Investing in Nutrition in the

New Normal
Building Pandemic Resiliency of Local Governments
through Investments in Nutrition

Workshop on Integrating Nutrition

in the 2021 Annual Investment Program
 The Good News
Nutritional Status of Filipino Children 0-5 Years Old
50
44.5
40.5 40
38.8 38.9
40 35.9
33.8 32.9 33.7 33.4
32.2
30.3 30.3
28.8
30

20

10

0 1989 1992 1993 1996 1998 2001 2003 2005 2008 2011 2013 2015 2018 2019
Source: NNS, FNRI-DOST

STUNTING UNDERWEIGHT WASTING OVERWEIGHT FOR HEIGHT

But Covid-19 challenges the gains
• Involuntary hunger doubled in the country from 8.8%
in December 2019 to 16.7% in May 2020
• A global food price crisis in 2008 led to 50% increase
in acute malnutrition among poor children and
higher stunting rates
• Estimated 10 - 45% increase in deaths of under five
children and 8 - 39% maternal deaths every month
with disruptions in health services
• Pandemic remains unchecked. Poses continuing
negative impact in the economy and disruption in
services
Sources: (1) SWS Survey of May 2020, (2) Nutrition and Covid-19: Nutrition is a Threat-Multiplier.
2020 Global Nutrition Report. 21 May 2020
Covid-19 is not the first nor
the last pandemic
Barriers to pandemic resilience

WASTING STUNTING
5.8% of children under-5 28.8% of children under-5
(800,000) (3.4 Million)

MICRONUTRIENT
OBESITY
2.9% of children under-5 DEFICIENCIES
9.6% among adults (Hidden Hunger)

CHRONIC ENERGY FOOD INSECURITY

DEFICIENCY 53.9%
6.9% of adults
 Embarrassment for a
middle-income country

in the ASEAN Region

global stunting burden

in ASEAN Countries
 Simplifying the problem and the
recommended strategy for LGUs
• Among all forms of malnutrition, stunting is the key
problem to solve
• The program for the First 1000 Days (PPA) is the key
program to reduce and prevent stunting
• Together with the First 1000 Days Program, there are
three other nutrition PPAs that will build increased
resiliency against the pandemic
• All these PPAs exist in one form or the other and can
be implemented and budgeted by the local
governments of all income types
Understanding the First 1000 Days
THE FIRST 1000 DAYS OF LIFE

PREGNANCY 270 DAYS

Pre- pregnancy to birth

YOUNGER STAGE
OF INFANCY 180 DAYS
Birth to 6 months

OLDER STAGE OF INFANCY

AND TODDLERHOOD
6 months to 2 years 550 DAYS
Prevalence of stunting among children
0 to 3 years old, 2008-2015
NEGATIVE IMPACT OF STUNTING
ON BRAIN DEVELOPMENT

PERCEPTION &
COMPREHENSION

Temporal
Lobe

MEMORY
LANGUAGE

Source: http//www.globalhealthhub.org/2016/09/19mri-evidence-favor-cash-tranfers/
 WELL-NOURISHED CHILDREN IN THE
FIRST 1000 DAYS…

are10X more Are more likely

likely to overcome the as adults to
most life- threatening have
childhood diseases
healthier
families

Go to earn
Complete 21% more
4.6 more in wages as adults

grades in school
 CONTINUE AND SCALE UP CRITICAL
INTERVENTIONS IN THE FIRST 1000 DAYS OF LIFE
PREGNANCY
1. At least 4 pre-natal visits in 3 trimesters (1-1-2)
2. 180 tablets of Iron-folic acid supplementation
3. Balanced protein-energy dietary supplementation
YOUNGER STAGE OF INFANCY
(Birth to 5 months)
4. Exclusive breastfeeding for the first 6 months
OLDER STAGE OF INFANCY & TODDLERHOOD
(6 -24 months)
5. Age-appropriate complementary feeding with continued
breastfeeding
6. Micronutrient supplementation (Vit. A, Micronutrient Powder)

“Evidence suggests that specific multisectoral, nutrition-specific evidence-

based interventions could reduce child stunting by 20%, if scaled to 90%
coverage” – World Health Organization (WHO) and Lancet Journal
 STATUS OF THE CRITICAL INTERVENTIONS IN THE
FIRST 1000 DAYS IN THE PHILIPPINES

Target Latest
Indicators for the First 1000 Days Coverage Coverage
Source

Pregnant women with 4 or more pre-natal care

visits 90% 52.6 FHSIS 2018

Pregnant women given complete Iron with Folic

Acid (IFA) 90% 54.1 FHSIS 2018

Filipino infants who are exclusively breastfed up to

6 months 90% 29.0 ENNS 2018

Filipino infants 6-23 months meeting the

Minimum Acceptable Diet (MAD) 90% 13.4 ENNS 2018

Vitamin A supplementation (6-59 mos.) 90% 54.9 FHSIS 2018

Micronutrient Powder supplementation (6-23

mos.) 90% 31.3 FHSIS 2018
 WHAT EXPLAINS THIS LOW COVERAGE?
• Philippines is lagging in the league of countries with
positive nutrition outcomes
• Six critical interventions exist in local governments. At
least three of these are budgeted and supported by the
DOH
• Returns to investment in programs in malnutrition are
the highest across thousands of different programs
(Copenhagen Consensus)
• The cost of undernutrition to the Philippine economy is
4.5 Billion Dollars
• There is serious negative impact of stunting to health,
mortality, learning abilities, income, and
intergenerational health
• We have successful models on stunting reduction around
the world and in our country
 SUCCESS STORIES IN STUNTING REDUCTION
28% 13%
Peru (Year 2008) (Year 2016)

7.3%
Mongolia 29.8%
(Year 2016)
(Year 2000)

42.1%
Tajikistan (Year 2000)
17.5%
(Year 2017)

33% 19%
Senegal (Year 1993) (Year 2014)
What did Peru do?
(1) Rallied strong political commitment and a clear direction expressed in
measurable, time-bound goals

(2) Improved quality and coverage of nutrition services, especially in rural areas

(3) Effective financing and targeting for maximum results

 SUCCESS STORIES IN STUNTING REDUCTION
PROVINCE OF QUEZON FIRST 1000
DAYS OF LIFE PROGRAM (Q1K)

At least 4 prenatal visits Stunting

NNS 2015
FHSIS 2017 (12-23 mos., 24-35
mos.)

Q1K Cohort
2018 Q1K Cohort 2018

Exclusive Breastfeeding Low Birthweight

FHSIS 2017 NDHS 2013
(CALABARZON)
Q1K Cohort
2018 Q1K Cohort 2018
 SUCCESS STORIES IN STUNTING REDUCTION
MALABON CITY FIRST 1000 DAYS PROGRAM
Stunting and wasting among children under-five years old in
Malabon City
Operation Timbang Plus, 2013-2019
18 16.3
16 14.9
14
12
11.6
10 8.5 7.9
8 6.6 6.9
5.9
6 4.4 3.7
4 2.8
1.9 1.3 1.2
2
0
2013 2014 2015 2016 2017 2018 2019

Stunting Wasting
 SUCCESS STORIES IN STUNTING REDUCTION
GAMAY BUYAG FIRST 1000 DAYS PROGRAM
(Bata ang Una sa Yaman ng Gamay)
 KEY ACTIONS TAKEN BY LGUs TO
ACHIEVE STUNTING REDUCTION
Leadership of the First 1000 Days Program and the LGU
Nutrition Program
• Establishment of the F1K Program with budget
appropriations and supported by local ordinance
• Scale up implementation and track progress of the six
critical interventions for increased coverage
• Focus on results and stunting outcomes
• Establish information systems for effective monitoring
of results and stunting outcomes, as well as progress
across the six critical interventions
Recommendation for LGUs on
nutrition PPAs in the 2021 AIP
 Nutrition PPAs for LGUs to
invest in the 2021 AIP
First 1000 Days Program
1 To reduce and prevent stunting among children

Philippine Integrated Management

2 of Acute Malnutrition (PIMAM)
To treat and rehabilitate severely wasted children

Food Production, Livelihood, Employment Generation

3 Programs (Nutrition-sensitive Programs)
To ensure food security in the household WATER AND
SANITATION – 15M
Enabling Programs
4 To strengthen governance, capacity, and institutions for effective implementation of nutrition
programs including Nutrition in Emergencies

Other supportive programs in health, water and sanitation, and other sectors in the LGU
Pilot Online AIP Workshop with Municipality of Talibon

Completed 2021 AIP Output from the Workshop

Pilot Online AIP Workshop with Municipality of Talibon

Completed 2021 AIP Output from the Workshop

Pilot Online AIP Workshop with Municipality of Talibon

Completed 2021 AIP Output from the Workshop

 Imperatives for Building Pandemic
Resiliency through Investing in Nutrition
1. Alarming nutrition problem
2. Negative impact of malnutrition on immunity,
resiliency, and overall development
3. Cost of malnutrition to the economy when the
economy is already being devastated
4. Embarrassment for a middle income country
5. Returns to investment in nutrition very high
6. Intervention to address malnutrition exists
7. There are supportive policies for LGUs to invest
in nutrition
 Policies supportive of
scaling up nutrition in the Philippines

Republic Act 11148 Republic Act 11223

“Kalusugan at Nutrisyon ng “Universal Health
Mag-Nanay Act” –
Care Law”
First 1000 Days Law

DILG-DOH-NNC Joint
Memorandum Circular 2019-01
 Policies supportive of
scaling up nutrition in the Philippines

DILG Memorandum Circular 2018-42 DBM Local Budget Memorandum (LBM)

Adoption and Implementation of the No. 77 & 77a for 2019, No. 78 for 2020,
Philippine Plan of Action for Nutrition and No. 80 for 2021
(PPAN) 2017-2022.
 Policies supportive of
scaling up nutrition in the Philippines
DBM Local Budget Memorandum (LBM) No. 80 for 2021 Annual Budgets of LGUs
“Malnutrition is a threat-multiplier…
If no action is taken, the effects of the
current COVID-19 pandemic will only make
it harder for vulnerable populations to
protect themselves against malnutrition”
Global Nutrition Report and the World Bank Group,
21 May 2020