Philippine Plan of Action for Nutrition (PPAN)

Philippine Plan of Action for Nutrition (PPAN) 2017-2022
Let me now give you an overview of PPAN and I hope you will say, “Ahh the PPAN is consistent with the SUN road map to 2030”.

Addresses nutrition situation
Guide for all who want to be involved in nutrition action Lays out targets, directions, and priority actions PNP PNP FNP PFNP PPAN PPAN PPAN The Philippine Plan of Action for Nutrition PPAN The Philippine Plan of Action for Nutrition is a companion plan of the Philippine Development Plan. It lays out the targets, directions, and priority actions to achieve nutrition targets that are in turn based on the nutrition situation. 9/22/2018

Plan formulation process
Engagement of a team of consultants with funding support from Micronutrient Initiative and UNICEF Desk review Key informant interview/one-on-one consultations Focus group discussions (national and local) Consultation workshops NNC Technical Committee as final vetting body Plan formulation involved various methodologies and was both multi-sectoral and multi-level. It involved two consultation workshops.

Nutritional problems to address
Child stunting and wasting Deficiencies in vitamin A, iron, and iodine Overweight and obesity Poor nutritional status of pregnant and lactating women Poor infant and young child feeding Hunger and food insecurity The PPAN aims to address malnutrition in the form of child stunting and wasting, micronutrient deficiencies, overweight and obesity across the population. It also hopes to address maternal malnutrition, poor infant and young child feeding and hunger and food insecurity that are contributory to the major forms of malnutrition. I will not discuss the details of these problems in the interest of time.

Maternal and child undernutrition and death
Inadequate dietary intake Disease Household food insecurity Unhealthy household environment & poor health services Inadequate care Income poverty: employment, self-employment, dwelling, assets, remittances, pensions, transfers Lack of capital: financial, human, physical, social, natural Social, economic, and political context To address malnutrition effectively, one should address its immediate and basic causes as shown in the slide. This is the framework for undernutrition that has been used globally. Source: Black, Robert E. et al. The Lancet Series on Maternal and Child Undernutrition

PPAN Outcome targets In general, consistent with the 2025 Global Targets for Maternal, Infant and Young Child Nutrition Let me now touch on the outcome targets, that is the situation we wish to achieve by 2022. As a rule, the targets for 2022 are consistent with the 2025 global targets for maternal, infant, and young child nutrition. This means that the estimated numbers for 2022 are part of a straight line to lead to the desired situation in 2025.

Outcome targets Reduce levels of child stunting and wasting Indicator
Baseline Target, 2022 Prevalence (in percent) of stunted children under 5 years old* 33.4 21.4 Prevalence (in percent) of wasted children: - Children under 5 years old* 7.1 <5 - Children 6-10 years old 8.4 Thus, the targets are as follows: reduce child stunting to about 21.4%, wasting among children to be less than 5% *Targets are consistent with the 2025 Global Targets Maternal, Infant, and Young Child Nutrition

Outcome targets To reduce micronutrient deficiencies to levels below public health significance Indicator Baseline Target, 2022 Vitamin A deficiency Prevalence (in percent) of children 6 months to 5 years old with vitamin A deficiency (low to deficient serum retinol) 20.4 <15 Anemia Prevalence (in percent) of anemia among women of reproductive age* 11.7 6.0 For micronutrient malnutrition, the intent is to bring the problem down to levels that are below public health significance for vitamin A, anemia, and *Targets are consistent with the 2025 Global Targets Maternal, Infant, and Young Child Nutrition

Outcome targets To reduce micronutrient deficiencies to levels below public health significance Indicator Baseline Target, 2022 Iodine deficiency disorders Median urinary iodine excretion, ug/L - Children 6-12 years old 168 ≥100 - Pregnant women 105 ≥150 - Lactating mothers 77 Percent with urinary iodine concentration <50 mcg/L 16.4 <20% - Lactating women 33.4 Iodine deficiency.

Outcome targets No increase in overweight among children, reduced overweight among adolescents and adults Indicator Baseline Target, 2022 Prevalence (in percent) of overweight - Children under five years old* 3.8 <3.8 - Children 6 – 10 years old 8.6 <8.6 Adolescents 9.2 <5 Adults 31,1 28.0 For overweight, the target is to prevent a further increase among children years old, a reduction to less than 5% among adolescents and from 31.1% to 28% among adults. *Targets are consistent with the 2025 Global Targets Maternal, Infant, and Young Child Nutrition

Sub-outcome or intermediate outcome targets
Reduce the proportion of nutritionally-at- risk pregnant women from 24.8% in to 20% by 2022 (about 20% reduction between 2013 and 2022) Reduce the prevalence of low birthweight from 21.4% in 2013 to 16.6% by 2022 (to reach the 2025 Global target of 30% reduction)* *Targets are consistent with the 2025 Global Targets Maternal, Infant, and Young Child Nutrition We also propose suboutcome targets or targets that can lead to the achievement of the main outcomes. Again, when there are global targets committed to by the Philippines, the targets were based on these commitments. In some cases, the targets were based on observed changes in the past 20 years or so with an additional acceleration factor. Outcome objectives include reducing nutritionally at risk pregnant women to 20% by 2022, low birthweight to 16.6%

Sub-outcome or intermediate outcome targets
Increase the prevalence of exclusive breastfeeding among infant 5 mos old from 24.7% in 2015 to 33.3 by 2022 Increase the percentage of children months old meeting the minimum acceptable diet from 18.6% in 2015 to 22.5% by 2022 Increase the proportion of households with diets that meet the energy requirements from 31.7% in 2013 to 37.1% by 2022 For EBF, the outcome indicator has been limited to the 5-month old age group for a more sensitive measure of EBF, and the target is to increase EBF rates to For children meeting the minimum adequate diet, the target is a 22.5% level by 2022. And the last suboutcome target is to increase the proportion of households with diets that meet the energy requirements from 31.7% to 37.1%. Note for A/Sec. The target for EBF aims for a 50% increase by For complementary feeding, the target is an increase by 30%. These are “arbitrary” numbers. For households meeting energy requirements, the target is to increase the households with adequate calorie intake by 15% by This is more or less, twice the observed reduction between 1993 and 2003 (period of 20 years), applied to a period of about 17 years.)

Strategic Thrusts, 2017-2022 Focus on the first 1000 days of life
Complementation of nutrition-specific and nutrition-sensitive programs Intensified mobilization of local government units Reaching geographically isolated and disadvantaged areas (GIDAs) and communities of indigenous peoples Complementation of actions of national and local governments For the strategic thrusts for nutrition action are as follows: Focus on the first 1000 days or the period of pregnancy up to the 23th month of life Complementation of nutrition-specific and nutrition-sensitive programs Intensified LGU mobilization Priority to GIDAs and communities of indigenous peoples Complementatin of actions of national and local governments

Priority provinces REGION PROVINCE CAR Abra 2. Apayao I 3. Pangasinan II 4. Isabela III 5. Aurora Bataan 7. Bulacan 8. Nueva Ecija IV - A 9. Quezon IV - B 10. Palawan 11. Marinduque V 12. Albay 13. Camarines Norte 14. Camarines Sur 15. Catanduanes 16. Masbate VI 17. Aklan 18. Antique 19. Iloilo REGION PROVINCE VII 20. Bohol 21. Cebu 22. Negros Oriental VIII 23. Biliran 24. Leyte 25. Northern Samar IX 26. Zamboanga del Norte 27. Zamboanga del Sur X 28. Bukidnon 29. Lanao del Norte 30. Misamis Oriental XI 31. Davao del Norte 32. Davao del Sur XII 33. North Cotabato 34. South Cotabato ARMM 35. Sulu 36. Tawi-Tawi CARAGA 37. Agusan del Sur NCR 38. CAMANAVA For the LGU mobilization strategy, 37 provinces and a district in NCR will be prioritized as convergence areas of national and local programs. These areas were chosen based on the magnitude of stunting.

Nutrition-specific programs Nutrition-sensitive programs
Sustainable Development Goals Philippine Development Plan Goal Foundation for inclusive growth, a high-trust society, and a globally competitive knowledge economy Reduced wasting among children under-five years old Reduced stunting among children under-five years old Reduced micronutrient deficiencies Improved situation in overweight and obesity Reduced nutritionally-at-risk pregnant women Increased exclusive breastfeeding Improved food intake Reduced low birthweight Improved complementary feeding Nutrition-specific programs Nutrition-sensitive programs To achieve target outcomes, a mix of nutrition-specific and nutrition-sensitive programs will be implemented together with those that will create an enabling environment. I will discuss these in more detail in a while. Please note that there is a set of what we call nutrition-supportive programs Nutrition-supportive programs Enabling programs

Nutrition supportive programs, examples
Immunization Food and agricultural systems, programs and projects that impact on food supply Social protection programs like the conditional cash transfer, health insurance that include immunization, food and agriculture systems programs and projects that impact on food supply, conditional cash transfer, and health insurance. These programs are not included in PPAN because these programs were not designed to contribute directly to nutritional outcomes.

Nutrition-specific programs – Address immediate causes of malnutrition
Program/Project Agency involved Infant and Young Child Feeding Health systems support DOH, LGUs Community-based health and nutrition support DOH, NGOs, LGUs, Development Partners (DPs) Maternity Protection and Improving Capacities of Workplaces on Breastfeeding DOLE, Employers, Employees’ Unions, NGOs, LGUs, DPs Establishment of breastfeeding places in non-health establishments All agencies, NGOs, LGUs, DPs, CSC Enforcement of the Milk Code Let me now go to nutrition-specific programs or programs that address the immediate causes of malnutrition specifically inadequate food and poor nutrient quality, poor maternal and child caring practices. The first program is on infant and young child feeding that has 5 projects or program components that aim to ensure that all environments support the mother for optimum infant and young child feeding.

Nutrition-specific programs – Address immediate causes of malnutrition,
Program/Project Agency involved Integrated Management of Acute Malnutrition DOH, NGOs, LGUs, DP National Dietary Supplementation Program Pregnant women DOH, NGOs, LGUs, DPs Children, 6-23 months old Children 24 – 59 months old DSWD, NGOs, LGUs, DPs School-age children DepEd, NGOs, LGUs, DPs Food plant for producing food supplements FNRI, LGUs, SUCs, NGOs The second program is on the management of acute malnutrition. The third program is the National Dietary Supplementation Program that targets pregnant women, children 6-23 months old in food-insecure households, children 3 to under-five years old, and school–age children. Supplementary feeding programs that target pregnant women and children 6-23 months old are new and will be implemented progressively. Also for , there will be a more conscious effort to link the food plants set up by partners of FNRI with supplementary feeding programs.

Program/Project Agency involved National Nutrition Promotion Program for Behavior Change In schools DepEd, NGOs, LGUs, DPs In communities DOH, DSWD, NGOs, LGUs, DPs In workplace DOH, DOLE, NGOs, LGUs, DPs Resource center NNC (coordinator) There will be a nutrition promotion program that will aim for behavior change and will tap into various channels, specifically schools, communities, and the workplace. A resource center will also be set up with the NNC as coordinator. This program component will aim to integrate all related efforts to a coordinated effort for promoting desired actions along the Nutritional Guidelines for Filipinos.

Program/Project Agency involved Micronutrient supplementation (vitamin A, iron-folic acid, multiple micronutrient powder, zinc) In health unit DOH, NGOs, LGUs In schools DepEd, NGOs, LGUs Communication support The distribution of vitamin A capsules, iron-folic acid tablets, and micronutrient powder, and zinc through the health and school systems will continue under the Micronutrient Supplementation Program. The program will also include communication support.

Program/Project Agency involved Mandatory food fortification (technology development, capacity building, regulation and monitoring, promotion) Rice fortification with iron DOH, DSWD, DepED, NGOs, LGUs, industry Flour fortification with iron and vitamin A Cooking oil fortification with vitamin A Sugar fortification with vitamin A Salt iodization Mandatory food fortification of staples and salt will continue, and technology development, capacity building, regulation and promotion will be pursued and strengthened.

Program/Project Agency involved Nutrition in emergencies Capacity building for mainstreaming nutrition protection in emergencies DOH, DSWD, National/Local DRRMC, NGOs, LGUs, DPs Overweight and Obesity Management and Prevention Program Healthy Food Environment Promotion of Healthy Lifestyle Weight Management Intervention DOH, DSWD, DOLE, NGOs, LGUs, industry, CSC, DPs Under the Nutrition in Emergencies Program, nutrition protection in emergencies and disasters will be strengthened and through a purposive effort of capacity building for a nutrition response in emergencies. There will also be a program on the management and prevention of overweight and obesity.

Nutrition-sensitive programs – Address underlying causes of malnutrition
Projects in development sectors that were tweaked to produce nutritional outcomes Targeting households with undernourished children, or pregnant women or children 0-23 months old for employment Targeting areas with high levels of malnutrition Channel or platform for delivering nutrition-specific interventions Complementing these nutrition-specific interventions are nutrition-sensitive projects. These are development projects that were tweaked to produce nutritional outcomes. Tweaking can be done by targeting households with undernourished children or nutritionally-vulnerable groups, or targeting areas with high levels of malnutrition, or being a channel for delivering nutrition-specific interventions.

Nutrition-sensitive program – Address underlying causes of malnutrition
Farm-to-market roads and child nutrition, DA Target Actions to Reduce Poverty and Generate Economic Transformation (TARGET) and child nutrition, DA Coconut Rehabilitation Program, PCA Gulayan sa Paaralan, BPI, DepEd Diskwento caravans in depressed areas, DTI Family development sessions for child and family nutrition, DSWD Mainstreaming nutrition in sustainable livelihood, DSWD Public works infra and child nutrition, DPWH Adolescent Health and Nutrition Development, DOH SALINTUBIG and other water, sanitation and hygiene, DOH, DILG For PPAN , we have initially identified specific programs that will be tweaked to contribute more directly to nutritional outcomes. These are as listed in this slide. Additional programs or projects can be identified along the way.

Enabling programs Mobilization of LGUs for nutritional outcomes
Enabling policy and legal framework for LGU mobilization Development of continuing opportunities for LGU excellence in nutrition programming Mobilization of RICs and other community- based organizations for nutrition action Three (3) enabling programs will be implemented to support the operationalization of the PPAN. These include the Mobilization of LGUs for nutritional outcomes. Thus, selected LGUs will be handheld to formulate, implement, coordinate, and monitor their responses to their nutrition situation. Other LGUs will be tapped to be hubs of learning or inspiration of other LGUs. This strategy will be employed to ensure that nutrition programs are budgeted and is well within the local development plans of LGUs.

Enabling programs Policy development for food and nutrition
Securing policy support for nutrition along the priority nutrition legislative measures Public advocacy Strengthened management support to PPAN Securing vital nutrition infrastructure and resource requirements Strengthened coordination, monitoring, evaluation and management of PPAN Policy development on the other hand is expected to strengthen the creation of an enabling environment for the implementation of nutrition programs both at the national and local levels. The strategy to strengthen the management support to PPAN, covers two projects namely, Project 1: Securing Vital Nutrition Infrastructure and Resource Requirements for PPAN; Project 2: Strengthening coordinating, monitoring, evaluation and management of PPAN across NNC including member agencies and NNC Secretariat.

Implementation mechanism
National PPAN Implementation Plan, Agencies will commit what chunk of the targets they will “bite” Those involved will outline the things that should be done to implement the program To establish accountabilities Should be basis of agency budget proposals For annual updating How will the PPAN be implemented? A National PPAN Implementation Plan for will be formulated. At this stage, agencies will commit what chunk of the targets they will bite. Those involved will also outline the things that should be done to implement the program. The intent is to establish accountabilities. And we hope the civil society alliance organized today will participate in this process. It is hoped that the implementation plan will be the basis of preparing agency budgets and forward estimates. The implementation plan will be updated annually.

Regional Plan of Action for Nutrition, What agencies at the regional level will do Those involved will outline the things that should be done to implement the program To establish accountabilities Should be basis of agency budget proposals For annual updating A similar plan will be done at the regional level.

Local nutrition action plans Management will involve Organization of technical working groups at the national level to tackle technical details of each program The NNC Technical Committee will provide the venue for ensuring cohesive action across the different programs Crucial to the implementation mechanism is the role of the Local Government Units (LGUs) particularly in ensuring that local nutrition committees are functional, a local nutrition action plan is regularly formulated, updated and provided funds. Managing the PPAN will involve the organization of TWGs at the national level to tackle technical details of the program, while the NNC Technical Committee will continue to provide the venue for ensuring cohesiveness of program implementation across different partners and stakeholders.

Monitoring system to be set up Reporting by national agencies on physical and financial accomplishments–semestral Assessment of LGUs according to key parameters A monitoring system will be set up that will include reporting on physical and financial accomplishments. This will be complemented by a system for assessing the performance of LGUs along nutrition program management.

Nutrition-specific programs Nutrition-sensitive programs
Sustainable Development Goals Philippine Development Plan Goal Foundation for inclusive growth, a high-trust society, and a globally competitive knowledge economy Reduced wasting among children under-five years old Reduced stunting among children under-five years old Reduced micronutrient deficiencies Improved situation in overweight and obesity Reduced nutritionally-at-risk pregnant women Increased exclusive breastfeeding Improved food intake Reduced low birthweight Improved complementary feeding Nutrition-specific programs Nutrition-sensitive programs In closing the discussion, let me project once again the overall framework for PPAN Some of the elements of PPAN are not new. Many are continued initiatives. However, what will be endeavored is a better convergence of services at the community and household levels. Nutrition-supportive programs Enabling programs

NATIONAL NUTRITION COUNCIL
Thank You! NATIONAL NUTRITION COUNCIL Chino Roces Ave Extension, Taguig City Official website: FB Pages: Youtube acct: us at: telephone no. (02) or fax no We have once again started a nrw journey for nutrition. I am confident that all here present will join us in this journey. Thank you and mabuhay!

Nutrition problems to address
The PPAN for , like its predecessor plans aims to address prevailing nutrition problems.

Stunting Stunting or being short for age is most prevalent form of undernutrition; and we have a VERY slow decline that includes various forms of undernutrition specifically, stunting or being short-for-age, Child on the right is a “picture” of a stunted child

Wasting The other form of child undernutrition is wasting or being extremely thin High risk of dying wasting or extreme thinness,

deficiencies in vitamin A, iron, and iodine, as well as overall hunger and food insecurity

Overweight and obesity
Then on the other end of the pendulum, we do have overweight and obesity specially among adults.

Undernutrition among children under five years old
Two key points should be noted in this slide. The level of stunting at 33.4% is considered high based on the WHO assessment criteria for severity of the problem. The level for wasting is considered poor also by WHO standards. The other key point is on how undernutrition has remained at about the same level since 2005, with an increase in stunting between 2013 and 2015. Source. National Nutrition Surveys. Food and Nutrition Research Institute, DOST

Trends in the prevalence of stunting from birth up to 3 years of age
A look at stunting prevalence rate by single age group by month would show that stunting prevalence among one-year old children is almost double the prevalence rate among infants. Thus, there is a need to focus actions on preventing stunting early in life.

Overweight by age/population group
Even as we have undernutrition among children, overweight and obesity are also concerns across various age groups, with the problem more serious among adults. Source. National Nutrition Surveys. Food and Nutrition Research Institute, DOST

Trends in the prevalence of nutritionally at-risk pregnant and lactating women, 1998-2015
Part of child undernutrition could be traced to poor maternal nutrition. And based on the national nutrition surveys of FNRI-DOST, undernutrition among pregnant women while showing a downtrend from 1998, has stayed at about the same level since On the other hand, undernutrition among lactating women showed an increasing trend since 2011. Source. National Nutrition Surveys. Food and Nutrition Research Institute, DOST

A look at nutritionally at-risk pregnant women by various socio-demographic characteristics would show that undernutrition is higher among adolescent pregnant women; among those with low level of education, are not working and belonging to the lowest wealth quintile.

Percent low birthweight
Year Percent low birthweight 1998 9.6 2003 13.0 2008 19.6 2013 21.4 Source: National Demographic and Health Survey While low birthweight can be due to many reasons, poor maternal health and nutrition during pregnancy is one important cause, resulting to slow growth of the fetus in the womb. The results of the National Demographic and Health Surveys have not been encouraging as the percentage of low birthweight has been increasing progressively since This gives us the signal to increase focus on the nutrition of women.

Service targets Program Service target
Infant and Young Child Feeding Program 90% of pregnant women receive counseling support on nutrition 90% of mothers with infants 0-5 mos old receive counseling support on EBF 90% of mothers with infants 6-11 mos old receive counseling support on complementary feeding For the service targets or how much of the needy population should be reached, we have set a 90% target for most of the services, except for those for management and prevention of overweight and obesity. The 90% was based on a simulation study by a group of researches that showed covering 90% of the nutritionally needy population could lead to reduced mortality and stunting. Thus, for the IYCF program, pregnant women, and mothers with children 0-23 months old will be reached.

Philippine Integrated Management of Acute Malnutrition 90% of severe acute malnutrition (SAM) cases are treated 90% of near-SAM cases are treated National Dietary Supplementation Program 90% of poor pregnant women who are nutritionally-at-risk receive food supplementation 90% of children 6-23 mos old from poor families receive food supplementation For the PIMAM Program the target is treatment of 90% of severe acute malnutrition or SAM cases, and 90% of near-SAM cases/ The new projects under the National Dietary Supplementation Program will target pregnant women and children 6-23 months old who come from poor and food insecure households.

National Dietary Supplementation Program 100% of children in day care centers receive food supplementation Supplementary feeding expanded to children enrolled in the Supervised Neighborhood Play 100% of severe acute malnutrition cases of school children receive appropriate food supplementation 100% of children in day care centers are targeted for supplementary feeding as are 100% of severe acute malnutrition cases

National Nutrition Promotion Program for Social and Behavior Change 90% of pregnant women, mothers with infants 0-23 months old and acutely malnourished children receive nutrition information through counseling and nutrition classes Multi-media nutrition campaign on key desired behaviors implemented Micronutrient Supplementation 90% of target population receive vitamin A capsules, iron-folic acid supplements, iodized oil capsules and zinc The National Nutrition Promotion Program targets at least 90% of those in the first 1000 days.

Service targets Program Service target Nutrition in Emergencies
Nutrition-related services delivered to affected population in disaster situations Overweight and Obesity Management and Prevention Program 50% of preschool children, school children, and adults covered by healthy eating environment and promotion of healthy lifestyle 50% coverage of preschool children, school children, and adults on weight management interventions For the overweight and obesity management and prevention program, about 50% of target population are covered by Healthy Eating Environment, the promotion of healthy lifestyle, and of adult management interventions.

Philippine Plan of Action for Nutrition (PPAN)

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