Multi-sectorality comes of age in the Philippines: Rollout at sub-national level
ENN’s SUN Knowledge Management team
The Philippines is an archipelago in Southeast Asia with a population of over 105 million. Although a lower middle-income country, the latest Expanded National Nutrition Survey (ENNS) (2018-2020) shows a prevalence of stunting in children under five (CU5) of 30% and a CU5 wasting of 5%, while 4% of CU5 are overweight1. Over the past decade, stunting and wasting prevalence rates have remained relatively stagnant2.
Between July and September 2019, Emergency Nutrition Network (ENN) conducted a detailed case study under the guidance and facilitation of the Philippines National Nutrition Council (NNC) to explore sub-national nutrition programming, with a specific focus on the implementation of the Philippine Plan of Action for Nutrition in two locations, Gingoog City in Misamis Oriental province and Quirino province3. This article summarises the main findings.
Evolution of a multi-sector approach to nutrition
The Philippines has a long history of nutrition programmes, with a multi-sector approach and, following a presidential decree, the National Nutrition Council (NNC) was formed in the 1970s. From its inception, the NNC worked with an interagency committee drawn from the Departments of Health, Education, Social Welfare and Development, and Science and Technology. Various nutrition interventions were implemented at scale, such as setting up nutrition centres and rural improvement clubs, and recruiting and training agricultural workers on developing kitchen gardens in homes, schools and communities, using biointensive agricultural technologies. Despite these efforts, however, there were limited improvements in the country’s nutrition situation.
In 2014, the Philippines joined the SUN (Scaling Up Nutrition) Movement in order to enhance its existing multi-sector nutrition strategy. As expressed by the NNC officials interviewed, by joining a global movement, more clarity was expected on how to make multi-sector approaches work more effectively.
Philippine Plan of Action for Nutrition (PPAN) (2017-2022)
The current PPAN (there have been six since 1993) advocates a multi-sector approach, with a combination of nutrition-sensitive and nutrition-specific programmes implemented at scale. However, from its earliest stage of development, the PPAN (2017-2022) was developed differently from preceding plans. It was formulated over a two-year period, with extensive input and consultations across all levels, including sub-national representation (from regions, provinces, cities and municipalities)4.
PPAN (2017-2022) places particular emphasis on the first 1,000 days of life (from conception to two years old) and includes a focus on school-aged and adolescent nutrition. The plan is partially costed: the cost of commodities for delivery of nutrition-specific interventions is known, and individual agencies receive budgets for planned sector activities. However, there is no costing of nutrition-sensitive actions.
Devolved responsibility through Local Governing Units
A key development in the early 1990s was the devolution of national government services, including devolution of health services to locally elected provincial, city and municipal governments referred to as Local Governing Units (LGUs). The case study found a high level of buy-in from the LGUs in both locations. This included: active nutrition committees; dedicated allocations for staffing in critical positions, such as the Municipal/City Nutrition Action Officers (MNAO/CNAO); increased support to frontline nutrition workers, known as Barangay Nutrition Scholars (BNS)5; and numerous other activities funded from the LGU’s resources.
However, it was clear that commitment to nutrition was very much dependent on the leadership of the local chief executive, be it the governor or the mayor. Leadership also needs to be stable to be effective, as highlighted in the province of Quirino, where critical posts, including Nutrition Action Officers, who are responsible for the coordination of nutrition committees at the LGU level and for development of the Municipal/City Nutrition Action plans, have been in place for several years.
Furthermore, as seen in Quirino, there has been a continuity of plans and programmes across terms of leaders. Ensuring such continuity, irrespective of change in leadership, and ensuring that the nutrition agenda is firmly entrenched in all local development plans, have clearly been significant steps towards enabling sustainability in the province.
Sensitising sectors to make small changes for nutrition improvement
The PPAN emphasises that sectors do not need to radically shift programming, but rather to ‘tweak’ existing approaches to be more nutritionally focused. For example, the Ministry of Agriculture has worked closely with the Ministry of Education to establish gardens in all schools, distributing seeds and conducting agriculture training. The model of multi-sector collaboration also results in each sector identifying interventions for target households within the first 1,000 days (pregnant and lactating women and children under two) and households with children who are either wasted or stunted or both.
The stakeholders interviewed as part of this case study noted that, while nutrition is the prime responsibility of the health sector, there was widespread recognition of each sector’s specific roles in contributing to the improvement of the population’s nutrition status.
Creating a motivating environment
A unique feature of the current PPAN is its incentive and rewards mechanism. An annual awards system, based on performance of the LGUs, uses a specific monitoring tool (the Monitoring of Local Level Plan Implementation (MELLPI Pro) to assess the performance of barangay health stations and local nutrition workers. LGUs are assessed annually by regional teams and receive cash awards based on their scores. This is viewed as significant motivation, with each LGU placing great emphasis on proper documentation to ensure compliance.
Need for further collaboration
Owing to geographical challenges, there is a separation between national government agencies and the LGUs in some instances, and slow bureaucratic processes and national procurement procedures impact on the ability of LGUs to effectively source materials to implement programmes.
Monitoring and evaluation mechanisms also need to be strengthened. For example, one piece missing from all sectors at the LGU level is a joint monitoring mechanism that tracks the coverage of multi-sector interventions that converge on the same households.
The Philippines is faced with a high prevalence of all forms of malnutrition, including rising rates of overweight in all population groups; yet, with a renewed commitment to a multi-sector nutrition approach, ownership at the local government level and adequate resources allocated for the implementation of the PPAN, the country is well placed to accelerate achievement of its nutrition targets.
The full ENN case study is available (https://www.ennonline.net/mspcasestudyphilippines2020) and a video interview with the NNC Chief of Policy and Planning Division on PPAN (2017-22) https://www.ennonline.net/mediahub/video/implementingppanphilippines.
3 The Philippines case study is part of an ENN series to understand country experiences in rolling out multi-sector programmes for nutrition, with a focus on the sub-national level. The Philippines is one of two countries studied in 2019 and completes the series of eight case studies planned in the Technical Assistance for Nutrition (TAN) project, providing knowledge management support to the SUN Movement. The other country case studies are: Bangladesh, Ethiopia, Kenya, Nepal, Niger, Senegal and Zimbabwe.
4 The process was supported by Nutrition International (NI) as a part of the TAN project to provide technical assistance to SUN countries in developing multi-sector plans and mechanisms for nutrition, under the guidance of the NNC. Support also came from UN agencies, including World Food Programme, the Food and Agriculture Organization of the United Nations, United Nations Children’s Fund, and the World Health Organisation. International non-government organisations, civil society organisations and academic institutions were also part of this process.
5 A barangay is the smallest administrative division in the Philippines and is the Filipino term for a village, district or ward. In metropolitan areas, the term often refers to an inner-city neighbourhood, a suburb or a suburban neighbourhood.
More like this
NEX: A catalyst for scale-up in SUN countries: Experiences of technical assistance for Tajikistan and the Philippines
ENN's SUN Knowledge Management team with contributions from Nutrition International (NI) and Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+) Click here and...
Blog post: Blog: Exploring Multi-Sectoral Programming for Nutrition in the Philippines
In 2019 ENN, continuing its case studies series on Multisectoral programming at the Subnational level, plans to study two more countries -Philippines and Zimbabwe, within the...
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...
NEX: Aux Philippines, la multisectorialité est devenue une réalité : déploiement au niveau infranational
Visualiser cet article en PDF Read an English version of this article here L'équipe de gestion des connaissances SUN de l'ENN Introduction Les Philippines sont un...
en-net: Recruiting: TA consultancy to formulate social marketing and communication plan to promote rice fortification in Philippines
PHL-04- Formulation of Social Marketing and Communication Plan to Promote Rice Fortification in Philippines Objectives Overall objective Support the formulation of an...
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...
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...
NEX: Putting communities at the heart of improving nutrition: Experiences from Bénin
View this article as a pdf Lisez cet article en français ici Professor Roch Mongbo is Chief Executive of the Food and Nutrition Council of the Republic of Bénin...
NEX: El Salvador: the road from national nutrition strategy to local implementation
View this article as a pdf Lisez cet article en français ici Dáysi de Marquez is Executive Director of the National Council for Food Security and Nutrition...
NEX: Mapping multi-sector actions in Burundi and Myanmar: Towards more effective coordination
Ernest Niyokindi is Deputy Chief of Cabinet in the Second Vice President's Office for the Republic Burundi and the SUN Movement Government Focal Point. Dr Célestin...
Resource: Multi-sector programming at the sub-national level: A case study of Gingoog City and Diffun and Saguday Municipalities, Philippines
The case study describes the implementation of the The Philippine Plan of Action (PPAN) 2017- 2022 which is a blueprint for an integrated programme of nutrition interventions...
Video: Multi-sector nutrition programming in The Philippines
This video examines the implementation of the The Philippine Plan of Action (PPAN) 2017- 2022 which is a blueprint for an integrated programme of nutrition interventions under...
FEX: Who’s Listening? Accountability to affected people in the Haiyan Response
Summary of case study report1 Report front cover image Thanks to Margie Buchanan-Smith and Sarah Routley, researchers and co-authors of the original report, for sharing this...
FEX: 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...
FEX: Coordination of the Nutrition Sector response for forcibly displaced Myanmar nationals in Cox’s Bazar, Bangladesh
View this article as a pdf Lisez cet article en français ici By Abigael Naliaka Nyukuri Abigael Naliaka Nyukuri worked for United Nations Children's Fund (UNICEF)...
Video: Interview with Ms. Maria Lourdes A. Vega (Didi) NNC Philippines - Implementing PPAN and the challenges ahead
Philippines is a middle income country with a per capita income of 2970 USD. Undernutrition is a serious problem with 30.3 % of children U5 being stunted with very slow...
NEX: Meeting the global nutrition targets 2025: Nepal’s unfinished agenda
View this article as a pdf Lisez cet article en français ici Kiran Rupakhetee is Division Chief/Joint Secretary of the Good Governance and Social Development Division,...
FEX: Municipal budget allocation and utilisation for nutrition in Nepal
View this article as a pdf Lisez cet article en français ici By Shraddha Manandhar, Pramila Shrestha, Bishow Raman Neupane, Satya Narayan Acharya, Harendra Bahadur...
NEX: Mobilising innovative financing and domestic resources for nutrition: Progress and challenges in Burkina Faso
View this article as a pdf Lisez cet article en français ici Ella Compaoré is the Technical Focal Point at the Technical Secretariat in the Ministry of Health...
en-net: Province level SUN platform
What are some good examples of where multisectoral platforms for SUN have been successfully established at province or county level ? Which actors have been involved in these...
Reference this page
ENN’s SUN Knowledge Management team (). Multi-sectorality comes of age in the Philippines: Rollout at sub-national level. Nutrition Exchange 13, March 2020. p11. www.ennonline.net/nex/13/philippines