BARANGAY NUTRITION ACTION PLAN

CY: ___________

Barangay: ________________________________
City/Municipality: _________________________
Province: _________________________________
Region: __________________________________

THE BARANGAY NUTRITION COMMITTEE

 THE BARANGAY NUTRITION COMMITTEE

Signature over Printed Name Office Designation Roles / Responsibilities / Functions

Chairman: _____________________ _________________ _________________ ________________________________________

Co-Chairman: __________________ _________________ _________________ ________________________________________

BNS: ____________________________ ___________________ _________________ ________________________________________

Members

1. _______________________________ ___________________ _________________ ________________________________________

2. _______________________________ ___________________ _________________ ________________________________________

3. _______________________________ ___________________ _________________ ________________________________________

4. _______________________________ ___________________ _________________ ________________________________________

 Signature over Printed Name Office Designation Roles / Responsibilities / Functions

5. ____________________________________ ___________________ _________________ ________________________________________

6. ____________________________________ ___________________ _________________ ________________________________________

7. ____________________________________ ___________________ _________________ ________________________________________

8. ____________________________________ ___________________ _________________ ________________________________________

9. ____________________________________ ___________________ _________________ ________________________________________

10. ____________________________________ ___________________ _________________ ________________________________________

11. ____________________________________ ___________________ _________________ ________________________________________

12. ____________________________________ ___________________ _________________ ________________________________________

 Format A
BARANGAY PROFILE – 1. Health and Nutrition Situation

Name of Barangay: ______________________________________ City/Municipality: ______________________________ Region: ___________________

Part A.
Total No. of Puroks: ________________________ SCHOOL CHILDREN (SC) Latest Period of OPT: ____________________________
Total Population: ___________________________ No. with Normal Weight: _____________________ % OPT Coverage of Preschoolers: __________________
Total No. of Households: ____________________ No. of Underweight SC: _______________ Age Specific Proportionate Mortality Rate: ____________
Total No. of Preschoolers (0-71 mos.): __________ No. or Overweight SC: _______________ No. of Households with Home Gardens: ______________
Total No. of School Children: _________________ Total No. SC weighed: ______________________ Common Occupation of HHold Heads: _______________
Total No. of Pregnant Women : _______________ Total No. of Families with:
Total No. of Lactating Women: _______________ a. UW and SUW PS: _______________
MICRONUTRIENT DEFICIENCES (TOTAL NO.) b. UW and OW SC: _______________
PRESCHOOL CHILDREN (PS) PS SC P/L 15 yrs. & over
No. of PS with Normal Weight: ____________________
No. of Underweight Children: ____________ Nightblindness _______ _______ ______ _______
No. of Severely Underweight Children: _______ Anemia _______ _______ ______ _______
Total No. of UW and SUW PS: _______ Goiter _______ _______ ______ _______
No. of Overweight and Obese Children : _______________
Total PS weighed: __________________________

Part B.
Total Number Pre-School Children (0-71 months old) School Children Nutritional Deficiencies
R
UW and Total PS Underweight Total SC Night- Anemia Goiter A
Preschool Children

Purok N
Pregnant Women

Lactating Women

SUW Weighed Weighed blindness

School Children

Overweight and
(Name or Number) K
UNderweight
Underweight

Overweight
15 I
Household
Population

Severely

No. % No. % No. % PS SC SC P/L SC yrs. N

Normal

Normal
Obese
& G
over

Total/Percent
 Format B
BARANGAY PROFILE – 2. Geo-Ag and Socio-Economic Situation

I. GEOGRAPHICAL PROFILE III. SOCIO-ECONOMIC SITUATION

A. Location/Boundary A. Family Size (Household Size) C. Most Common Source of Potable Water Supply
A.1. Within City/Poblacion [ ] (Ranking)
A.2. Along shoreline (lake-sea) [ ] No. of Children How many families Source:
A.4. Near shoreline (lake-sea) [ ] 12 _______ Artesian Well [ ]
A.4. Inland [ ] 11 _______ Deep Well [ ]
10 _______ Waterworks [ ]
B. Topography 9 _______
B.1. Plain [ ] 8 _______ D. Electric and Telephone Services (% Coverage)
B.2. Rolling Terrain [ ] 7 _______ D.1. Electric _____%
B.3. Predominantly Upland [ ] 6 _______ D.2. Telephone _____%
5 _______
II. AGRICULTURAL PROFILE 4 _______ E. Presence of Educational Institutions in the
3 _______ Barangay (Check Only)
2.1. Total no. of vegetable gardens: 2 _______
a. home (backyard) [ ] E.1. Government:
b. school [ ] B. Most Common Type of Dwelling Unit a. Elementary [ ]
c. community [ ] (Ranking) b. High School [ ]
Type: c. College [ ]
2.2. Total no. of households with Concrete [ ] d. Vocational [ ]
Livestock/poultry [ ] Semi-Concrete [ ]
Wood [ ] E.2. Private:
2.3. Common livestock/poultry (rank): Barong-barong [ ] a. Elementary [ ]
a. swine [ ] others (specify) [ ] b. High School [ ]
b. goat [ ] ______________ c. College [ ]
c. chilcken [ ] d. Vocational [ ]
d. ducks [ ]
e. others (specify) [ ]
Cont. Format B. Barangay Profile

F. Medical Facilities in the Barangay I. Source of Income of the Household’s

(Check Only) Main Earners (Ranking)

F.1. Government: I.1. Employment

a. Barangay Health Station [ ] a. Government Offices [ ]
b. Health/Nutrition Center [ ] b. Private Enterprises [ ]
c. Community Hospital [ ] c. Family Business [ ]

F.2. Private: I.2. Farming [ ]

a. Dental Clinic [ ] I.3. Self-Employed [ ]
b. Medical Clinic [ ] I.4. Oversea Contractual [ ]
c. Hospitals [ ] Worker (OCW)
I.5. Pursuit of Profession [ ]
G. Most Common Transport Facilities (Ranking) (ex. Lawyer, private doctor,
Midwife, etc.)
G.1. Buses [ ]
G.2. Jeepney [ ] J. Main Source of Income of the Barangay
G.3. Tricycle [ ]
G.4. Others [ ] %
1. Share from Real Estate Tax _____
H. Type of Toilet Facility 2. Share from Dev’t. Fund _____
% of Total Household 3. Business and other Taxes _____

Water-sealed (di-buhos) _______ K. Infrasructure: Distance from the Barangay (check only)
Flush toilet _______ Traversed Along Near Far Very Far None
Antipolo _______ 1. National Road (Highway) [ ] [ ] [ ] [ ] [ ] [ ]

Sanitary Pit Privies _______ 2. Provincial Road [ ] [ ] [ ] [ ] [ ] [ ]

None _______ 3. Municipal Road [ ] [ ] [ ] [ ] [ ] [ ]
4. Feeder Road [ ] [ ] [ ] [ ] [ ] [ ]
5. Seaport [ ] [ ] [ ] [ ] [ ] [ ]
6. Airport [ ] [ ] [ ] [ ] [ ] [ ]
Sample BNAP Format C – Programs, Projects and Activities

Programa/ Target
Proyekto/ Year 1 Year 2 Year 3 Sektor/Taong Pagkukuna Inaasahan
Layunin Basehan Lokasyon Schedule Halaga
Aktibidad Group Itinalaga n ng pondo g resulta
No. No. No.
Sample BNAP Format D – Quarterly Accomplishments of Programs, Projects, and Activities

Targets Quarterly Outreach

Program/
Project/ Indicator Q1 Q2 Q3 Q4
Activity Group Number No. No. No. No.
% % % %
Served Served Served Served