Assessment of the Local Implementation of the Philippine Plan of Action for Nutrition (PPAN) 2011-2016.

Assessment of the Local Implementation of the Philippine Plan of Action for Nutrition (PPAN)

Context of the Study Philippine Plan of Action for Nutrition (PPAN)
DILG Memo Circular PPAN the country’s directional framework for nutrition improvement a systematic integration of efforts of government and private agencies and institutions to address and prevent malnutrition through direct nutrition interventions and development measures

PPAN PPAN is periodically updated to be more responsive to current socio-political and economic developments PPAN the country’s 8th national plan for nutrition Like the earlier national nutrition plans, it aims to reduce the prevalence of malnutrition in the country. The goal of PPAN is to contribute to improving the quality of the human resource base of the country and to reducing child and maternal mortality It is also envisioned to contribute to the achievement of the UN Millennium Development Goals as well as poverty reduction.

PPAN The key strategies and priorities for action of PPAN are a “mix of services that are specific to the form of malnutrition and those that would impact on all forms of undernutrition” Like the earlier national nutrition plans, it aims to reduce the prevalence of malnutrition in the country. The goal of PPAN is to contribute to improving the quality of the human resource base of the country and to reducing child and maternal mortality It is also envisioned to contribute to the achievement of the UN Millennium Development Goals as well as poverty reduction.

Context of the Study Despite eight national nutrition plans formulated since 1974 the nutritional situation of the country has not improved significantly

Prevalence of malnourished children, 0-5 years
(0-60 months): Philippines, *based from 2011 FNRI Updating Survey

Memorandum Circular Department of Interior and Local Government issued a Memorandum Circular in order to strengthen the implementation of PPAN at the local level While it is the National Nutrition Council (NNC) an intersectoral national policy-making and coordinating body on nutrition provides overall leadership in formulating, monitoring and coordinating the implementation of the PPAN. Local government units (LGUs) play a crucial role in implementing PPAN Mandates LGUs to: Translate the priorities for action of PPAN into specific programs and projects; Organize, re-organize, and strengthen functional local nutrition committees; Designate nutrition action officer with adequate office and staff support and provisions for continuous capacity building; Sustain, recruit and deploy Barangay Nutrition Scholars (BNS); Formulate, implement, monitor and evaluate local nutrition action plans; and Implement programs and projects to achieve nutrition targets

Purpose and Scope of the Assessment
Assess the localization of the PPAN and the implementation of Memorandum Circular No issued by the DILG.

Describe the implementation of the nutrition program in selected LGUs 2. Identify strategies that worked and did not work based on the assessment of the stakeholders 3. Assess the effectiveness and efficiency of the strategies employed by selected LGUs on reducing hunger and malnutrition as perceived by the stakeholders

Identify factors that may have contributed to the accomplishment and non-accomplishment of nutrition program objectives 5. Identify issues and concerns and come up with recommendations to guide programming and implementation of PPAN at the local level

Assessment Model Inputs Process Outcome Financial Material
Political support Human resource development Stakeholder partnerships Stakeholders’ self-assessment of adequacy of investments in nutrition Explanation of how and why activities are planned Mechanisms and dynamics of coordination and collaboration of various stakeholders Surfacing of issues and concerns related to program management and implementation Stakeholder’s perception on the relevance and appropriateness of the components of the nutrition program Achievement of targets Stakeholders’ self-assessment of outcome Inputs Process Outcome

METHODS

Study Design Qualitative study (Descriptive study)
Multiple perspectives from the various nutrition stakeholders- the Municipal Nutrition Action Officer (MNAO), the Barangay Nutrition Scholars (BNS) and community partners were explored to come up with a more inclusive and comprehensive assessment

Data Collection Qualitative Data Collection Consultative meeting
Key Informant Interview Focus Group Discussion Respondents NNC Technical Staff MNAO BNS Community Partners (mostly mothers of PS child) 2. Document Analysis Municipal Nutrition Action Plan (MNAP) Barangay Nutrition Action Plan (BNAP) Accomplishment reports Minutes of Meetings Budgetary Allocation OPT results Consultative meeting In order for the assessment to be organizationally anchored, consultation meetings with the technical staff of the National Nutrition Council Secretariat was also conducted. Focus group discussion Key informant interview Participatory approaches and appreciative inquiry processes were observed during data collection

Data Collection Methods
Participatory approaches and appreciative inquiry processes were observed during data collection   Very Happy/ Satisfied Happy/ Satisfied Sad/ Unsatisfied Very Sad/ Unsatisfied Neutral Self-rating, Level of Satisfaction, Perceived effects of nutrition programs, etc.

Selection of Study Site
Basis for Selection Province Low, medium, high prevalence of underweight 0-60 months based on FNRI 2011 updating survey WHO classification Low - < 10 Medium – 10-20 High – 21-30 Very high - > 30 Municipality - high and low prevalence Based on OPT 2011 Barangay high and low prevalence Based on OPT 2012 OPT 2011 was obtained from NNC website, and was utilized to choose the municipalities 2012 data was used to choose the barangays, these were obtained at the barangay level

Selection of Study Sites
The Provincial Nutrition Action Officer and the Municipal Action Officer were consulted in the selection of municipalities and barangays

Study Participants The Municipal Nutrition Action Officer (MNAO), Barangay Nutrition Scholars (BNS) and selected community members-beneficiaries participated in the assessment.

Data Processing and Analysis
Collected data were consolidated, summarized and analyzed Themes arising from the interviews and focused group discussions were grouped and cross-checked with field notes and observations

Data Processing and Analysis
Comparison and contrasts of the variables of the assessment framework (input-process- outcome) between and among provinces, municipalities and barangay using the prevalence of underweight as the unit of analysis

Limitations of the Study
Limited coverage so no generalization may be done Field realities such as lack of an appropriate venue to conduct the FGD and KII may have affected the response of the respondents

Report is based mainly on the reported experiences and perceptions of the respondents and on the records made available to the investigators

No control in the selection of community partners to participate in the FGD One MNAO not interviewed (non-availability, already retired)

RESULTS

Province Prevalence Classification*
Study Sites Selection: Prevalence of Underweight (0-60 months) FNRI 2011 Updating Nutrition Survey Province Prevalence Classification* IFUGAO 7.2 Low BULACAN 13.3 Medium SIQUIJOR 46.0 Very High National Average Prevalence 20.2 Prevalence Range 7.2 – 46.0 *based on Prevalence Ranges of WHO (1995)

Municipality Classification
Municipality Selection: Prevalence of Underweight (0-71 months) Results of Operation Timbang for 2011, by Cities and Municipalities Municipality Classification PROVINCE IFUGAO BULACAN SIQUIJOR Low Lagawe (2.96) Sta. Maria (1.40) E. Villanueva (2.13) High Kiangan (3.65) DRT (8.63) San Juan (8.46) Average Prevalence 3.76 2.52 6.26 Prevalence Range 2.04 – 6.32 0.06 – 8.63 2.13 – 8.46

Barangay Basis: Prevalence of Underweight (0-71 months) 2012 OPT results
Province Municipality Barangay Prevalence Range Average Prevalence Low High IFUGAO Lagawe (Low) (Olilicon) 3 (Boliwong) 0.00 – 12.50 2.75 Kiangan (High) (Tuplac) 5.09 (Baguinge) 0.00 –7.34 3.59 BULACAN Sta. Maria 0.59 (Buenavista) 0.83 (Sta. Cruz) 0.00 – 3.70 1.13 DRT 4.91 (Camachile) 5.74 (Pulong Sampaloc) Not available SIQUIJOR E. Villanueva 2.15 (Libo) 4.54 (Poblacion) 0.00 – 9.00 3.00 San Juan 6.49 (Maite) 9.43 (Cansayang) 1.37 – 12.70 6.99 Not available because not all barangays have been covered in the 2012 OPT results that we reviewed; records not supplied by MNAO and not available at the municipal level

MELLPI Standing Year Ifugao Bulacan Siquijor 2009 None CROWN Year 1
2010 CROWN First Year Maintenance 2011 CROWN Second Year Maintenance 2012 Vying for Second Year Maintenance Vying for Nutrition Honor Award ?

INITIAL FINDINGS

Nutrition Office Set -up Municipality Classification
Where Observed Municipality Classification Nutrition office exists with budget Sta. Maria, Bulacan Low prevalence Nutrition office exists but no separate budget Kiangan, Ifugao High prevalence No nutrition office but nutrition program has budget for supplies and clerical staff Lagawe, Ifugao Nutrition office non-existent (nutrition files in MNAO designate office DRT, Bulacan E. Villanueva, Siquijor San Juan, Siquijor (Note: Siquijor a high prevalence province) variations in the organizational set-up of the Nutrition Office Separate Nutrition Office exists; with budgetary allocation; no support staff for MNAO Separate Nutrition Office exists; no budgetary allocation; no support staff for MNAO Separate Nutrition Office exists with budget only to hire a clerical staff and purchase office supplies Nutrition Office non-existent and no separate budget (nutrition files in the office of the MNAO)

MNAO Position Where Observed Municipality Classification
MNAO designate but relieved of other duties as CAO With separate budget No support staff Sta. Maria, Bulacan Low prevalence MNAO designate concurrently functioning as Budget Officer With budget for support staff and office supplies Lagawe, Ifugao MNAO item but job order No separate budget (with health) Kiangan, Ifugao High prevalence *Community Affairs Officer (CAO)

MNAO Designate Where Observed Municipality Classification MNAO designate concurrently functioning as: Midwife (MHO) Social worker (MSWDO) Municipal Health Officer (MHO) DRT, Bulacan San Juan, Siquijor E. Villanueva, Siquijor High prevalence Low prevalence

Perceived Strength and Limitation of their Present Organizational Set-up
Efficient set-up because they can still deliver their primary function (e.g. doctor, nurse, midwife) at the same time they are functioning as MNAO There is a tendency that less attention is given to nutrition because the priority would be the activities of the agency where the MNAO belongs the nutrition-related program being strengthened is the nutrition-related activities of their primary agency Example: If MNAO is with health - then the health component is strengthened if the MNAO is an Agriculturist, the seed distribution component is given more attention all of them expressed that there should be a focal person for nutrition-related activities

Recommended Set-up by the MNAOs
Create an MNAO item whose primary responsibility is to oversee and coordinate the proper implementation of the nutrition program formulated by the Municipal Nutrition Committee If MNAO-designate, s/he should be relieved of other responsibilities

Other Recommendation If the proposed ideal set-up is not feasible, MNAO-designate should be given additional honorarium to compensate for the additional work

Perceived Elements of an Ideal Nutrition Office
Permanent MNAO item in the plantilla Knowledgeable in nutrition program management With budget allocation Support staff

MUNICIPAL NUTRITION COMMITTEE

Municipal Nutrition Committee (MNC)
Most of the municipalities reported having MNC Composition - members vary from 11 to 22 agencies and organizations

Municipal Nutrition Committee
Core members (constant) Mayor (Chair) MNAO Municipal Agriculture Office (MAO) Municipal Social Works and Development Office (MSWDO) Municipal Planning and Development Office (MPDO) Municipal Budget Office (MBO) Municipal Local Government Office (MLGOO) Department of Education (DepEd) Non-government Organization (NGO)

Variations in MNC Composition
Varying members Municipal Fire Marshal School Nurse SK President Chief of Police Population Officer BNS President Municipal Sanitary Inspector Nutrition Worker Municipal Engineer People’s Organization (e.g. Municipal Government Employee Association) MPOW Nutrition worker in Lagawe: clerical worker w/o Nutrition background, midwife

Are the MNCs Functional?
Indicators Active MNC evidenced by holding quarterly meetings Collectively formulating the Municipal Nutrition Action Plans, implementing and monitoring the agreed upon plans With adequate funding support

MNC Functionality as Perceived by the MNAOs
Perception Area Classification Functional Sta. Maria, Bulacan Lagawe, Ifugao DRT, Bulacan Low prevalence High prevalence Not functional Kiangan, Ifugao San Juan, Siquijor E. Villanueva, Siquijor

MNAOs Satisfaction of MNC Performance
Area Classification Satisfied/Happy  Sta. Maria, Bulacan Lagawe, Ifugao DRT, Bulacan Low prevalence High prevalence Neutral  Kiangan, Ifugao Not applicable (no MNC) E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor *San Juan: An OIC has been appointed but during the time of interview, he has assumed office for two weeks and has never been involved in any MNC activities; former assistant of MSWDO (former MNAO)

FORMULATION OF MUNICIPAL ACTION PLAN

Process of MNAP Formulation
Area Classification Collective Sta. Maria, Bulacan Lagawe, Ifugao DRT, Bulacan Low prevalence High prevalence Individual (consolidates agency commitment) Kiangan, Ifugao No MNAP E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor Collective: every member participates in the formulation of MNAP; they conduct meeting, normally during the first quarter; MNAP formulation is completed after 3-4 sessions Individual: MNAO obtains nutrition-related activities from agencies and consolidates these activities to become the MNAP. Consolidated report is presented to MNC for approval. This normally takes 1 week if reports are complete, if reports are incomplete, the process takes 1 month.

Problems in MNAP Formulation
Budgetary allocation not enough even if they have very comprehensive plans Sometimes plans remain plans and not fully implemented It takes time to “make the rounds” (other agencies) to gather the information needed Complicated PPAN forms PPAN forms

Overcoming Problems Regarding MNAP Formulation
Low Prevalence High Prevalence Insufficient funds to fully implement their projects is a recognized problem but through dialogue and proper coordination with the implementing agency, they are able to get their commitment to allocate funds for the activities Resigned to the reality of constant lack of funds without trying to be innovative in overcoming the resource constraints

Overcoming Problems… Low Prevalence High Prevalence
Advocate for supplemental budget from the Office of the Mayor. Oftentimes, the supplemental budget is released if MNAO is able to justify the need for more funds.

AWARENESS OF PPAN

Municipal Classification
Level of Awareness Awareness Area Municipal Classification Aware (discussed in a meeting with PNAO) Lagawe, Ifugao Low prevalence Aware only of the impact programs but not the PPAN document Sta. Maria, Bulacan DRT, Bulacan Kiangan, Ifugao High prevalence Aware but has not seen the PPAN document Not aware E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor

Knowledge of PPAN Most of the MNAOs equate the PPAN to the forms with the seven impact programs which they need to accomplish and submit quarterly MNAOs observed that the suggested activities remained essentially the same from the time they became a member of the MNC and until they were eventually appointed MNAO

USEFULNESS OF PPAN FOR LOCAL LEVEL PLANNING

Perceived Usefulness Usefulness Area Municipality Classification
Useful as shopping list of activities Facilitates targeting DRT, Bulacan Kiangan, Ifugao High prevalence Useful to some extent but with or without PPAN, MNAP is developed based on the analysis of the local situation Sta.Maria, Bulacan Lagawe, Ifugao Low prevalence Not applicable E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor

POLITICAL SUPPORT

Forms of Political Support
Adequate budget Passing of laws and ordinances related to nutrition Overall staff support Since implementation of the Philippine Plan of Action for Nutrition has been devolved to the local government units, political support is a key element in effective implementation

Budget System Area Municipality Classification With separate budget Sta. Maria, Bulacan Low prevalence Incorporated in agency budgetary allocation DRT, Bulacan Kiangan, Ifugao High prevalence Municipal wide budgeting Lagawe, Ifugao No budget E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor High prevalence With separate budget: with line item for nutrition projects from the municipal budget Incorporated in agency budgetary allocation: nutrition component c/o DA is under DA budget; nutrition component for Health is under Health budget Municipal wide budgeting: all the budgets allocated for nutrition is still with the line agencies; there’s a separate budget hearing for all agencies; MNAO serves as the advocate for nutrition, seeking support for the different line agencies (e.g. feeding from DSWD, micronutrient supplements c/o Health, seedlings c/o DA)

Perceived Budget Adequacy
 Most of the MNAOs seem to be happy with their respective budgetary system All expressed that it is never enough given the work that needs to be done

Perceived Budget Adequacy
 Appreciative of whatever resources coming from the province or national government But they prefer that the funds from the province or national office be “downloaded” to the municipality instead of sending IEC materials or food commodities which may not be appropriate to their locality For example, in one municipality where English is more understandable rather than Filipino (Lagawe, Ifugao), the IEC materials sent to them are in Filipino so they cannot distribute it to the BNS. If they get supplementary funds from the province or national government, they can use it based on the needs of the municipality.

Municipal Resolutions
Adoption of MNAP for implementation Specific resolutions - Adoption of IYCF - Selling of iodized salt - Supplementary feeding The passage of municipal resolutions and ordinances in support of nutrition programs is another indicator of political will to address the nutrition problems of the municipality. For the municipalities with active MNC (Bulacan and Ifugao), many nutrition related resolutions and ordinances have been promulgated by their respective Sanggunian Bayan

Role of MNAO in Local Legislations on Nutrition
Advocate- brings to the attention of Committee on Health urgent nutrition related concerns Enabler- so head of committee will be able to propose specific resolution or ordinance to support nutrition activities Example: If the needed resolution/ordinance is related to budget, then the Budget Officer is approached. Sometimes concerns are brought directly to the Mayor who in turn will discuss with the people concerned so that it is elevated to the Sanggunian Bayan.

Staff Support All of the MNAOs are “MNAO-designate” Staff Support Area Municipality Classification With support staff Lagawe, Ifugao Low prevalence Without support staff Sta. Maria, Bulacan E. Villanueva, Siquijor Kiangan, Ifugao DRT, Bulacan San Juan, Siquijor High prevalence “MNAO-designate” - meaning the person occupying the post is appointed by the Mayor but selected from among the members of the Municipal Nutrition Committee - their main responsibility is the expected tasks of their primary position

Preparation as MNAO All MNAOs feel inadequate in performing their functions Expressed the need for formal training upon designation as MNAO PNAOs can be approached if they have questions

INTER-AGENCY COLLABORATION

Inter-agency Collaboration
Perception Area Municipality Classification Nutrition activities integrated in the programs of other agencies Lagawe, Ifugao Sta. Maria, Bulacan Low prevalence Agencies not fully committed to integrate nutrition in their programs DRT, Bulacan Kiangan, Ifugao High prevalence No integration E. Villanueva No response (MNAO not interviewed) San Juan, Siquijor High prevalence Considering that the causes of malnutrition are multifactorial requiring multi-sectoral actions, the collaboration of the different front line agencies (e.g. health, agriculture, social welfare, population, etc) is crucial in implementing the nutrition program. The MNAOs in these municipalities are satisfied with the cooperation of the various agencies despite some problems of delays in their submission of quarterly report needed by the MNAO to accomplish the PPAN monitoring form. For them, delay in reporting can be easily solved by going personally to the agency staff and get the information needed. For the MNAOs of these two low prevalence municipalities, they think they have a good working relationship with the personnel of the front line agencies.

Indicators of Integration
Collectively set targets, monitor and evaluate They also share resources if needed Ways to collaborate, problems encountered and suggested solutions are discussed during MNC meetings There is a deliberate and conscious effort to integrate programs - This means that in the various front line agencies nutrition concerns are carried in the programs of the front line agencies. For example, agriculture will target families of undernourished children in their seed distribution and other food production programs; health will ensure that the identified undernourished children receive the micronutrient supplements, they are fully immunized, their mothers given adequate prenatal care if pregnant etc.

Perceived Absence of Inter-agency Collaboration
“ Not all of them are 100% committed in their efforts. They still have to be reminded whenever we have meetings. Even the Mayor observes that they are only enthusiastic in the beginning but lose steam along the way. They have to be pushed and needs follow-up. They have no initiative.” (DRT, Bulacan)

Perceived Absence of Inter-agency Collaboration
“I am not aware of any inter-agency collaboration here. No working together at all. If you interview the BNS, they will probably tell you the same thing. That is why I really want to re-activate the MNC if it existed before I became MNAO.” (E. Villanueva, Siquijor)

SUPPORT OF OTHER ORGANIZATIONS

Ways of Getting Support
Inviting them to be members of the MNC Approaching them for specific support Accepting whatever the organizations can offer Actively seeking the support of the private sector by writing to them attending their meetings and presenting the needs of the program inviting them to sponsor certain activities However, assistance is not long term and not sustained Examples of projects sponsored by various private organizations include one day feeding program for the undernourished children in one barangay, donation of IEC materials, malunggay planting, livelihood training for families of undernourished children and gift giving during Christmas.

DILG Memo Circular 2012-89 Mandates LGUs to
Translate the priorities for action of PPAN into specific programs and projects; Organize, re-organize, and strengthen functional local nutrition committees; Designate nutrition action officer with adequate office and staff support and provisions for continuous capacity building;

DILG Memo Circular Sustain, recruit and deploy Barangay Nutrition Scholars (BNS); Formulate, implement, monitor and evaluate local nutrition action plans; and Implement programs and projects to achieve nutrition targets

MNAO Awareness of DILG Memo Circular 2012-89
Area Municipality Classification Memo discussed in MNC meeting Lagawe, Ifugao Kiangan, Ifugao Low prevalence High prevalence Simply given a copy Sta. Maria, Bulacan DRT, Bulacan E. Villanueva, Siquijor No response (MNAO not interviewed) San Juan, Siquijor *DILG discussed the memo during MNC meeting

MNAO Perception of Importance of the DILG Memo
All the MNAOs acknowledge the importance of the memorandum circular It gives the various front line agencies legal basis for compliance Compels them to integrate nutrition in their programs and collaborate with one another

BRINGING MNAP TO THE BARANGAY

Reaching Out to the Barangay Officials
Ways Area Municipality Classification Through ABC meeting Lagawe, Ifugao Kiangan, Ifigao Low prevalence High prevalence Personal approach (MNAO goes down to the barangay) Sta. Maria, Bulacan Through BNS/Midwife E. Villanueva, Siquijor DRT, Bulacan Implementing the MNAP to the various barangays require informing the barangay officials about scheduled activities. This is usually done through the monthly ABC meetings or the MNAO will go to the barangay to personally talk to the barangay captain/officials.

Meron naman po Kapitan na mas gusto nila yun, “ay mainam naman at nababa niyo kami”. Iba-iba din ang ugali ng mga Kapitan, minsan meronng ibang Kapitan verbal lang okay na sa kanya, merong iba na de papel. Depende po. (MNAO, Sta. Maria)

Difficulties Encountered in MNAP Implementation
Attitude of the target beneficiaries Commitment of the frontline agency workers Lack of support from barangay (high prevalence) Physical characteristics of the barangay Far location Rough terrain Difficult access to transportation passive attitude of the target beneficiaries is perceived as the major setback in delivering the nutrition services few families of undernourished children will go out of their way to get the milk supplements intended for their children due to work and distance of the barangay hall More often than not, it is the BNS or Mother Leader who delivers the milk supplements to the houses of undernourished children most of the families with undernourished children live far from the barangay hall where occasional feeding, milk distribution and mothers classes are usually conducted. To reach the barangay hall, the families will spend for transportation which drains the already meager family resources. Lack of support from barangay officials Another MNAO from a high prevalence municipality (DRT) perceive the lack of interest in nutrition activities by the local officials as another reason for failure to implement most of the activities included in the MNAP. Nutrition is not prioritized and it is seldom mentioned in barangay meetings.

Program Monitoring Monthly meetings with the BNS
Monthly reports submitted by the BNS Field visits of the MNAO Requesting for the accomplishment reports of the line agencies whose programs are also part of the MNAP

Monthly Meetings with BNS
The following are discussed Accomplishments in terms of target beneficiaries visited Activities implemented Difficulties encountered and how the problems have been resolved The results of the monthly weighing and reasons for increase or decrease in weights are discussed with the BNS

Field Visits by MNAO The MNAOs visit each barangay at least once a month and ask the beneficiaries what services reached them

Reports of Frontline Agencies
The line agencies given MNAP monitoring forms to accomplish on a quarterly basis If targets are not met for the month, the MNAO usually discusses with the line agency personnel the reasons for failure to reach the target For example: DA has made a commitment to target the undernourished families with their seed distribution or hog dispersal program. However, during monitoring, the may MNAO notice that there were target families who did not receive any of the programs mentioned so there is a discussion on the possible reasons.

Some Reasons for Non-implementation by Frontline Agency
“They were not given fingerlings because they don’t have fishponds. They were not given pigs because they have nothing to feed the pig. If we give the pig , the pig might die because they have no source of income to buy feeds for the pig.” The MNAO and the line agency personnel will then explore ways to overcome the difficulties In the above case, their solution is to give goats instead

Problems in Monitoring
Accuracy of data from BNS Delay in the submission of reports from line agencies Transportation and logistics problems in monitoring

Problems in Monitoring
The high prevalence municipalities (DRT, Kiangan) do not benefit from inter-agency discussion because they merely collect the reports from the line agencies and consolidate the data

Overcoming Problems of Monitoring
MNAO sits down with the BNS and checks the accuracy of their report The problem of delay in submitting reports by the line agency personnel, the MNAOs solution is “pakikisama” - They just continue coordinating and requesting for the reports

BARANGAY NUTRITION SCHOLAR

Typical Tasks of a BNS Low Prevalence Municipality
(Lagawe, Sta. Maria, E. Villanueva) High Prevalence Municipality (Kiangan, DRT, San Juan) Pabasa sa Nutrisyon/ Mothers’ class/IEC Feeding OPT Distribution of Vitamin A supplements Distribution of vegetable seeds Assist midwife in immunization

(Lagawe, Sta. Maria, E. Villanueva) High Prevalence Municipality (Kiangan, DRT, San Juan) Deworming Submission of monthly and quarterly reports Prenatal care Home visits, consultation, counseling Family profile survey

(Lagawe, Sta. Maria, E. Villanueva) High Prevalence Municipality (Kiangan, DRT, San Juan) Distribution of multivitamin supplements Distribution of vegetable seeds Monitoring of community garden Assist midwife in newborn care IEC on IYCF Conduct of family planning sessions Cooperation in studies of FNRI Monitoring of CCT beneficiaries (DRT) Social services (e.g. collection of support for the dead, occasionally) (DRT) Duty at the at Health Center (e.g. assist patients, take BP, clean wounds and act as utility persons) Salt testing

Perceived Easy Tasks for BNS
Low Prevalence Municipality High Prevalence Municipality OPT Assisting in immunization Directing patients to the Health Center Conduct of IEC BNAP formulation Duty at the Health Center Distribution of vitamin supplements

Perceived Hard Tasks for BNS
Low Prevalence Municipality High Prevalence Municipality OPT plus Conduct of IEC Home garden implementation and monitoring Actual implementation of programs/involving people in programs BNAP formulation Family profile survey Computation and consolidation of OPT results Making agenda for meetings Conduct of feeding program Conduct of Pabasa sa Nutrisyon

Low Prevalence Municipality High Prevalence Municipality
Training as BNS Low Prevalence Municipality High Prevalence Municipality BNAP formulation No initial formal trainings for BNS (there was training for BHW, did self-study, was coached by former BNS, was mentored by MNAO) Training by MNAO and/or PNAO Orientation upon being a BNS OPT Plus Family Planning Accelerated Hunger Pabasa sa Nutrisyon

Self Rating of Preparedness as BNS
Reasons Municipality Classification Very Happy Full support of Barangay Captain and MLs Good relationship with people (e.g. MLs and kabarangay) Enjoys credibility Confident in fulfilling BNS roles Contented with present tasks but longs for trainings Sta. Maria DRT San Juan Low prevalence High prevalence

Reasons Municipality Classification Happy New in the position, still have a lot to learn and accomplish Enjoys caring for the children Barangay Council’s choice Enjoys giving advice Finds work easy (former BHW) Uncertain if she can respond during emergencies because she still has a baby Sta. Maria E. Villanueva Lagawe Low prevalence 

Reasons Municipality Classification Happy Job insecurity With similar work experience Has attended seminar Able to conduct weighing even if she’s just borrowing weighing scale from HC Cannot dedicate entire time due to having a baby Has established records system Barangay has few cases of undernutrition Learned to mingle and deal with people DRT San Juan Kiangan High prevalence 

Reasons Municipality Classification Neutral SB prioritized nutrition just recently “Minsan may masaya sa pagserbisyo, minsan may mahirap.” She is not well-trained Uncooperative parents No weighing scale Lack of knowledge and mentor Lack of knowledge Being a BNS at first was hard but they learned to like it especially when the children approach them Sta. Maria E. Villanueva Lagawe Kiangan Low prevalence High prevalence 

Reasons Municipality Classification Sad Lack of knowledge at the start and was instructed to ask other BNS for help Was “forced” to be the BNS despite the incumbent BNS’ disapproval Lagawe Low prevalence

Reasons Municipality Classification Very Sad Lack of knowledge/ orientation on BNS tasks Lagawe Low prevalence

  

Suggestions to Improve Self-Rating
Low Prevalence Municipalities High Prevalence Municipalities Honorarium/increased incentives Provision of tools (e.g. weighing scale) Provide materials/goods to encourage parents’ participation Better relation with former BNS and people who appointed them There should be love for work and volunteerism Conduct workshop on BNAP formulation More BNSs in barangays with large population Support from Barangay Captain/officials Funding support for nutrition programs Eliminate politicking in implementation of nutrition programs Job security as BNS Guidance in fulfilling BNS tasks

How they Became BNS All were appointed by the Barangay Captain
- recommended by MSWDO or MHO - replacement of former BNS was fired due to inefficiency, died, resigned, relative of former BNS

How they Became BNS Previous work Mother Leaders (Bulacan)
Applicant to the post, selection thru votation by Barangay Council (Ifugao) Concurrent BHW, as per MHO recommendation made to assume BNS function (Siquijor)

Barangay Nutrition Activities by BNS
Frequency/ Duration Municipality Classification OPT Every first quarter DRT San Juan Kiangan High Prevalence House to house weighing Monthly Lagawe Sta. Maria E. Villanueva Low Prevalence

Frequency/Duration Municipality Classification Pabasa sa Nutrition Irregular (April and October or July) Lagawe Sta. Maria E. Villanueva DRT San Juan Kiangan Low Prevalence High Prevalence DCC feeding Daily, during school days, 120 days

Frequency/Duration Municipality Classification Distribution of vitamin supplements Irregular (April and October, or while supply lasts) Lagawe Sta. Maria DRT Kiangan Low Prevalence High Prevalence Distribution of seeds DA schedule; while supply lasts E. Villanueva

Role of BNS in BNAP Formulation
Low Prevalence Municipality (Lagawe, Ifugao; Sta. Maria, Bulacan) High Prevalence Municipality (Kiangan, Ifugao; DRT, Bulacan) Convene BNC Present OPT findings to BNC Consolidate BNAP Lobby for funding of BNAP Prepare agenda (DRT) Creation of Causal Model (Kiangan) Knowledge on BNAP Formulation

Difficulties in BNAP Formulation
Low Prevalence Municipalities (Lagawe, Sta. Maria, E. Villanueva) High Prevalence Municipalities (Kiangan)* No regular budget allocated for nutrition programs Uncooperative BNC members/BNC difficult to convene Looking for individual BNC members to sign the BNAP *San Juan does not have BNAP

Other Members (varies per barangay)
BNC Members *based on BNAP 2012 Constant Members Other Members (varies per barangay) Barangay Captain (Chairman) Vice Chairman (Kagawad or First Lady) BNS/BHW Midwife DCW DepEd Nutrition Coordinator SB Council (Committee Heads) SK Chairman Mother Leaders Barangay Clerk Barangay Secretary Barangay Treasurer People’s organization (e.g. Women’s Association) NGO Barangay Training and Employment Coordinator (BTEC) Barangay Tanod Barangay Training and Employment Coordinator (BTEC) *only in Bulacan

Involvement of NGOs in BNAP Implementation
Low Prevalence High Prevalence Livelihood projects Distribution of vitamin supplements or medicines Distribution of food commodities Feeding

Perceived Changes as BNS
Low Prevalence Municipality High Prevalence Municipality Improved social relations Increased self-confidence and confidence in public speaking Increased self-worth Developed sense of responsibility Increased knowledge Lack of time for family Obtained people’s trust, respect Improved time management Additional work Additional source of income Before and after self image of a BNS is summarized in this table

Perceived Satisfactions as BNS
Reasons  Improvement in children’s nutrition Supportive barangay officials Awareness of mothers on the health and nutrition conditions of their children  BNAP not implemented due to lack of budget They wish more cooperation from the community They wish that more families will exhibit the behavior of that which shown by 4Ps beneficiaries

BNS Recommendations to Improve Perceived Satisfaction
  More incentives Budget for BNAP More support from the barangay officials Security of tenure More community participation/cooperation

Wish List to Improve Barangay Nutrition Service Delivery
Ifugao Bulacan Siquijor Additional weighing scale with baby bag not OBAN Flashlight, umbrella, boots Travel & food allowance PhilHealth card Retirement/separation package Support for supplementary feeding Additional kits for teaching mothers Rice allowance, umbrella Cooperative parent during OPT Support for feeding & mother’s classes Seminar to community to reduce indifference and sarcastic remarks to BNS National Office (NNC) to look into their plight Security of tenure Orientation of Bgy Council on BNS role and impt of organizing BNC and BNAP

BNSs’ Perceived Effects of BNAP Implementation on the Community*
Reduction in the number of underweight children Level of awareness on nutrition increased Increased community participation in DCC feeding 4Ps beneficiaries more cooperative and participative Increase in number of overweight children (Lagawe) Note that Lagawe is being a peri-urban community, being the capital of Ifugao *Only in Bulacan and Ifugao

Training Needs of BNS Communication and presentation skills Advocacy
Resource mobilization Developing indigenous IEC materials How to better perform their function as BNS

Mentoring and Coaching Needs
How to simplify BNAP formulation BNC organization and activation How to accurately consolidate OPT report PPAN

MNAO Satisfaction on BNS Performance
Awareness Municipality Classification Very happy/happy Lagawe, Ifugao Sta. Maria, Bulacan E. Villanueva Low prevalence Happy but needs improvement Kiangan, Ifugao DRT, Bulacan High prevalence No response (MNAO not interviewed) San Juan, Siquijor  

BNS Incentive Barangay (PHP) Municipality Province Total IFUGAO
400 – 800 500 200 1100 – 1700 BULACAN 250 – 1100 1000 SIQUIJOR* None *BNS concurrently BHW; they are getting BHW incentive

MNAO’s Perception on the Adequacy of BNS Incentive
Not sufficient (all MNAOs) pesos a month (Lagawe) other MNAOs did not specify an amount but merely said the present allowance is not enough Case: In Ifugao, some of the barangays are very far like Dulao. The BNS has to spend mga PhP500 coming and going - first she rides on the banca to cross the river and that’s PhP or PhP200. And then she has to ride a tricycle and from the tricycle, she transfers to a jeep from Cordon, Isabela to Bagabag, Nueva Vizcaya. Then from Bagabag to Lagawe. So more or less when she comes to Lagawe, she will spend PhP500 one way. So if the meeting is monthly, papano yun? She can only attend the quarterly meetings.

MNAO Recommendation Related to BNS Incentive
The barangay, municipality and provincial government should agree on how much each level will allocate as the minimum Increase BNS allowance from the national government who at present gives per month

COMMUNITY PARTNERS’ VIEWS ON BARANGAY NUTRITION ACTION PLAN IMPLEMENTATION

Community Partners’ Awareness of Barangay Nutrition Program
1. DCC Feeding & OPT (all barangays) 2. Pabasa sa Nutrition, monthly weighing of PS, vitamin A supplementation, vegetable seed distribution-home gardening, cooking demo/lesson 3. Distribution of milk, cookies/biscuits, breastfeeding promotion, family planning, deworming, feeding during nutrition month, prenatal care, immunization 4. Livelihood, school gardening, school feeding, gift giving (bag of groceries) during December

Memorable Experiences in Nutrition Activities
Memorable activities Reasons Barangays OPT house to house Weight of children tracked, BNS concerned about health of their children Camachile,Olilicon, Tuplac (low prev) Baguinge (high prev) Feeding at DCC Learned new cooking techniques Gained new friends Able to eat left over Brought home left over ingredients Camachile, Cansayang , Libo (low prev), Maite, Baguinge , Sta. Cruz, Poblacion (high prev) Backyard gardening, Family Development Sessions (4Ps), distribution of milk to malnourished children, livelihood Reduced vegetable expense, access to fresh produce, extra income from hair-cutting and soap making Buenavista ,Tuplac, Olilicon (low prev), Sta Cruz, Baguinge (high prev)

Barriers to Participation in Nutrition Activities
Nobody is left to take care of their children (Tuplac, Ifugao) Time set for nutrition activities usually conflict with household chores and work in the field (Tuplac, Ifugao) Nutrition seminars are scheduled on school days, mothers have to prioritize children needs than attendance to said seminar (Tuplac, Ifugao)

Barriers to Participation in Nutrition Activities
Some mothers with small business can attend seminar if scheduled on weekend and no classes(where other families are available to take care of small kids) (Tuplac, Ifugao) Non-4 Ps mothers are not interested to attend nutrition activities (Camachile, DRT, Bulacan) Husbands are unable to attend nutrition activities on weekdays (Sta. Cruz, Sta. Maria, Bulacan; Cansayang, Siquijor)

Perceived Effects of Nutrition Activities on Child’s Health
Positive effects Children gained weight Weight improved but still underweight Children learned to eat vegetables/ variety of foods everyday (from Pabasa sa Nutrisyon) Children’s appetite improved Children became sociable/alert/no longer sleepy in school Children became worm-free due to deworming Immune system improved, less sickly due to immunization Indigent children became healthier

Perceived Effects of Nutrition Activities on Child’s Health
Negative effects “ Wala kaming nakitang napakagandang epekto” (Poblacion, E. Villanueva) No observable change (Baguinge, Kiangan) There are still underweight children in the community

Community Satisfaction on the Effect of Nutrition Activities on Children’s Health
Reasons Increase in weight Child learned to eat vegetables Increase in appetite Improved overall health Improved resistance against illness due to vitamin supplementation and immunization Family participated in nutrition activities  Happy face from Camachile, Sta. Cruz, Olilicon, Cansayang, Libo, Tuplac, P. Sampalok, Buenavista, Boliwong, Baguinge Very happy:

Community Satisfaction on the Effect of Nutrition Activities on Children’s Health
Reasons They feel that something is still lacking Have not participated in any nutrition activities Children’s food intake has not improved Still want to have continuous supply of vitamin supplements “No effect”: children still thin and sickly Conduct of feeding not regular Children’s performance in school has not improved  Neutral face from: Libo, P. Sampalok, Buenavista, Boliwong, Poblacion Something lacking: Child is not eating that well No effect on child’s health: Poblacion Conduct of feeding not regular (“Nagbabaon pa ng biscuit ang anak ko.”): Poblacion

Suggestions to Improve Community Satisfaction on Nutrition Program Implementation in the Community
Continuous feeding of children Continuous distribution of vitamins More nutrition activities for mothers and children Livelihood activities and financial support (lending) - sari-sari store, poultry, goat raising, buy & sell - vegetables & junk shop expansion

Perceived Effects of the Barangay of Nutrition Program on Community
Positive effects Strong bond among mothers in some barangays was established as a result of involvement in nutrition activities (all barangays) Weight improvement among children who participated in the feeding (all barangays) Improved resistance to illness due to vitamin supplementation, deworming & immunization

Positive effects Children are no longer underweight because of the persistence of BNS to monitor their weight every month and their constant giving of advice on proper nutrition (Tuplac, Olilicon Boliwong and Baguingue) Children became hearty eaters (Tuplac, Olilicon Boliwong and Baguingue)

Negative effects DWSD conducts feeding only once a month. Children have to bring their own “baon” i.e. biscuits Sometimes the mothers contribute money just to conduct feeding for their children Child is still underweight even after deworming and vitamin A supplementation (Boliwong, Ifugao) “wala kaming nakitang magandang epekto” (Baguinge Ifugao, Poblacion, E. Villanueva, Siquijor)

Observed Hindrances in Barangay Nutrition Program Implementation
Inadequate financial support to the livelihood program “pinagdadala ako ng gamit, dahil wala, hindi na lang ako umattend” (P. Sampaloc, DRT) Feeding supplies/ingredients are insufficient. Sharing some cost to some is acceptable. To some it’s an issue “gobyerno dapat ang magbigay ng supply sa feeding” (Boliwong, Baguinge , Ifugao; Poblacion, E. Villanueva) Inadequate financial support to the program. This is noted during feeding and conduct of mother’s classes with cooking demonstration and livelihood component.

Inability of the MLs to saturate the households in the barangay to regularly monitor weight of their children Budget is the primary reason for poor implementation of nutrition. It is not coursed through the barangays in real need. “ Budget from Malacanang for NFA and from Kapuso Foundation do not reach the community” (Brgy. Poblacion, Enrique Villanueva, Siquijor) “ This is also seen as cause for unfair enrollment in the feeding program” (Brgy. Poblacion, Enrique Villanueva, Siquijor) Inadequate financial support to the program. This is noted during feeding and conduct of mother’s classes with cooking demonstration and livelihood component.

Poor participation is due to late/delayed dissemination of information on details of nutrition activities (Tuplac, Kiangan) Reluctant attitude of the people to contribute when there is inadequate supplies during cooking demonstration (Tuplac, Kiangan) Vitamin distribution is inadequate because the activity is not continuous (Boliwong, Kiangan) Inadequate financial support to the program. This is noted during feeding and conduct of mother’s classes with cooking demonstration and livelihood component.

Unsanitary surroundings is a hindrance to improvement in nutrition in the community “here are lots of open pit toilets and some even do not have toilets” (Baguinge, Kiangan) Lack of budget for food supplementation. One time children were given expired/almost expired sachets of arroz caldo and milk supply (Baguinge, Kiangan) Inadequate financial support to the program. This is noted during feeding and conduct of mother’s classes with cooking demonstration and livelihood component.

A few have fatalistic attitude, expressed resignation on the nutritional state of their barangay due to people’s attitude “maglisod gyud dagway na pagsulabad kay tawo dinhi kuan man” “kung mu apil, apil ra, kung dili, dili ra” (some are participative, others are not) “some parents are reluctant to contribute ingredients for the preparation of supplemental feeding” “Some people are simply hard-headed- they would rather spend time gambling than attend meetings”

People are not well informed of the nutrition activities-there is poor communication and information dissemination (Bgy Poblacion, Enrique Villanueva)

Suggestions to Overcome Hindrances
More coordinated nutrition activities i.e feeding, vitamin supplementation & livelihood activities with sustained funding and support from barangay officials Avoid “politicking” in BHW/BNS appointed to minimize turn over Stricter implementation of nutrition program by the barangay. BNS and regular budgetary support to barangay nutrition programs (Baguingue)

Interestingly, mothers share the sentiments of the BNS/BHs in this barangay because most of them suggested to the interviewer to inform and ask assistance from Secretary Joel Rocamora to look into their situation and ask him to intervene and settle the issues between the Barangay Captain and BNSs/BHWs and facilitate issuance of resolution for regular funding of nutrition program. “dumudulog kay Secretary Joel Rocamora upang i dig up ang kanilang sitwasyon” (Brgy. Maite, San Juan)

Stricter implementation of nutrition program by the barangay. BNS and regular budgetary support to barangay nutrition programs (Baguingue, Kiangan)

Suggested Community Partners’ Role to Improve & Sustain Barangay Nutrition Program
1- Help convince mothers to support OPT(all bgy), continue participation in DCC feeding, convince mothers to breastfeed, practice family planning, continue to go to HC for vitamin A supplements 2- Attend mother’s classes, convince mothers to submit for prenatal, feed children with cerelac or lugao with vegetables when they reach 4-6 months 3- Give birth only in HC, farmers to continue sharing seeds/seedlings, convince bgy to give small loan, conduct livelihood project

Additional Thoughts Livelihood programs
Logistical support for nutrition programs (food commodities, vitamins, for deworming) Financial assistance for medical care Ensure free medicines from Botika ng Barangay Increase incentives of BNS/BHW

Additional Thoughts Bgy Boliwong, Ifugao (high prev)
More mother’s classes Bgy Baguingue, Ifugao (high prev) Additional contraceptives supplies More programs that would encourage community participation Bring back bulgur wheat and skim milk distribution

Recommendations to Increase Community Participation in Barangay Nutrition Program Implementation
Provide jobs for mothers as the root cause of the malnutrition problem is poverty. They cannot forever be depending on the government for support in terms of food and vitamins and health care Provide small loan/financial support to mothers to enable them to earn income Give them variety of vegetables seedlings to have a variety of vegetable sources in their backyard

Improve information dissemination on nutrition activities and enough lead time to give them time to adjust work and arrange for caregivers of children Schedule nutrition activities on weekends, no classes so entire family can participate

Sustain conduct of feeding (not just for 3 months) to prevent backsliding of weight of marginally undernourished children Implement feeding program for children not in DCC

INITIAL CONCLUSIONS

Assessment Model Inputs Process Outcome Financial Material
Political support Human resource development Stakeholder partnerships Stakeholders’ self-assessment of adequacy of investments in nutrition Explanation of how and why activities are planned Mechanisms and dynamics of coordination and collaboration of various stakeholders Surfacing of issues and concerns related to program management and implementation Stakeholder’s perception on the relevance and appropriateness of the components of the nutrition program Achievement of targets Stakeholders’ self-assessment of outcome Inputs Process Outcome

Inputs and Processes that Contributed to Positive Program Outcome
Political support (with budget for nutrition) Functional nutrition committees MNAO’s function dedicated to nutrition work only MNAO designate with other functions with staff support (Nutrition Worker) BNS enjoying high credibility and people’s confidence in the community Presence of inter-agency collaboration Collective formulation of MNAP and BNAP Resourcefulness and innovativeness in addressing issues and concerns related to nutrition implementation MNAOs are satisfied with the performance of BNSs MNAOs coaching/mentoring the BNS

INITIAL OVERALL RECOMMENDATIONS

Recommendations Political support Staff support Capacity building
Structure of the local nutrition committee (inter-agency collaboration) Support the passage of the Magna Carta for BNS

Political Support Provide a legal basis for institutionalizing political support for the nutrition program (similar to the GAD budget allocation) Develop an LGU Nutrition Scorecard which LGUs can use as access to get more support for nutrition from the national government

Staff Support Creation of a permanent MNAO item in the municipal plantilla 2. Standardization of MNAO qualifications in terms of educational preparation and relevant training 3. Develop an incentive system for promotion of MNAOs MNAO qualification: licensed ND

Capacity Building 1. Develop a training program for MNAOs to develop both their managerial and technical competencies 2. Develop a ladderized training program for BNS following a modular approach so there is continuous upgrading of knowledge and skills with corresponding incentive as they go up the ladder without undermining the spirit of volunteerism (similar to civil service career system)

Inter-agency Collaboration
Review the structure, composition and responsibilities of the local nutrition committees Core members (Mayor, MNAO, line agencies, NGO representative) Support group (all other stakeholders) Core members (Mayor, MNAO, line agencies, NGO representative): mirror image of NNC Governing Board

Proposed Structure of MNC

Magna Carta for BNS Support the proposed bill on Magna Carta for BNS (pending in Congress)

References National Nutrition Council. Guidelines on the Monitoring and Evaluation of Implementation of the Philippine Plan of Action for Nutrition at Provincial, City and Municipalities. NNC Secretariat, 2006 Food and Nutrition Research Institute. Philippine Nutrition Facts and Figures FNRI-DOST, 2010 Mapa, D. Han FC, Estrada CO. Hunger Incidence in the Philippines: Facts, Determinants and Challenges ( Accessed May 26, 2013). National Nutrition Council. Philippine Plan of Action for Nutrition, Abridged version. NNC Secretariat, April 13, 2013 National Nutrition Council. Awarding Ceremony. Philippine International Convention Center. November 9, 2012. Food and Nutrition Research Institute-Department of Science and Technology. Philippine Nutrition Facts and Figures Paper presented at Nutrition Summit on the Nutritional Status of Filipino Children and Selected Population Groups: 2011, Makati, Philippines, April 13, 2012.

References Department of Trade and Industry-Cordillera Administrative Region. “Provincial Profile.” National Statistics Office. “The 2010 Census of Population and Housing Reveals the Philippine Population at Million”. April 4, Ciencia, Shubert L. “MDG Midterm Report: The case of Ifugao” Paper presented in a focused group discussion with key officers of the Save the Ifugao Rice Terraces (SITMO), August 9, 2007. National Statistical Coordination Board. “Province: Bulacan.” provcode= Provincial Information Technology Office. “People.” Last modified Provincial Information Technology Office. “Industries and Products.” Last modified Provincial Information Technology Office. “Location and Physical Profile.” Last modified

References National Economic and Development Authority. “Status Report on the Millenium Development Goals Using CBMS Data.” PROVINCIAL_Reports/SIQUIJOR.pdf. National Statistical Coordination Board. “Region: Region VII (Central Visayas).” regview.asp?region=07 National Statistical Coordination Board. “Municipality/City: Lagawe.” Alberto et.al. “Municipality of Kiangan.” Last modified September 17, National Statistical Coordination Board. “Municipality/City: Kiangan.” gov.ph/activestats/psgc/municipality.asp? muncode= &regcode=14&provcode=27 World Bank Office Manila. Rural Water Supply Design Manual volume 1. Manila: The World Bank Office Manila, Accessed October 1, worldbank.org/files/publication/Water-OUTPUT-RWSVolIDesignManual.pdf NSCB. “Municipality/City: San Juan.” municipality.asp? muncode= &regcode=07&provcode=61

References Unpublished reports
Municipal Nutrition Action Plan of Lagawe Municipal Nutrition Action Plan of Kiangan Municipal Nutrition Action Plan of Sta. Maria Municipal Nutrition Action Plan of Doña Remedios Triniad Barangay Nutrition Action Plan of Olilicon Barangay Nutrition Action Plan of Boliwong Barangay Nutrition Action Plan of Tuplac Barangay Nutrition Action Plan of Buenavista Barangay Nutrition Action Plan of Sta. Cruz Barangay Nutrition Action Plan of Camachile Barangay Nutrition Action Plan of Pulong Sampalok

Assessment of the Local Implementation of the Philippine Plan of Action for Nutrition (PPAN) 2011-2016.

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