Philippine Plan of Action for Nutrition 2011-2016

5 July 2012

Republic of the Philippines NATIONAL NUTRITION COUNCIL NNC GOVERNING BOARD Resolution No. 1, Series of 2012 Approving and Adopting the Philippine Plan of Action for Nutrition (PPAN) 2011-2016 WHEREAS, the social contract of His Excellency, President Benigno Simeon C. Aquino III is focused on institutional reform, economic stability and inclusive growth; WHEREAS, the Philippine Development Plan 2011-2016 under chapter 8 translates inclusive growth by ensuring improvement in the lives of all Filipinos through equitable access to adequate and quality social services and assets; WHEREAS, consistent with the international commitment to achieve the Millennium Development Goals (MDGs), the overall goal of the PPAN is to contribute to improving the quality of the human resource base of the country and to have substantial decreases in child and maternal and overall disease burden; WHEREAS, recognizing the right to food is a moral and legal right, PPAN upholds that food and nutrition is a right of every individual and in every nutrition intervention rights is essential part of a holistic process; WHEREAS, the PPAN believes that attainment of nutritional well-being is a main responsibility of families but duty bearers like government organizations and nongovernment organizations should help the families especially the marginalized, to be able to provide for their own nutritional needs; WHEREAS, PPAN is guided by the principles of multisectoral approach, equity, evidence-based interventions and programs, and good governance; NOW THEREFORE, BE IT RESOLVED AS IT IS HEREBY RESOLVED, in consideration of the foregoing, we the NNC Governing Board do hereby approve and adopt the PPAN 2011-2016 as the framework for achieving nutritional adequacy and thus, contribute to a better quality of life of Filipinos; RESOLVED FURTHER, that we commit our departments or agencies or organizations to: 1. Translate the priority actions into concrete activities, the budgetary requirements of which will be integrated in our annual budgets, which will include funding from development partners; in the spirit of cooperation, complementation of each others efforts and in coordination with the NNC Secretariat; and Advocate for the translation of the priority actions into concrete activities to those within the scope of our influence.

2.

NNC GOVERNING BOARD Resolution No. 1, Series of 2012 Approving and Adopting the Philippine Plan of Action for Nutrition (PPAN) 2011-2016

RESOLVED FURTHER, for the National Nutrition Council Secretariat to ensure that the PPAN 2011-2016 is disseminated as widely as possible to enable stakeholders to align their efforts along the priority concerns; RESOLVED FURTHER, for the National Nutrition Council to monitor and to ensure that this resolution is fully implemented. Approved this 12th day of January 2012.

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NNC GOVERNING BOARD Resolution No. 1, Series of 2012 Approving and Adopting the Philippine Plan of Action for Nutrition (PPAN) 2011-2016

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Philippine Plan of Action for Nutrition 2011-2016

Contents
Challenges.......................................................................................................................................... 1 Hunger ........................................................................................................................................... 1 Underweight, stunting, wasting ....................................................................................................... 2 Micronutrient malnutrition .............................................................................................................. 3 Overnutrition .................................................................................................................................. 6 Regional dimension ........................................................................................................................ 7 Factors affecting undernutrition ...................................................................................................... 8 Objectives .......................................................................................................................................... 9 Hunger ........................................................................................................................................... 9 Underweight-for-age, stunting, wasting ........................................................................................... 9 Vitamin A deficiency .................................................................................................................... 10 Anemia......................................................................................................................................... 10 Iodine deficiency disorders .......................................................................................................... 10 Overweight and obesity ................................................................................................................ 10 Guiding principles ............................................................................................................................ 10 Directions......................................................................................................................................... 11 Strategies and priorities for action ..................................................................................................... 12 Promotion of optimum infant and young child feeding practices in various settings........................ 12 Adoption and implementation of appropriate guidelines for the community-based management of acute malnutrition ........................................................................................................................ 13 Integration and strengthening of nutrition services in ante-natal care services................................. 13 Delivery of an integrated package of nutrition services in the school and alternative school system 13 Increasing the supply and consumption of micronutrients .............................................................. 14 Increasing food supply at the community level and economic access to the available food supply .. 16 Promoting a healthy lifestyle ......................................................................................................... 17 A range of cross-cutting strategies................................................................................................. 18 Plan implementation, monitoring and evaluation ............................................................................... 21 Plan implementation ..................................................................................................................... 21 Monitoring and evaluation ............................................................................................................ 21 Organization and management .......................................................................................................... 22 The NNC Governing Board .......................................................................................................... 23 The NNC Secretariat..................................................................................................................... 24 NNC Technical Committee ........................................................................................................... 25 Regional Nutrition Committee ...................................................................................................... 25 Local Nutrition Committees .......................................................................................................... 25

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Philippine Plan of Action for Nutrition 2011-2016

List of figures
Figure 1 2 3 4 5 6 7 8 9 10 11 Trends in hunger incidence, 1998-2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trend in percent of underweight-for-age children 0-59 months old compared with MDG target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Causes of under-five child mortality, global . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 3

Prevalence (in percent) of vitamin A deficiency among children 6-60 months old, and pregnant and lactating women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Percent of children 6-12 years old with urinary iodine excretion less than 50 mcg/L, Philippines, 1998, 2003, 2008 . . . . . . . . . . . . . . . . . . . . . . . Median urinary iodine excretion among pregnant and lactating women in mcg/L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prevalence of anemia among children, Philippines, 1993, 1998, 2003 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prevalence of overweight-for-age among children under-five years old, 1990-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prevalence of overweight and obesity among adults, Philippines, 2008, based on body mass index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Framework on causes of maternal and child undernutrition . . . . . . . . . . . . . . . . 4 5 5 6 6 8

National Nutrition Council Structure for Coordination . . . . . . . . . . . . . . . . . . . . 23

List of tables
Table 1 2 Regions with high levels of malnutrition using different indicators . . . . . . . . . . . 7 Functions of local nutrition committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Attachment
1 Regional breakdown of selected nutrition indicators . . . . . . . . . . . . . . . . . . . . . . 27

Republic of the Philippines

Philippine Plan of Action for Nutrition (PPAN) 2011-2016

The past years have seen a shift in the nutrition-development paradigm from one that recognizes good nutrition not simply as a by-product of development but as an important input to development. This recognition is not empty as it draws from evidence of the farreaching negative consequences of undernutrition in the early years of life on capacity to learn, to be economically productive in adulthood, and even on the development of noncommunicable diseases like hypertension and diabetes. Thus, efforts to address nutritional problems should be parallel to efforts to address poverty and achieve inclusive economic growth and development to create mutually reinforcing effects. Furthermore, nutrition should be treated as a concern by itself, and one that cuts across and through various sectors.

Challenges
Hunger continues to be a serious concern
The percent of Filipino households with inadequate calorie intake decreased between 1990 (74.2%) and 2008 (66.9%). However, the rate of decline is slower (0.17 percentage point per year) when compared to the targeted decline of 1.5 percentage points per year to reach one of the targets of Millennium Development Goal (MDG) 1. Thus, to reach the MDG on halving levels of hunger in 1990 by 2015, efforts should be geared toward achieving an annual reduction of 4 percentage points per year. In addition, surveys on hunger of the Social Weather Stations since 1998 have shown that hunger situation has been volatile within a year, with spikes and dips (Figure 1). The spikes have been associated with increases in prices of food and key non-food goods specifically fuel, as well as with underemployment. The increase in prices of food has also been associated with the occurrence of both natural and human-induced disasters. Common natural disasters were due to typhoons or flooding (both water and mud), which in the case of Albay in 2006 was exacerbated by the eruption of Mt. Mayon that destroyed many homes and residential areas. Typhoons Ondoy (Ketsana), and Pepeng (Parma) in the late 2009 were not only heavy in rain causing severe flooding particularly in Metro Manila, but happened too soon after each other. On the other hand, human-induced disasters of note in the previous plan period was that of the oil spill in Guimaras and the armed conflict in Mindanao resulting to a surge of internally displaced persons. And in 2010, the El Nio phenomenon was felt more severely in some parts of the country.

Philippine Plan of Action for Nutrition 2011-2016

Figure 1.
28

Trends in hunger incidence, 1998-2010

14

Source: Social Weather Stations Based on responses to the question, Nitong nakaraang tatlong buwan, nangyari po ba kahit minsan na ang inyong pamilya ay nakaranas ng gutom at wala kayong makain? Kung oo, nangyari po ba yan ng minsan lamang? Mga ilang beses o madalas o palagi?

In the last 3 years or so, these disasters have become much more severe with the resulting displacement more protracted. The resulting displacement from home, property and livelihood as well as the negative effect of disasters on agricultural production and incomes further increased the risk of increasing hunger incidence.

Underweight, stunting, wasting continue to be serious nutritional problems

The 2008 national nutrition survey showed a significant decline in the prevalence of underweight-for-age under-five children since 1990 (Figure 2). However, the overall decline was not fast enough and the 20.6 percent prevalence in 2008 was equivalent to an average annual percentage point decrease of 0.37, lower than the targeted 0.55 annual percentage point reduction from 2000 to achieve one of the targets of Millennium Development Goal 1. In addition, stunting (32.3%) among under-fives (an indication of prolonged deprivation of food and frequent bouts of infections) and wasting (6.9%) indicative of a lack of food or infection or both in the immediate past are at levels considered to be high per WHO cut-off points. While stunting decreased from the 2003 level of 33.9%, the average percentage point decrease from 2003 (0.32) was about one-third of the targeted decline of one percentage point per year. Wasting, on the other hand, remained at about the 6% level from 2003 to 2008. The prevalence of underweight, stunting, and wasting among school-age children (6-10 years old) was 33.6% and 33.9%, and 8.1% respectively, based on the 2008 national nutrition survey. (These prevalence rates were based on the IRS). The prevalence of underweight school-age children decreased from 25.6% in 2003 to 22.8% in 2005. However the reported prevalence in 2008 was at the same level as 2003. Thus, the target for underweight school-age children was not met. The 2008 prevalence of nutritionally-at-risk pregnant women was reported to be 26.3%, almost the same level as the 26.6% in 2003. This reduction is equivalent to an average annual reduction of 0.06 percentage points, way below the targeted 0.82 annual percentage point reduction.

Philippine Plan of Action for Nutrition 2011-2016

As noted earlier, undernutrition, particularly early in life, reduces learning capacity in the school-age and economic productivity in adulthood. Figure 2.
40

Trend in percent of underweight-for-age children 0-59 months old compared with MDG target

27.3 23.8 26.6 25.6 23.6 23.0 20.7 20.0 20.6

27.3 20

13.7
Trend Target

0 1990 2001 2010 2015

Source of data on trends in underweight-for-age is based on the national nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology

Undernutrition in childhood has also been identified to be the single major contributor to under-five child mortality (Figure 3). The Philippines is one of the countries that account for 90% of under-five mortality. Figure 3. Causes of under-five child mortality, global

Malnutrition 53%

Source of data: Child Health Epidemiology and Research Groups estimates of under-five deaths 2000-2003

Philippine Plan of Action for Nutrition 2011-2016

Significant improvements in micronutrient malnutrition, but levels still of public health significance
The 2008 national nutrition survey reported significant gains as levels of vitamin A deficiency among pregnant and lactating women (Figure 4) and iodine deficiency disorders among children 6-12 years old, indicative of the situation for the population (Figure 5) registered prevalence rates below public health significance. Figure 4.
50
38 35.3 40.1

Prevalence (in percent) of vitamin A deficiency among children 6-60 months old, and pregnant and lactating women
6 mos. - 5 years old Pregnant Women

Lactating Mothers

25
16.4

22.2

20.1

17.5 16.4 16.5

9.5

15.2

6.4

0 1993 1998 2003 2008

Source: Note:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology Vitamin A deficiency is based on serum retinol. Per WHO guidelines, a prevalence of 15% or more indicates a public health problem deficient

Figure 5.

Percent of children 6-12 years old with urinary iodine excretion less than 50 mcg/L, Philippines, 1998, 2003, 2008
40 35.8

Median urinary iodine excretion of 6-12 year olds WHO 100 mcg/L recommendation 1998 71 2003 201 2008 132

19.7 20 11.4

0 1998 2003 2008

Source: Note:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology Iodine deficiency in a population is determined based on median urinary iodine excretion (should not be lower than the prescribed level) and the population with urinary iodine excretion less than 50 mcg/L (should not be more than 20%).

In addition, iodine deficiency among pregnant and lactating women is of public health significance based on WHO guidelines (Figure 6). Furthermore the prevalence rate of anemia among children decreased significantly (Figure 7). However, levels of IDA among one-year olds (41%), pregnant women (42%), and infants 6-11 months old (55.7%) remained at levels that are considered high as per WHO classification (<40%).
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Philippine Plan of Action for Nutrition 2011-2016

Figure 6.

Median urinary iodine excretion among pregnant and lactating women in mcg/L

180 150 142 135 111 100

105 81

90
WHO recommendation 2003 2008

45

0 Pregnant women Lactating women

Source: Note:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology Iodine deficiency in a population is determined based on median urinary iodine excretion (should not lower than the prescribed level

Figure 7.

Prevalence of anemia among children, Philippines, 1993, 1998, 2003 and 2008
60.0

40.0

20.0

0.0 1y 2y 3y 4y 5y 6-12 y

1998 53.2 36.9 23.4 20.0 18.2 35.6

2003 53.0 34.8 24.8 18.8 14.0 37.4

2008 41.0 26.6 13.7 13.6 10.6 19.8

Source:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology

Deficiencies in vitamin A and iron have been associated with retarded growth, increased morbidity due to infections and increased risk of mortality especially among young children and pregnant women. On the other hand, IDD has been associated with pregnancy wastage (stillbirth and miscarriage), and congenital physical (deaf-mutism, squint or pagkaduling) and mental defects.

Philippine Plan of Action for Nutrition 2011-2016

Overnutrition is also increasing among children and is at a high level among adults
Overnutrition and obesity among children, while at relatively low levels, has been steadily increasing and could increase further if not addressed adequately (Figure 8). About one-fifth of adults 20 years old and over were reported to be overweight, with highest levels among those who are 30-59 years old (Figure 9). Overweight and obesity are among the risk factors associated with diabetes, hypertension, and cardiovascular diseases. Figure 8.
10

Prevalence of overweight-for-age among children under-five years old, 1990-2008

3.5 2.9 2.1 1.1 0 1990 1992 1993 1996 1998 2001 2003 2005 2008 1.1

2.3
1.7 1.7

1.9

Source:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology

Figure 9.
30

Prevalence of overweight and obesity among adults, Philippines, 2008, based on body mass index
24.4 26.3 24.8 20.1

Percent

15

13.1 6.1 2.9 6.8 6.3 4.8

14.4

2.4

0 20-29 y 30-39 y 40-49 y 50-59 y 60-69 y 70 y and above

Overweight

Obese

Source:

National nutrition surveys conducted by the Food and Nutrition Research Institute of the Department of Science and Technology

Philippine Plan of Action for Nutrition 2011-2016

Regional dimension
Hunger and malnutrition are prevalent nationwide. However, some regions are more seriously affected by one or more forms of malnutrition (Table 1 and Attachment 1). Table 1. Regions with high levels of malnutrition using different indicators Under-five children Region Underweightfor-age1
x x Anemia4 IDD5

Stunting2

Wasting3
x x x x x x x x x x x x x x x x

6 mos. 5y
x x x x x x x x x x x x x x x x x

Pregnant
x xx x xx xx x xx xx xx xx x x x xx xx x xx

Pregnant
x x x x x x x x x x x x x x x x

Lactating

Overweight and obesity among adults6

x x x x

1 2 CAR 3 NCR 4-A 4-B 5 6 7 8 9 10 11 12

CARAGA

x x

x x x x x x x x x x x

x x x x x x x x x x

ARMM
1 2

x x x x x x x x x x x

x x x x x

Regions with high level of underweight-for-age are those with prevalence rates of 20% or higher Regions with high level of stunting are those with prevalence rates of 30% or higher 3 Regions with high level of wasting are those with prevalence rates greater than 5% 4 Regions with high prevalence rate of anemia are those with anemia prevalence of 10% or more. The notation xx indicates that the regions prevalence rate is 40% or more 5 Regions with high prevalence of IDD are those with UIE less than 150 mcg/L for pregnant women and 100 mcg/L for lactating women 6 Regions with high level of overweight and obesity are those with prevalence rates higher than the national level prevalence for adults 20 years olds and above

Underweight-for-age is high in almost all regions except Regions 3, 4A, 7, NCR and CAR. Similarly, stunting is high in almost all regions except for Region 1, 3, 4A, and NCR, which are all in Luzon. On the other hand, wasting is high in all regions except for Region 7. Anemia among children 6 mos-5 years old and pregnant women is a problem in all regions, with Regions 2, 3, NCR, 4B, 5, 6, 7, 11, 12 and ARMM registering high prevalence rates (>40%) for pregnant women. Regions 7, 8, 10, and 11 recorded high levels of overweight and obesity among adults.

Philippine Plan of Action for Nutrition 2011-2016

Factors affecting undernutrition

Undernutrition results from the interplay of various factors (Figure 10), with inadequate dietary intake and disease as immediate causes. However, underpinning these immediate causes are underlying ones related to household food security, health services and environmental quality and care practices. However, these factors cannot be isolated from basic causes related to formal and informal institutions, economic structure, and potential resources. Thus, addressing all these factors are important to achieve nutrition targets. Figure 10. Framework on causes of maternal and child undernutrition
Maternal and child undernutrition and death Inadequate dietary intake Disease Immediate causes

Household food insecurity

Inadequate care

Unhealthy household environment and poor health services

Income poverty: employment, selfemployment, dwelling, assets, remittances, pensions, transfers etc

Underlying causes

Lack of capital: financial, human, physical, social, and natural Basic causes Social, economic, and political context
Source: Black, Robert E. et al. The Lancet Series on Maternal and Child Undernutrition. 2008

Philippine Plan of Action for Nutrition 2011-2016

Goals
To contribute to improving the quality of the human resource base of the country and to reducing child and maternal mortality.

Objectives
Hunger
Indicator Households with inadequate calorie intake
*

2008 (Baseline) 66.7

Target by 2016 * 32.8

Targeted reduction of households with inadequate calorie intake is based on an annual percentage point reduction of 4.23 from 2008 to meet the MDG target by 2015, and extended to 2016

Underweight-for-age, stunting, wasting

Indicator Prevalence (in percent) of underweight under-five children Prevalence (in percent) of stunted under-five children Prevalence (in percent) of wasted under-five children Prevalence (in percent) of underweight children 6-10 years old (IRS) Prevalence (in percent) of thin children 6-10 years old Percent of pregnant women who are nutritionally-at-risk Percent of low birthweight
Notes:
1. 2. 3. 4. 5. 6. 7. Baseline data except for low birthweight is based on the 2008 National Nutrition Survey using WHO-Child Growth Standards Targeted reduction of underweight for age under-fives is based on an annual 1.0 percentage point reduction to meet the MDG target by 2015, and extended to 2016 Targeted reduction of stunted under-fives follows the target for underweight-for-age among under-fives, i.e. 50% of 1990 levels since most of the underweight-for-age is due to stunting Targeted reduction of underweight children 6-10 years old is based on the trend for the past 18 years The <5% level of wasted under-fives and school-age children is the level at which the problem is not of public health significance Targeted reduction of nutritionally-at-risk pregnant women is based on mean annual percentage point reduction of 0.44 from 1998 to 2008 Low-birthweight baseline is based on the 2008 National Demographic and Health Survey

Baseline (2008) 20.6 32.3 6.9 25.6 8.1 26.3 19.6

Target by 2016 12.7 20.9 < 5.0 21.8 < 5.0 22.3 < 19.6

Philippine Plan of Action for Nutrition 2011-2016

Vitamin A deficiency, percent of population with low to deficient serum retinol, mol/L
Population Group Preschool children, 6-60 months old Pregnant women Lactating women
*

2008 15.2 9.5 6.4

2016 * < 15% < 15% < 15%

Target is to keep prevalence rates below WHO levels of public health significance

Anemia, percent with hemoglobin level below recommended level

Population Group Infants One-year old children Pregnant women Lactating women
*

2008 55.7 41.0 42.5 31.4

2016 * < 40% < 40% < 40% < 40%

Target is to bring levels to levels considered as moderate based on the WHO criterion

Iodine deficiency based on urinary iodine excretion (UIE), g/L

Indicator Children, 6-12 years old - Median UIE - Moderate and severe (%) Pregnant women - Median UIE Lactating women - Median UIE
*

2008 132 19.7 105 81

2016 * At least 100 <20% At least 150 At least 100

Target is to keep at levels below public health significance per WHO cut-off

Overweight and obesity

Population Group Children, 0-5 years old Children 6-10 years old Adults, 20 years and above
*

2008 3.3 6.5 26.6

2016 * 3.3 6.5 26.6

Target is to at least maintain current levels

Guiding principles
1. 2. Attainment of nutritional well-being is a main responsibility of families It is the duty and obligation of government to assist those who are unable to enjoy the right to good nutrition
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Philippine Plan of Action for Nutrition 2011-2016

3. 4. 5.

Priority given to those with less access and most nutritionally at-risk Evidence-based interventions and strategies, with bias to local research Good governance is at the center of efforts for nutrition improvement

Directions
1. Contribute to the reduction of disparities related to nutrition through a focus on population groups and areas highly affected or at-risk to malnutrition, specifically: a. b. c. 2. Pregnant women, infants, and children 1-2 years old Families with pregnant women, children 0-2 years old, and underweight children 0-5 years old Local government units (LGUs) with high levels of child undernutrition or at risk to increased levels of undernutrition

Increase investments and go to scale in effective interventions that could impact more significantly on undernutrition among under-fives a. Promotion of optimum infant feeding and young child feeding practices anchored on exclusive breastfeeding in the first six months of life, the introduction and use of complementary foods that are calorie- and nutrientdense and safe from 6th month of life onward with continued breastfeeding up to 2 years of age and beyond. Promotion of sanitary practices including personal hygiene and handwashing Supplementation with vitamin A, zinc in the management of diarrhea, ironfolic acid for pregnant women and infants and young children and iodine for pregnant women in areas with levels of iodine deficiency disorders and low access to adequately-iodized salt. Deworming Appropriate medical and dietary management of acute malnutrition as well as of other forms of nutrition-related infections Iron fortification of rice and flour, vitamin A fortification of other staples, and iodization of salt

b. c.

d. e. f. 3. 4. 5.

Revive, identify, document, and adopt good practices and models for nutrition improvement Strengthen food-based approaches to address malnutrition Strengthen the nutrition component of the healthy lifestyle package

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Philippine Plan of Action for Nutrition 2011-2016

6.

Strengthen the linkage of nutrition with other sectors of development and converge with existing sectoral efforts, e.g. conditional cash transfer, universal health care coverage, agriculture development, labor and employment, among others. Strengthen and nurture interagency structures for integrated and coordinated implementation of nutrition and related services at national and local levels Strengthen system for planning, monitoring and evaluation of nutrition plan implementation at national and local levels Formulate and implement a nutrition research agenda

7. 8. 9.

Strategies and priorities for action

Strategies to address nutrition problems are a mix of services that are specific to the form of malnutrition and those that would impact on all forms of undernutrition. Strategies related to governance, i.e. policy, plan and program formulation and coordination, monitoring and evaluation as well as research and policy advocacy also cut across all forms of malnutrition. The following describe these key strategies while Attachment 2 contains target outputs or intermediary outcomes.

Promotion of optimum infant and young child feeding practices in various settings to reduce the prevalence of underweight (from 20.6% in 2008 to 12.7% in 2016) and stunted under-five children (from 32.3% in 2008 to 20.9% in 2016)
The main strategy will be anchored on the promotion of exclusive breastfeeding for the first six months of life and the introduction and use of calorie- and nutrient-dense and safe solid and semi-solid foods (complementary foods) with continued breastfeeding in various settings, specifically the home, rural health units and barangay health stations, birthing facilities, and the formal and informal workplace. Specific interventions to be pursued are as follows: 1. Organization, training, and continuous capacity building of community-based support groups on infant and young child feeding composed of peer counsellors or mothers who have successfully applied optimum infant and feeding practices. Training of health and nutrition workers, including those in birthing facilities and in the workplace, on counselling on infant and young child feeding. Setting up and maintaining human milk banks in selected regional hospitals and medical centers. Setting up of lactation stations in the workplace Enforcement of the Milk Code on the Marketing of Breastmilk Substitutes (EO 51) Group counseling for the promotion of optimum complementary feeding practices
12

2. 3. 4. 5. 6.

Philippine Plan of Action for Nutrition 2011-2016

7. 8. 9.

Home fortification of complementary food through the use of multiple micronutrient powder Multimedia campaign on IYCF-related concerns Integration of IYCF concerns in the curriculum of primary, secondary and tertiary education

Adoption and implementation of appropriate guidelines for the communitybased management of acute malnutrition to reduce the prevalence of wasted under-five children from 6.9 percent in 2008 to less than 5% (not of public health significance) in 2016
Actions will include: 1. 2. 3. 4. Active identification of cases of acute malnutrition particularly in protracted disaster situation Setting up and use of a referral system for acute malnutrition cases with infections Building capacities of health care facilities and the community to provide the appropriate medical and dietary interventions Provision of appropriate medical and dietary interventions

Integration and strengthening of nutrition services in ante-natal care services to reduce the prevalence of nutritionally-at-risk pregnant women from 26.3% in 2008 to 22.4% in 2016
These nutrition services will include the following: 1. 2. 3. Counseling the mother on the appropriate dietary intake, as well as preparing her physically and psychologically for breastfeeding Supplementary feeding when needed and possible Iron-folic acid supplementation.

Delivery of an integrated package of nutrition services in the school and alternative school system to reduce the prevalence of underweight children 610 years old (from 25.6% in 2008 to 21.8% in 2016) and of thin children from 8.9% in 2008 to <5% (not of public health significance) in 2016
The integrated package of services will include 1. 2. Supplementary feeding for thin children Nutrition education through the strengthened integration of nutrition concepts in the school curriculum and consideration of the different nutrition needs of boys and girls
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Philippine Plan of Action for Nutrition 2011-2016

3. 4.

Provision of safe drinking water and sanitary toilet facilities Sustained implementation of the Essential Health Care Program, which includes the promotion of sanitary practices including personal hygiene and handwashing and biannual deworming Growth monitoring and promotion

5.

At the same time, modules on nutrition and food safety and sanitation in the Alternative Learning System including the curriculum developed for indigenous peoples

Increasing the supply and consumption of micronutrients to reduce or maintain the prevalence of vitamin A deficiency and iodine deficiency disorders to levels below public health significance; reduce the prevalence of anemia among infants 6-11 months old, one-year -olds, pregnant and lactating women to less than moderate levels (<40%)
This strategy will involve the following interventions. 1. Micronutrient supplementation a. Ensuring high coverage of prophylactic vitamin A supplementation for children under five years old through the Garantisadong Pambata Expanded Program Vitamin A supplementation of high-risk cases specifically children with measles Iron supplementation of pregnant women for 180 days as well as weekly iron supplementation of non-pregnant women including adolescent females Iodine supplementation for pregnant women in areas with high levels of iodine deficiency disorders that are not well reached by adequately-iodized salt Use of multiple micronutrient powder for infants and young children

b. c. d.

e. 2.

Food fortification that will involve public-private partnership include: a. Continued implementation of RA 8976 on the mandatory fortification at prescribed levels of rice with iron, flour with vitamin A and iron, sugar and cooking oil with vitamin A until a new policy on mandatory food fortification of staples is adopted Strict implementation of salt iodization program through the enforcement of RA 8172 or ASIN Law 1) 2) Close monitoring at the points of production and storage, ports, food establishments and outlets Mobilizing local government units for closer monitoring through Bantay Asin or equivalent groups

b.

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Philippine Plan of Action for Nutrition 2011-2016

3) 4) 5) c.

Adoption of the WYD testing for quality assurance and investing in the needed equipment and supplies accordingly Implementation of internal on-site quality assurance system Increasing accredited laboratories for salt testing in different parts of the country

Provision of support to salt industry along technology development and improvement, quality assurance systems, and incentives related to investment priorities 1) Assistance to salt producers and traders in developing and setting up and maintaining quality control systems, including the training of plant managers on quality control and assurance Assessment and implementation of viable incentives from the national and local governments Strengthening the provision of effective incentive structures to salt producers, traders, and importers Organization of salt cooperatives Facilitating access to fortificant, and qualitative and quantitative test kit

2) 3) 4) 5)

d. 3.

Strengthened implementation of voluntary food fortification to sustain the fortification of processed foods with one or more of vitamin A, iron, or iodine

Promotion of the home-based production and consumption of foods rich in vitamin A and iron with emphasis on animal food sources especially for infants and young children and including fortified foods; as well as on substances that facilitate (e.g. fats for vitamin A and vitamin C-rich foods for iron) or prevent the absorption of nutrients (e.g. substances in coffee and tea) and what can be done to enable the body to absorb as much nutrients as possible a. b. c. Provision of material support for fruit and vegetable gardening, and raising of small animals Multimedia campaign on increased consumption of foods rich in vitamin A and iron, and of fortified food Integration of related information in the school curricula

4. 5. 6.

Promotion of the consumption of fortified foods Continuing advocacy among producers of fortified foods to ensure their compliance to related regulations Prevention and management of related infections (Please see page 16)

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Philippine Plan of Action for Nutrition 2011-2016

Increasing food supply at the community level and economic access to the available food supply to decrease the percentage of Filipino households with inadequate calorie intake from 66.7% in 2008 to 34.7% in 2016
1. Increasing food supply at the community and household levels through food production policies and programs and the development and maintenance of facilities that will allow improved distribution of food a. Pursue appropriate agriculture, agrarian reform, and trade policies and programs that will ensure stable supply of key food commodities at affordable prices 1) 2) 3) 4) 5) Implement the Food Staples Self-Sufficiency Roadmap for 2011-2016 Ensure availability of staples at affordable prices Raise productivity, diversify production, promote value-adding to products, develop markets and sharpen regulatory competence Optimize operations of mariculture and broaden the aquaculture base Enhance farmer access to knowledge and innovation, assets particularly land and water; markets, to enable farmers to pool their outputs and sell to large purchasers, and credit

b.

Improve agriculture infrastructures and facilities (irrigation, post-harvest facilities, ports development, construction of farm-to-market roads, land and air transport) to ensure equitable distribution of food and stabilize food prices Establish kitchen gardens in homes to include small-sized animals all year round Stockpile basic commodities to ensure food supply during emergencies Pursue policies and programs that will stabilize the prices of non-food goods (especially fuel) and services Increase investments in agriculture and give farmers access to: 1) 2) 3) 4) Knowledge and innovation (research and development on more resilient and more sustainable agriculture technologies) Assets particularly land and water Markets, to enable farmers to pool their outputs and sell to large purchasers Credit and financing

c. d. e. f.

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Philippine Plan of Action for Nutrition 2011-2016

2.

Improving economic access to food a. Pursue appropriate policies and programs that will create an environment conducive to investments that will also generate sustainable jobs through public-private partnership 1) 2) 3) 4) Transform agrarian reform beneficiaries into viable entrepreneurs Direct or indirect creation of employment opportunities both at the industry and SME levels Promote creation of permanent employment side by side with emergency employment Support micro-entrepreneurs by establishing relationships with neighboring communities as service providers or building capacities as potential supply chain

b. 3.

Pursue appropriate policies and programs that will develop skills that are consistent with the job market at national and local levels

Build capacities for rural development a. b. c. Off-farm and in-between seasons employment (product development, packaging and marketing) Employment of at least one member of the poor household Creation of links with industries and markets

4.

Protect the vulnerable from food insecurity through food-based safety nets, specifically direct distribution of rice and other basic commodity, and providing emergency employment Converge social protection like health insurance, social security (pensions), conditional transfers, employment guarantees, microcredit and crop insurance in areas must vulnerable to food insecurity and hunger

5.

Promote a healthy lifestyle to prevent a further increase in the levels of overweight and obesity among children and adults
Promotion of healthy lifestyle will be anchored on healthy eating, increased physical activity, managing stress, no smoking and drinking of alcohol in the community, school, and workplace. The nutrition component of the healthy lifestyle package include the following intervention packages: 1. Multimedia campaign on increased consumption of fruits and vegetables including root crops

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Philippine Plan of Action for Nutrition 2011-2016

2. 3. 4. 5.

Wellness programs with a nutrition component in elementary and secondary schools and in the workplace Enforcement of the school policy regulating school canteens on the sale of cola drinks and snack foods in line with the promotion of good nutrition Installation of appropriate infrastructure like walking and running lanes, bicycle lanes to promote physical activity Use of a network for referrals for a comprehensive program for weight reduction a. b. c. Network of nutritionist-dietitians, pediatricians, child psychologists for overweight and obese children Teen centers for adolescents Network of nutritionist-dietitians and endocrinologists for overweight and obese adults

6.

Appropriate nutritional care of older persons .

A range of strategies to contribute to the achievement of all nutrition outcomes

1. Prevention and management of infections particularly diarrhea, pneuomonia, malaria and schistosomiasis a. b. c. d. e. f. Immunization of children Appropriate management of childhood illnesses Zinc supplementation in the management of diarrhea Setting up systems of safe water supply Regular deworming of children Appropriate management of infections with direct link to one or more nutritional deficiencies like malaria and schistosomiasis

2. 3. 4.

Promotion of desirable nutrition and lifestyle behaviours through a multimedia campaign on the Nutritional Guidelines for Filipinos Ensuring access to safe drinking water supply, sanitary toilet facilities and promotion of personal hygiene and sanitary practices Monitoring of weight and height of preschool and school-age children a. Provision of tools for measuring height (height board) and weight (weighing scale) and determining weight and height status (growth charts and table of standards)
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Philippine Plan of Action for Nutrition 2011-2016

b. 5. 6. 7.

Training, monitoring, and coaching on the proper measurement and use of information generated to promote optimum growth

Ensuring universal health insurance coverage Managing population size, growth and distribution, including appropriate birth spacing Coordination and integration of efforts for addressing hunger and malnutrition a. Organization and operations of coordinating structures for nutrition at national and local levels, specifically the NNC Governing Board, the Salt Iodization Board, local nutrition committees, and subject matter-specific technical working groups. Formulation of PPAN strategic plans, updated PPAN 2011-2016 and annual operational plans at national and local levels that could involve the formulation of programs along the priorities of action, e.g. 1) 2) 3) 4) 5) 6) 7) 8) c. d. e. f. Program on Infant and Young Child Feeding Food Fortification Program Micronutrient Supplementation Program Nutrition education Home, School and Community Food Production Program Healthy Lifestyle Program Hunger Mitigation Program Water, Sanitation and Hygiene Program

b.

Integration of nutrition considerations in overall development and sectoral policies, plans, programs, and projects Capacity building for local nutrition program management Development, training, continuing education, and mentoring supervision of community-based nutrition volunteers or barangay nutrition scholars Development, implementation of results-based monitoring and evaluation system and its integration into the Philippine Food and Nutrition Surveillance System Adoption of key nutrition and related policies at national and local levels 1) Legislation on a) b) c) Mandatory plantilla positions on nutrition at the local level Incentives for barangay nutrition scholars Funding allocation for nutrition and related programs, e.g. assured funding for micronutrient supplementation, establishment of Nutrition Improvement Fund

g.

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Philippine Plan of Action for Nutrition 2011-2016

2)

Policies, guidelines, and standards on a) b) c) d) e) f) g) h) Operation Timbang Plus Growth monitoring of preschool and school children Nutrition planning at national and local levels Nutrition education Integration of nutrition considerations in development and sectoral policies, programs, and projects Strengthening the gender perspective of nutrition action Community-based management of acute malnutrition Guidelines to implement the policy on nutrition management in emergencies

h.

Conduct of research for informed decision making on nutrition action to include but not limited to the following: 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Causality of thinness among school-age children Causality of undernutrition among boys Nutrition conditions of children with disabilities, in institutions, and out-of-school youth Assessment and determination of incentive package for the salt industry Research related to legislation on extended maternity leave and on mandatory nutrition labeling Modeling of the integration of nutrition and related interventions in antenatal care Modeling of a sustainable school nutrition program Potential use of positive deviance approach to prevent undernutrition Evaluation of specific components of MTPPAN 2011-2016 Nutritional implications of macro-economic and sectoral policies and programs

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Philippine Plan of Action for Nutrition 2011-2016

Plan implementation, monitoring and evaluation

Plan implementation
Implementing and translating the PPAN 2011-2016 into specific programs, projects, and activities will be the joint effort of selected national government agencies, local government units, nongovernment organizations, the food industry, the academe, and international development organizations. While plan implementation will be the primary responsibility of local government units, national government agencies will provide the needed policy support, continuously build capacities for nutrition program management (that will include the range of processes related to planning, monitoring, evaluation and coordination), and the provision of various forms of logistics support especially to poor municipalities and provinces. The involvement of national government agencies in implementing PPAN 2011-2016 will be further concretized in the PPAN 2011-2016 investment plan and integrated in the agencys annual budget proposal. Nongovernment organizations will also be involved in plan implementation through their specific nutrition and related programs and projects in close coordination with relevant national government agencies and the local governments in their areas of operation. The food industrys main involvement will be along compliance to legislation on mandatory and voluntary food fortification. It will also continue to ensure the safety of foods that it manufactures and markets. It will also be involved and participate in efforts for continuously raising awareness and consciousness on desirable nutrition and related practices as contained in the Nutritional Guidelines for Filipinos. Academic institutions will contribute primarily through the conduct of researches that will address information gaps for more effective policy, plan, and program formulation, and in the dissemination of research results. The integration of key nutrition concepts and practices in the curricula especially in medicine and allied medical courses, agriculture, and other development-oriented courses will also be an involvement of academic institutions, together with extension services through which various forms of nutrition and related services are delivered in target communities. Academic institutions will also be tapped for training nutrition and related workers along specific concerns of PPAN 2011-2016. International development organizations will complement the resources of national and local governments for nutrition programs and projects. They will also continue to extend technical assistance and facilitate across-country sharing and learnings along efforts for nutrition improvement. They will coordinate among themselves and with national and local governments in their areas of operation.

Monitoring and evaluation

The Philippine Food and Nutrition Surveillance System will continue to provide the overall mechanism for monitoring and evaluating PPAN 2011-2016. It will include three componentsone for collecting, processing, and analysing data that will indicate progress of plan implementation at both output and financial utilization levels, another for assessing the progress toward achieving the plan targets in terms of changes in the nutrition situation, and another for providing early warning on an impending worsening situation in specific parts of the country. .
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Philippine Plan of Action for Nutrition 2011-2016

Assessing progress of plan implementation will use a mix of strategies that include a system for regular reporting horizontally (within one level) and vertically (from one level to the next higher level), conduct of regular meetings of the various committees in the nutrition policy and coordination structure, and the conduct of field visits for first-hand observation of outputs, activities, and interaction with implementors and beneficiaries. Determining changes in the nutrition situation will use extensively the results of existing national survey systems. These survey systems include the national nutrition survey of the FNRI-DOST, the National Demographic and Health Survey, Family Income and Expenditure Survey, and the Annual Poverty Indicator Survey, among others. It will likewise strengthen related local systems at the local level, particularly the Operation Timbang Plus system as well as the system for Monitoring and Evaluation of Local Level Plan Implementation (MELLPI). Plan implementation will be assessed through the conduct of annual program implementation review (PIR) at the national and local levels. A mid-term review will be conducted at the middle of the plan cycle in time for the assessment of the NEDA PIR for the assessment of the Philippine Development Plan, and an end-term review in the last year of the planning cycle in preparation for plan formulation for the next development planning cycle. The regular program review will enable stakeholders to make appropriate decisions to enhance or modify program strategies. It will involve discussions and sharing of good practices to identify emerging opportunities for nutrition improvement and quickly respond to implementation issues. An appropriate nutrition early warning system will be set up at both national and local levels within the plan period. The system is envisioned to generate key and sensitive indicators that could signal an impending worsening of the nutrition situation to allow timely intervention. The monitoring and evaluation system will likewise have a feedback mechanism to ensure that the results of monitoring will be used to institute adjustments for improvement and acknowledge those with outstanding performance. At the local level, the monitoring system will provide the basis for local nutrition committees to immediately act and intervene for nutrition problem.

Organization and management

The structure for coordinating nutrition action at the national and local levels (Figure 11) will continue to provide the mechanism for integrating and harmonizing actions for nutrition improvement. A continuing effort will be along ensuring the functionality and sustainability of these structures.

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Philippine Plan of Action for Nutrition 2011-2016

Figure 11. National Nutrition Council Structure for Coordination

National Nutrition Council Governing Board Technical Committee National Nutrition Council Secretariat

Regional Nutrition Committee Chair: Regional Director*

Provincial Nutrition Committee Chair: Governor

City Nutrition Committee Chair: City Mayor

Municipal Nutrition Committee Chair: Municipal Mayor

Barangay Nutrition Committee Chair: Barangay Chairman

* Elected from among the regional directors of regional government agencies

The NNC Governing Board

The National Nutrition Council Governing Board will continue to provide overall leadership in plan formulation, implementation, monitoring, evaluation, and coordination. The NNC Governing Board is composed of the following: 1. Secretary of Health, Chairperson 2. Secretary of Agriculture, Vice-Chairperson 3. Secretary of the Interior and Local Government, Vice-Chairperson 4. Secretary of Budget and Management 5. Secretary of Education 6. Secretary of Labor and Employment 7. Secretary of Science and Technology 8. Secretary of Social Welfare and Development 9. Secretary of Trade and Industry 10. Secretary of Socio-Economic Planning and Director-General, National Economic and Development Authority 11. Three private sector representatives appointed by the President of the Philippines for a two-year term
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Philippine Plan of Action for Nutrition 2011-2016

The NNC Governing Board draws its mandate from various policy instruments as listed below. EO 234, which has the effect of a law : 1. 2. 3. Formulate national food and nutrition policies and strategies for nutritional improvement; Coordinate the planning, and monitor and evaluate the implementation of the integrated national food and nutrition program; Coordinate the release of funds for nutrition programs and projects as well as the requests for grants and loans by government and non-government agencies involved in the food and nutrition program; and Call on any department, bureau, office, agency, and other instrumentalities of government for assistance in the form of personnel, facilities, and resources as the need arises.

4.

EO 616, April 2007. Oversee implementation of the Accelerated Hunger-Mitigation Program (AHMP) to ensure that hunger-mitigation measures are in place. SDC Resolution No. 1 series 2003. Lead in ensuring the achievement of MDG goals and targets on hunger and malnutrition RA 8976, 2000. Determine need for continued mandatory fortification; which nutrients, which staples or food vehicles RA 8172, 1995. Formulate policies and coordinate the national salt iodization program

The NNC Secretariat

The NNC Secretariat will continue to serve as the executive arm of the NNC Governing Board. It is headed by an executive director, assisted by two (2) deputy executive directors. It has three technical divisions (nutrition policy and planning; nutrition surveillance; and nutrition information and education) and two support divisions (administrative and finance). Its seventeen (17) regional offices are headed by nutrition program coordinators. The functions of the NNC Secretariat are: 1. 2. 3. 4. 5. 6. Advise the Board on nutrition policy and program matters; Coordinate with government agencies and non-government organizations for nutrition program management and resource programming; Recommend a comprehensive food and nutrition policy; Develop measures to improve the implementation of PPAN; Monitor and analyse nutrition and related socio-economic data for a periodic statement on the countrys nutrition situation; Monitor and evaluate the PPAN;
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Philippine Plan of Action for Nutrition 2011-2016

7. 8.

Develop and implement a comprehensive advocacy, information and education strategy for the PPAN; and Provide technical, financial, and logistics support to local government units and agencies for the development and implementation of nutrition programs and projects.

NNC Technical Committee

The NNC Technical Committee is composed of heads of major department bureaus and agencies involved in nutrition and appropriate non-governmental organizations. It provides technical assistance to the Board and NNC Secretariat and facilitates inter-agency and intraagency coordination, supervision and monitoring, and implementation of nutrition policies and programs. When needed, the NNC Governing Board and Council Secretariat may also create Technical Working Groups (TWGs), task forces, ad hoc bodies, and other interagency bodies as may be needed to address particular issues and strengthen interagency collaboration.

Regional Nutrition Committee

At the regional level, the Regional Nutrition Committee will continue to coordinate nutrition action at the local level. It will be composed of the same agencies as the NNC Governing Board with additional member agencies as may be needed and appropriate for the region. Its functions are to formulate, coordinate, monitor, and evaluate the regional nutrition action plan. It also extends technical assistance to local nutrition committees along nutrition program management. It may create technical working groups and other similar inter-agency groups to attend to address particular issues and strengthen interagency coordination. The NNC Regional Office will provide technical and secretariat support to the Regional Nutrition Committee

Local Nutrition Committees

Local nutrition committees that replicate the inter-agency composition of the NNC Governing Board will also continue to be the coordinating structure for nutrition action at the local level. Local nutrition committees will be advocated to be either a committee or a subcommittee of the local development council. The functions of the local nutrition committee are shown in Table 2. Table 2. Functions of local nutrition committees
City/Municipal Nutrition Committee 1. Assesses the city/municipal nutrition situation 25 1. Barangay Nutrition Committee Assesses the barangay nutrition situation

Provincial Nutrition Committee 1. Assesses the provincial nutrition situation

Philippine Plan of Action for Nutrition 2011-2016

Provincial Nutrition Committee 2. Formulates the provincial nutrition action plan complementary to and integrated with other plans of the LGU and higher level plans Coordinates, monitors and evaluates plan implementation and recommends and adopts appropriate actions 2.

City/Municipal Nutrition Committee Formulates the city/municipal nutrition action plan complementary to and integrated with other plans of the LGU and higher level plans Coordinates, monitors and evaluates plan implementation and recommends and adopts appropriate actions 2.

Barangay Nutrition Committee Formulates the barangay nutrition action plan complementary to and integrated with other plans of the LGU and higher level plans Coordinates, monitors and evaluates plan implementation and recommends and adopts appropriate actions Organizes groups to implement nutrition intervention activities Mobilizes resources to ensure the plan is implemented Holds at least quarterly meetings to monitor program performance

3.

3.

3.

4.

4.

Mobilizes resources to ensure the plan is implemented Holds at least quarterly meetings to monitor program performance Extend technical assistance to municipal nutrition committees on nutrition program management and related concerns, including the conduct of periodic visits and meetings with the C/MNC Monitors the performance of Municipal/ Barangay Nutrition Action Plan

4.

Mobilizes resources to ensure the plan is implemented Holds at least quarterly meetings to monitor program performance Extend technical assistance to barangay nutrition committees on nutrition program management and related concerns, including the conduct of periodic visits and meetings with the BNC Monitors the performance of Barangay Nutrition Action Plan

5.

5.

5.

6.

6.

6.

7.

7.

The local chief executive chairs local nutrition committees, providing leadership in nutrition planning, implementation, monitoring and evaluation. More specific functions include 1) the organization, reorganization, and strengthening of the local nutrition committee (horizontally and vertically), 2) securing and providing funds for implementing the local nutrition action plan, and 3) presiding over meetings of the local nutrition committee. The local chief executive also appoints the nutrition action officer either as a full-time worker or a designee from among the heads of offices of the local government. The city/municipal mayor also appoints barangay nutrition scholars The nutrition action officer attends to the day-to-day coordination of local nutrition action. He/she initiates the activities to actualize the functions of the local nutrition committee, e.g. plan formulation, monitoring, evaluation, advocacy for the concerns of the nutrition action plan, provision of technical assistance to the lower nutrition committee and conduct of regular meetings. An effort during the plan period will be to encourage local chief executives to hire full-time nutrition action officers with the appropriate staff and office support.

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Philippine Plan of Action for Nutrition 2011-2016

Attachment 1 Regional breakdown of selected nutrition indicators Prevalence rate of various forms of undernutrition based on the 2008 national nutrition survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology Children 0-5 years old Underweight for-age Philippines I II III IV-A IV-B V VI VII VIII IX X XI XII CARAGA NCR CAR ARMM 20.7 20.3 20.5 14.5 16.5 26.6 26.4 25.0 19.4 26.4 25.4 21.6 22.0 24.7 22.7 17.4 15.5 24.4 Stunting 32.3 27.5 31.1 22.3 24.8 37.2 38.2 39.1 35.1 41.1 40.3 37.7 37.0 39.6 37.2 24.7 36.3 39.7 Wasting 6.9 6.5 8.0 7.1 6.5 7.0 8.0 8.5 4.6 6.7 8.0 6.6 5.7 6.9 7.8 6.2 5.8 10.3 Thinness among 6-10 year olds 8.1 10.1 7.3 7.7 9.8 11.0 10.3 11.3 5.1 5.9 7.5 5.9 6.3 5.6 4.6 8.1 4.5 8.7 Anemia 6 mos 5 years 23.7 29.4 39.3 21.4 22.9 25.4 24.9 29.1 20.4 16.1 20.5 16.0 15.4 34.8 29.0 23.7 12.4 22.7
27

Pregnant 42.5 33.3 60.0 40.7 37.8 49.6 51.1 61.5 40.4 39.5 34.1 35.7 22.6 49.8 34.3 48.0 22.6 47.3

Lactating 31.4 36.6 58.2 31.5 25.6 28.1 24.3 44.5 35.0 23.6 17.3 22.9 24.1 39.6 25.8 39.8 26.8 29.8

% with UIE<50 mcg/L 6-12 yrs old 19.7 9.9 4.7 10.2 11.9 28.3 13.7 24.0 24.5 37.7 26.0 30.4 37.4 27.9 36.1 13.8 13.8 17.8

Median urinary iodine excretion 6 12 years 132 159 233 191 170 115 135 117 119 83 84 90 68 109 85 202 158 101 Pregnant 105 82 157 143 111 75 125 111 82 83 68 38 62 105 94 135 107 85 Lactating 81 112 161 94 97 67 97 74 63 58 48 55 50 72 49 128 99 88

Philippine Plan of Action for Nutrition 2011-2016

Prevalence rate of various forms of overweight and obesity based on the 2008 national nutrition survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology Overweight children 0-5 years old 3.3 3.6 3.4 5.1 3.9 2.5 1.6 3.2 2.2 1.8 2.0 2.2 2.0 2.2 2.0 4.1 4.9 5.9 6-10 years old Overweight 6.5 3.5 3.2 4.1 4.7 2.3 1.9 2.7 2.8 2.8 1.9 3.7 3.5 3.4 3.7 5.7 6.9 3.0 3.0 3.3 4.3 4.0 0.9 0.8 2.5 1.7 1.5 1.5 1.8 2.8 1.7 1.9 6.9 3.2 2.4 5.5 4.6 5.5 6.6 2.4 2.4 2.7 3.7 2.6 2.2 3.5 4.7 3.4 4.9 7.6 6.6 4.5 Obesity 10-19 years old Overweight 4.6 1.9 1.3 2.3 2.0 0.9 0.2 1.2 1.8 0.8 1.3 1.0 1.2 0.6 0.8 2.6 1.6 1.2 19.5 18.7 23.8 23.3 16.8 17.5 16.2 22.4 20.9 19.2 23.1 23.4 20.9 23.9 34.8 24.4 14.3 Obesity 20 years and above Overweight 26.6 3.5 3.6 6.0 6.0 3.7 3.0 3.2 5.6 6.1 4.7 6.0 5.4 4.5 5.7 7.4 5.5 2.8 Obesity

Philippines I II III IV-A IV-B V VI VII VIII IX X XI XII CARAGA NCR CAR ARMM

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