters Discussed Action to be taken/

Agreements Made

I Hereby certify to the corrections of the above highlights of the minutes of

_________________________________ held at ____________________________ on

(Group) (Place)

________________________ at ____________________________
(Date) (Time)

_________________________
(Secretary/ Recorder)

Attested by:

__________________________
(Chairman)