Hunger and Malnutrition in the Philippines

1. Hunger and Malnutrition in the Philippines Danilo Villa B. Agcopra, Nutrition Officer IV National Nutrition Council-Department of Health Philippines

2. NNC Governing Board DOH - Chair DSWD DILG DOST Vice-Chair DBM DA DepEd DTI NEDA DOLE League of Corporate Foundations Rural Improvement Clubs of the Phil Union of Local Authorities of the Phil 2

3. 17 Regional Offices NNC Secretariat Office of the Executive Director Executive Director Deputy Executive Directors Nutrition Policy & Planning Division Nutrition Surveil-lance Division Adminis-trative Division Finance Division Nutrition Information & Education Division

4. NNC Mandates • Formulate national nutrition policies and strategies • Coordinate the national food and nutrition program • Coordinate funds for nutrition • Call on any government instrumentality for assistance

5. NNC Mandates (additional) • EO 616 (April 2007) created the Anti-Hunger Task Force • Oversee implementation of Accelerated Hunger-Mitigation Program • Ensure that hunger-mitigation measures are in place • Report to the President

6. NNC Other assignments • RA 8172 - Formulate policies and coordinate salt iodization program • RA 8976 – Determine need for continued mandatory fortification; which nutrients, which food vehicles

7. NNC Other assignments • DA SO98 S1999 - Focal agency for FIVIMS (Food Insecurity and Vulnerability Information and Mapping Systems) • NEDA Social Development Council Cabinet Level Resolution 1 S2003 - Lead agency to ensure achievement of MDG goals and target on hunger and malnutrition

8. Organizational Structure

9. Outline • Hunger • Malnutrition • Underweight, stunting, wasting • Micronutrient deficiencies • Overnutrition • Actions to address hunger and malnutrition

10. MDG 1 • Reduce by half by 2015 • Prevalence of underweight-for age among under-fives • Percent of households with inadequate energy intake Eradicate extreme poverty and hunger 10

11. Hunger . . . a serious, persistent problem A condition in which people do not get enough food to provide nutrients for fully productive, active and healthy lives If prolonged and severe, can lead to malnutrition

12. Hunger • Proportion of Filipino households with per capita intake below 100% dietary energy requirement, 1993-2008 Source : FNRI-National Nutrition Surveys

13. Quarterly surveys on hunger QUESTION: “In the last 3 months, did it happen even once that your family experienced hunger and did not have anything to eat? If yes, did it happen only once? (moderate) a few times? (moderate) often or always? (severe)”

14. Hunger

16. Undernutrition (underweight, stunting, wasting) --serious nutritional problems

17. Underweight • Trends in percent of underweight-for-age children 0-59 months old compared with MDG target Source : FNRI-National Nutrition Surveys

18. Stunting- short for age, indicate long-term food deprivation and frequent infections Wasting– food deprivation or infection in immediate past

19. High level of stunting & wasting among children under 5 years old Source : FNRI-National Nutrition Surveys

20. Source : FNRI- 2008 National Nutrition Survey

21. High level of stunting & under- weight-for-age among children 6-10 years old Source : FNRI-National Nutrition Surveys, based on NCHS-IRS

22. Nutritional risk among pregnant and lactating women Source : FNRI-National Nutrition Surveys

23. Undernutrition, numberaffected Source : FNRI-National Nutrition Surveys 2008 *Using NSO 2008 Projected Population based on 2000 Census

24. Micronutrient deficiencies --still of public health significance

25. Micronutrient deficiencies • Prevalence of vitamin A deficiency Source : FNRI-National Nutrition Surveys

26. Micronutrient deficiencies • Prevalence of iron deficiency anemia by age and physiologic state Source : FNRI-National Nutrition Surveys

27. Micronutrient deficiencies • Iodine deficiency based on median urinary iodine excretion (UIE) levels Source : FNRI-National Nutrition Surveys

28. Overnutrition is increasing and at a high level among adults (about 20%)

29. Actions to address hunger and malnutrition PNP 1974-1977 PNP 1978-1982 FNP 1984-1987 PFNP 1987-1992 PPAN 1993-1998 The Medium-term Philippine Plan of Action for Nutrition 2011-2016 PPAN 1999-2004 PPAN 2005-2010

30. Philippine Plan of Action for Nutrition, 2011-2016 Philippine Development Plan, 2011-2016 Health, Nutrition and Population Social Protection Basic Education Housing Peace and security Asset reform Chapter 9: Social Development Theme: “Enhancing Peace and Security for Development”

31. MDG 1 • Reduce by half by 2015 • Prevalence of underweight-for age among under-fives • Percent of households with inadequate energy intake Eradicate extreme poverty and hunger 31

32. Goal and targets • To contribute to • improving quality of human resource base of country • reducing child and maternal mortality. • Reduce malnutrition to levels below public health significance

33. Strategies • Focus on the first 1,000 days of life or -9 (pregnancy) to 24 months • Support for pregnant and lactating mothers for desirable infant and young child feeding practices • Capacity building on IYCF counseling • Peer counseling • RA 10028 and EO 51 or the Milk Code • Human milk bank

34. Strategies • Integration of nutrition services in ante- and post-natal care services • Adoption and implementation of community management of acute malnutrition (CMAM) guidelines • Nutrition services for school children (nutrition education, water and sanitation, and personal hygiene)

35. Strategies • Micronutrient supplementation – vitamin A, iron, and iodine • Food fortification - Mandatory for staples (rice, sugar, flour, cooking oil, and salt)

36. Strategies • Home, school and community-based food production - fruit and vegetable or kitchen gardening, raising of small-sized animals, fish production (fish cages, inland fishing or pond) • Improve local food supply and physical and economic access to food

37. Strategies • Prevention and management of infections – deworming, provision of potable water and sanitation facilities • Promotion of good nutrition and healthy lifestyle behaviors – family, school, community using multi-media

38. Sustaining Strategies to Address Hunger “Food for Thought: What do the numbers tell us about hunger and what do we do about it?”

39. Causality MALNUTRITION Low supply of food Low demand for food HUNGER

40. HUNGER MITIGATION MEASURES SUPPLY Increase food production Enhance efficiency of logistics & food delivery Provision of farm inputs, e.g. improved seeds (OPV vegetables and rice), small animals, post-harvest facilities such as flat-bed dryers Construction of small-water impounding projects, diversion dams and other rain-water harvesting and storage facilities Construction and maintenance of RORO systems and farm-to-market roads Provision of rice subsidy Establishment of trading posts

41. HUNGER MITIGATION MEASURES DEMAND Manage population Put more money in poor people’s pockets Promote good nutrition Promotion of responsible parenthood including to access to family planning services Microfinancing Skills training and development for increased employability Employment opportunities in construction & maintenance of rural infrastructure and facilities, e.g. farm-to-market roads, irrigation canals, national and provincial road systems Promotion of exclusive breastfeeding and appropriate complementary feeding Promotion of positive nutrition behavior e.g. reduce plate waste, increase consumption of vegetables

42. Program Highlights • Focused hunger-mitigation measures and services in priority areas

43. A bit of history —Target areas Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS) Very, very vulnerable Provinces (VVV) Very vulnerable (VV) Vulnerable (V) Priority provinces based on the 2003 Family Income and Expenditure Survey (FIES) Priority 1 provinces (P1) Priority 2 provinces (P2) Priority 3 provinces (P3)

44. What did being a priority province mean • More resources to P1 provinces • More counterpart funding expected from P2 and P3 provinces

45. Program Highlights • Gave a hunger-mitigation perspective to some programs, e.g. irrigation, farm-to-market roads, ports construction and improvement

46. Program Highlights • Reached out to hungry and poor with key services • Small animal raising and fisheries-related activities; coconut intercropping and salt fertilization; restoration and rehabilitation of irrigation facilities • Construction/rehabilitation of ports; distribution of flat-bed dryers • Employment generation

47. Program Highlights • Developed new programs to increase food supply and reduce prices • Food for School Program • TindahanNatin • ProgramangGulayan (home, school and community gardening) • Barangay Food Terminal or Barangay Bagsakan

48. Program Highlights • Increased investments in nutrition promotion from almost nothing to about Php 400 M annually • Increased investments in promoting responsible parenthood

49. Learnings • Importance of the following • Data for targeting and on impact • Participative planning • Location-specific intervention

50. Learnings • Support from the top-most leadership (EO 616, 29-member Anti-Hunger Task Force; regular agenda item in Cabinet meetings) • Closely working with local government units to facilitate complementation with local initiatives