Malabon City in the Philippines Mobilizes to Reduce Malnutrition TABLE of CONTENTS Rates, 2013–2018 Executive Summary
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CASE STUDY November 2019 “It Takes a Village to Raise a Child”: Malabon City in the Philippines Mobilizes to Reduce Malnutrition TABLE OF CONTENTS Rates, 2013–2018 Executive Summary ............ 1 Introduction ......................... 1 PROJECT DATA Delivery Challenges .............. 2 ORGANIZATION: SECTOR: Tracing the Implementation Malabon City government Health and Nutrition Process ................................. 4 ORGANIZATION TYPE: COUNTRY: Local government The Philippines Lessons Learned .................. 8 DEVELOPMENT CHALLENGE: REGION: References ............................ 9 Eradicating child malnutrition East Asia and Pacific Appendix ........................... 10 DELIVERY CHALLENGES: PROJECT DURATION: Lacking in Priority, Low Budget, Lack 2013–2018 of Skilled Manpower, Stakeholder AUTHOR Engagement, Lack of Awareness, and Patricia Anne Pasion Misguided Norms on Nutrition Executive Summary Malabon City has long been one of the areas with the highest rates of malnutrition in the capital region of the Philippines. In 2013, 16.3 percent of children in the city were stunted, or short for their age because of low nutritional intake. Stunting causes diminished cognitive and physical development, which limits the productive capacity of children. The high stunting rate meant a huge loss in human capital potential for the city. The city’s Nutrition Office had found it difficult to reduce the incidence of malnutrition because of budgetary constraints and a lack of awareness among mothers and caregivers about proper child nutrition. In 2014, the local government started to prioritize eliminating malnutrition by drafting a comprehensive nutrition plan that involved attracting donors and educating mothers. The city encouraged businesses to donate goods and facilitated community participation in delivering feeding programs. The city also encouraged mothers to attend family development sessions and provided school supplies, groceries, and free meals to participants. By 2017, the city had cut stunting rates to 5.13 percent. Introduction This case study was authored by Patricia Pasion based on interviews conducted in In the Philippines, three babies are born every minute, but the country’s the Philippines. The case study is part of a 12 million children often receive inadequate childcare and nurturing services Global Delivery Initiative series produced in partnership with the Korea Development (Philippine Statistics Authority 2017). Child poverty has been on the rise since Institute School of Public Policy and 2009, with malnutrition being among the biggest contributing factors (Reyes Management. 1 GLOBAL DELIVERY INITIATIVE et al. 2014). In 2017, Save the Children, an international their children. Their lack of education also keeps them nongovernmental organization (NGO), ranked the from getting employment with sufficient pay, making it Philippines 96th out of 172 countries in its child difficult for them to buy basic household requirements development index, a tool used to measure child well- such as food. In 2016, Malabon City recorded a total of being around the world (Geoghegan 2017). According to 888 pregnant girls, some as young as 10 to 13 years old 2015 government figures, more than 3.7 million Filipino (Malabon City 2017a, 24). The largest number of young children ages 0 to 5 were stunted, meaning they had low mothers was found in Catmon, the barangay that also height for their age (Aquino 2016). Stunted children suffer had the highest prevalence of malnutrition (Malabon from diminished cognitive and physical development, City 2017a, 24). A barangay, which is loosely translated and they experience reduced productive capacity and an in English as “village,” is the smallest administrative unit increased risk of degenerative diseases. in the Philippines Chronic child malnutrition was highly prevalent The National Nutrition Council, the country’s policy- in Malabon City, part of the National Capital Region making and monitoring body for nutrition, recommended surrounding Manila, the Philippine capital. Located at that each city’s first lady become a champion of nutrition, the northwestern tip of the Manila metropolitan area, appointed as a city nutrition action officer. Following Malabon City was home to about 350,000 people in 2017. those guidelines, Malabon mayor Antolin Oreta III The Department of Social Welfare and Development appointed his wife, Melissa Sison-Oreta, as city nutrition considered about a quarter of the households poor action officer in 2014, putting her in charge of the city’s (National Housing Target System for Poverty Reduction, Nutrition Office. Sison-Oreta had previously been a chef as cited in Malabon City 2017b). More than 6,000 and a program director of the Center for Culinary Arts, a businesses were registered in the city, and the employment leading culinary education institution in the Philippines. rate was high at 95 percent; however, a significant portion Her extensive experience in food preparation and of the labor force was engaged in vulnerable, low-income nutrition made her a good candidate for the role of employment (Malabon City 2017a, 70). nutrition action officer. For years, the city had one of the highest rates of stunting as well as wasting (that is, a low weight for Delivery Challenges height) in the capital region. In 2013, the World Health Organization recorded a 16.3 percent stunting rate in Financial Constraints Malabon City, meaning that about 5,700 of the 35,000 children in the city who were under five years old were In 2012 and 2013, Malabon City’s Nutrition Office had ₱ stunted.1 Other nutritional status indicators, such as a budget of just 300,000 (about US$7,000 at the time), being underweight and wasted, were relatively low at reflecting the low priority the government placed on 3.79 percent and 2.75 percent, respectively. nutrition programs. With such a low budget, the office Part of the reason for the high stunting rate was that could fund only an annual weighing program called some families simply did not have enough income to buy Operation Timbang Plus (OPT+) that compiled data on food for their children, but parents’ lack of awareness of child malnutrition (see figure 1) and some promotional proper nutrition and food preparation was also a major activities during “National Nutrition Month” in July. factor. Families with low nutrition awareness are often Feeding programs occurred only when the national those in which the parents have a low level of education, government or NGOs sponsored such activities. and in Malabon City, just 58 percent of the urban poor had reached secondary school. A high incidence Lack of Skilled Personnel of teenage pregnancy among low-income families is The Nutrition Office lacked sufficient personnel usually correlated with poor nutrition awareness because to provide effective nutrition services. In 2014, the young girls in this socioeconomic bracket often lack government employed just one nutritionist for all of the education, experience, and maturity to take care of Malabon City. Before 2011, Malabon City had five nutritionists, but when four of them resigned in 2011, the government did not hire replacements. The nutritionists 1 Population data, as of 2010, provided by the city government. in the office played a critical role because their 2 “It Takes a Village to Raise a Child” FIGURE 1. OPERATION TIMBANG PLUS (OPT+) FLOW CHART Preparation for OPT+ Actual OPT+ Processing of OPT+ Results Post scheduled time, date, Weigh child. and place of weighing in Record child’s name, age, date of birth, Validate computation, age strategic places. and weight. in months, and nutritional Prepare supplies and ma- counseling. Compute age in months. terials for weighing. Update master list. Determine nutritional status. Prepare master list. Provide nutritional counseling. Prioritization for Intervention Feedback Recording and Reporting of OPT+ Use OPT results to determine number Present OPT results Results and at-risk groups for nutrition and to Barangay Nutrition health interventions. Committee. Record OPT results on Provide appropriate intervention: prescribed OPT forms. l Growth monitoring or reweighing Perform spot mapping. l Recording and computation of age in months l Determination of nutritional status Source: Adapted from National Nutrition Council 2014. responsibilities included managing nutrition programs the Public Employment and Services Office, the City and submitting project proposals related to improving Environment and Natural Resources Office, the Public the nutritional status of the children. They coordinated Information Office, the Planning Department, and the with the barangay nutrition scholars and barangay health Budget Department, which were all located in City Hall, workers, who worked at the village level, and with higher- and the Nutrition Office, which was in a different location. ranking officers such as the city nutrition action officer The distance between the offices prevented the Nutrition (Sison-Oreta). The nutrition scholars and health workers Office, which chaired the committee, from establishing implemented and monitored the nutrition programs on close communication with the other committee the ground while the nutritionist provided the general members. The Nutrition Office collected reports on vision and direction of the team, with the approval of each unit’s activities but struggled to coordinate the Sison-Oreta. committee’s efforts. The local office of the Education Department, part Poor Stakeholder