Menu ENN Search

Philippine Nutrition Cluster’s battle for the best: the breast

By Ms. Florinda Panlilio, Department of Health, Philippines

Ms. Florinda Panlilio is a Nutritionist-Dietitian IV in the Department of Health -Health Emergency Management Staff, which she joined in 2003. Her current responsibilities include training of nutritionists/dietitians in relation to emergencies and disasters and the development of training modules for nutritional assessment and management during emergencies/disasters.

The author would like to acknowledge the technical and funding support of the UNICEF - Philippines Office, which enabled participation in the regional IFE workshop in Bali at which these experiences were shared, and Dr. Nicholas Alipui, UNICEF country representative in the Philippines at the time, whose work was consulted in preparation for this article.

The Philippines lies along the typhoon belt of the Western Pacific, making it prone to various hydro-meteorological hazards. The country experiences about 20 typhoons annually, which is almost one quarter of all typhoons that occur in the world. Five to six of these typhoons are considered to be of the strongest types and usually cause major damages to life and property. Aside from the destructive winds brought about by typhoons, these can also trigger floods, landslides, and mudslides. Out of all the natural disasters which affect the Philippines, typhoons prove to be the largest killers followed by earthquakes, volcanoes and floods. An inter-agency government team, representing the National Disaster Coordinating Council, has identified 27 out of the 80 provinces as the most prone to hydrological hazards.

The occurrence of strong typhoons always has severe consequences for affected communities, especially if followed by secondary hazards such as floods, landslides and mudslides. Death, loss of livelihoods and destruction of infrastructure frequently occur. Access to food supplies may be constrained while food interventions like school feeding may be disrupted. A significant number of food warehouses and commercial stocks are often destroyed/damaged.

The Cluster Approach in the Philippines

UNICEF supported a mass breastfeeding event that earned a Guinness World Record for simultaneous breastfeeding.

The National Disaster Coordinating Council (NDCC) Memorandum Circular No.5 of May 10 2007 called for the institutionalisation of the Cluster Approach1 in the Philippine Disaster Management System. With the introduction of the Cluster Approach by the UN-Office for Coordination of Humanitarian Affairs (OCHA) eleven clusters were organised. The Nutrition Cluster is led by the Department of Health (DOH) with the Health Emergency Management Staff (HEMS) as its lead, the National Nutrition Council (NNC) as its Assistant Lead and UNICEF as the Inter-Agency Standing Committee (IASC) Focal Agency Counterpart. The leads and member agencies2 participated in a National Clusters' Contingency Planning Workshop in Pampanga on September 18-20, 2007 where agreement was reached on the general objective of the Nutrition Cluster. This is 'to ensure that the nutritional status of affected populations will not worsen or deteriorate due to the impact of a disaster'. Specific nutrition cluster objectives are enumerated below:

Challenges to protection and support of IFE

Prevailing infant and young child feeding practices

One of the priority areas for the Nutrition Cluster is the protection and support of infant and young child feeding in emergencies. However one of the key challenges is the poor prevailing IYCF practice. Survey data from 20033 found that half of all infants were exclusively breastfeeding for less than 24 days, down from 1.4 months in 1998, and only 16% of babies were exclusively breastfed for 4-5 months - well short of the recommended six months. Reasons given by surveyed mothers were: not enough breastmilk (30%), mother working (17%), and nipple/breast problems (17%)4. These responses indicate that women were not properly informed and supported to initiate and sustain breastfeeding. Other significant constraints include the limited government resources for breastfeeding promotion, strong and persistent marketing by milk/infant formula companies, penetration of the health care system by infant formula marketing and little concern, support or protest from the public, civil society or media.

The power of marketing

In the Philippines, the legislative enactment of the International Code of Marketing of Breastmilk Substitutes is reflected in the national Milk Code. Efforts to strengthen it in 2006 - in the form of the Implementing Rules and Regulations (IRR) of the Milk Code - were challenged in court (see Box 1 for details). Despite an initial restraining order, the eventual ruling in favour of the DOH and the IRR has proved an inspirational test case for many other countries. While the Nutrition Cluster considers the Supreme Court's ruling to be a major victory for children in the Philippines, it recognises that the work has just begun if the breastfeeding culture in the country is to be revived, especially during emergencies/disasters. An enormous challenge is the battle against the milk companies, with their multi-billion peso budgets and widespread influence. UNICEF has been consistent in supporting the DOH in pushing the 'BREAST' brand through strong communication and advocacy principles. It is also recognised that public awareness must be increased and institutional involvement strengthened through initiatives such as the provisions of 'Breastfeeding Corners/Stations' in selected malls like the Shoemart located nationwide and the New City Commercial Centre Malls in the Visayas and Mindanao Regions.

Donor driven assistance

A record was kept of 'in kind' donations channelled through the Department of Social Welfare and Development (DSWD) in April 2007 for the victims of Typhoon Reming. The donations by non-governmental organisations (NGOs), government agencies, and schools included infant formula and assorted powdered milk. In the disaster sites, evacuation camps typically had no space to promote breastfeeding. Forty per cent of all that arrived in the first three days was mostly from foreign sources and was not monitored. The humanitarian response was fragmented, independent, and reflected the donor driven assistance of NGOs. Generally, NGOs preferred to have their own system of distributing aid, at times choosing areas with the widest media coverage. Some donor agencies went directly to communities without prior consultation and coordination with national and local disaster coordinators to assess needs. Unsurprisingly, therefore, there was an abundance of relief goods available and inefficient distribution systems in place.

Protective policy

Formula for Disaster DVD

In order to resolve certain issues and generate policy from best practices, the DOH-Health Emergency Management Staff (HEMS) in collaboration with the World Health Organisation (WHO) conducted a series of Post-disaster Evaluation Workshops:

  1. WHO/DOH-HEM Collaborative Post- Disaster Workshop on the Development of a Health Sector Rehabilitation Plan for the Most Affected Municipalities of the Philippine Floods of 2004 (February 22, 2005)
  2. Department of Health/NGO Coordination Meeting on the Health Emergency/Disaster Response (May 03, 2006)
  3. Workshop to evaluate the health cluster response to the typhoon disasters of 2006 (conducted on 15 May - 30 June 2007).

These evaluations concluded that the lack of guidelines and clear-cut strategies for managing the flood of donations post-disaster meant that there was a lack of local capacity to handle the volume of aid, and inappropriate as well as inequitable distribution of donations. There was an immediate 'Call for Action', specifically the development of a national policy for managing humanitarian aid and strengthening of local capacities to prepare for and manage relief supplies. This initiative was primarily aimed at increasing public awareness, sustaining public support, promoting breastfeeding practices especially in the evacuation centres/ camps, establishing a better relationship with donors, setting standards and procedures on management of donations, and enhancing local capacities in handling donations.


Box 1: The Code/Milk Code in the Philippines

The International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly Resolution in May, 1981. The Code has been further clarified and augmented through subsequent World Health Assembly Resolutions. Companies are urged to ensure their practices comply with the Code at all levels. It is a global recommendation and all States are urged to incorporate it into national legislation.

Reflecting this, in 1986, the Philippines adopted legislation to control the marketing of BMS - called the Milk Code. However a move to strengthen it in 2006 (Implementing Rules and Regulations of the Milk Code) was met by opposition from the Pharmaceutical and Health Care Association of the Philippines (PHAP), and a temporary restraining order was placed by the Supreme Court on the new regulations. In June 2007, the Supreme Court heard arguments from both sides. Their decision in October 2007 agreed partially with PHAP in relation to a total ban on advertising of all products under the scope of the Milk Code and that administrative sanctions exceeded the power conferred upon DOH by the Milk Code. However, they ruled in favour of the DOH and lifted the TRO - based on the fact that other parts of the RIRR were consistent with the objective, purpose and intent of the Milk Code and it constituted reasonable regulation of an industry whose activities affect public health.

The experience from the Philippines is significant because the ruling very much supports the principles and implementation of the International Code and has relevance to other countries. The second unique and significant lesson about the Code fight in the Philippines was that despite the size, power and resources behind the PHAP case, the DOH, with the support of UNICEF, WHO and many national and international NGOs, was able to develop a massive, powerful lobby for breastfeeding protection and support, that has been sustained.

The International Code is available at:


The availability of a number of key national and international guidelines and policies facilitated the drafting of the policy. The observed organisational support and agency collaboration was an added strength in pursuing the initiative. The Health Department's budget for breastfeeding promotion for 2008 was increased to $818,000, in addition to funding support from international organizations like UNICEF and WHO. Notable sectoral support included:

Box 2: Philippine's National Policy on acceptance and handling donations in emergencies


Administrative Order 2007 - 0017 "Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations


This shall provide a rational and systematic procedure for the acceptance, processing, and distribution of foreign and local donations that are exclusively for unforeseen, impending, occurring, and experienced emergency/disaster situations.

Definition of terms

DOH Package List for Emergencies and Disasters - shall refer to a listing of items for donation, such as, drugs/medicines, medical supplies, medical equipment, processed foodstuff, micronutrients, environmental supplies, and others. Such list shall be issued by the DOH, in consultation with other government agencies, NGOs, GOs, and other concerned entities.

General Guidelines

Items for donation may be in any form, such as drugs/medicines, medical supplies, medical equipment, processed foodstuff, micronutrients, environmental supplies, and others that may be substantial in addressing emergencies and disaster situations.

Guidelines for Acceptance

Infant formula, breast-milk substitute, feeding bottles, artificial nipples, and teats shall not be items for donation. No acceptance of donations shall be issued for any of the enumerated items.

Dissemination strategy

In the process of writing the policy, the Technical Working Committee led by the DOH - Bureau of International Health Cooperation (BIHC) was engaged in a series of critiquing, revisions, and securing clearances from relevant and concerned agencies before the policy was finally approved and signed by the Secretary of Health. This was immediately followed by intensive dissemination by cluster members at a national convention on HEM, cluster and sectoral meetings, IYCF training and donor conferences. BIHC further endorsed the policy to the foreign embassies based in the Philippines through the Department of Foreign Affairs, in order to safeguard arrival and receipt of foreign donations. The key points of the Signed National Policy that supports IFE is presented in Box 2.


The Nutrition Cluster commits to remain active and vigilant in protecting, promoting and preserving breastfeeding practices in the Philippines, especially in times of emergencies/disasters. Since every disaster is unique, each experience offers an opportunity to learn and strengthen emergency/ disaster management systems. The Nutrition Policy in Emergencies/Disasters is nearing finalisation. Furthermore, the cluster membership will now be guided by a Terms of Reference (TOR) in order to strengthen partnership and clearly define areas of collaboration. The wide dissemination of the policy guidelines and the IRR of the Milk Code are among priority concerns. The advocacy campaign is being reinforced but nutrition workers need to be oriented in nutrition management in emergencies/disasters. At the end of this process, it is hoped that sound nutrition management in emergencies will be a way of life for every Filipino.

For further information, contact: Florinda Panlilio, email: or or Florinda V. Panlilio, Health Emergency Management Staff , 1st Floor , Bldg 12 Department of Health Central Office, San Lazaro Compound, Tayuman, Sta. Cruz Manila or tel: +6329275343287

Show footnotes

1For more information on the Cluster Approach, visit

2Member agencies include DOH-National Center for Disease Prevention and Control (DOH-NCDPC), Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI), Philippine National Red Cross (PNRC), World Health Organization (WHO), Save the Children, Plan International, Hellen Keller International, Department of Social Welfare and Development (DSWD), Department of Interior and Local Government (DILG), Department of Education (DepEd), and United Nation's Population Fund (UNFPA)

3National Demographic and Health Survey, 2003

4NDHS, 2003

5View the film at or order the DVD from Baby Milk Action,

More like this

FEX: Contributing to the Infant and Young Child Feeding in Emergencies (IYCF-E) response in the Philippines: a local NGO perspective

By Romelei Camiling-Alfonso, Donna Isabel S. Capili, Katherine Ann V. Reyes, A.M. Francesca Tatad and Maria Asuncion Silvestre Romelei Camiling-Alfonso has worked for the...

FEX: Issue 34 Editorial

Issue 34 of Field Exchange has a special focus on infant and young child feeding in emergencies (IFE) and is dedicated to the memory of Tom Marchione. Leading the IFE 'show'...

FEX: Management of SAM in the Philippines: from emergency-focused modelling to national policy and government scale-up

By Aashima Garg, Anthony Calibo, Rene Galera, Andrew Bucu, Rosalia Paje and Willibald Zeck Lisez cet article en français ici Aashima Garg is Nutrition Specialist based...

Resource: Guidelines on the acceptance and processing of foreign and local donations for infant feeding during emergency and disaster situations, Philippines

Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations, Administrative Order No. 2007 - 0017. DOH, Rep of...

FEX: Philippines Nutrition Cluster: lessons learnt from the response to Typhoon Haiyan (Yolanda)

By Aashima Garg, Andrew Rene Bucu and Rene Gerald Garela Aashima Garg is Nutrition Specialist based in UNICEF New York. At the time of writing, she was Nutrition Manager with...

FEX: Increased diarrhoea following infant formula distribution in 2006 earthquake response in Indonesia: evidence and actions

By Fitsum Assefa, Sri Sukotjo (Ninik), Anna Winoto and David Hipgrave Fitsum Assefa is a nutritionist with over 15 years experience working on public nutrition in various...

FEX: Challenges of dealing with unsolicited donations during emergencies

A house damaged by flooding By Sawsan Rawas, UNICEF DPRK Thanks to the UNICEF Representative in DPRK, Balagopal Gopalan, for his guidance and support throughout the whole...

FEX: Infant Feeding in Emergencies: Experiences from Indonesia and Lebanon

By Ali Maclaine and Mary Corbett Ali Maclaine has a MSc in Human Nutrition from the London School of Hygiene and Tropical Medicine. She has been involved in infant feeding and...

FEX: Strategy Meeting on Infant Feeding in Emergencies

Summary of international meeting Media/communication Working Group in the foreground and Implementation/Capacity building Working Group in the background On 1st and 2nd...

FEX: Letter on relevance of IFE guidelines in developed countries, by Sarah Saunby

Recently, ENN was party to an exchange of questions and discussion between field staff and 'experts' relating to decisions on the use of readymade therapeutic products versus...

FEX: Regional IFE workshop in Bali

Summary of meeting1 One hundred and twelve participants from 16 countries and special territories, together with regional and international representatives of United Nations...

FEX: The Haiti Earthquake - Country and Global level Cluster Coordination Experiences and Lessons Learnt

By Carmel Dolan and Mija Ververs Carmel Dolan was Global Nutrition Cluster Coordinator-Consultant at the time of the earthquake and located from the UK to UNICEF Headquarters...

FEX: IYCF-E Tech RRT support: Experiences from Iraq

By Sebsibie Teshome, Tech RRT IYCF-E adviser seconded from Save the Children, and Daniel Hadgu Takea, Tech RRT SBC adviser View this article as a pdf Lisez cet article en...

FEX: Infant and young child feeding in emergencies: Programming adaptation in the context of COVID-19 in Lebanon

View this article as a pdf By Bayan Ahmad Bayan Ahmad is Senior Field Officer at International Orthodox Christian Charities (IOCC), where she is responsible for overseeing...

FEX: Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context

Research snapshot1 Information and promotional materials produced by breast-milk substitute (BMS) companies and the distribution of free samples of BMS have a well understood...

Resource: Infant feeding in disasters - A call for awareness (WBW) Title: INFANT FEEDING IN DISASTERS: A CALL FOR AWARENESS Author: Section/SPIG:...

Resource: Formula milk 'dangerous' as humanitarian aid, Indonesia, news article Formula milk 'dangerous' as humanitarian aid *Prodita Sabarini*, The Jakarta...

FEX: Barriers to infant feeding in emergencies programming in middle and high-income countries

View this article as a pdf By Mija Ververs and Cindy Hwang Mija Ververs is a Senior Associate for the Center for Humanitarian Health at Johns Hopkins Bloomberg School of...

FEX: Building national capacities for emergency nutrition preparedness and response in East Asia and the Pacific

View this article as a pdf Lisez cet article en français ici By Mueni Mutunga, Caroline Abla, Alexandra Rutishauser-Perera and Sri Sukotjo Mueni Mutunga is a regional...

FEX: 2011 Edition of the Sphere Handbook Humanitarian Charter and Minimum Standards in Humanitarian Response

Farmers association level consultation at Chuko, Southern Nations, Nationalities and Peoples (SNNPR) province, Ethiopia, August 2009 By Susan Thurstans, Paul Turnbull, Devrig...


Reference this page

Ms. Florinda Panlilio (). Philippine Nutrition Cluster’s battle for the best: the breast. Field Exchange 34, October 2008. p37.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.