Philippine Plan of Action

for Nutrition 2017-2022

Executive Summary

1. The Philippine Plan of Action for Nutrition (PPAN) 2017-2022 is an integral part of
the Philippine Development Plan 2017-2022. It is consistent with the Duterte
Administration 10-point Economic Agenda, the Health for All Agenda of the
Department of Health (DOH), the development pillars of malasakit (protective
concern), pagbabago (change or transformation), and kaunlaran (development), and
the vision of Ambisyon 2040. It factors in and considers country commitments to
the global community as embodied in the 2030 Sustainable Development Goals, the
2025 Global Targets for Maternal, Infant and Young Child Nutrition, the 2014
International Conference on Nutrition.

2. It is a results-based plan with SMART results at different levels designed in a results

framework.

3. It consists of 12 programs and 45 projects serving as a framework for actions that

could be undertaken by member agencies of the National Nutrition Council (NNC),
other national government agencies, local government units, non-government
organizations, academic institutions, development partners. For better
accountability, a member agency of the NNC Governing Board has been designated
as lead for one or more of these programs.

4. Of these 12 programs, 8 are nutrition-specific, one is nutrition-sensitive and three

are enabling support programs. A program for local government mobilization is
among the three enabling programs to ensure their wider participation in delivering
nutritional outcomes.

5. The PPAN 2017-2022 comes with a budget estimate for the entire period of six years.
The plan has a monitoring and evaluation framework showing the plan for progress
monitoring and evaluation through the six year period.

6. Operationalizing the PPAN 2017-2022 will involve the formulation of the National
PPAN Implementation Plan also for the same time period. This implementation plan
will cover specific activities to be undertaken for each program for each year. It will
be updated annually to respond to the evolving situation. The implementation plan
will include a resource framework with explicit estimates of funded and unfunded
budgets and a resource mobilization strategy. This strategy will endeavor to ensure
that needed resources will eventually be available within the plan period.
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

7. At the regional level, a Regional Nutrition Action Plan will be formulated to capture
initiatives of regional offices of member agencies of the Regional Nutrition
Committee along the PPAN programs for 2017-2022. Like the National PPAN
Implementation Plan will be updated annually.

8. At the local level, local nutrition committees will formulate or reformulate their
respective nutrition action plans (LNAPs). These plans, while formulated along the
PPAN programs, will consider the locality’s nutrition problems and causes. Per
guidelines these LNAPs should cover the three-year term of the local chief executive,
and relevant items integrated in the annual investment plan of the local government
unit.

9. The National Nutrition Council Secretariat led and coordinated plan formulation.
Plan formulation started with the conduct of a nutrition landscape analysis
commissioned by NNC with support from Micronutrient Initiative and the United
Nations Children’s Fund (UNICEF). A team of Filipino consultants conducted the
assessment from August to October 2016 using landscape analysis based on
document reviews, focus group discussions, key informant interviews, inter-sectoral
consultations and validation meetings with a wide range of stakeholders. The results
of the analysis is contained in a separate document “Situation Analysis of Nutrition in
the Philippines”. However, its key findings are in the first part of the plan document.

10. Plan formulation was participatory, inter-sectoral, and multi-level. It engaged the
participation of the NNC member agencies and their department senior officials at
the national and regional levels as well as members of provincial and municipal
nutrition committees of LGUs where the FGDs were held, i.e. 6 regions, 5 provinces,
and 22 cities and municipalities. Please see Attachment 1 for the list of LGUs and
persons covered by the FGDs.

11. Two consultation meetings, prior to the drafting of the plan and after the plan was
drafted, were convened to ensure a wide participation in the plan formulation. The
first round of consultation with an inter-sectoral group of 16 agencies joined by
development partners and the academe was held in Tagaytay on 12-16 September.
During the consultation, the national nutrition situation was reviewed together with
issues related to policy and program formulation and implementation. The overall
strategy and programs for PPAN 2017-2022 was agreed on during this consultation.

12. The national round of consultation was held in Cebu on 17-18 November. During
this consultation, more specific directions for the programs identified in the Tagaytay
workshop were discussed and refined.

13. This was followed by two more meetings of the NNC Technical Committee on 23
November 2016, and 12 January 2017 before the final approval of the NNC
Governing Board on 21 February 2017.

14. Even as the PPAN 2017-2022, related concerns were brought into discussions of
relevant sectors of the Philippine Development Plan.
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

15. The PPAN 2017-2022 is divided into two parts: Part 1 consists of a summary of the
situation analysis of nutrition in the country in 2016; and Part 2 presents the plan.

16. Part 2 is divided into section describing the rational for the PPAN, followed by a brief
description of the PPAN, a description of the 11 programs and their classification, the
projects included in each program, the program structure and results framework,
PPAN strategy, the organization for its overall management and coordination, the
monitoring and evaluation framework, and the plan’s budget estimates section
including a resource framework and resource mobilization strategy.

Nutrition problems to be addressed

17. High levels of stunting and wasting among children under-five years of age, with
levels that have remained unchanged over the years (Figure 1). Also stunting is
relatively low among infants 0-11 months old, but is significantly higher among one-
year olds (Figure 2). The prevalence of stunting remains high for the older children.

Figure 1. Trends in the Prevalence of Malnutrition among Children Under Five

Years Old: NNS, 1989-2015
50 44.5
40.5 40
38.8 38.9
40 35.9
33.8 32.9 33.7 33.4
32.2
30.3
30 27.3 26.6 25.6
23.8 23.6 23
20.7 20.6 20.2 21.5
20 20
20

7.5 7.8 6.8 6.8 7.3 8.0 7.1

10 6.2 6.2 6.1 5.8 6.0
4.3 5.1 3.9
2.1 1.7 2.3 1.9 2.9 3.5
1.1 1.1 1.7
0
1989 1994 1999 2004 2009 2014

Underweight Stunting Wasting Overweight-for-height

Source: NNS 1989-2015, FNRI-DOST

Figure 2. Trends in the Prevalence of Stunting in Children from Birth to Three
Years: NNS, 2008 to 2015
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

18. Deficiencies in vitamin A, iron, and iodine particularly among groups for which the
problem is of public health significance (Table 1)

Table 1. Prevalence rate of micronutrient malnutrition

Micronutrient deficiency/ Population Prevalence rate

group affected
2008 2011 2013

Vitamin A deficiency: % of children 6 15.2 No data No data

mos-6 years old with low to deficiency
serum retinol
Anemia: % of anemic women of 18.6 No data 12.0
reproductive age (*20-39)
Iodine deficiency: No data
- Median urinary iodine concentration
o Children, 6-12 years old 132 ug/L 168 ug/L
o Pregnant women 105 ug/L No data
o Lactating women 81 ug/L No data
- Percent with iodine excretion
concentration <50 mcg/L
o Children, 6-12 years old 19.7% 16.4%
o Pregnant women 25.8% No data
o Lactating women 34.0 % No data

19. Hunger and food insecurity with 68.3% of Filipino households not meeting their
caloric requirements. While this level is lower than that recorded in 1989 (74.1%) it
is higher than the level reported in 1998 (57%) and 2008 (67%).

20. At the same time, overweight and obesity among various population groups should
be addressed, especially among adults (Figures 3).

Figure 3. Overweight and obesity among various population groups

 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

21. Maternal nutrition should also be addressed as survey results have shown that the
prevalence of nutritionally-at-risk women

Figure 4. Prevalence of Nutritionally At-Risk Pregnant Women by Age,

Educational Attainment, Place of Residence and Wealth Index

Wealth index
Age (years)
≥ 20 21.9 Richest 18.6
< 20 39.6 Rich 22.1
Educational attainment Middle 24.1
College, graduate 15 Poorest 24.4
College, undergradute 20.8 Poorest 29.7
Vocational graduate 19.8 Place of residence
Vocational undergraduate 27.7
Rural 23.8
High school graduate 28.6
Urban 24.8
High school undergrad 24.3
Working/employment status
Elem graduate 18.3
non-working 26.4
Elem, not completed 30.5
No grade completed 49 Working 17.9

0 10 20 30 40 50 60 0 10 20 30 40

Source: NNS 2015, DOST-FNRI

Goal

22. To improve the nutrition situation of the country as a contribution to:

a. The achievement of Ambisyon 2040 1 by improving the quality of the human

resource base of the country

b. Reducing inequality in human development outcomes

c. Reducing child and maternal mortality

Objectives

23. PPAN 2017-2022 has two layers of outcome objectives, the outcome targets and the
sub-outcome or intermediate targets. The former refers to final outcomes against
which plan success will be measured. The latter refers to outcomes that will
contribute to the achievement of the final outcomes.

1
Ambisyon 2040 is the Philippines’ long-term vision, i.e. “By 2040, the Philippines shall be a prosperous,
predominantly middle-class society where no one is poor, our people shall live long and healthy lives, be smart
and innovative, and shall live in a high-trust society. The Philippine hereby aims to triple real per capita
income, and eradicate hunger and poverty by 2040, if not sooner” (Executive Order 05, October 2017).
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Outcome targets

24. To reduce levels of child stunting and wasting

Indicator Baseline 2022 Target

• Prevalence (in percent) of stunted children 33.4 21.4
under five years old*
• Prevalence (in percent) of wasted children
o Under five years old* 7.1 <5
o 6 – 10 years old 8.6 <5
* Consistent with the 2025 Global Targets for Maternal, Infant and Young Child Nutrition

25. To reduce micronutrient deficiencies to levels below public health significance

2022
Indicator Baseline
Target
Vitamin A deficiency
• Prevalence (in percent) of children 6 months to 5
years old with vitamin A deficiency (low to deficient 20.4 <15
serum retinol)
Anemia
• Prevalence (in percent) of anemia among women of 11.7 6.0
reproductive age*
Iodine deficiency disorders
• Median urinary iodine concentration, mcg/L
- Children 6-12 years old 168 ≥100
- Pregnant women 105 ≥150
- Lactating women 70 ≥100
• Percent with urinary iodine concentration <50 mcg/L
- Children 6-12 years old 16.4 <20
- Lactating women 33.4 <20
* Consistent with the 2025 Global Targets for Maternal, Infant and Young Child Nutrition
No increase in overweight among children

Baseline 2022
Indicator
Target
• Prevalence (in percent) of overweight
o Under five years old* 3.9 <3.9
o 6 – 10 years old 4.9 <4.9
* Consistent with the 2025 Global Targets for Maternal, Infant and Young Child Nutrition

26. To reduce overweight among adolescents (from 8.3% to <5%) and adults (from
31.1% to 28%)

Sub-outcome or intermediate outcome targets2

2
Suboutcome 1 is a 20% reduction level, Suboutcome 2 is consistent with the 2025 Global Targets for 1
Maternal, Infant, and Young Child Nutrition, i.e. 30% reduction by 2025, Suboutcome 3 represents an
arbitrarily set 50% increase by 2025; Suboutcome 4 represents an arbitrarily set 30% increase by 2025; while
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

27. To reduce the proportion of nutritionally-at-risk pregnant women from 24.8% to 20%
by 2022

28. To reduce the prevalence of low birthweight from 21.4% in 2013 to 16.6% by 2022

29. To increase the prevalence of exclusive breastfeeding among infants 5 mos old from
24.7% in 2015 to 33.3 by 2022

30. To increase the percentage of children 6-23 months old meeting the minimum
acceptable diet from 18.6% in 2015 to 22.5% by 2022

31. To increase the proportion of households with diets that meet the energy
requirements from 31.7% in 2013 to 37.1 by 2022

Strategic Thrusts

32. Focus on the first 1000 days of life. The first 1000 days of life refer to the period of
pregnancy up to the first two years of the child. This is the period during which key
health, nutrition, early education and related services should be delivered to ensure
the optimum physical and mental development of the child. This is also the period
during which poor nutrition can have irreversible effects on the physical and mental
development of the child, consequences of which are felt way into adulthood.

33. Complementation of nutrition-specific and nutrition-sensitive programs. This

strategic thrust recognizes that malnutrition has immediate, underlying, and basic
causes, which should be addressed to achieve targeted nutritional outcomes. Thus,
there is a need to implement and deliver nutrition-specific interventions. These
interventions “address the immediate determinants of fetal and child nutrition and
development, i.e. adequate food intake and nutrient intake, caregiving and
parenting practices, and low burden of infectious diseases.

34. Intensified mobilization of local government units. To ensure that PPAN 2017-2022
delivers the planned outcomes, 37 provinces with greater magnitude of the stunting
and wasting will be prioritized for mobilization of local government units.
Mobilization will aim to transform low-intensity nutrition programs to those that will
deliver targeted outcomes. It will involve capacity building and mentoring of LGUs
on nutrition program management to transform them to self-propelling LGUs able to
plan, implement, coordinate, and monitor and evaluate effective nutrition programs.
This strategy is also expected to compliment the interventions in the First 1000 Days.

Table 2. PPAN 2017-2022 Priority Provinces

REGION PROVINCE REGION PROVINCE

CAR 1. Abra VII 20. Bohol
2. Apayao 21. Cebu
I 3. Pangasinan 22. Negros Oriental
II 4. Isabela VIII 23. Biliran

Suboutcome 5 is based on a 15% increase by 2030 for the Sustainable Development Goals, and is based on a
doubling of observed decrease between 1993 and 2013.
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

REGION PROVINCE REGION PROVINCE

III 5. Aurora 24. Leyte
6. Bataan 25. Northern Samar
7. Bulacan IX 26. Zamboanga del Norte
8. Nueva Ecija 27. Zamboanga del Sur
IV - A 9. Quezon X 28. Bukidnon
IV - B 10. Palawan 29. Lanao del Norte
11. Marinduque 30. Misamis Oriental
V 12. Albay XI 31. Davao del Norte
13. Camarines 32. Davao del Sur
Norte
14. Camarines Sur XII 33. North Cotabato
15. Catanduanes 34. South Cotabato
16. Masbate ARMM 35. Sulu
VI 17. Aklan 36. Tawi-tawi
18. Antique CARAGA 37. Agusan del Sur
19. Iloilo NCR 38. CAMANAVA

35. Reaching geographically isolated and disadvantaged areas (GIDAs) and

communities of indigenous peoples. Efforts to ensure that PPAN 2017-2022
programs are designed and implemented to reach out to GIDAs and communities of
indigenous peoples will be pursued. The community of NGOs and development
partners’ resources will be engaged for this purpose.

36. Complementation of actions of national and local governments

Program Framework

37. Consistent with the recommendations from the Lancet Series on Maternal and Child
Health and Nutrition in 20083, the PPAN 2017-2022 adopts the Nutrition Specific and
Nutrition Sensitive Programs as essential interventions to address the underlying
causes of malnutrition along the life cycle. Thus, PPAN 2017-2022 consists of 12
programs and 45 projects to be implemented by member agencies of the National
Nutrition Council (NNC) in cooperation with local government units. Of these 12
programs, 8 are nutrition-specific, one is nutrition-sensitive and three are enabling
support programs (Figure 3).

Nutrition-specific programs

38. Nutrition-specific programs are those that were planned and designed to produce
nutritional outcomes (Table 3). The selection of nutrition-specific programs to
include was inspired by already-existing programs, the WHO Essential Nutrition
Actions, the recommendations of the Lancet Maternal and Child Nutrition Series, the
International Conference for Nutrition 2 Framework for Action, among others.

3
The Lancet Series on Maternal and Child Health Nutrition, 2008
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Nutrition-sensitive program

39. Complementing these nutrition-specific interventions are nutrition-sensitive

projects. These are development projects that were tweaked to produce nutritional
outcomes/tweaking can be done by targeting households with undernourished
children or nutritionally-vulnerable groups, or targeting areas with high levels of
malnutrition, or being a channel for delivering nutrition-specific interventions. Table
4 shows a list of development programs and projects that will be tweaked to produce
nutritional outcomes in addition to their original objectives. This list in this program
is an initial one and will be updated in the course of plan implementation.

Figure 5. PPAN 2017-2022 Program Framework

 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Table 3. Nutrition-specific programs

 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Table 4. Nutrition-sensitive program

 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Enabling programs

40. Mobilization of local government units for nutrition outcomes

41. Policy development for food and nutrition, including pushing for the nutrition
legislative agenda that among others aims to facilitate the passage of legislation
along the following concerns:

a. Plantilla position for Nutrition Action Officers (NAOs)

b. Amendments to RA 8976 (Mandatory Food Fortification Law)
c. Strengthening of the Barangay Nutrition Scholar Program (PD 1569)
d. Expanded Maternity Protection
e. Institutionalization of the First 1000 Days
f. Imposition of an Ad Valorem Tax on Sugar Sweetened Beverages
g. An Act Creating a System of Food Distribution and Addressing Nutritional
Problems
h. Protecting Children from Marketing of Unhealthy Food

42. Strengthened management support to the PPAN 2017-2022

43. The program is composed of two projects—Project 1: Securing Vital Nutrition

Infrastructure and Resource Requirements for PPAN; Project 2: Strengthening
coordinating, monitoring, evaluation and management of PPAN across NNC including
member agencies and NNC Secretariat. Combined together, the two projects are
aimed to produce changes in the current system of PPAN delivery involving
management and coordination, monitoring and evaluation, budgeting, and other
vital processes, as well as staffing requirements for the efficient and effective PPAN
2017-2022 implementation. The priority agenda for action in the area of
management strengthening are listed in Annex 1 of this program. Included in this list
is the review and strengthening of the Philippine Food and Nutrition Surveillance
System (PFNSS). The two projects are the full responsibility of the NNC Secretariat,
supported by NNC member agencies.

44. The program for management strengthening does not have geographical areas like
the nutrition-specific and nutrition-sensitive programs. But because the coverage of
these two latter programs is nationwide, the effect of the support provided by the
Program for Management Strengthening can also be considered nationwide. While
each of the projects will be implemented by specific agencies, the coordination for
the overall program will be under the responsibility by the NNC Technical Committee
using its management sub-group for this program.

45. The budget for the program will be negotiated by the NNC for 2018-2022 with the
DBM. Budget requirements for 2017 will be reviewed within the budget available to
NNC and other development partners.
 Philippine Plan of Action for Nutrition (PPAN) 2017-2022

Implementation and Management Mechanism

As noted earlier, a National PPAN 2017-2022 Implementation Plan will be formulated

The PPAN 2017-2022 comes with a budget estimate for the entire period of six years. It has
a resource framework with explicit estimate of funded and unfunded budgets and a brief
resource mobilization strategy. The plan has a monitoring and evaluation framework
showing the plan for progress monitoring and evaluation through the six year period.

Service Targets

As a rule, achieving 90% of the target population group will be for specific programs and
services, there are 8 programs and services that are expected to be implemented and
delivered to be able to achieve the targets set forth under the PPAN. Of this programs and
services, targets were also identified so as to measure the level of success since monitoring
and evaluation of nutritional outcomes is a very essential component of the PPAN. These
programs are as follows:

1) Infant and Young Child Feeding (IYCF)

2) Philippine Integrated Management of Acute Malnutrition (PIMAM)
3) National Dietary Supplementation Program
4) National Nutrition Promotion for Behavior Change
5) Nutrition in Emergencies and
6) Overweight and Obesity Management Program.

This policy document embodies the alarming situation of nutrition in the country and thus,
the call for urgent action and leadership cannot but be over emphasized. Looking at the
problems of malnutrition and doing intervention “business as usual”, may further
compromise the future of this country.