The First 1000 Days

MANUAL OF PROCEDURES
 Table of Contents
INTRODUC TION PAR T 4
What is the purpose of the MOPr?
8 ROLES
52 AND RESPONSIBILITIES
Who is the MOPr for?
8 Roles
54 and responsibilities at the barangay level
How is the MOPr structured?
8 54 Barangay nutrition committee
55 Barangay health station
PAR T 1 56 Frontline workers
HIGHLIGHTS OF THE KALUSUGAN
AT NUTRISYON NG MAG-NANAY ACT (RA 11148)
9
At
63the city/municipal level
Objectives of RA 11148
10
63 City/municipal health office
Key Provisions of RA 11148 and its Implementing Rules and
Regulations (IRR)
11 64 City/municipal nutrition office, if present
65 Local social welfare and development office
PAR T 2 65 Secondary and tertiary levels of health care
FRAMEWORK FOR INTEGRATION
12 Other city/municipal government
The Nurturing Care Framework
13 65 organizations and offices
13 What is the nurturing care framework?
13 Why nurturing care? At
67the provincial level
14 Components of nurturing care
Integrated Multi-Sectoral Action to Implement RA 11148
17 At
70the regional and national level
Challenges in implementing RA 11148
18 70 The National Nutrition Council
71 National government agencies
PAR T 3 Civil society organizations, state universities and colleges,
IMPLEMENTING RA 11148 AT THE LOCAL LEVEL
21 private sector, and development partners
79
Guiding principles for implementation
23
Activities to undertake
24 Capacity building and development
80
25 Conduct an F1KD+ situational analysis
29 Strengthen planning and budgeting mechanisms
33 Identify how F1KD+ services will be integrated PAR T 5
37 Strengthen service delivery INFORMATION RESOURCES
FOR IMPLEMENTING RA 11148
45 Strengthen monitoring and evaluation 81
References
51 Advocate for whole-of-government action 85

ii
List of Tables List of Annexes
TABLE 1 Components of nurturing care 15 ANNEX 1 Program components by life stage per RA 11148 89

TABLE 2 Challenges in integrated service delivery for F1KD+ 19

ANNEX 2 Template for a local policy issuance on an F1KD+ team 96
ANNEX 3 Notes on doing the F1KD+ situational analysis 100
TABLE 3 Talking points for discussions on F1KD+ plans 32
ANNEX 4 Integrating F1KD concerns in comprehensive
TABLE 4 Indicators for monitoring F1KD+ services 47 development planning 106
ANNEX 5 ECCD Community Risk Targeting 107
TABLE 5 F1KD+-related activities
undertaken by frontline workers 58 Notes on promoting responsive caregiving
ANNEX 6
and early stimulation 112
TABLE 6 Sectoral involvement in F1KD+ concerns
ANNEX 7
A way of discussing agenda on the status of F1KD+
at the city/municipal level 66
services in meetings of the local nutrition committee 114
ANNEX 8
Possible action lines for observed gaps and
deficiencies in service delivery 115
ANNEX 9 Illustration of the use of the ABCDE
framework for advocacy 116

List of Figures
FIGURE 1 The Nurturing Care Framework 14 ANNEX FIGURE 1 Problem Tree for F1KD+ Situational Analysis 104

ANNEX FIGURE 2 Solution Tree for F1KD+Situation Analysis 105

FIGURE 2 Relationship
of city/municipal plans and instruments
adapted from the Local Planning Illustrative Guide ANNEX FIGURE 3 Flow for ECCD Community Risk Targeting 108
with revisions to include health, and nutrition plans 30
ANNEX FIGURE 4 Nurturing Care Risk Factor Checklist for ECCD 109
FIGURE 3 Flow of reporting for monitoring F1KD+ services 50
ANNEX FIGURE 5 Core Developmental Milestones 110

FIGURE 4 Overview of program components by life stage 53 ANNEX FIGURE 6 Signals of possible developmental delay 111

WHO Recommendations for

ANNEX FIGURE 7
Care for Child Development 113

iii
 Acronyms
AIP Annual Investment Program DOST Department of Science and Technology
ANC Antenatal Care DRRM Disaster Risk Reduction and Management
AO Administrative Order DSWD Department of Social Welfare and Development
BHW Barangay Health Worker ECCD Early Childhood Care and Development
BNS Barangay Nutrition Scholar ECCD-C Early Childhood Care and Development Council
C/PWHS City-Wide and Province-Wide Health System ELA Executive Legislative Agenda
C4D Communications for Development ELP Early Learning Program
CARP Comprehensive Agrarian Reform Program EO Executive Order
CDC Child Development Center ERPAT Empowerment and Reaffirmation of Paternal Abilities
CDP Comprehensive Development Plan F1KD+ First 1000 Days or 0-24 months old
+ 25-35 months old
CDW Child Development Worker
FBD Facility-Based Deliveries
CHED Commission on Higher Education
FDA Food and Drug Administration
CSC Civil Service Commission
FDS Family Development Sessions
CSO Civil Society Organization
FHSIS Field Health Service Information System
CWC Council for the Welfare of Children
FIC Fully Immunized Children
CWD Children with Disabilities
GIDA Geographically Isolated and Disadvantaged Areas
DA Department of Agriculture
IMCI Integrated Management of Childhood Illness
DAR Department of Agrarian Reform
IRR Implementing Rules and Regulations
DBM Department of Budget and Management
ITC ITC Inpatient Therapeutic Care
DepEd Department of Education
LCE Local Chief Executive
DILG Department of the Interior and Local Government
LDIP Local Development Investment Plan
DOF Department of Finance
LGU Local Government Unit
DOH Department of Health
LNAP Local Nutrition Action Plan
DOLE Department of Labor and Employment

1
LNC Local Nutrition Committee P/C/M/ Provincial/ City/ Municipal/ Barangay
BNAP Nutrition Action Plan
M/BNC Municipal/ Barangay Nutrition Committee
PAP Program, Activity, and Project
MELLPI Monitoring & Evaluation of
Local Level Plan Implementation PDP Philippine Development Plan
MNCHN Maternal, Neonatal, Child Health and Nutrition PDPFP Provincial Development and Physical Framework Plan
MNP Micronutrient Powder PES Parent Effectiveness Services
MOP Manual of Operations PhilHealth Philippine Health Insurance Corporation
MOPr Manual of Procedures PPAN Philippine Plan of Action for Nutrition
MSME Micro, Small, and Medium Enterprise PRC Professional Regulation Commission
NAO Nutrition Action Officer PSA Philippine Statistics Authority
NAPC National Anti-Poverty Commission RA Republic Act
NCDC National Child Development Center RUSF Ready-to-Use Supplementary Food
NCF Nurturing Care Framework RUTF Ready-to-Use Therapeutic Food
NEDA National Economic and Development Authority SGA Small for Gestational Age
NGA National Government Agency SNP Supervised Neighborhood Play
NGO Non-Government Organization TESDA Technical Education and Skills Development Authority
NICU Neonatal Intensive Care Unit TT Tetanus Toxoid
NNC National Nutrition Council TWG Technical Working Group
Non-BMS Non-Breastmilk Substitutes UHC Universal Health Care
NPAC National Plan of Action for Children UNCRC United Nations Convention on the Rights of the Child
NYC National Youth Commission UNICEF United Nations Children’s Fund
OPT Plus Operation Timbang Plus WASH Water, Sanitation, and Hygiene
OTC Outpatient Therapeutic Care WHA World Health Assembly
WHO World Health Organization
ZOD Zero Open Defecation

2
 Foreword
Republic Act 11148 or the Kalusugan at Nutrisyon empowering local government units (LGUs) in taking (2) we should be able to look into our own
ng Mag-Nanay, also known as the First 1000 up health and nutrition as priority investments, offices’ mandates in ensuring that public health
Days Act, signed in November 2018, consolidates especially with the Mandanas-Garcia Supreme Court and nutrition services are accessible to Filipino
health and nutrition services to make sure that the ruling—which increases the value of their forty (40) families; and
country’s future is secure in the hands of healthy percent share from national taxes. The Act and this
women and children. To better reach them, this MOPr propose that funding, among other acts of (3) collaborations are key to innovative,
Manual of Procedures (MOPr) provides a template governance, should be harmonized to fully support the mass-accessible, and palatable strategies to
of governance strategies for our local government health and nutrition needs of mothers and children, in communicate our Implementation Plans to our
health and nutrition champions—from Chief order to bring about lifelong positive impact not only agencies and our citizens. Let us keep an open
Executives, Local Health Officers, Nutrition Action to individuals but to the community’s productivity and mind, free of conflicting interests, in exploring
Officers, Program Managers, and our implementers economy. new and efficient avenues of communication
in the person of barangay health workers, barangay in collaboration with diverse sectors in both
nutrition scholars, child development workers, and We also thank the United Nations Children’s Fund, public and private practice.
the rest of the community. World Health Organization, Save the Children, Inc.,
and our development partners in blazing the path The goal of the whole-of-government, whole-
in assisting LGUs in adopting the First 1000 Days of-society approach is to reach the sweet spot
Maternal health and nutrition, newborn care, infant
Strategy. We are all witness to a number of outbreaks, of collaborative governance in order to deliver
and young child feeding, and early childhood
including the 2020 pandemic, and we have always the full range of quality services to Filipinos to
care and development services delivered only by
been on our toes ever since. Our partnerships have support our countrymen in reaching their full
the healthcare system will not be able to attain its
always emphasized the convergence of multiple potential as citizens. May this MOPr guide you
maximum impact. This MOPr presents a mandated
services for health, nutrition, adolescent health and in the implementation of the First 1000 Days
proposition that collaborative health and nutrition
nutrition, water, sanitation, and hygiene (WASH), and Act through the full-scale implementation of
governance are also influenced by policies and
in the light of the passing of the First 1000 Days Act universal health care with you at the helm—
operational investment in environmental health,
and Republic Act 11123 (the Universal Health Care while we, at the national government, stand
agriculture, social welfare, and political leadership.
Act), health systems integration. to support the delivery of services to Filipino
There is local evidence that the first implementers
families through policy, technical assistance,
of the First 1000 Days Strategy were driven by
In the pursuit of the implementation of the First 1000 and continuous evolution of grassroots-based
Local Chief Executives who had the best interest
Days Strategy, we take the time to review our plans, strategies that fortify high-quality, accessible
of their constituents in mind. They started with
milestones, targets, and indicators that will foster health and nutrition services.
taking care of pregnant women and their newborns
this active and fruitful collaboration between the
for better health outcomes harnessing technical Mabuhay po tayong lahat!
government and the public and private sectors.
assistance from the private and public sectors,
including development partners, non-government We have to keep in mind three points:
organizations, and civil society organizations.
(1) our process must focus on the convergence
The Department of Health (DOH), together with of investments for the continuity of services Francisco T. Duque III, MD, MSc
the National Nutrition Council (NNC), as lead in through integration of critical strategies and Secretary of Health
the implementation of the First 1000 Days Act, interventions, based on the full cycle of life Chair, NNC Governing Board
recognizes that we are in a critical position in stages within the first 1000 days of life and
continued until adolescence;

3
Messages
The passage of RA 11148 or the First 1000 Days Law provides the enabling environment for the sustained
provision of critical early child care interventions for the first 1000 days of a child’s life, for optimal growth and
development. This ensures that a child’s future is protected from the devastating effects of malnutrition.
The Manual of Procedures (MOPr) for the First 1000 Days, a product of the partnership between NNC and
DOH, is now available for use. The team who developed the MOPr has drawn on the accumulated wisdom of
health, nutrition and child development workers and experts at various levels. The MOPr is a document that
aims to equip policymakers, program implementers and the frontline workers with the basic knowledge and
skills necessary to provide basic services for the first 1000 days following the nurturing care framework.
The intended users of the MOPr are encouraged to participate in relevant capacity building activities
to support the information gleaned from the Manual. Much more can also be learned from model local
government units on how to effectively deliver services for the first 1000 days at scale.
With the MOPr in our hands, I believe that all stakeholders will be provided with invaluable guidance on how to
implement efficient First 1000 Days (F1KD+) services that will achieve good outcomes. The MOPr also provides
guidance on how to use local and national data to better understand the strengths and limitations of the
F1KD+ services and interventions, along with advice on planning and programming following the budget cycle;
developing innovations; and in evaluating interventions and projects.
Again, let me express my appreciation and heartfelt gratitude to everyone involved in making this MOPr
a reality, an important document in support of the RA 11148 -- First 1000 Days Law or the “Kalusugan at
Nutrisyon ng Mag-Nanay Act.” Together, let us continue on the path of providing better quality of services for
the first 1000 days.

Azucena M. Dayanghirang, MD, MCH, CESO III

Assistant Secretary and Executive Director
National Nutrition Council

4
 Messages

In 2018, we started the project on the integrated nutrition and health actions in the first 1000 days.
Part of the 3 outcomes is to provide a more responsive enabling policy and governance environment
at the national and local levels that support the comprehensive approach to maternal, infant and child
nutrition and health in the critical first 1000 days window.
One of the initiatives under this project is the development of RA 11148’s Implementing Rules and
Regulations (IRR) and the Manual of Procedures (MOPr). The recent finalization of the MOPr completes
the package of the said law. This was made possible with the strong partnership among the Korean
Government through the Korea International Cooperation Agency (KOICA), the United Nations
Children’s Fund (UNICEF), and the Philippine Government.
This newly developed MOPr for RA 11148 will guide the health workers in providing quality and
comprehensive nutrition and health services delivered to women, newborns and children. In addition,
KOICA is hopeful that this will serve as a platform to hone and share many best practices among
health workers.
On behalf of the Korean Government, I sincerely express my appreciation to UNICEF, the Department
of Health, the National Nutrition Council and all our stakeholders for the commitment and dedication
they showed for this project despite the ongoing COVID-19 pandemic. Rest assured that KOICA will
continuously support the project on the integrated nutrition and health actions in the first 1000 days.

HWANG Jaesang
Country Director
Korea International Cooperation Agency (KOICA)

5
Messages
The first 1000 days of a child’s life is a critical window of opportunity that sets out their future path in life.
That’s why UNICEF in the Philippines worked to place this important issue on the Philippine agenda, as
neglecting this significant period would be a gross injustice to children and their families.
Today, many Filipino children still suffer from malnutrition. A third of them are stunted and/or suffer from
deficiencies in essential micronutrients. Less than 10 per cent of Filipino children are consuming the minimum
acceptable diet. Because of poverty and exclusion, women and children from the poorest and most
disadvantaged communities face the greatest risk for all forms of malnutrition.
I witnessed this in my travels to Albay, Catanduanes, Tawi-Tawi, Basilan and other places in the Philippines.
Vulnerable children who are in isolated, typhoon-prone and conflict areas suffer the most.
We advocated with partners to pass Republic Act 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act.
It provides comprehensive, sustainable, multisectoral strategies and approaches to improve the health and
nutrition of newborns, infants and young children, pregnant and lactating women, and adolescent females.
It institutionalized the First 1000 days program in all development plans of the national and local government.
National Government Agencies (NGAs) and Civil Society Organizations (CSOs) developed a guide to
operationalize RA 11148 to ensure integration and implementation by Local Government Units (LGUs) as they
formulate their respective health and nutrition plans.
UNICEF Philippines, with support from the Korea International Cooperation Agency (KOICA), supported the
development of this Manual of Operations to guide nutrition workers and other stakeholders. We continue
to be inspired by the many hardworking nutrition workers and advocates who work with us to ensure that
children not only survive but thrive.
For every child, nutrition.

Oyunsaihan Dendevnorov
UNICEF Philippines Representative

6
 Introduction
This document is the Manual of Procedures (MOPr) for With these areas of concern covered by the Kalusugan at
implementing Republic Act 11148 entitled, “An Act Scaling Nutrisyon ng Mag-Nanay Act of 2018, several policies, offices,
up the National and Local Health and Nutrition Programs partner implementers and activities have to be considered.
through a Strengthened Integrated Strategy for Maternal, This situation tends to result in an assortment and redundancy
Neonatal, Child Health and Nutrition in the First 1000 Days of of program planning, implementation, and monitoring
Life, Appropriating Funds Therefore and for Other Purposes” and evaluation. Thus, the Act calls for a strengthened and
otherwise known as “Kalusugan at Nutrisyon ng Mag-Nanay integrated strategy especially at the barangay level.
Act of 2018” (sometimes also referred herein as “RA 11148” or
This integrated strategy operates horizontally (i.e., components
“the Act”) and its Implementing Rules and Regulations (IRR).
within and across thematic or sectoral areas, both in the public
This MOPr was developed as a reference and a guide to and private sectors), and vertically (i.e., program components
achieve the main objective of the Kalusugan at Nutrisyon at different administrative levels: national, regional, provincial/
ng Mag-Nanay Act of 2018: to “provide comprehensive, city, municipal, barangay, purok).
sustainable, multisectoral strategies and approaches to address
The integration must be guided by a family-centered
health and nutrition problems of newborns, infants and young
approach, inclusivity, enhanced equity, whole-of-government
children, pregnant and lactating women, and adolescent
action, improved multi-sectoral programming, enhanced
females as well as multifactorial issues that negatively affect
quality of ECCD services, and stakeholder engagement in all
the development of newborns, infants, and young children.”
stages of the policy and program cycle.
To be successful, the following areas along Early Childhood
Fundamental in all of these efforts is the adherence to the
Care and Development (ECCD) must be supported:
Nurturing Care Framework (NCF), which provides a roadmap
• Maternal, Neonatal, Child Health and Nutrition (MNCHN) for action. Its components include adequate nutrition,
• Adolescent health and nutrition responsive caregiving, opportunities for early learning, good
• Responsive caregiving and early stimulation health, security and safety. The Framework builds on the
• Integrated Management of Childhood Illness (IMCI) foundation of universal health care, with primary care at its
• Water, Sanitation and Hygiene (WASH) core, as essential for all sustainable growth and development.1
• Child protection and security The framework will be further explained in the next section of
the MOPr.

1 Nurturing Care for Early Childhood Development, 2018.

7
What is the purpose of the MOPr? Who is the MOPr for?
The MOPr is designed to aid in strengthening the local This MOPr is primarily for the direct implementing level, i.e.,
government unit’s (LGU’s) integrated strategy to implement the city/municipality and barangay levels, and program managers
Kalusugan at Nutrisyon ng Mag-Nanay Act of 2018 by: and service providers in health, nutrition, social welfare, in
1. Outlining steps that LGUs and other stakeholders can these levels, e.g., staff of the rural health unit, nutrition office,
take to identify their integrated first 1000 days strategy. social welfare office, barangay health workers, barangay
nutrition scholars, and child development workers.
2. Providing guidance for program planning,
implementation, monitoring and evaluation. It is also for the other members of the provincial/city/municipal
and barangay nutrition committee as well as national
3. Defining roles and responsibilities per stakeholder and government agencies, Local Development Investment Plans,
across governance levels (national to barangay). and development partners, to enable them to undertake
4. Delineating roles and functions among frontline workers. their roles effectively, especially along supporting the direct
implementing levels of the Kalusugan at Nutrisyon ng Mag-
Nanay Act of 2018.

How is the MOPr structured?

The MOPr is divided in five parts, with each part discussing the following:
1. Overview of Kalusugan at Nutrisyon ng Mag-Nanay Act of 2018, highlighting
its objectives. The section also identifies the sections of the law but does not
provide the specific contents, some of which are presented in Parts 3 and 4.
2. Framework for integration that gives an overview of the Nurturing Care
Framework, presents challenges in integration.
3. How RA 11148 can be implemented by the LGU at the city/municipal level and
barangay levels.
4. Roles and functions of key players at the city/municipal and barangay levels
and how the other levels (province, region, national) support the key players.
5. Information resources for implementing RA 11148 that lists related policy
issuances and references for actualizing RA 11148.
8
 PA RT ONE
Highlights of the Kalusugan at Nutrisyon
ng Mag-Nanay Act (RA 11148)
This part presents the highlights of the Kalusugan at Nutrisyon
ng Mag-Nanay Act or RA 111482. It shows the objectives of the
law, and key provisions. Specifics of the law are elaborated on in
the other parts of the MOPr.
The Kalusugan at Nutrisyon ng Mag-Nanay Act of 2018 is
anchored on the Philippine Constitution, various laws, country
commitments, medium-term plans, and doctrines as indicated in
the law.
It is to be noted that implementation of RA 11148 is part of the
National System for Early Childhood Care and Development
(ECCD) as mandated by RA 10410 or the Early Years Act.
This national system “is comprehensive, integrative and
sustainable, that involves multisectoral and interagency
collaboration at the national and local levels among
government; among service providers, families and
communities, and among the public and private sectors,
nongovernment organizations; professional associations and
academic institutions.”

2 Access the full text of RA 11148 and its IRR through these integrated links:
https://www.congress.gov.ph/legisdocs/ra_17/RA11148.pdf
https://nnc.gov.ph/phocadownloadpap/userupload/Ro1-webpub/DOH%20MC%202019-0027.pdf

9
Objectives of RA 11148 5. Institutionalize and scale up nutrition in the first one
RA 11148 aims to: thousand (1000) days of life in the national plan on
1. Provide comprehensive, sustainable, multisectoral nutrition—particularly the Philippine Plan of Action
strategies and approaches to address health and for Nutrition (PPAN), the Early Childhood Care and
nutrition problems of newborns, infants and young Development (ECCD) intervention packages developed
children, pregnant and lactating women, and by the NNC, the Philippine Development Plan (PDP), the
adolescent females, as well as multifactorial issues National Plan of Action for Children (NPAC), the regional
that negatively affect the development of newborns, development plans, and Local Development Investment
infants and young children, integrating the short-, Plans (LDIP), as well as those for health and nutrition;
medium-, and long-term plans of the government 6. Ensure the meaningful, active and sustained participation,
to end hunger, improve health and nutrition, and partnership and cooperation of NNC-member agencies,
reduce malnutrition; other national government agencies (NGAs), LGUs, civil
2. Provide a policy environment conducive to nutrition society organizations (CSOs), and the private sector in
improvement; an integrated and holistic manner for the promotion of
the health and nutritional well-being of the population,
3. Provide evidence-based nutrition-specific interventions prioritizing interventions in areas with high incidence
and actions which integrate responsive caregiving and magnitude of poverty, Geographically Isolated and
and early stimulation in a safe and protective Disadvantaged Areas (GIDA), and in hazard and conflict
environment over the first one thousand days of life zones;
as recommended by the United Nations International
Children’s Emergency Fund (UNICEF) and the World 7. Strengthen enforcement of Executive Order No. 51,
Health Organization (WHO), as well as nutrition- series of 1986 (EO 51,s. 1986), otherwise known as the
sensitive mechanisms, strategies, programs, and “National Code of Marketing of Breastmilk Substitutes,
approaches in implementing programs and projects Breastmilk Supplements and Related Products” or the
to improve nutritional status, and to eradicate “Milk Code,” and RA No. 10028, otherwise known as the
malnutrition and hunger; “Expanded Breastfeeding Promotion Act of 2009,” to
protect, promote, and support optimal infant and young
4. Strengthen and define the roles of the Department child feeding and maternity protection, and in consultation
of Health (DOH), the National Nutrition Council with the stakeholders in the public and private sectors,
(NNC), and other government agencies tasked consider the new recommendations from the World Health
to implement nutrition programs for the first one Assembly (WHA) Resolution 69.9 to end the inappropriate
thousand (1000) days of life; promotion of food for infants and young children;

10
 8. Strengthen the implementation of other nutrition-related laws, Key Provisions of RA 11148 and its
programs, policies, and guidelines including multisectoral
integration, inclusivity, gender equality, and promotion of the Implementing Rules and Regulations (IRR)
UN Convention on the Rights of the Child (UNCRC); and The different sections of the law and their corresponding
9. Strengthen family community support systems with the active rules in the IRR specify the following:
engagement of parents and caregivers, with support from 1. Coverage of those in the F1KD+, i.e., pregnant
LGUs, the NGAs, CSOs, and other stakeholders. women (including pregnant adolescents), children
0-35 months old, and female adolescents.
2. Prioritization and coverage of geographic areas
that because of their location, ecology, and socio-
economic characteristics, e.g., Geographically
Isolated and Disadvantaged Areas (GIDAs), area
affected by disasters and emergency situations, and
threaten the optimum and holistic development of
children.
3. Based on the NCF, the range of services and
interventions that need to be provided at the
different life stages and in both non-emergency and
emergency situations as well as the cross-cutting
concerns to enable effective integrated service
delivery (Annex 1).
4. Prioritization of services to those in the F1KD+
during disasters and emergency situations,
and specific guidelines on the protection of
While RA 11148 limits the age group coverage to 0-24 months breastfeeding in such situations.
old, there is wisdom to extend the concern to include those
5. Arrangements for monitoring, evaluation, and
25-35 months old to ensure that all children are looked after reporting.
and to be consistent with the Nurturing Care Framework.
Thus, this document will use F1KD+ to refer to those in the 6. Institutional arrangements that focus on roles of
agencies, and LGUs as well as mechanisms for
first 1000 days plus the 25-35 months old age group. coordination.

11
 PA RT T WO

The Framework for Integration

This part gives an overview of the Nurturing Care Framework (NCF)
and its link to RA 11148.

FIRST 1000 DAYS MANUAL OF PROCEDURES 12

 The Nurturing Care Framework If these “ingredients” are lacking, brain development will
not be optimum, affecting the development of the child,
with consequences throughout life. For instance, delays in
cognitive development could result in the reduced ability
What is the Nurturing Care Framework? to learn in the school-age period. Delays in the social and
emotional domains may result in difficulties “understanding
The NCF is a framework “for helping children survive and thrive social cues, initiating communication or carrying on two-way
to transform health and human potential” (Figure 1). communications,” and “difficulties in dealing with frustrations
Its use enables communities, parents, and caregivers to create or coping with change.” 5
a stable environment for children’s good health, good nutrition, Related to and interacting with brain development is physical
protection from threats, early learning and responsive caregiving. development, which is also rapid in the F1KD+. Thus, poor
nutrition and poor health in the F1KD+ result in stunting or
being short for one’s age.
Why Nurturing Care?
But stunting is not just about physical growth. The WHO notes,
Nurturing care is needed so that children will survive, thrive,
and develop fully. While nurturing care is important throughout “Stunting in early life – particularly in the first 1000
life, it is most critical in early childhood or the F1KD+. days, from conception until the age of two – has adverse
functional consequences on the child. Some of these
The F1KD+ is when a baby’s brain grows at a phenomenal rate, consequences include poor cognition and educational
creating up to 1000 neural connections per second, a rate that performance, low adult wages, lost productivity, and
is never again achieved in a lifetime. The growth of the brain
when accompanied by excessive weight gain later in
depends not only on genetic factors but on the environment,
childhood, an increased risk of nutrition-related chronic
i.e., the availability of nutrients needed as building blocks,
diseases in adult life. Linear growth in early childhood is
protection and stimulation from “talk, play and responsive
a strong marker of healthy growth given its association
attention from caregivers.” 3
with morbidity and mortality risk, non-communicable
“For healthy brain development, children need a safe, secure diseases in later life, and learning capacity and
and loving environment, with the right nutrition, and productivity. It is also closely linked with child
responsive care and early learning activities provided by development in several domains including cognitive,
their parents or other caregivers.4” language, and sensory-motor capacities.” 6

3 United Nations Children’s Fund, 2017 5 NYU Langone Health, n.d.

4 From the Nurturing Care Handbook 6 World Health Organization, 2018

13
FIGURE 1.
THE NURTURING CARE FRAMEWORK

ADEQUATE Components of Nurturing Care

GOOD HEALTH
NUTRITION The five components of nurturing care are: good
health, adequate nutrition, responsive caregiving,
opportunities for early learning, and security and safety
(Table 1).
These components interact with each other.
For instance, responsive caregiving helps a caregiver
recognize and respond to cues that a child is hungry.
And feeding the child is important to ensure that
he or she gets the nutrients needed for growth and
development.

COMPONENTS Breastfeeding, while primarily done to provide

nourishment, allows eye contact and touch between
OF the mother-baby dyad that helps in strengthening
NURTURING their bond, giving the infant a sense of security.
Breastfeeding sessions are also opportunities to talk
CARE and sing to the infant, which stimulates the infant’s
sense of hearing.
On the other hand, a child who is physically and
emotionally abused may not have the appetite to eat
well, compromising his or her nutritional needs.
The same abused child may also be unresponsive to
OPPORTUNITIES RESPONSIVE the environment and experience delays in the different
FOR EARLY CAREGIVING domains of child development. A neglected child may
not be brought to the health facility for immunization;
EDUCATION that makes the child susceptible to disease.

SAFETY AND
SECURITY 14
TABLE 1
Components Of Nurturing Care
1 . G O O D H E A LT H C A R EG I V ER AC T ION S

• Refers to the health and well-being of the ✔ Respond affectionately and well to children’s daily needs.
children and their caregivers.
✔ Be hygienic and minimize infections among children.
• Caregivers should also be physically and ✔ Protect children from danger at home and outside.
mentally healthy to be able to care for children.
✔ Use health services, both promotive and preventive,
e.g., antenatal care, immunization, deworming.
✔ Give sick children the right treatment.
✔ Monitor how children are, physically and emotionally.
✔ Make sure that children get enough physical activity and sleep.

2 . A D EQ U AT E N U T R I T IO N C A R EG I V ER AC T ION S

• Refers to maternal and child nutrition. ✔ Breastfeed exclusively for the first 6 months.
• The mother’s nutrition during pregnancy affects ✔ After that, give solid and semi-solid food (complementary
her health and wellbeing as well as the growth foods) in adequate amounts while continuing to breastfeed,
of the fetus. The nourishment of the growing up to at least the age of 2.
fetus relies on the pregnant woman’s food
intake.
✔ Help children during meals by supporting responsive feeding.
• After delivery, the mother’s nutritional status
✔ Give micronutrients such as vitamin, iron-folic acid, zinc, and
multiple micronutrients.
affects her ability to provide adequate care
for her child ✔ Help children transition to eating nutritious family foods.
✔ Ensure good maternal nutrition.

15
3. RESPONSIVE C AREGIV ING C A R EG I V ER AC T ION S

• Refers to the ability of the parent/caregiver to Observe and respond to children’s movements, sounds,
notice, understand, and respond to the child’s gestures and verbal requests.
signals in a timely and appropriate manner. ✔ Feed children when hungry.
• Responsive caregivers are better able to
support the other four components.
✔ Protect children against injury and the negative effects of adversity.
• Responsive caregiving helps the child to
✔ Recognize and respond to illness.
understand the world around them and to learn ✔ Enrich learning through enjoyable interactions
about people. (e.g., talking, singing, smiling, touching, playing).
✔ Build trust and social relationships.
4. OPPORT U N I T I E S FOR E A RLY L E A RN I NG C A R EG I V ER AC T ION S

• Refers to any opportunity for the baby, toddler or ✔ Use daily routines (e.g., eating, changing diapers, dressing up)
child to interact with a person, place, or object in to talk to, play, and interact with the child.
their environment.
✔ Engage in activities that encourage young children to
• Every interaction (positive or negative) or absence move their bodies, activate their five senses,
of an interaction contributes to the child’s brain hear and use language, and explore.
dev’t and lays the foundation for later learning.
✔ Tell stories and explore books.
• Such early interaction begins as early as conception.

5. S AFE T Y AND SECURIT Y C A R EG I V ER AC T ION S

• Refers to safe and secure environments Ensure that children have access to:
for children and their families. ✔ Safe and nutritious food. ✔ Safe spaces to play.
• Addresses physical dangers, emotional stress, ✔ Clean water and sanitation. ✔ Protection from
environmental risks (e.g., pollution), ✔ Clean indoor and outdoor air. physical punishment,
mental/emotional abuse,
and access to food and water.
✔ Good hygiene. and neglect.

16
 Integrated Multi-Sectoral Action to Implement RA 11148
The components of the Nurturing Care Framework have been factored in RA 11148.
A significant part of the services mentioned in RA 11148 are related From the aforementioned, the importance of the health,
to health and nutrition (e.g., antenatal care, promotion of optimum nutrition, and social welfare sectors in delivering services
infant and young child feeding, age-appropriate immunization, related to nurturing care is evident. This calls for closer
micronutrient supplementation, water sanitation and hygiene). links among these concerns to ensure that those in the
F1KD+ receive services when and where they need them.
RA 11148 also recognizes the other elements of the NCF, as follows:
However, effective delivery of these services require
• Item k of Section 2 of Rule 8 on Program Components is on action from other sectors as well. For instance, since
“Counseling and support to parents and caregivers on poverty is a main threat to the full development of the
parent/caregiver-infant/child interaction for responsive care, child, actions from poverty-alleviation sectors (e.g.,
early stimulation, and promotion of early literacy for early agriculture and labor and employment) that are focused
childhood development and early detection, identification, on those in the F1KD+ and their families are important.
referral, and provision of appropriate intervention for Similarly, ensuring a hygienic environment would require
developmental delays and disabilities.” action from the infrastructure sector for the installation of
• Item m of the same section is on “Protection against child safe water systems.
abuse, violence against women and children, injuries and Thus, to result in holistic child development, integrated
accidents including the provision of first aid, counseling, service delivery is imperative.
and proper referrals.”
Integrated action inevitably leads to the strengthening
RA 11148 also recognizes the vulnerability of the Philippines to of systems, which in turn, translates into sustainable
natural and human-induced emergencies and disasters. and equitable results for children. From effectiveness,
Thus, Section 11 of RA 11148 notes efficiency, sustainability and equity arguments, sectors
“Areas that are affected by disaster and emergency situations, have the greatest imperative to work together to take
full advantage of this period because of the enormous
both natural and man-made must be prioritized in the
potential gains and the otherwise proportionate losses for
delivery of health and nutrition, and psychosocial services.”
every child and the society at large.
The IRR clarifies that
“The accountability for integrated action of duty
“All services included in the program components of this law bearers across all relevant sectors is never more
and IRR shall be immediately provided during emergencies as pronounced than when they can maximally effect
applicable based on DOH and other related agency guidelines.” change in the life of every child, and that is,
during early childhood.”

17
Challenges in Implementing RA 11148
Most of the program components (or services) in RA 11148
are existing programs implemented at varying levels of
coverage and quality. However, there is a need to
recalibrate and implement these existing programs
in an integrated and holistic manner.
In this regard, integrated service delivery is defined as
the organization and management of services in health,
nutrition, social development, and other related sectors
so that those in the F1KD+ “get the care that they need,
when they need it, in ways that are user-friendly, achieve
the desired results, and provide value for money.”7
Challenges that hinder integrated service delivery are
shown in Table 2, together with possible action responses.
Part 3 outlines what LGUs could do to address some of
these challenges, while Part 4 includes roles of different
stakeholders along these action responses.

7 The WHO Technical Brief on Integrated Health Services —

What and Why (2008) proposes a definition for integrated health
services as, “the organization and management of health services so
that people get the care they need, when they need it,
in ways that are user-friendly, achieve the desired results and provide
value for money.”

18
TABLE 2 Challenges In Integrated Service Delivery For F1KD+
CHALLENGE 1 CHALLENGE 2 CHALLENGE 3
Some services are not available or Several parenting support
Monitoring child development
integrated in existing programs, interventions are being implemented
especially for the F1KD+ at the local
specifically, those on early by government and non-government
level is not institutionalized.
stimulation/ learning, responsive stakeholders with limited coordination
caregiving, and security and safety and harmonization. The wealth of
for children, especially for those Action Response
interventions presents an opportunity
below 3 years old, and dietary a. DOH to issue a policy or guidelines for drawing on effective materials and
supplementation for pregnant on monitoring child development delivery methods, and ensuring better
and lactating women and children using the ECCD Checklist or an coordination and harmonization.
6-35 months old. appropriate tool as part of the
health system.
Action Response b. LGUs to adopt the DOH ECCD Action Response
a. DOH and DSWD to issue a Community Risk Targeting scheme a. Stakeholders at all levels to improve
policy on how the integration (See Part 3). planning and programming,
will be done, also inclusion in participate in joint budgeting, and
service packages of the health share information.
system. b. Stakeholders at all levels
b. NGA, LGU, or NGO, or to strengthen coordinative
development partner to model mechanisms like the NNC and
or initiate related action, and nutrition committees to provide
document experiences for the venue for harmonization.
possible scaling up. c. DOH and NNC to establish a
repository of information resources.

19
CHALLENGE 4 CHALLENGE 5 CHALLENGE 6
Variable quality and reach of the Limited funding for F1KD+-related services and The effectiveness of coordinative
different services for the F1KD+ programs especially at the local level. There is structures like councils or their
arising from various reasons. no policy mandating that a portion of the local equivalent for planning, financing, and
budget should be earmarked for nutrition and implementation of holistic integrated
related programs unlike gender concerns, the ECCD services still has to be realized.
Action Response Would depend protection of children, and others.
on causes of the variability, but
possible action responses are: Action Response
Action Response a. DOH, NNC, ECCD-C, and Council
a. LGUs can improve availability for the Welfare of Children (CWC)
of services that are physically a. LGUs to include programs on the F1KD+
closer to target groups; and their budgetary requirements in the to clarify and delineate their roles
telehealth strategies can also local development plan, local investment and how they will work together in
be considered. plan, and annual investment programs. the implementation of RA 11148.
b. Stakeholders at various levels to b. Identify and tap into mandated budgets, b. NNC, ECCD-C, and ECCD to
continually build capabilities of e.g., 5% gender fund, 1% for the protection build capacities of their respective
service providers. of children, 5% calamity fund. Consider too, focal persons at the local level on
increase in local budget with the Mandanas effective coordination.
c. Program managers at the local ruling.8
level to clarify and delineate c. Member agencies to include
roles of various workers within c. LGUs to tap non-government channels, in performance metrics active
and across sectors. e.g., non-government organizations like participation in coordinative structures,
the Rotary Club, Lion’s Club, Kiwani’s, and e.g., not just attending meetings
d. DOH and local government the like, as well as private foundations
units to improve management but pursuing actions to mainstream
and private companies, but with an eye nutrition concerns in agency policies,
of the supply chain and prevent for preventing and managing conflicts of
stock-outs. programs, & projects.
interest.
e. LGUs to adapt services and d. LGUs to create a nutrition office
d. Local government agencies to ensure and appoint a full-time nutrition
service delivery according efficient use of allocated funds to
to the situation and cultural action officer, district/city nutrition
acceptability at the local level, demonstrate absorptive capacity. program coordinators to facilitate
e.g., GIDAs or communities of the overall management and
indigenous persons. 8 The Supreme Court has ruled that all collections of coordination of multisectoral
national taxes except those accruing to special purpose
f. LGUs to improve the incentive funds and special allotments for the utilization and
nutrition action plan of the LGU.
system for community development of the national wealth, should be included e. Creation and filling up of a
volunteers, and protect these in the computation of the base of the just share of permanent position for Registered
volunteers from political threats. LGUs. Thus, the internal revenue allotment of LGUs are
expected to increase significantly starting 2022.
Nutritionist-Dietitians.

20
 PA R T T H R E E
Implementing RA 11148
at the local level
This section will discuss how the provincial, city/municipal,
and barangay levels can implement RA 11148. It is guided
by the roles of LGUs as per Section 3, Rule 13 (Role of NNC
Member Agencies, Other NGAs, and LGUs) as follows:

“LGUs are encouraged to integrate maternal,

neonatal, child, and adolescent health and nutrition
programs in the local nutrition action plans
(LNAPs), and investment plans for health. For this
purpose, the local nutrition action officers (NAOs)
designated or appointed by their local chief
executives (LCEs) shall facilitate processes for the
formulation, approval, coordination, monitoring,
and evaluation of the LNAPs and its integration in
the Comprehensive Development Plans (CDPs), LDIPs,
and Annual Investment Plans (AIPs). They shall
coordinate closely with offices/departments of their
respective LGUs to ensure the harmonization and
integration of efforts for nutrition improvement.”

The Mandanas ruling presents an opportunity to increase

funding support for the full implementation of RA 11148.

21
The provincial, city, and municipal governments shall ensure the integrated and multisectoral management
of efforts related to the F1KD+, and more specifically,

1. Exercise general supervision and control in the 6. Provide the facilities and platforms for the implementation
implementation of the F1KD+ Strategy at their respective of the F1KD+ Strategy, maximizing opportunities for
local levels in coordination with the DOH, NNC, and other integrated activities; and
NGAs, and promote—as well as enforce—local legislative
measures relevant to the Strategy that will aim to strengthen
7. Ensure functionality and effectiveness of their respective
and enhance its implementation in the communities;
provincial/city/municipal nutrition committees to:
a. Assess the local nutrition situation.
2. Integrate the F1KD+ comprehensive and sustainable
strategy into their respective Provincial Development and b. Oversee the implementation and provide technical
Physical Framework Plan (PDPFP), CDPs, LDIPs, and AIPs with support to lower levels to ensure the effective and
clear and appropriate guidance and extensive support from efficient delivery of services in the continuum of care.
NGAs, their regional offices;
c. Formulate the LNAPs complementary to and integrated
with other plans of the LGU and higher-level plans with
3. Ensure the effective and efficient delivery of services in the focus on the F1KD+.
continuum of care;
d. Coordinate, monitor, and evaluate plan implementation
and recommend and adopt appropriate actions related
4. Provide mentoring and supervision for trained staff and to the F1KD+.
service providers so that they can provide quality care,
facilitate timely referrals for specialized care as needed, and e. Mobilize resources to ensure the plan is fully
collect and report quality data; implemented.
f. Hold at least quarterly meetings to report progress on
5. Provide counterpart as necessary that will tap into potential the implementation of the local multisectoral nutrition
funding sources in addition to other local funds to be utilized action plan especially the component on the F1KD+.
to support the implementation of this program, organize and g. Extend technical assistance to municipal and barangay
support parent cooperatives to establish community-based nutrition committees (MNCs/BNCs) on planning,
programs, and provide counterpart funds for the continuing nutrition program management, and related concerns,
professional development of their service providers; including the conduct of periodic visits and meetings.

22
 This section presents activities that can be undertaken, and how these can be done. The overriding
concern for these activities is to ensure integrated service delivery, i.e., services reach those needing
them when needed, produce the intended outcome, with efficient use of resources.

Guiding principles for implementation

The strategic actions should always be contextualized along key principles that guide the various
plans (National Objectives for Health, Universal Health Care, Philippine Plan of Action for Nutrition,
National Strategic Plan for Early Child Care and Development or the Early Years First) on which RA
11148 is anchored.
These guiding principles include:

1. FA M I LY- C EN T ER E D. As noted in the National Strategic 2. INCLUSIVE TO ENSURE THAT NO ONE IS LEF T BEHIND.
Plan for ECCD 2019-2030 or Early Years First, “Families are This means that services for the F1KD+ should be available
at the center of young children’s survival and optimal to all children and their families regardless of gender,
development. For most young children, their family disability, ethnicity, religious affiliation, political affiliation,
members are the people who are most consistently in and socio-economic class.
their lives. To provide supportive and nurturing care
for the survival and optimal development of young 3. EQUI TA BL E .
children, families need information, resources and While services should be inclusive, there should be extra
services, particularly when they are facing adversities efforts to reach out to the marginalized and vulnerable,
and crises. The Government must, therefore, support e.g., poor families and communities; those in GIDAs;
all families but especially those families who have areas, communities and families affected by emergencies/
vulnerabilities and face adversities, so they have access calamities; children with delays and disabilities, etc.
to the knowledge, skills, resources and services they
need to provide supportive, protective and nurturing
4. I N T EGR AT E D A N D MU LT I S EC TOR A L .
care to their young children.”
This means that children and their families receive the
services as indicated in RA 11148 when they need it, where
Similarly, a guiding principle of the PPAN 2017-2022 notes,
they are, in ways that uphold their human dignity, to allow
“Attainment of nutritional well-being is a main
for optimum child development. Achieving integrated
responsibility of families, but government and other
service delivery will require a whole-of-society and whole-
stakeholders have the duty to assist those who are
of-government approach. Thus, various stakeholders
unable to enjoy the right to good nutrition.” at all levels of governance have roles to play in child
development.

23
 Strengthen planning Identify how F1KD+
Conduct an F1KD+ and budgeting services will be
situational analysis mechanisms integrated

A C T I V I T I E S T O U N D E R TA K E

Strengthen Service Strengthen Advocate for

Delivery monitoring and whole-of-government
evaluation action

24
 Conduct an F1KD+ Situational Analysis
A first step in implementing RA 11148 is assessing the F1KD+ situation. On the other hand, the functions of a more permanent
This involves having a shared (among all those to be involved in structure could be as follows:
delivering services in the F1KD+) view on issues affecting children, 1. Facilitate the integration of services across sectors to
causes of these issues and priority actions that should be pursued. The ensure the delivery of needed services in the F1KD+.
situational analysis can also look into good practices in service delivery,
capacity building, management and coordination and other concerns. 2. Formulate medium-term and annual plans on the
F1KD+ (for integration in “mother plans,” e.g., LIPH,
The NNC has tools and sample situational analysis in its website PPAN, and eventually in the CDP and AIP).
(Ensuring Nutrition Priorities in Local Development Plans and Budgets)9 3. Monitor the progress of implementation of the plan
that can be referenced and tweaked to cover the concerns of the F1KD+. referred to in item 2 and attend to corrective actions
as needed.
Who should do the situational analysis? 4. Prepare reports on the F1KD+ as may be needed.
For the assessment to be meaningful, it should be done by a team 5. Evaluate the effectiveness of the plan formulated in
that, at the least, includes representatives from the health office, the item 2.
nutrition office, social welfare and development office, agriculture
office, planning and development office, and at least one civil Whatever, the form, having an appropriate policy
society organization, preferably a women’s group or organization, instrument, e.g., city/municipal executive order for the
operating in the area. Other members of the local nutrition creation of the team is important. The policy instrument
committee may be added as needed. should indicate the name of the team, the composition
(preferably expressed as position title rather than names
This team can be ad hoc (specific to the situational analysis), or a of persons), the functions of the team, the relationship with
more permanent structure under the local nutrition committee. The existing structures, and other provisions that will define
functions of an ad hoc situational analysis team could be as follows: how the team will operate. See Annex 2 for a template for
1. Define the scope of the assessment as well as data the policy instrument.
requirements and sources. In addition, the sector representative in this team should
2. Collect, process, and analyze data. facilitate intra-sector or agency coordination. For instance,
there is no single person in the health office that works
3. Prepare the assessment report that should include the results on all the health services for the F1KD+. Thus, the
of the assessment as well as recommendations to address the representative of the health sector should coordinate with
findings of the assessment. colleagues in the health office along with the tasks of the
assessment team.
4. Lead in the dissemination of the results of the situational
analysis. The organization of the team should be initiated by the
city/municipal nutrition action officer.
9 https://www.nnc.gov.ph/component/phocadownload/
category/223-ensuring-nutrition-priorities-in-local-development-plans-and-budgets
25
When should the situational analysis be done?
The assessment can be done in any phase of the program
management cycle. It can be done to respond to a finding or
monitoring of an emerging concern. In this case, the assessment can
cover a specific area of concern for the assessment.

It can also be done when an emergency/disaster happens, especially

for those that are estimated to be protracted. For this, there is more
specific guidance as contained in Administrative Order (AO) 2017-0007
on the Essential Health Service Package during Emergencies and
Disasters. The AO specifies when assessments should be done after
an event that could lead to an emergency/disaster. In addition, the
Information Management for Nutrition in Emergencies for Local
Government Units Participant’s Manual can be referred to for nutrition
assessment in emergencies.

However, a comprehensive assessment should be done for the

formulation of the Provincial/City/Municipal/Barangay Nutrition Action
Plan (P/C/M/BNAP) and P/C/M Investment Plan for Health (P/C/MIPH).

Per NNC Guidelines, the P/C/MNAP is ideally formulated in the

first quarter of an election year. This will make available an agenda
for nutrition action that can be submitted for consideration in
the formulation of the executive legislative agenda (ELA) and the
comprehensive development plan. It is to be noted that the ELA
should be done within one month after the assumption to duty of the
LCE. Thus, formulating the P/C/MNAP way ahead (i.e., first quarter of
the election year or earlier) is a pro-active strategy for putting nutrition
in the agenda for local development.

An assessment can also be done when a new program or project is

being developed.

26
 How can the situational analysis be done?
The main effort is to generate and analyze information. Information can be generated
using both quantitative and qualitative methods, which can be either primary or secondary.
The assessment can thus involve the following:
1. Generation of information
a. Desk review of existing information, usually from administrative reporting
systems like the Field Health Service Information System (FHSIS), Operation
Timbang Plus (OPT Plus), Monitoring and Evaluation of Local Level Plan
Implementation (MELLPI) Pro, or from existing plans like the CDP or LNAP
or LIPH that already have a situational analysis, or from published studies.
b. Key informant interviews that can cover the range of those involved in
program/ project planning and implementation, e.g., program manager,
those who deliver the services including volunteers, and the mothers,
fathers, and caregivers themselves.
c. Focus group discussions to tackle a specific concern
d. Others

2. Analysis of information generated to understand the situation

3. Consultation with stakeholders on the initial analysis

4. Finalizing the analysis

5. Writing the report that can include the following:

a. Introduction
b. Objectives of the situational analysis
c. Methodology
d. Findings that answer the questions listed in Annex 3. Annex 3 contains further
e. Recommendations details on doing the
situational analysis.
6. Disseminating the results of the assessment

27
How can results of the analysis be used and disseminated?
A situational analysis is meaningful only if its results are used. Closely linked with using the results of a situational analysis is
28
These uses can include: the purposive dissemination of the results of the assessment,
1. In making strategic decisions, e.g., what would be priority especially to those who can use the results.
geographic areas or target groups or components, what Dissemination can be done in various ways, as follows:
new programs, projects or approaches to develop and
1. Writing up and publishing the situational analysis and
their design.
giving copies to key stakeholders.
2. For formulating ordinances that may be needed to
2. Preparing and distributing flyers or simplified materials
address the situation.
on the assessment results .
3. For convincing stakeholders to adopt certain behaviors
3. Preparing information bites from the assessment that
and development, and execution of advocacy campaigns
can be featured in the LGU social media account.
to strenghten F1KD+ governance in LGUs.
4. Holding meetings or forums not only to present
the results of the assessment, but also to generate
commitments in pursuing the assessment
recommendations.

28
 Strengthen Planning And Budgeting Mechanisms
To be effective and to ensure appropriate financing, concerns on the F1KD+ should
be integrated in the Comprehensive Development Plan (CDP), the Executive
Legislative Agenda (ELA), and the local development investment plan, which are the
bases for the annual investment program and ultimately the budget of the LGU.
The investment plans for health, and the nutrition action plan, are formulated to
allow a close look at health and nutrition issues. F1KD+ concerns should be in these
thematic plans, and eventually integrated in the CDP.
Figure 2 shows the link of these two thematic plans with the local development plan.

How can these Planning and Budgeting Systems be Strengthened?

1) Ensure integration of F1KD+ concerns in the local development plan.
Prepare the LIPH and LPAN way before the LGU formulates its CDP, ELA, LDIP, and AIP.
For instance, per NNC guidelines, LPANs should be formulated in the first quarter of
an election year. This will allow the availability of a nutrition agenda that will, in turn, Since the local nutrition
facilitate the integration of nutrition concerns in the CDP. committee is the main mechanism
Important dates to remembers and their respective milestones as per Joint (DILG, for harmonization, the provincial,
DBM, NEDA, DOF) Memorandum Circular No. 1, series of 2016 and possibilities for city, municipal, and barangay
integrating F1KD+ concerns in each phase are shown in Annex 4.
nutrition action plans should be
The DILG “Local Planning Illustrative Guide,” and the “Budget Operations Manual revised to include all services
for Local Government Units” can be used as references in understanding the local related to F1KD+ either as a
planning and budget process.
nutrition-specific or nutrition-
For barangay development planning, the “Primer on Barangay Development sensitive component.
Planning” can be a reference. A related document developed recently is on “Ensuring
Nutrition Priorities in Local Development Plans and Budgets” could also be referred
to, and adapted to cover the entire range of F1KD+ services and interventions.

29
FIGURE 2 Relationship Of City/Municipal Plans & Instruments 10

Local Development Plan

Phil. Regional COMPREHENSIVE LAND USE PLAN (CLUP)
LONG-TERM
Dev’t Dev’t Settlement
Policies
Protection
Policies
Production
Policies
Infrastructure
Policies FRAMEWORK PLAN
Plan Plan
(9 YEARS)

(PDP) (RDP) ZONING OTHER REGULATORY

ORDINANCE MEASURES

COMPREHENSIVE DEVELOPMENT PLAN MULTI-YEAR, 

MULTI-SECTORAL
Social Economic Environmental Infrastructure Intitutional DEVELOPMENT
Philippine Regional Development Development Development Development Development PLAN
(6 YEARS)
Plan of Plan of
Action for Action for EXECUTIVE - LEGISLATIVE AGENDA (ELA)
TERM BASED
AGENDA
Nutrition Nutrition (3 YEARS)
(PPAN) (RPAN)
IMPLEMENTATION
INSTRUMENTS

Local Development Capacity Monitoring Legislative

Investment Program Development and Evaluation Requirements
(LDP) Program Strategy and Support

ANNUAL INVESTMENT ANNUAL

Local Nutrition Action Plans PROGRAM (AIP) BUDGET

• Provincial Nutrition Action Plan

OUTPUT

• City/ - Improved Public Services - Increased Private sector

Municipal Local Investment - New and Improved Public Facilities and Infrastructure Investment in local, social and
Nutrition
Action Plan Plans for Health - Increased Public Awareness and Participation economical development

• Barangay • Provincial Investment

Nutrition Plan for Health
✔ Change in economic and social well-being of constituents
OUTCOME

Action Plan
• City/Municipal
✔ Change in the configuration and quality of the physical environment
Investment
Plan for Health ✔ Change in local institutional capacities
10 Adapted from the DILG Local Planning Illustrative Guide and the eLearning Course on Local Nutrition Program Management Course Guide of
NNC with revisions to include local health and nutrition plans 30
 2) Ensure consistency across plans. Having a joint planning and budgeting session for agencies (at the
Similar information (data or indicators, targets, elements) least health, nutrition, social welfare and development, agriculture)
used in all the plans should be the same. has been challenging due to constraints in time as well as human
resource. In many instances, sectors or agencies plan separately and
3) Ensure regular communication across and within these plans are put together in a plan. However, for integration to
agencies as sectoral plans are being formulated. happen, joint planning and budgeting should be done.
This will allow the identification of points of coordination A possibility is to have at least one meeting during which all agency
and complementation of activities and budgets. plans and budget for the F1KD+ are discussed. Staff work is needed
for this not just in putting information together for the agency activities,
4) Share final plans with stakeholders. targets, and budgets, but in identifying talking and action points.
Working with the SP/SB committee on health could help also in
5) Work with the LCE and the local ensuring budgetary allocation for the nutrtion action plan.
development planning office so that:
Possible talking and action points are shown in Table 3.
a. Budget calls and guidelines for the preparation of If convening a meeting is challenging, one-on-one discussions
budget proposals will indicate that agencies are between agencies could be considered.
required to specify what they will do for those in
the F1KD+ and their families. The budget call can
also require a form of joint budgeting among, at
the least, the health, nutrition and social welfare
and development sectors. While bottom-up planning and
b. Reviewers of agency budgets at the provincial
budgeting is ideal, adopting a
level purposely look for and ask what the agency bibingka approach to planning
has planned or budgeted for the F1KD+. is more realistic.
They can also probe on the extent to which the In the BIBINGKA APPROACH,
different LGU offices “talked” to each other and
harmonized their budgets for the F1KD+.
each level plans simultaneously
but have consultations with
c. Budgets related to F1KD+ services are tagged. each other so that concerns
can be reconciled and
integrated in the plans.

31
TABLE 3
Talking Points For Discussions On F1KD+ Plans

CONCERNS TA L K ING /AC T ION POINT S

1. Barangays that have high levels of Can agencies involved in the F1KD+ redirect
problems in the F1KD+ and low services (best if identified) agree to adopt the
coverage of services are not targeted same priority barangays and re-direct services
by all agencies. accordingly?

2. The target of a service is low Can the agency/ies increase budget allocation for
compared to the identified needy increased coverage of the needy population?
population. What will be the fighting target coverage?

3. Some services are missing. Can the agency/ies develop a program or project or
activity that will address this gap?

4. Budgets are allocated for services Can this budget be rechanneled to other services
and activities that, by evidence, are that are more effective and give more value for
not as effective. money?

32
 Identify How
F1KD+ Services Converge in the same
priority barangays
will be Integrated and households

The health sector is the anchor sector for the

F1KD+ since most of the services for those in
the F1KD+ are delivered through the health Add or modify
system. a component of the
Thus, it should ensure horizontal (within one
F1KD+ services
level, e.g., the city/municipal level) and vertical
(across levels, e.g., from the national down
to the barangay level) integration within the
health sector, and with other sectors, especially
that of social welfare and development. Establish
It should be an effective gatekeeper for referral systems
services to those in the F1KD+.

Ensuring integrated service delivery can be

achieved using a mix of strategies according to
the situation of the LGU. These strategies are Synchronize service
discussed in this section.
delivery schedules within
and across sectors

33
Converge in the same priority barangays and priority households
Data from the situational analysis can help identify The local nutrition committee (as the mechanism for coordination
cities, municipalities, and barangays that need to and partnerships per Section 7 of the IRR of RA 11148) can decide
be focused on. Priority areas can be identified on the indicators to use for prioritizing barangays, and how these
using one or more indicators, e.g., population size, indicators will be processed for the selection process.
average household size, number (or percentage)
While using prevalence rates or percentages is a usual practice,
of stunted children, number (or percentage) of
there is also a need to consider the equivalent numbers
wasted children, coverage of one or more services,
for these rates or percentages. For instance, consider two
percentage of households with sanitary toilets, etc.,
barangays, one has 100 under-five children, the other 1000.
depending on the purpose of the prioritization.
A prevalence rate of 10% for say, stunting, in the former is
If the intent is to choose barangays with a higher equivalent to 10. On the other hand, a prevalence rate of 5% in
need for F1KD+ services, a mix of outcome the latter translates to 50 children. In such a situation, choosing
indicators and service indicators can be used. the barangay with the lower prevalence rate is more judicious.
If the intent is to choose priority barangays for
Within the barangay, frontline workers should agree on which
a particular intervention, a single indicator
households will be prioritized for certain interventions.
related to the intervention can be used.

34
 Add or modify a component of the F1KD+ services
If based on the assessment, one or more components of the F1KD+ services is not present in the
province/city/municipality, and that component is crucial given the situation of children, then an action
line would be to develop a project or activity related to the component.
The following are examples of components to add in existing services. The LGU can identify others based on its situation.

1. ECCD Community Risk Targeting (Annex 5) that will 5. Activities that will increase the participation of fathers
involve an initial assessment by the Barangay Health in maternal and child care. These activities can include
Worker (BHW) and Barangay Nutrition Scholar (BNS), holding health and nutrition classes for fathers, requesting
and a system for referral to the local health office for the agriculture sector to include a health and nutrition
further assessment, and developmental specialists topic in farmers’ classes, including health and nutrition
through the levels of care. topics in Parent Effectiveness Services (PES) and Family
Development Sessions (FDS). The Idol Ko si Tatay
2. Responsive caregiving and early stimulation in
modules developed by NNC and the Empowerment and
contacts with the mother and caregiver through one-
Reaffirmation of Paternal Abilities (ERPAT) of the DSWD are
on-one consultations and group learning session.
resources that can be tapped.
Annex 6 provides key points for promoting responsive
caregiving and early stimulation based on the WHO 6. Activities that will increase the participation of other
Care for Child Development Module. The Idol Ko si caregivers in maternal and child care.
Nanay Learning Sessions developed by NNC that
7. Having toys in waiting areas of health facilities including
contains modules on responsive caregiving can be
facilities for outpatient treatment care for acute
used for group sessions.
malnutrition, but ensure that these toys are made of safe
3. Dietary supplementation of pregnant women materials and that they are sanitized regulary.
and children 6-35 months old that can adapt the
8. Regular checking of physical facilities to ensure that
NNC “Guidelines on Early Childhood Care and
there are no materials on infant formula.
Development in the First 1000 Days (ECCD F1KD+)
Program in the Context of COVID-19 Pandemic and 9. Regular checking and fixing of health facilities, nutrition
Related Emergencies.” centers, and other points of service delivery to ensure
that there are no threats to physical safety, e.g., no
4. Projects or service packages for adolescents that
beams, doors, or walls in danger of falling on people, no
include not only prevention of pregnancy, but overall
protruding nails, clear corridors and walking spaces to
health and nutritional well-being.
prevent tripping, etc.

35
Establish referral systems within the health Synchronize service schedules within
system and with other sectors and across sectors
If the City-Wide and Province-Wide Health System (C/PWHS) has This can be done to maximize contacts with those in
been defined, then the presence of a system for referring cases the F1KD+. For example, health outreach activities on
from the primary care to the secondary and tertiary care levels can measles immunization could include the administration
be safely assumed. of vitamin A supplements and the distribution of
micronutrient powders.
If the C/PWHS has not been defined, the recommended referral
system and tools as per DOH Administrative Order No. 2020-0020, Community outreach activities can include various
“Guidelines on Integration of the Local Health Systems into services delivered in a common place, e.g., birth
Province-Wide and City-Wide Health Systems (P/CWHS)” can be registration, delivery of health services (ante-natal care,
adapted. The city/municipal health office can also advocate with growth monitoring, check-up, oral care, reproductive
the provincial health office to organize the C/PWHS to facilitate health services, etc.), provision of social welfare support,
integrated service delivery within and across levels of health care. distribution of planting materials, and small animals,
parenting support sessions, and many more.
A similar referral system could be established for referral to services
across sectors. For instance, health care providers should know to
whom and where to refer cases of violence against women and
children at each administrative level.
In the same way, social welfare and development workers should
know to whom and where to refer cases that they encounter who
need health services.
The needed mechanisms to “formalize” the referral across sectors
should also be developed.

36
 Strengthen Service Delivery
Service delivery can be strengthened through strategies that will increase both the demand for and the
availability and quality of services. Since most of the services in the F1KD+ are delivered through the health
system,
the MNCHN Manual of Operations (MOP) can be referred to.
Guided by the results of the situational analysis, the following can be done:

Ensure the delivery Adopt local policies

Increase demand Improve of services in to facilitate
and use of services services emergencies/disasters implementation

Increase Demand and use of services

Based on the situational analysis, and as indicated in
the MNCHN MOP, increasing demand can involve:
In addition, the community
1. Organizing and mobilizing community health
and target population groups
teams or community F1KD+ teams, which can
should be constantly reminded
be composed of the midwife, barangay health
of services available, where
workers, barangay nutrition scholars,
they are available and when.
child development worker, and
representative of the 4Ps or parent-leaders. Points of resistance to services
should be identified and ways
2. Organizing a transportation and communication
to break through the resistance
system to facilitate access to health facilities.
implemented.
3. Conducting outreach activities.

37
Improve services
The main principle for improving services is addressing gaps
along the human resources, infrastructure and equipment,
and supplies and logistics. Again, the MNCHN MOP has
extensive guidance on this concern. In addition, following
the DOH guidance on C/PWHS, Health Care Provider
Networks (HCPN), as well as the standards for primary care
facilities is important to improve the supply of services.
In the context of RA 11148, the following can be considered:
1. Capacity building of service providers, including 2. Ensuring availability and use of supplies such as
community workers and volunteers along the calibrated weighing scales, validated height boards,
following: mid-upper arm circumference tapes, mother-baby
books, checklist on developmental milestones, health/
a. Effective delivery of antenatal care, essential nutrition education cards, vaccines, deworming
maternal and newborn care and lactation medicines, supplements (vitamin A capsules, iron-folic
management, among others. acid tablets, micronutrient powder, zinc), ready-to-use
b. Working with others, breaking down turfs, and supplementary food, among others.
keeping communication lines open. a. Manage the supply chain, e.g., improve processes
c. Improving processes related to Operation Timbang Plus. to estimate supply requirements, set reasonable
cut-off points to trigger re-ordering or re-
d. Effective health/nutrition education, with emphasis requesting for supplies, factor in turn-around time
on listening and learning; building confidence and for procurement.
giving support skills.
b. When feasible and applicable, tap into community
e. Knowledge on the components of the NCF, e.g., participation in procurement. The “Manual
social welfare staff should know more about health on Community Participation in Government
and nutrition, those in the health system should Procurement” and GPPB Resolution 28-2016 can be
know more about social protection, community used as references.
volunteers should know and understand concepts
on WASH and the sanitary inspector about 3. Harmonization of parenting support interventions not
nutrition, etc. only to ensure consistency of messages but also to
keep stakeholders informed of their related initiatives
f. Supportive supervision and mentoring.

38
 Ensure the delivery of services in emergencies/disasters
An emergency is any actual threat to public safety. It is a situation where there
is imminent or actual disruption or damage to communities. It is the period
characterized by chaos, death, injuries, damage to properties, displacement of
families, and inadequate or lack of basic supplies. A disaster, on the other hand, is a
serious disruption of the functioning of a community or a society involving human,
material, economic, or environmental losses and impacts, which exceeds the ability
of the affected community or society to cope using its own resources.
Emergencies and disasters are not new in the Philippines, the country being in the
Pacific Rim of Fire and in the pathway of typhoons. The COVID-19 pandemic has
added to country experiences related to a long-term medical emergency.
With RA 10121 (2010), or the Philippine Disaster Risk Reduction and Management
(DRRM) Act, the Philippines has adopted an approach that is holistic, comprehensive,
integrated, and proactive in lessening the socio-economic and environmental
impacts of disasters including climate change and promotes the involvement and
participation of all sectors/stakeholders concerned.
The same principle is applied to F1KD+ services. Thus, concerns on the F1KD+
should be integrated in DRRM plans and operations.
In emergencies/disasters, services for the F1KD+ should continue to be delivered,
with guidance from the following:
1. RA 10821 (2015), “Children’s Emergency Relief and Protection Act” and its IRR
2. DOH AO 2017–0007, “Guidelines in the Provision of the Essential Health
Service Packages in Emergencies and Disasters”
3. DOH AO 2016-0005 National Policy on the Minimum Initial Service Package
(MISP) for Sexual and Reproductive Health (SRH) in Health Emergencies and
Disasters
4. NNC Governing Board Resolution No. 1, S 2009 on Adopting the National
Policy on Nutrition Management in Emergencies and Disasters

39
During the COVID-19 pandemic, DOH and To implement Section 11 of RA 11148, section 5, of Rule 9 of the IRR
NNC issued several issuances that call for reiterates policies on donations of milk breastmilk substitutes, and/or
the continued delivery of services but with products covered by the Milk Code, as follows:
appropriate infection control measures. 1. Such donations, without the approval of the Inter-agency
These issuances are: Committee created under EO 51, 2 1986 are prohibited before,
during, and after a disaster.
1. Department Circular No. 2020-0167 on the
Continuous Provision of Essential Health 2. Donations of non-breastmilk substitutes (non-BMS) and non-
Services During COVID-19 Epidemic BMS-related products from the private sector with no conflict of
interest and not involved in the manufacture of products under
2. DM 2020-150 - Interim Guidelines for
EO 51 shall be allowed immediately in the aftermath of disasters
Immunization Services in the Context of
and calamities.
COVID-19 Outbreak
3. Provisions of EO 51 will be upheld and options for mothers with
3. Department Memorandum (DM) 2020-0237
breastfeeding problems will be provided.
- Interim Guidelines for the Delivery
of Nutrition Services in the Context of In relation with the Milk Code and in the context of emergencies, and
COVID-19 Pandemic disasters, the DOH also issued the following:
4. DM 2020-0341 - Interim Guidelines on 1. AO 2007-0017 – Guidelines on the Acceptance and Processing
Continuous Provision of Adolescent Health of Foreign and Local Donations During Emergency and Disaster
Services During COVID-19 Pandemic Situations. Item VI B of the AO specifies that “Infant formula,
breastmilk substitute, feeding bottles, artificial nipples, and
5. DM 2020-0319 - Interim Guidelines on
teats shall NOT be items for donation. No acceptance of
COVID-19 Management of Pregnant
donation shall be issued for any of the enumerated items.”
Women, Women About to Give Birth and
Newborns 2. DM 2020-0231 – Guidelines on the Standardized Regulation
of Donations, Related to Executive Order 51, series of 1986
6. Nutrition Cluster Advisory 1 - Nutrition
(The Philippine Milk Code), to Health Facilities and Workers,
Cluster Guidelines on LGU Nutrition
Local Government Units, Non-Government Organizations, and
Actions Relative to COVID-19
Private Groups and Individuals in Support to the Response
7. Nutrition Cluster Advisory 2 - Nutrition to Emergencies, Disasters, and Situations Where Health and
Cluster Recommendations on Healthful Nutrition of Mothers, Infants, and Young Children are Affected.
and Nutritious Family Food Packs and
3. DC 2020-0217 – Reiteration of DOH DM 2020-0231.
Sustainable Food Sources

40
 Adopt local policies to facilitate implementation
Section 2, Rule 7 (Program Implementation) of the IRR of RA 11148
indicates that “implementation of the First One Thousand Days
Strategy shall be supported by a local resolution or policy form
their respective Sangguniang Bayan, Sangguniang Panlunsod, and
Sangguniang Barangay.
Local ordinances on the F1KD+ should be informed by the results of
the situational analysis, and best practices from other cities. On the
next page is a suggested template for a local ordinance on RA 11148.

Some LGUs have adopted their respective ordinances on

RA 11148. Two examples that can be referred to are:

1. Malabon City Ordinance No. 08-2018

An Ordinance Providing Strategic Focus on Nutrition for the
First 1000 Days of Life Through a Strengthened and Integrated
Strategy for Maternal, Newborn, and Child Health and Nutrition
and Appropriating Funds Therefore and for other Purposes.
Available at: https://www.nnc.gov.ph/images/abook/NCR_4_
Ordinance%20No.%2008-2018_Malabon_NCR.pdf

2. Navotas City Ordinance No. 2018-02

An Ordinance Creating the Navotas First 1000 Days of Life
Program (N1k) and its Adoption in All Barangays of the City of
Navotas; available at https://www.nnc.gov.ph/images/abook/
NCR_7_Ordinance%20No.%202018-02_Navotas_NCR.pdf

41
 A Suggested Template For An Ordinance To Localize RA 11148 11
Local Ordinance Sections Section 1 Title Section 2 Declaration of Policy
1. Title This section simply contains the This section provides the rationale and
2. Declaration of Policy title of the ordinance. policy basis for the proposed ordinance.
Either add the whole of Section 2 of RA
3. Objectives Example:
11148 or have a statement, “As per Section
Adoption of the Kalusugan at
2 of RA 11148.”
4. Coverage Nutrisyon ng Mag-Nanay Act in
(name of city/municipality). This section could also include related
5. Definition of Terms
ordinances on which the ordinance on RA
6. Responsibilities of the Parties 11148 could be anchored on.
7. Description of First 1000 Days Plus
Section 3 Objectives Section 4 Coverage
8. Programs and Services for F1KD+
This section contains the aims of This section contains the target beneficiaries
9. Nutrition in the Aftermath of a the ordinance. and geographic coverage of the F1KD+
Natural/Human-Induced programs.
The LGU may choose to localize
Emergency and Disaster
objectives of RA 11148, e.g., Please note that the coverage by population
10. Capacity Building of Barangay Health rephrase so that the reference group cannot be changed. However, the LGU
and Nutrition Workers and the F1KD+ is to the city/municipality and may indicate the need to prioritize barangays,
not the national level. Also, and the basis for prioritization, etc.
11. Implementing Rules and Regulations references to the age group 0-24
Also, ensure that the age coverage is
12. Appropriations months old can be modified to
“0-35 months old.”
0-35 months old.
13. Separability Clause
14. Repealing clause Section 5 Definition of Terms
15. Effectivity This section may be lifted from the F1KD+ IRR but updated to include other terms
referred to in the ordinance.

11 Adapted from the templates developed by Save the Children as part of its efforts in localizing the implementation of RA 11148
42
 Section 6 Responsibilities of the Parties Section 7
This section should detail the roles and Description of First 1000 Days Plus
responsibilities of the different stakeholders This can be lifted from the F1KD+ Law IRR.
with regard to the F1KD+ strategy.
These include the following: Section 8
1. City/municipal mayor Programs and Services for F1KD+
2. City/municipal health officer This contains the health and nutrition programs
and services that must be provided by the LGU
3. City/municipal nutrition action officer up to the barangay level. This includes F1KD+
4. HCPN of the city/municipality programs and services during emergency
situations. Refer to Annex 1 for the list of
5. Health care facilities in the program components (or services) indicated in
City-wide, province-wide health RA 11148.
system (particularly the portion
of the municipality)
Section 9
6. City/municipal health board Nutrition in the Aftermath of a Natural/
7. City/municipal nutrition committee Human-Induced Emergency & Disaster
This section details the priority F1KD+ services
8. Specific offices or departments of
that have to be delivered in emergencies and
the city/municipality, e.g., member
disasters
agencies of the local nutrition
committee
Section 10
9. Sangguniang Panlunsod/
Panlalawigan/Bayan/Barangay Capacity Building of Barangay
Health and Nutrition Workers and the F1KD+
10. Civil society organizations
This section highlights the need for capacity
11. Private sector building programs for F1KD+ personnel,
particularly those working at the barangay level.

43
Section 11 Implementing Rules and Regulations There should also be efforts to ensure that the ordinance is
passed. These efforts could include the following:
This section would indicate that IRR will be developed,
who will develop them, and by when. 1. Identify a potential sponsor in the Sanggunian
2. Work with the sponsor and his/her staff in crafting and
Section 12 Appropriations refining the ordinance

This section details the budget needed for the 3. Provide technical assistance in hearings
implementation of the F1KD+-related programs and 4. Identify potential non-supporters and find ways to reach out
projects as well as funding sources. to convince them to support the proposed ordinance
5. Prepare policy and program briefs on background
Section 13 Separability Clause information on proposed issuances for the LCE, and
members of the local Sanggunian
This indicates that the provisions of the ordinance are
severable, i.e., an invalid section does not invalidate the 6. Generate position papers and statements of support from
entire ordinance. various stakeholders
7. Follow closely the progress of a proposed ordinance or
Section 14 Repealing Clause resolution, and pursue actions to hasten adoption
This is a clause that states that the local ordinance The city/municipal nutrition action officer should anchor the
repeals other issuances, ordinances, executive orders, efforts to push for the approval of the ordinance.
and administrative orders that are inconsistent with the
provisions of the ordinance. A related effort is to determine if additional ordinances are
needed to improve the integrated delivery of F1KD+ services.

Section 15 Effectivity The NNC has a Compendium of Local Ordinances and Issuances
on Nutrition ( https://www.nnc.gov.ph/policy-database ) that
This section details the effectivity of the ordinance. can serve as a reference if and when LGUs decide to have an
It can also include provisions for review of ordinance on nutrition.
implementation every five years.
Knowing rules, regulations, and procedures related to local
legislation as defined by the Local Government Code of 1991,
specifically Chapter 3 on Local Legislation will be helpful.

44
 Strengthen Monitoring and Evaluation
There are existing mechanisms for monitoring What questions should monitoring
concerns on the F1KD+ in the different sectors.
These include the FHSIS, the LGU Health Scorecard, and evaluation answer?
MELLPI Pro, and the required quarterly reporting on Monitoring should answer the following questions.
nutrition programs per DILG MC 2018-42. Related 1. What is the status of services being delivered compared
information from these systems can be put together to the target? Plan?
to have a view of the evolving situation on the F1KD+.
2. What specific services are not being delivered as desired
and as targeted?
Who will be the main monitor?
3. What specific population groups and geographic areas are
Since local nutrition committees have been assigned not being covered adequately by which specific services?
to provide the basic mechanism for sectoral
collaboration and partnership in the implementation 4. What factors are hindering the delivery of services?
of the F1KD+ strategy (IRR of RA 11148, item d of Rule  Supply of service?
6 on Cross-Cutting Components), they shall be the  Demand for service?
main monitor. As such, reports on F1KD+ concerns  Breakdown in the HCPN?
should be submitted to the Provincial/City/Municipal  Breakdown in the C/PWHS?
 Lack of coordination across sectors?
Nutrition Committee through the Provincial/City/
Municipal Nutrition Action Officer (P/C/MNAO).
5. How much funds were allocated for the F1KD+ services?
How much of the allocated funds used?
6. What should be done to correct the situation in the next
quarter? Who will be in charge?
7. Are longer-term measures needed? If so, what are these?
Who will be in charge?

Evaluation, usually done at the end of the year, looks into

the extent to which outcome targets have been achieved.
Evaluation processes also look into the same concerns as
monitoring. They should also identify corrective measures
that should be applied in the next implementation cycle.

45
What indicators will be monitored? How can monitoring be strengthened?
Table 4 lists a set of indicators that should be monitored Monitoring of F1KD+ services can be strengthened in several ways as
for which reports should be prepared and submitted to follows:
the P/C/M/BNC. The indicators in the list are outcome, 1. Improve the quality (completeness, correctness) of data
sub-outcome, and some output indicators. The LGU may recording tools of data sources by doing regular data quality
identify additional indicators to add in the list. It is also to audits.
be noted that these are indicators related to the F1KD+ Annex C of the MNCHN MOP can be referred to for data
and could be considered a sub-set of the indicators quality checks. Similar checks for OPT Plus is being developed
monitored by the P/C/M/BNC. Furthermore, the national and will be shared once available.
level is constantly reviewing and revising indicator
2. Ensure submission of reports as per agreed schedule.
systems and such changes should be noted and adopted
at the city/municipal level. 3. Prepare reports regularly and disseminate accordingly.
4. Within each agency, conduct internal reviews that will answer
What is the flow of reporting? the questions listed in the section on “What questions should
Since indicators are generated by existing systems, monitoring and evaluation answer?”.
the vertical flow of data through these systems should
be followed. However, such data are shared with the 5. Include in the agenda of quarterly meetings of the C/MNC an
corresponding local nutrition committee and the NNC agenda item on the status of F1KD+ services. See Annex 4 for
(Figure 3). a suggested way of handling the agenda item.
6. Conduct field monitoring.
Having an inter-agency team for field monitoring is ideal to
allow a shared view of the situation at the ground level. Field
monitoring helps identify issues affecting service delivery that
numbers do not capture. In addition, troubleshooting of issues
will also be facilitated. These field monitoring activities can
also be used for supportive supervision. Having a monitoring
checklist is also useful.
7. Ensure that issues identified by monitoring are linked with
corrective measures and that the implementation of these
corrective measures are also monitored. Annex 5 provides a list
of possible action lines for common service delivery issues.

46
TABLE 4 Indicators for Monitoring F1KD+ Services
GOOD HEALTH Frequency of
Indicator Report source reporting to LNC

1. Number of maternal deaths Local FHSIS Semi-annually

2. Number of deaths among under-fives Local FHSIS Semi-annually
3. Number of deaths among infants Local FHSIS Semi-annually
4. Number of deaths among newborns Local FHSIS Semi-annually
5. Proportion of pregnant women who received four or more antenatal care visits Local FHSIS Quarterly
6. Proportion of pregnant women who were dewormed Local FHSIS Quarterly
7. Proportion of pregnant women who received 2 doses of tetanus-containing vaccines Local FHSIS Quarterly
8. Proportion of live births that are Facility-Based Deliveries (FBD) Local FHSIS Quarterly
9. Proportion of mothers with at least 2 or more postpartum visits to a health facility Local FHSIS Quarterly

10. Number of current users of modern contraceptive prevalence rate Local FHSIS Quarterly
11. Number of adolescent pregnancies, 10-14 years old Local FHSIS Semi-annually

12. Number of adolescent pregnancies, 15-19 years old Local FHSIS Semi-annually
13. Proportion of newborns who underwent newborn screening Local FHSIS Semi-annually

14. Proportion of children fully immunized (FIC) Local FHSIS Semi-annually

15. Proportion of cases of diarrhea among 0-59 months old Local FHSIS Quarterly
receiving oral rehydration salts with zinc
16. Proportion of cases of pneumonia among 0-59 months old completing treatment Local FHSIS Quarterly

47
 A DEQUATE NU T R IT ION Frequency of
Indicator Report source reporting to LNC

17. Number and prevalence of stunting among children 0-35 months old OPT Plus Annually
18. Number and prevalence of wasting among children 0-35 months old OPT Plus Annually
19. Number and prevalence of overweight and obesity among children 0-35 months old OPT Plus Annually
20. Proportion of newborns initiated on breastfeeding immediately after birth for at least 90 minutes Local FHSIS Semi-annual
21. Proportion of infants exclusively breastfed until 6th month Local FHSIS Semi-annual
22. Proportion of infants who continued breastfeeding and were introduced to complementary
feeding beginning at 6 months of age
Local FHSIS Semi-annually
23. Proportion of pregnant women, 10-14 years old with low BMI Local FHSIS Quarterly
24. Proportion of pregnant women, 15-19 years old with low BMI Local FHSIS Quarterly
25. Proportion of pregnant women, 20-49 years old with low BMI Local FHSIS Semi-annually
26. Proportion of pregnant women, 10-14 years old with high BMI Local FHSIS Quarterly
27. Proportion of pregnant women, 15-19 years old with high BMI Local FHSIS Quarterly
28. Proportion of pregnant women, 20-49 years old with high BMI Local FHSIS Quarterly
29. Proportion of live births who weigh less than 2500 grams as a percentage Local FHSIS Quarterly
30. Proportion of infants born preterm or with low birth weight given iron supplements Local FHSIS Quarterly
31. Number of pregnant women who completed the dose of iron-folic acid supplementation Local FHSIS Quarterly
32. Number of post-partum women with post-partum vitamin A supplementation Local FHSIS Quarterly
33. Proportion of infants/children (6-23 months old) who completed Vitamin A supplementation Local FHSIS Quarterly
34. Proportion of high-risk infants and children with measles and/or persistent diarrhea who received
Vitamin A capsule aside from routine supplementation
Local FHSIS Quarterly
35. Proportion of infants 6-11 months old and children 12-23 months old who completed
micronutrient powder (MNP) supplementation
Local FHSIS Quarterly
36. Percent of nutritionally-at-risk pregnant women completing dietary supplementation LGU implementing agency Quarterly
37. Percent of infants 6-23 months old completing dietary supplementation LGU implementing agency Quarterly
38. Percent of pregnant women, and mothers, fathers or caregivers of infants 0-35 months old
completing the Idol Ko si Nanay Learning Sessions or similar learning sessions
LGU implementing agency Quarterly
39. Percent of wasted infants and young children 0-59 months old admitted in OTC or ITC Local FHSIS Quarterly

Indicator numbers 36-38 to be monitored only if the LGU has planned for these activities. 48
 Frequency of
Indicator Report source reporting to LNC

RESPONSIVE CAREGIVING
40. Proportion of children under 12 months old who are on track with respect to
C/MHO Semi-annually
developmental milestones

41. Proportion of husbands/partners of pregnant women, and fathers of infants and LGU social welfare and
development office and
children 0-35 months old participating in ERPAT, FDS, PES, and other related or Quarterly
CSOs operating CDCs, SNP,
similar activities and other forms of ELPs
42. Percentage of children between 0 to 35 years old who are identified with a
disability, and are referred to appropriate disability services C/MHO Semi-annually

EARLY LEARNING
43. Participation rate of 24-35 months old in Early Learning Programs (ELPs), Child LGU social welfare and
Development Centers (CDC), Supervised Neighborhood Play (SNP), and other development office and other
local agency or CSO providing Quarterly
alternative forms of ELPs livelihood assistance

SAFETY AND SECURITY

LGU social welfare and
44. Proportion of households with those in the first 1000 days that receive inputs for development office and other
livelihood assistance (inputs refers to training, seed capital or inputs to improve Quarterly
existing livelihood activities) local agency or CSO providing
livelihood assistance
45. Proportion of households with those in the first 1000 days that receive inputs for
home gardening Local agriculture office Quarterly

46. Proportion of households with those in the first 1000 days that receive support in Local social welfare and Quarterly
crisis situations development office
47. Proportion of households with access to basic safe water supply Local FHSIS Semi-annually
48. Proportion of households using safely managed drinking-water services Local FHSIS Semi-annually
49. Proportion of households with basic sanitation facility Local FHSIS Semi-annually
50. Proportion of households using safely managed sanitation services Local FHSIS Semi-annually
51. Proportion of barangays declared Zero Open Defecation (ZOD) areas Local FHSIS Semi-annually

49
FIGURE 3 Flow of Reporting for Monitoring F1KD+ Services

Other data sources per Table 5

50
 Advocate for Whole-of-Government Action
Implementing RA 11148, like all development programs, requires action from
the whole of government and the whole of society. Therefore, there is a need
to constantly make a case for needed actions for the first 1000 days.
Thus, advocacy is integral to the implementation of RA 11148.
Advocacy activities, to be effective, should be planned and deliberate.
The following is a framework that can be used in planning and
implementing these advocacy efforts.
The advocacy action should start with the identification of the
issue that needs to be resolved and can be resolved with
the help of advocacy. When such has been identified,
the following can be used to plan and implement the
advocacy effort.

A. Identify and characterize the audience or the person, D. Determine the design of the advocacy or how the
institution or stakeholder that can act on the issue. information will be communicated to the target
audience. This can be through mix of face-to-face
B. Determine and be clear on the specific behavior interaction that use compelling audio-visual support,
(e.g., not just support F1KD+ strategy but more and use of other channels like television, radio, social
specific behaviors indicative of support, e.g., issue media. Design of the advocacy includes determining
an executive order, or allocate funds or hire more the tone that will be used, e.g., Logical? Emotional?
community workers, etc. requested of the audience) Mix of logical and emotional?

C. Determine information that needs to be conveyed E. Evaluate the advocacy effort by determining if it
to the target audience. In many cases, information resulted in the desired behavior. If not, assess why
on the situation of those in the F1KD+ is needed, not and adjust accordingly.
together with information on the consequences of
the situation.
Annex 9 shows how this
framework can be used.
51
PART FOUR

Roles and Responsibilities

This section discusses the roles and responsibilities
of stakeholders involved in implementing RA 11148.
It presents the roles and responsibilities for the city/
municipal and barangay levels and for the other levels
to support the implementing levels.

The specification of roles and responsibilities continues

to be in the context of integrated service delivery, i.e.,
ensuring that those in the F1KD+ receive the services
they need when they need the service, “in ways that
are user-friendly, achieve the desired results, and
provide value for money.”

As a review, Figure 4 shows the range of health and

nutrition services that are needed through the F1KD+.
It also includes all the services through all the stages
of the F1KD+. Specifics of these services are found in
Annex 1.

52
FIGURE 4 Overview Of Program Components By Life Stage
H E A LT H I N T E R V E N T I O N S
• Family Planning • Routine antenal care • Essential Intrapartum Newborn • Newborn and infant care
Care (EINC)
• Life skills counseling • Maternal infection prevention • Routine immunization
diagnosis and treatment • Immediate newborn care including
care for small baby • Integrated Management of
• Assessment and management
of fetal health and growth • Management of birth complications Childhood Illnesses (IMCI)
• Routine immunization including
• Early identification and management Hepa B, BCG
of pregnancy complications
• Newborn screening

ADOLESCENCE PREGNANCY LABOUR AND BIRTH NEONATAL INFANCY

AND ADULTHOOD 1st Trimester 2nd Trimester 3rd Trimester Labour onset - first 3 days First week - first month 1 - 23 Months
10 12 13 16 +18 0 4 8 12 16 20 24 28 32 36 40 WEEKS BIRTH 24 36 48 72 1 2 3 4 6 12 18 24
YEARS HOURS WEEKS MONTHS

• Maternal nutrition • Promotion of optimal IYCF and WASH practices

(micronutrient supplementation, dietary
• Periconceptional supplementation if needed, monitoring • Micronutrient supplementation
nurition including including iron for low birth weight
of maternal weight, deworming) • EINC - Breastfeeding initiation
Micronutrient • Growth monitoring and promotion
supplementation • Promotion of optimal Infant and Young • Vitamin A supplementation
(iron, folic acid) Child Feeding (IYCF) and WASH practices for mothers • Management of severe acute malnutrition

NUTRITION INTERVENTIONS

S O C I A L & OT H E R S E C TO R A L I N T E RV E N T I O N S I N A LL PH A S E S
• Positive parenting (to include fathers) • Protection against child abuse, • Services related to water,
support/interventions on responsive violence against women and sanitation, a
 nd promotion of
caregiving, early stimulation, early literacy, children, injuries, and accidents hygienic practices
detection and management of child disability
• Support for home and • Oral health care services
• Social welfare support community kitchen gardening

53
Roles And Responsibilities At The Barangay Level

Barangay Nutrition Committee

Under the leadership of the barangay chairperson,

1. Formulate the barangay 2. Monitor the implementation 3. Coordinate the 4. Reach out to other
nutrition action plan that of the barangay nutrition implementation of the groups in the barangay
should include all related action plan by preparing barangay nutrition action for the delivery of
services as per RA 11148. and reviewing quarterly plan by making sure complementary
While there are no guidelines progress reports, holding that responsibilities are services.
for barangay nutrition quarterly meetings to clearly delineated among
planning, the guidelines for discuss progress, and the frontline workers,
city/municipal nutrition action conducting on-site resolving implementation
plans can be adapted to the visits of projects. issues that may arise.
situation of the barangay.

54
 Barangay Health Station

1. Deliver quality health and services for the F1KD+, and

ensure the following:
a. Compliance to DOH guidelines on primary care
b. Compliance to DOH guidelines on specific services
c. Connection with the other health facilities in the
city-wide health system or the province-wide
health system
d. Compliance to the Milk Code, e.g., no
paraphernalia (ballpen, calendar, poster, other
merchandising materials) on infant formula in the
barangay health station
e. Availability of supplies such as calibrated weighing
scales, validated height boards, mid-upper arm
circumference tapes, mother-baby books, checklist
on developmental milestones, health/nutrition 2. Conduct campaigns to improve use of health and
education cards, vaccines, deworming medicines, nutrition services
supplements (vitamin A capsules, iron-folic acid
tablets, micronutrient powder, zinc), ready-to-use 3. Coordinate with barangay officials on concerns to
supplementary food, among others improve use of health services, e.g., transport facilities
for pregnant women about to deliver; also, to refer
f. Availability of toys and other learning materials for cases of suspected maternal or child abuse
infants and young children
4. Record services in DOH-prescribed recording tools
g. Safety and security in the barangay health station
5. Prepare and submit FHSIS reports to RHU and the BNC,
and more importantly review of these reports to help
improve service delivery

55
Frontline Workers
In the Philippines, there are three main frontline workers involved in the F1KD+
—the Barangay Nutrition Scholar, Barangay Health Worker, and Child Development Worker.

The Barangay Nutrition Scholar The Barangay Health Worker is a The Child Care Worker in child
(BNS) is a trained community trained community worker who development centers is a community
worker who voluntarily renders voluntarily renders primary health worker trained to provide supplemental
nutrition services and other care services and other related parental care and early childhood
related activities in the barangay. activities in the community. enrichment activities to ensure that
physical, cognitive, social, and emotional
There should be at least one There should be one BHW for
needs of children are being addressed.
BNS/barangay. every 25 households.

Table 5 shows activities that these frontline workers undertake in the context of the F1KD+.
The list is not complete. In addition, these activities are done in a particular context,
i.e., the situation of the barangay and how F1KD+ services are delivered.

56
 Many of the possible activities of the BNS and BHW are the same. Thus, there is a
need to ensure that their activities do not overlap, cause unnecessary conflicts among
workers, and confuse the target groups. Certain actions should be done consciously
to maximize the participation of frontline workers in implementing the law.
Thus, these frontline workers can do one or more of the following:

1. Constantly be in touch with each other. They could hold 2. Use a common family profile to allow each
regular meet-ups, exchange information via SMS, and in frontline to see the holistic needs of a family
some instances even have a Viber group or Facebook with a member who is within the first 1000 days.
Group Chat. Being in touch could also include the midwife
or a health service provider (In fact, the meet-ups could be
organized by the midwife) to facilitate referral and related
concerns. Being in touch can cover specific concerns: 3. Use a common tool for
recording home visits.
a. Agreeing on who will do what, when, and how often.
This can help delineate what specific activity each one
will do. The delineation can also be in terms of specific
areas in the barangay to cover. For example, BHWs
may be assigned to do home visits in their respective
25-household groups. BNSs may be assigned to do
reinforcement visits to those needing more assistance.
The delineation can also be on agreeing schedule of
deployment in the healthy facility.
b. Sharing progress of assisting the target population that
can cover high points, e.g., successes in making caregivers
adopt desired behaviors, or low points, e.g., challenges
in making caregivers adopt desired behaviors, and
strategies that can be done to address these challenges.
c. Identifying who are not availing of services as desired and
agreeing on what can be done to correct the situation.
d. Sharing areas of expertise as appropriate.

57
TABLE 5 F1KD+-Related Activities Undertaken By Frontline Workers
A NTEN ATA L
BA R A NG AY N U T R I T ION S C HOL A R BA R A NG AY HE A LT H WORK ER C H I L D C A R E WORK ER

1. Assist in identifying pregnant women and coordinate with the 1. Assist in identifying pregnant women and
coordinate with the BNS and midwife on 1. Know who of the mothers
BHW and midwife on updating the Pregnancy Tracking Form or caregivers of children in
and Master List of Pregnant Women updating the Pregnancy Tracking Form
and Master List of Pregnant Women CDCs or day care centers
2. Assist the BHW and midwife in encouraging pregnant women are pregnant
to go to the health center for antenatal care 2. Encourage pregnant women to go to the
health center for antenatal care 2. Inform the BNS and
3. Identify from the master list the nutritionally-at-risk pregnant BHW of the name of the
women and enroll them to dietary supplementation program, 3. Coordinate with the BNS regarding the pregnant women
if available enrollment of nutritionally-at-risk pregnant
women to dietary supplementation program, 3. Advise the pregnant
4. Assist in weighing and measuring height of pregnant women if available woman to go to the health
in health centers during antenatal care visits, also in recording center for antenatal care
information in the appropriate form as may be assigned 4. Assist in weighing and measuring height of
pregnant women in health centers during 4. Include in Parents
5. Assist in activities related to dietary supplementation of antenatal care visits, also in recording Effectiveness Sessions
pregnant women, e.g., identify targets, hold dialogues information in the appropriate form reminders to pregnant
with beneficiaries on the design of the program, packing women to go to the health
and distribution of food packs, buying, preparing and 5. Assist the midwife in educating pregnant center for antenatal care
serving food, keeping feeding center clean, weighing and women on good nutrition, preparations
for breastfeeding, avoidance of risk-taking 5. Assist BHWs and
measuring height of pregnant women enrolled in dietary BNSs on messages to
supplementation program behaviors, smoking cessation, adoption of
healthy lifestyle practices, early stimulation pregnant women on early
6. Assist the BHW and midwife in educating pregnant women on of the fetus during both ante-natal visits and stimulation of the fetus
good nutrition during pregnancy and in encouraging them to home visits and possible post-partum family 6. Advise pregnant women
breastfeed their babies, perform early stimulation of the fetus, planning method to use based on felt need visiting CDCs to take in
avoid risk-taking behaviors, smoking cessation, adopt healthy daily their iron-folic acid
lifestyle practices, and avail of family planning services 6. Assist in packing iron-folic acid supplements
for distribution to pregnant women supplement
7. Assist in packing iron-folic acid supplements for distribution to
pregnant women 7. Track consumption of and encourage regular
use of iron-folic acid supplements, multiple
8. Assist BHW in conducting home visits to check on use of iron- micronutrient powder, and other commodities
folic acid supplements and multiple micronutrient powders intended for pregnant women and children
and in encouraging regular use of these commodities 6-35 months old especially during home visits

58
 BIRTH A ND NE W BORN PER IOD
BA R A NG AY N U T R I T ION S C HOL A R BA R A NG AY HE A LT H WORK ER C H I L D C A R E WORK ER

9. Assist in LGU birthing facilities, as may be 8. Assist in LGU birthing facilities, as may be
assigned, e.g., assist mothers in initiating assigned, e.g., assist mothers in initiating
breastfeeding breastfeeding
10. Visit mothers within the first month of 9. Visit mothers within the first month of
delivery to assist in breastfeeding concerns delivery to assist in breastfeeding concerns
as needed, integrate too messages on as needed, integrate too messages on
how breastfeeding sessions can be used how breastfeeding sessions can be used
for early stimulation of the infant through for early stimulation of the infant through
talking and singing, etc.; remind and talking and singing, etc.; remind and
encourage the mother to bring infant to encourage the mother to bring infant to
health center for immunization health center for immunization

F IRS T SI X MONTHS OF INFA NC Y

11. Assist in the organization of IYCF support 10. Lead in the organization of IYCF support
groups in the barangay groups in the barangay
12. Assist BHW in holding dialogues and 11. Assist in holding dialogues and meetings
meetings with IYCF support groups to with IYCF support groups to share
share experiences and address issues and experiences and address issues that arise,
concerns that arise remind pregnant women of need for the
continuous consumption of iron-folic acid
13. Visit mothers with infants in the first six
tablets
months of life for breastfeeding education
and follow-up, also for education on 12. Visit mothers with infants in the first six
good nutrition for the lactating mother; months of life for breastfeeding education
visits could also cover how breastfeeding and follow-up, also for education on
sessions can be used for early stimulation good nutrition for the lactating mother;
of the infant through talking and singing, visits could also cover how breastfeeding
etc. sessions can be used for early stimulation of
the infant through talking and singing, etc.

59
 INFA NT S 6 MONTHS UP TO T WO Y E A RS OF AGE
BA R A NG AY N U T R I T ION S C HOL A R BA R A NG AY HE A LT H WORK ER C H I L D C A R E WORK ER

14. Assist the BHW in sustaining the activities 13. Lead, under the supervision of the
and meetings of the IYCF support groups in midwife, in sustaining the activities
the barangay especially holding dialogues and meetings of the IYCF support
and addressing issues that arise groups in the barangay especially
holding dialogues and addressing
15. Visit mothers with children 6-35 months old issues that arise
and educate on appropriate complementary 14. Visit mothers with children 6-35
feeding practices with continued months old and educate on
breastfeeding, e.g., visits to mothers with appropriate complementary
infants 6 months old could initially focus feeding practices with continued
on the message of start giving other breastfeeding, e.g., visits to mothers
solid-or semi-solid foods with continued with infants 6 months old could
breastfeeding and subsequent visits could initially focus on the message of
focus on specific messages depending start giving other solid-or semi-solid
foods with continued breastfeeding
on the situation of the family, e.g., ensure
and subsequent visits could focus on
thickness of lugaw or porridge, add other specific messages depending on the
food items, how to practice responsive situation of the family, e.g., ensure
feeding, how to use feeding sessions for thickness of lugaw or porridge, add
early stimulation. other food items, how to practice
responsive feeding, how to use
Visits could also include other suggestions feeding sessions for early stimulation.
to mothers on early stimulation of the infant
Visits could also include suggestions
as well as reminders and encouragement
to mothers on early stimulation of the
to avail of immunization, vitamin A infant; follow up on immunization,
supplementation, deworming, oral health, Vitamin A supplementation,
and growth monitoring deworming, oral health and growth
monitoring

60
 THROUGHOU T THE F 1 K D +
BA R A NG AY N U T R I T ION S C HOL A R BA R A NG AY HE A LT H WORK ER C H I L D C A R E WORK ER

16. Weigh and measure height of children 15. Assist in weighing and measuring height
0-35 months old as part of annual of children 0-35 months old as part of
Operation Timbang Plus, growth annual Operation Timbang Plus and of
monitoring, or activities related to nutrition growth monitoring
in emergencies
16. Determine weight and height status of
17. Determine weight and height status of children measured
children measured
17. Assist in administering the Nurturing Care
18. Prepare relevant OPT Plus report Risk Factor Checklist for Early Childhood
Development and the Core Development
19. Assist in administering the Nurturing Care Milestones Checklist for children 0-35 7. Assist in administering
Risk Factor Checklist for Early Childhood months old and refer cases to the midwife the Nurturing Care
Development and the Core Development so the case can be referred to the RHU
Milestones Checklist for children 0-35 Risk Factor Checklist
doctor for further assessment for Early Childhood
months old and refer cases
Development and the
to the midwife so the case 18. Assist parents in identifying activities for
Core Development
can be referred to the play for early learning using community
Milestones Checklist for
RHU doctor for further and indigenous resources
assessment children 0-35 months
19. Assist parents in identifying activities for old and refer cases to
20. Assist parents in identifying play for early learning using community the midwife so the case
activities for play for early and indigenous resources can be referred to the
learning using community RHU doctor for further
and indigenous resources 20. Assist in activities related to dietary assessment
supplementation of young children 6-23
21. Assist in activities related to dietary months, e.g., identify targets, remind 8. Assist BNSs, BHWs, and
supplementation of young children mothers to regularly participate in the parents in identifying
6-23 months, e.g., identify targets, hold dietary supplementation program activities for play for
dialogues with beneficiaries’ caregivers early learning using
on the design of the program, packing community and
and distribution of food packs, buying, indigenous resources
preparing and serving food, keeping
feeding center clean

61
 THROUGHOU T THE F 1 K D +
BA R A NG AY N U T R I T ION S C HOL A R BA R A NG AY HE A LT H WORK ER C H I L D C A R E WORK ER

22. Assist wasted children in accessing outpatient 21. Assist in managing OTC facility for managing
care facilities for management of acute acute malnutrition, e.g., getting information
malnutrition, assist in the subsequent on the child, weighing and measuring height
distribution of RUTF or RUSF and other or MUAC, administering appetite test,
activities of the OTC as may be needed, also distributing RUTF or RUSF, following up child
in the follow up of child at home to measure in home, and others as may be assigned
height and weight or MUAC, as
may be assigned 22. Assist the sanitary inspector in
monitoring access to water supply
23. Refer to sanitary inspector families and sanitary toilet
visited not having access to water
supply, handwashing facilities, and 23. Assist the BNS in organizing
sanitary toilet nutrition classes for pregnant
women or mothers with children 0-3
24. Coordinate with city/municipal years old, including the invitation
level on organizing nutrition classes of resource persons from the city/
for pregnant women or mothers municipal health office, as needed
with children 0-3 years old
24. Watch out for signs of abuse among women 9. Watch out for signs of
25. Watch out for signs of abuse among women and children, e.g., presence of bruises and abuse among women
and children, e.g., presence of bruises and refer to barangay chairperson for further and children,
refer to barangay chairperson for further action e.g., presence of
action bruises and refer to
25. Coordinate with BNS for referral of patients
26. Coordinate with the appropriate organization or families to the appropriate organization or barangay chairperson
or person on various complementary services: person on various complementary services: for further action

a. Home gardens for priority families, a. Home gardens for priority families,
getting seeds and other planting getting seeds and other planting
materials materials
b. Cash assistance in distressed conditions b. Cash assistance in distressed conditions
c. Opportunities for income generation c. Opportunities for income generation

62
 AT THE CITY/MUNICIPAL LEVEL
The city/municipal mayor provides leadership and guidance in implementing RA 11148. He or she
ensures that all department and offices of the city/municipality identify, pursue, and report on their
specific accountabilities in implementing the law. Mayors also ensure that funds for F1KD+ services and
activities are not only available, but actually released and used in the most efficient and effective way.

City/Municipal Health Office

The city/municipal health office shall be the lead in the delivery of individual- and population-based
services in the F1KD+ being the sector that has the most contact with the population group covered
by the F1KD+. As such, the city/municipal health officer has the responsibility and accountability in
ensuring that the city/municipal health office undertakes its roles efficiently and effectively.
Specific roles of the C/MHO as lead in service delivery are as follows:

1. Organize the CWHS (for highly 4. In coordination with the city/municipal 8. Coordinate with secondary
urbanized cities), and work with the PHO government as well as the provincial care health facilities in the
on the organization of the PWHS (for government, establish a mechanism for C/PWHS to ensure the
components cities and municipalities) registration of the residents of a city/ seamless delivery of
municipality to a health care provider services related to high-
2. Develop guidelines, protocols,
risk pregnancies, newborns
programs and projects to operationalize 5. Ensure compliance to DOH Guidelines
with complications, and
the Policy Framework for Primary Care on Primary Care
management of childhood
3. Work with the PHO on the organization 6. Ensure that out-patient benefit illnesses, including acute
of the HCPN, including the Primary Care packages include those related to malnutrition.
Provider Network (PCPN). It will ensure the F1KD+ and that these services
9. Monitor the city’s/
that specific services and tasks related are available even in situations of
municipality’s performance in
to the delivery of the services are emergencies
service delivery and institute
identified, and quality standards, and
7. Establish a timely, effective, and corrective measures as needed
persons-in-charge defined at both the
efficient preparedness and response to
barangay and city/municipal levels 10. Monitor compliance of 4Ps
public health emergencies and disease
beneficiaries to health and
nutrition conditionalities
63
11. Undertake activities related to the implementation of City/Municipal Nutrition Office, if present
nutrition and related laws, e.g., EO 51, RA 10028, RA
8172, RA 8976, among others, in coordination with the Some cities and municipalities have a separate nutrition office.
city/municipal nutrition office The nutrition office acts as the executive arm of the C/MNC.
It provides both technical and secretariat support to the
12. Implement programs, projects, and activities to C/MNC. In some instances, it implements one or more
continually capacitate the PCPN, including BHWs, to nutrition programs or projects of the city/municipality. It is
provide quality services in the F1KD+ headed by the city/municipal nutrition action, who has the
13. Establish mechanisms for improved coordination with responsibility and accountability of ensuring that the city/
other offices or organizations of the city/municipality, municipal nutrition office fulfills its roles effectively and
including the local nutrition committee and local efficiently.
council for the protection of children Specific roles of the city/municipal nutrition office are:
1. Advise the local nutrition committee on nutrition
program matters
2. Coordinate the conduct of the F1KD+ situational
analysis
3. Coordinate the formulation of the local nutrition action
plan and the integration of nutrition concerns in the
CDP and AIP
4. Coordinate the formulation of the local nutrition in
emergencies and plan its integration in the local
DRRM-health plan
5. Monitor and evaluate the city/municipal nutrition
In some cases, conflicts have arisen between a nutrition office action plan, including the integrated delivery of F1KD+
and the health office. These conflicts can be prevented by clear services as described in the section on “Strengthen
delineation of responsibilities and accountabilities. Monitoring and Evaluation” in Part 3 of this MOPr
When the delineation may not be as obvious, the best option is
6. Provide technical assistance to local agencies on
to dialogue and negotiate, agree, and pursue the agreement.
integrating nutrition and related concerns in their
In the final run, the rule should be “eyes on the ball,” and programs, projects, and activities
the ball is ensuring the seamless delivery of F1KD+ services.

64
 7. Provide technical assistance to barangays on nutrition Local Social Welfare + Development Office
program management
The local social welfare and development office shall:
8. Provide technical andand, to the extent possible,logistical
1. Ensure that related social welfare services as per RA
and other forms of support to barangay nutrition scholars
11148 and its IRR are available and accessible to those in
9. In coordination with the city/municipal health office and the F1KD+
other offices of the LGU, implement specific projects and
2. Ensure that concerns related to the F1KD+ are integrated
activities of the LNAP, as may be assigned
in parental support activities, e.g., PES, FDS, ERPAT
10. In coordination with the city/municipal health office,
3. In coordination with the C/MHO and C/MNO, establish
undertake activities to ensure implementation of nutrition
and maintain a bi-directional referral system, e.g., cases
and related laws, e.g., EO 51, RA 10028, RA 8172, RA
needing health and nutrition services encountered in
8976, among others
social welfare contacts with the population are referred
11. Coordinate nutrition-related concerns in DRRM as a to the primary care network, and cases needing social
component of DRRM-health welfare support (including those related to maternal and
child abuse) encountered in health sector contacts within
12. In coordination with the C/MHO, implement programs,
the population are referred for social welfare services
projects, activities to continually capacitate the BNS to
provide quality services in the F1KD+ 4. Establish mechanisms for improved coordination with
other offices or organizations of the city/municipality,
13. Establish mechanisms for improved coordination with
including the local nutrition committee and local council
other offices or organizations of the city/municipality,
for the protection of children
including the local council for the protection of children

Secondary + Tertiary Levels Of Health Care Other City/Municipal Government

1. Ensure that care for those at the F1KD+ are available Organizations And Offices
2. Organize and maintain a Public Health Unit to facilitate The other LGU departments and offices should integrate
the implementation of population-based health services F1KD+ concerns in their respective programs and projects,
and seamless patient navigation within the HCPN e.g., in targeting and as platform for service delivery.
Examples of such integration are shown in the next section.

65
TABLE 6 Sectoral Involvement in F1KD+ Concerns at the City/Municipal Level
LGU OFFICE SAMPLE ACTIONS FOR INVOLVEMENTS /COMMITMENTS

SANGGUNIANG • Enact ordinances related to F1KD+, e.g., localization of RA 11148,

BAYAN comprehensive nutrition action in the city/municipality

• Ensure that approved local budgets have provisions for F1KD+ services

AGRICULTURE, • Support farmers and fisherfolk with wives who are pregnant or lactating and
FISHERIES children 0-35 months old to improve productivity and incomes, e.g., financing,
agriculture inputs, technology transfer, improved irrigation, fishnets, fishing
boats, etc.

• Integrate parenting skills related to F1KD+ in classes of farmers and fisherfolk

• Provide inputs for home and community food gardening

with priority to households with members in the F1KD+

• Submit reports of accomplishments to the city/municipal nutrition committee

RELATED TO • Identify employment opportunities for members of households with

EMPLOYMENT members in the F1KD+

• Assist in calibrating weighing scales and verifying height boards

ENGINEERING
• Assist local offices to ensure safety of facilities especially for women and children

PLANNING & • Ensure that F1KD+ concerns are integrated in the

DEVELOPMENT CDP, ELA, LIDP, and capacity building agenda

DRRMO • Ensure that F1KD+ concerns are integrated in the City/Municipal

DRRM Plan and in response, recovery, and rehabilitation phases

66
 At the Provincial Level
As in the city/municipal level, the provincial governor
provides leadership and guidance in implementing
RA 11148 in the province. He or she ensures that all
departments and offices of the province identify,
pursue, and report on their specific accountabilities in
implementing the law. Governors also ensure that funds
for F1KD+ services and activities are not only available,
but actually released and used in the most efficient and
effective way.
Specific roles and the corresponding office or organization
in the provincial government are shown below.

Actions of Provincial Offices related to F1KD+

Provincial health office
1. Organize the PWHS 6. Undertake activities to build the capacity of the
health system not only to deliver services, but also
2. Organize the HCPN in the province
to work effectively with other sectors, as well as
3. Ensure that services related to the F1KD+ are integrated in improve health information systems
program packages
7. Develop and implement integrated C4D
4. Monitor and ensure compliance of the province, cities, (Communications for Development)
and municipalities to DOH guidelines related to the strategies and materials
implementation of the UHC Law
8. Participate actively in the formulation, monitoring,
5. Undertake activities related to the implementation of evaluation, and coordination of the provincial
related laws, e.g., nutrition action plan
a. Regular monitoring on compliance to EO 51
b. Certification of lactation stations

67
Provincial Nutrition Office
1. Advise the provincial nutrition committee on nutrition
program matters
2. In coordination with the provincial offices and cities and
municipalities, coordinate the conduct of the F1KD+
situational analysis
3. Coordinate the formulation of the provincial nutrition
action plan and the integration of nutrition concerns in
the Provincial Physical Framework and Development Plan,
the Provincial Local Development Investment Plan, and
the Annual Investment Program
4. Coordinate the formulation of the provincial nutrition in
emergencies plan and its integration in the provincial
DRRM-health plan
10. In coordination with the city/municipal health office and
5. Monitor and evaluate the provincial nutrition action plan, other offices of the LGU, implement specific projects
including the integrated delivery of F1KD+ services as and activities of the PNAP, as may be assigned
described in the section on “Strengthen monitoring and
evaluation” in Part 3 of this MOPr. 11. In coordination with the provincial health office,
undertake activities to ensure implementation of
6. Provide technical assistance to local agencies on nutrition and related laws, e.g., EO 51, RA 10028, RA
integrating nutrition and related concerns in their 8172, RA 8976, among others
programs, projects, and activities
12. Coordinate nutrition-related concerns in DRRM as a
7. Provide technical assistance to cities, municipalities and component of DRRM-health
barangays on nutrition program management
13. In coordination with the city/municipality, implement
8. In coordination with the city/municipal government, programs, projects, activities to continually capacitate
provide technical and and, to the extent possible, the BNS to provide quality services in the first F1KD+
logistical and other forms of support to barangay
nutrition scholars 14. Establish mechanisms for improved coordination with
other offices or organizations of the province, including
9. Lead in the development and implementation of the local council for the protection of children
province-wide activities on nutrition promotion

68
 SOCIAL WELFARE + DEVELOPMENT RELATED TO EMPLOYMENT
1. Build capacities of city/municipal social Identify employment opportunities
welfare and development offices in for members of households with
carrying out their roles related to F1KD+ members in the F1KD+
2. Provide augmentation funding support
especially to poor cities/municipalities
for services related to the F1KD+
ENG I NEER I NG
S A NGGU N I A NG BAYA N 1. Assist in calibrating weighing
scales and verifying height
1. Enact ordinances related to F1KD+, boards
e.g., localization of RA 11148,
comprehensive nutrition action in the province 2. Assist local offices to ensure
2. Ensure that approved provincial, city, safety of facilities especially
and municipal budgets have for women and children
provisions for F1KD+ services

AGR ICU LT URE, F I S HER I E S PLANNING + DEVELOPMENT

1. Build capacities of city/municipal agriculture
Ensure that F1KD+ concerns are
offices on integrating F1KD+ concerns in
integrated in the PFDP, ELA, LIDP,
their programs and projects, e.g., by
and capacity building agenda
a. Supporting farmers and fisherfolk with wives who
are pregnant/lactating or children 0-35 months old
to improve productivity and incomes, e.g., financing,
agriculture inputs, technology transfer, improved
irrigation, fishnets, fishing boats, etc. DRR MO
b. Integrating parenting skills related to F1KD+ in classes of Ensure that F1KD+ concerns are
farmers and fisherfolk integrated in the Provincial DRRM
c. Providing inputs for home and community food gardening Plan and in response, recovery,
with priority to households with members in the F1KD+ and rehabilitation phases
2. Submit reports of accomplishments to the city/municipal
nutrition committee

69
At the Regional and National Level
As provided for by item d of Section 6, Rule 7 of the IRR of RA 11148, “the NNC, the regional nutrition, committee, and local nutrition
committees shall provide the basic mechanism for sectoral collaboration and partnership for the implementation of RA 11148.”

T H E N AT IO N A L N U T R I T IO N CO U N C I L
1. Formulate national nutrition 4. Receive grants, donations, and
policies, plans, strategies, contributions in any form from foreign
and approaches for nutrition governments, private institutions, and
improvement, including other funding entities for nutrition
strategies on women, infant and programs and projects: provided, that
young children, and adolescent no conditions shall be made contrary to
nutrition; the policies or the provisions of this Act Supporting the NNC Governing
and its IRR, and with special reference to Board is the NNC Technical
EO 51, s. 1986 and WHA Resolution 69.9; Secretariat. Specific to the
2. Oversee and serve as a focal
implementation of RA 11148, the
point in the integration of
NNC Secretariat shall:
nutrition policies and programs 5. Coordinate the joint planning and
of all member agencies and budgeting of member agencies to 1. Be the overall coordinator for
instrumentalities charged with ensure funds for relevant nutrition F1KD+ concerns
the implementation of existing programs and projects; to secure the 2. Facilitate annual convergence
laws, policies, rules, and release of funds in accordance with the planning and budgeting at the
regulations concerning nutrition; approved programs and projects; and to national level
monitor implementation and track public
3. Coordinate, monitor and expenditure on these programs; and 3. Ensure the dynamic flow
evaluate nutrition programs and exchange of information
and projects of the public and 6. Call upon any government agency on policy and program
private sectors and LGUs to and instrumentality for such assistance implementation
ensure their integration with as may be required to implement the 4. Prepare quarterly status
national policies; provisions of this Act and its IRR reports for submission to
demand agencies

70
 NATIONAL GOVERNMENT AGENCIES
Rule 13, Section 1 of the IRR of RA 11148 lists the following as roles of national government agencies.

1. Prioritize programs and projects in the 7. Regularly review and update

F1KD+ Strategy in long-term plans, competency profiles of all service
programs, and annual budgets; providers to strengthen workforce
capacities on health, nutrition, child
2. Formulate joint issuances along the development, child protection,
promotion, integration, and implementation responsive caregiving, early stimulation,
of the programs; and social protection;

3. Actively participate in the collaborative 8. Work closely with the academe,

activities of the NNC and its member professional societies, and
agencies; organizations from different sectors,
the Commission on Higher Education
4. Review and develop/update relevant (CHED), and the Professional Regulation
policies, guidelines, strategies, tools, and Commission (PRC) to update both
training packages to support integration of pre-service and in-service curricula;
F1KD+ Strategy Components across all levels
and sectors of government to facilitate the 9. Prioritize systems strengthening
implementation of the law and these rules; including the harmonization and
updating of information or surveillance
5. Prepare a long-term F1KD+ financing systems, logistics and supply chain
strategy to build on available funding management systems, and referral
streams that already support the different systems or service delivery networks;
components of the program and provide
additional resources in any form, including 10. Provide leadership in identifying the
technical assistance, sourced from the monitoring, evaluation, and research
budget in support of local nutrition priorities, make resources available
programs; for implementation of research, and
foster collaboration among program
6. Strengthen public financial management implementers, researchers, and
to increase allocation and efficiency of scientists to develop national and local
spending; evidence-based platforms for research
and learning of the F1KD+.

71
Specific agency roles identified in the IRR of RA 11148 are as follows:

The Department of Health (DOH) as lead technical The Department of the Interior and Local Government (DILG), as
agency for the F1KD+ strategies and services shall: Vice-Chair of the NNC Governing Board, shall:
1. Provide technical assistance at all levels for 1. Provide technical support to LGUs in the implementation
plans, policies, and program development and monitoring of the law through issuances encouraging all
as may be needed for health, nutrition, early LGUs to fully support the implementation of this Act and its
childhood development, and adolescent IRR, through
health, and development concerns
a. Enactment of local policies and ordinances
2. Provide augmentation support to identified
b. Participation of LGUs in the trainings and seminars to be
priority LGUs, including—but not limited to—
conducted by NNC Member Agencies
funding and supplies relevant to the program
and consistent with related guidelines on 2. Ensure that the implementation of this Act is integrated in
contracting city- and province-wide health the local development plans and investment plans of LGUs
systems
3. Monitor LGU compliance using the standard and innovative
3. As Chair of the NNC Governing Board, shall monitoring tools
lead in providing oversight for the F1KD+
Program with technical support from the NNC 4. Support the engagement of leagues of local governments
Secretariat and F1KD+ champions and form communities of practice to
enable peer learning and exchange for LGUs to share good
practices and address implementation problems

72
 The Department of Agriculture (DA) The Department of Agrarian Reform The Department of Budget
as Vice-Chair of the NNC Governing (DAR) shall: Management (DBM) shall:
Board, shall be the co-lead agency 1. Lead in the review, implementation, 1. Support member agencies
and shall: and monitoring of the in determining appropriate
1. Provide technical assistance to Comprehensive Agrarian Reform allocations for the program
the DOH and to other agencies Program (CARP) to support the
2. Ensure timely release of
on matters related to food design and coordinated delivery of
funds needed for the
security and food systems nutrition-sensitive support services
program
and prioritizing vulnerable groups
2. Provide technical assistance and
with land tenure security issues 3. Provide technical assistance
augmentation support to LGUs
on financial management
in strengthening food systems 2. In coordination with the DOH
and monitoring and
towards becoming resilient and and other concerned government
evaluation of the program
nutrition-sensitive agencies, provide technical support
in building capacities and awareness
3. Build capacities of local
of beneficiaries and service
agriculture officers in supporting
providers to prioritize interventions
the effective and integrated
for F1KD+
delivery of the program
3. Mobilize and capacitate Agrarian
Reform Beneficiaries Organizations
to participate in F1KD+ programs

73
The Department of Education (DepEd) The Department of Labor and The Department of Science
shall: Employment (DOLE) shall: and Technology (DOST) shall:
1. Review and develop modules 1. Lead in the review, updating, 1. Provide central direction,
on key core health and nutrition implementation and monitoring leadership, and
messages for the F1KD+ for of labor and employment- coordination of scientific
integration into the curriculum, related policies and programs in and technological efforts
as well as support to parent and accordance to these rules and ensure that the results
community education activities in therefrom are geared and
2. In coordination with the DOH
schools utilized in areas of maximum
and other NGAs concerned,
economic and social
2. Implement nutrition-specific and issue related guidelines and
benefits for the F1KD+
nutrition-sensitive initiatives for communicate the maternity
the adolescent female and at- protection provisions of these 2. Review and update existing
risk population in schools and rules to employers and workers surveys and tools to
the alternative learning system/ in the private sector support generation and
alternative delivery mode analysis of key indicators
structures of the agency on the F1KD+, in line
with global and national
3. Collaborate with the academe in
standards
reviewing and updating relevant
pre- and in-service curricula to
integrate nurturing care

74
 The Department of Social Welfare and The Department of Trade and Industry The Early Childhood Care and
Development (DSWD), shall: (DTI) shall be responsible in the review, Development Council (ECCD-C) shall:
1. Be responsible for strengthening updating, implementation, and monitoring 1. Provide technical and funding
social welfare and child protection of policies, standards, and programs to support on matters related
services and programs improve consumer awareness on their to ECCD, including early
rights and responsibilities, and ensuring stimulation and early learning
2. Provide technical assistance to consumer welfare and protection relevant
NGAs and LGUs in integration and to the F1KD+ 2. Establish National Child
improved delivery of parenting, Development Centers (NCDCs)
early childhood care and in identified priority areas,
development, and responsive care
3. Provide technical support that
services
may come in the form, but not
3. Build capacities of local social limited to the following:
welfare and development officers,
a. capacity building for ECCD
CDWs, and municipal links along
service providers, and
organizing and managing FDS,
parenting programs (e.g., PES, b. provision of ECCD packages
ERPAT, etc), and SNPs, among to CDCs in the priority areas
others
The National Economic and Development
Authority (NEDA) shall provide policy and
monitoring support, technical assistance,
and augmentation of resources to build
evidence and policy-related researches in
support of the Program

75
The Food and Drug Administration (FDA), as its The Philippine Health Insurance The Philippine Statistics
primary mandate, shall: Corporation (PhilHealth) shall: Authority (PSA) shall
1. Ensure the safety, efficacy or quality of health 1. Cover mothers and provide technical support
products as defined by RA No. 97111, otherwise children under the in harmonizing data and
known as “The Food and Drug Administration National Health Insurance information and in reviewing
Act of 2009” Program and updating existing
surveys and tools to support
2. Uphold and enforce laws and standards on food 2. Incorporate in its benefit generation and analysis of key
regulation, safety and fortification, and its other packages the health indicators on the F1KD+ in
mandates provided for by relevant laws that services for maternal and line with global and national
directly or indirectly affects the implementation child health and nutrition standards
of this Act
3. Enable mothers and
3. Investigate, verify reports of EO 51, s. 1986 children to have access to
violations, and when appropriate, apply health services covered
administrative sanctions against the violators by its benefit packages
and/or file criminal complaints against persons according to its existing
and entities found to have violated, singly or rules and regulations
repeatedly, the provisions of the Code or its
current IRR
4. Ensure that the labels of food products covered
by the scope of the Philippine Milk Code shall
conform to the rules and regulations of the FDA
and the Milk Code’s current IRR

76
 The Technical Education and Skills The Civil Service Commission (CSC) shall: The Commission on Higher
Development Authority (TESDA) shall: 1. Provide technical support in Education (CHED) shall lead in
1. Review and update the National reviewing and updating policies reviewing and updating relevant
Technical Education and Skills and standards for the economical, pre- and in-service curricula
Development Plan and all relevant efficient, and effective personnel in coordination with NGAs,
standards, tests, and systems administration in government, in professional societies, the academe,
to reflect needed reforms in formulating, administering, and and stakeholders
integrating skills development evaluating programs relative to
programs relevant to or that the development and retention of
can support the effective qualified and competent workforce
implementation of these rules
2. Inspecting personnel actions
2. Contribute directly to improved and programs of departments,
economic status of trained agencies, bureaus, offices, and local
graduates, food and nutrition government, including government-
security, increased access to other owned or controlled corporations;
basic social services, and better
3. In coordination with DOH and other
quality of life for their families.
NGAs concerned, communicate the
3. Collaborate with the academe in maternity protection provisions of
reviewing and updating relevant the law and these rules to the public
pre- and in-service curricula to sector workers
integrate nurturing care;

77
The National Youth The National Anti-Poverty Commission The Professional Regulation
Commission (NYC) shall: (NAPC) shall: Commission (PRC) shall
1. Provide leadership, 1. Coordinate and ensure the active administer, implement, and
technical and funding and meaningful participation of enforce the regulatory policies
support as the policy- the basic sectors of the national government
making coordinating with respect to the regulation
2. Recommend policies and other and licensing of the various
body on matters related
measures to guarantee the professions and occupations
to youth and adolescent
responsive implementation of under its jurisdiction, including
programming
the law the enhancement and
2. Engage and encourage maintenance of professional
3. In coordination with DOH and
youth leaders through and occupational standards and
other concerned government
the Sangguniang ethics, and the enforcement of
agencies, help along strategies to
Kabataan and build their the rules and regulations relative
strengthen provision of maternity
capacities and awareness to the F1KD+ Strategy
protection for workers in the
to prioritize interventions
informal economy, including
related to the F1KD+
workers in the informal sector,
as well as workers in MSMEs

78
 Civil society organizations, 1. Support one or more aspects of the F1KD+, e.g., capacity
building, service delivery, research, monitoring and evaluation, as
state universities and colleges, applicable, and as will be agreed with the national and regional
private sector, levels, as well as the provincial, city, municipal, and barangay levels

and development partners 2. Establish mechanisms for improved coordination with the national
and regional levels, as well as the provincial, city, municipal, and
barangay levels

79
Capacity Building and Development
Section 12 of RA 11148 stipulates that “The DOH and the NNC, in coordination with
LGUs, shall provide practical and effective training courses to BNSs, BHWs, CDWs, and
other personnel concerned to upgrade their skills and competence in the implementation
of services and interventions for the health and nutrition of women and children.”
The following is a partial list on areas of concern to be covered by capacity building:
Identifying the knowledge,
a. Effective delivery of antenatal care, g. Policy formulation and advocacy
essential maternal and newborn care
attitudes, and skills needed
and lactation management h. Multisectoral and joint planning and for the implementation of
budgeting
b. Effective health/nutrition education,
RA 11148 can be facilitated
with emphasis on listening and i. Supportive supervision and mentoring through a formal training
learning; building confidence and j. Supply chain management needs analysis exercise.
giving support skills
k. Skills related to adapting to the Capacity building programs
c. Integrating concerns on responsive fourth revolution, e.g., navigation of
caregiving, early learning, safety and can include but are not
the internet, use of internet-based
security in services platforms for service delivery, capacity limited to the following:
d. Designing, implementing,
monitoring, and evaluating effective
building, promotional efforts
✔ Training programs
behavior change programs for the
l. Working with others, breaking down
turfs, and keeping communication lines ✔ Continuing education
F1KD+ open programs
e. Improving processes related to
Operation Timbang Plus, e.g.,
m. Knowledge on the components of the
NCF, e.g., social welfare staff should
✔ Development of job aids
correct techniques in weighing,
recording, etc.
know more about health and nutrition,
those in the health system should
✔ Development of
know more about social protection,
certification programs
f. Use of the tools and application
of processes related to ECCD community volunteers should know and
understand concepts on WASH and the
✔ Supportive supervision
Community Risk Targeting
sanitary inspector about nutrition, etc.

80
 PA RT F I V E

REFERENCES
Infor mat ion Re source s For
Implementing R A 11148

Presented on the next pages are some references

that can be consulted if detailed instructions are needed.

81
LIFE STAGE/SERVICE REFERENCE

Antenatal AO 2008-0029 – Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal
Care Mortality

AO 2016-0035 Guidelines on the Provision of Quality Antenatal Care in All Birthing Centers and
Health Facilities Providing Maternity Care Services

Maternal, Newborn, and Child Health and Nutrition (MNCHN) Manual of Operations

Birth and emergency WHO’s Standards for Maternal and Neonatal Care
planning
Maternal, Newborn, and Child Health and Nutrition (MNCHN) Manual of Operations

JICA’s Guidebook for Community Health Teams

Women about to give birth WHO Early essential newborn care clinical practice pocket guide
and immediate post-partum
Maternal, Newborn, and Child Health and Nutrition (MNCHN) Manual of Operations

DM 2020-0319 – Interim Guidelines on COVID-19 Management of Pregnant, Women, Women About

to Give Birth and Newborns

Kangaroo Mother Care WHO’s Kangaroo Mother Care: A Practical Guide

Infant and Young Child Harmonized Maternal, Newborn, Infant, and Young Child Health and Nutrition (MNIYCHN) Training
Health and Nutrition Package, including IYCF-ECCD Counseling Cards

DOLE Department Order No.143, Series of 2015, Guidelines Governing Exemption of Establishments
from Setting Up Workplace Lactation Stations (includes prototypes for lactation stations)

DOH DC 2011-0365: Guidelines for the Mother and Baby-Friendly Workplace Certification

DOH AO 2006-0012: Revised Implementing Rules And Regulations (RIRR) of Executive Order No.
51, Otherwise Known as The “Milk Code,” Relevant International Agreements, Penalizing Violations
Thereof, and for Other Purposes
82
 LIFE STAGE/SERVICE REFERENCE

Immunization Manual of Operations on Immunization

DM 20200-150 - Interim Guidelines for Immunization Services in the Context of COVID-19 Outbreak

Assessment and DOH Administrative Order 2015-0055, National Guidelines on the Management of Acute
Management of Sick Malnutrition for Children under 5 years
Children National Guidelines on the Management of Severe Acute Malnutrition for Children Under Five Years
Old Manual of Operations
Care for Child Health and
Development (combined National Guidelines on the Management of Moderate Acute Malnutrition for Children Under Five
IMNCI & CCD) Years Old Manual of Operations

WHO’s Guidelines for Integrated Management of Childhood Illnesses (IMCI)

Micronutrient Administrative Order No. 2010-0010, Revised Policy on Micronutrient Supplementation to Support
Supplementation Achievement of 2015 MDG targets to Reduce Under-five and Maternal Deaths and Address
Micronutrient Needs of Other Population Groups

Manual of Operations on Micronutrient Supplementation

Oral Health DOH Administrative Order 2007-0007 Guidelines on the Implementation of Oral Health Program for
Public Health Services

Services and Interventions DM 2020-341 Interim Guidelines on Continuous Provision of Adolescent Health Services during the
for Adolescent Females COVID-19 Pandemic DOH’s Adolescent Health and Development Program Manual of Operations

83
LIFE STAGE/SERVICE REFERENCE

Health & Emergencies DOH Administrative Order No. 2017-0007, Guidelines in the Provision of Essential Health Service
and Management of Local Packages in Emergencies and Disaster
& Foreign Donations for Department Circular No. 2020-0167 on the Continuous Provision of Essential Health Services During
Normal & Emergency COVID-19 Epidemic
Situations
DOH AO 2020-0001 Guidelines in the Importation, Facilitation and Management of Foreign
Donations involving Health and Health-Related Products
DOH DC 2020-0217 Reiteration of the DOH Department Memorandum 2020-0231: Guidelines
on the Standardized Regulation of Donations, Related to Executive Order 51, series of 1986 (The
Philippine Milk Code), to Health Facilities and Workers, Local Government Units, Non-Government
Organizations, and Private Groups and Individuals in Support of the Response to Emergencies, Disasters,
and Situations Where the Health and Nutrition of Mothers, Infants, and Young Children are Affected

Nutrition in the Aftermath NNC Governing Board Resolution No. 1, S2009, Adopting the National Policy on Nutrition
of Natural Disasters and Management in Emergencies and Disasters
Calamities Training Manual on Nutrition in Emergencies
Training Manual on Nutrition in Emergencies Information Management
Department Memorandum (DM) 2020-0237 - Interim Guidelines for the Delivery of Nutrition
Services in the Context of COVID-19 Pandemic
Nutrition Cluster Advisory 1 - Nutrition Cluster Guidelines on LGU Nutrition Actions Relative to COVID-19
Nutrition Cluster Advisory 2 - Nutrition Cluster Recommendations on Healthful and Nutritious Family
Food Packs and Sustainable Food Sources

84
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PDF_File/reports_resources/dilg-reports-resources- DOH. (2020, May 22). DOH Administrative Order No. 2020-
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DOH. (2020). National Guidelines on the Management of
DOH & NNC Governing Board. (2009, December 3). Severe Acute Malnutrition for Children Under-Five
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October 10). Retrieved from https://pcw.gov.ph/ early-childhood-development
executive-order-no-51-national-code-of-marketing-
of-breastmilk-substitutes-breastmilk-supplement-and- UNICEF et al. (2019). Operationalizing Nurturing Care for
other-related-products/ Early Child Development. The Role of the Health
Sector Alongside Other Sectors and Actors.
Philippine Republic Act No. 10410: Early Years Act of Retrieved from https://nurturing-care.org/wp-
2013. (2013, March 26). Metro Manila. Retrieved content/uploads/2019/07/Operationalizing-NC.pdf
from https://www.officialgazette.gov.ph/2013/03/26/
republic-act-no-10410/ WHO. (2003). Kangaroo mother care: A practical guide.
Geneva.
Philippine Republic Act No. 10821: Children’s Emergency
Relief and Protection Act. (2016, May 18). Metro WHO. (2008). Technical Brief No.1, 2008: Integrated Health
Manila. Retrieved from https://www.officialgazette. Services - What and Why? Geneva: WHO. Retrieved
gov.ph/2016/05/18/republic-act-no-10821/ from https://www.who.int/healthsystems/service_
delivery_techbrief1.pdf
Philippine Republic Act No. 11148: Kalusugan at Nutrisyon
ng Mag-Nanay Act of 2018. (2018, July 23). Metro WHO. (2016). World Health Assembly (WHA) Resolution
Manila. Retrieved from https://www.officialgazette. 69.9 Ending inappropriate promotion of foods for
gov.ph/downloads/2018/11nov/20181129-RA-11148- infants and young children. Geneva: WHO.
RRD.pdf
WHO, Department of Making Pregnancy Safer and
Philippine Republic Act No. 7160: Local Government Code Department of Reproductive Health and Research.
of 1991. (1991, October 10). Metro Manila. Retrieved (2007). Standards for maternal and neonatal care.
from https://dilg.gov.ph/PDF_File/reports_resources/ Geneva: WHO.
dilg-reports-resources-2016120_fce005a61a.pdf
World Health Organization. (2015, November 19 ). Stunting
Philippine Republic No. 10028: Expanded Breastfeeding in a nutshell. Retrieved from https://www.who.int/
Promotion Act of 2009. (2010, Marc 16). Metro news/item/19-11-2015-stunting-in-a-nutshell
Manila. Retrieved from https://www.officialgazette.
gov.ph/2010/03/16/republic-act-no-10028/ World Health Organization. (2018). Nurturing Care for Early
Childhood Development: A Framework for Helping
Children Survive and Thrive to Transform Health and
Human Potential. Switzerland.

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ANNEXES
 ANNEX 1

Program Components By Life Stage (per RA 11148)

Pregnancy, first 270 days (Antenatal care)
1. Pregnancy tracking and enrollment in ANC 12. Counseling on proper handwashing, environmental
2. Regular follow-up to complete the recommended minimum sanitation, and personal hygiene
number of quality ANC care visits 13. Counseling on, and utilization of responsible parenthood
3. Proper referral for high-risk pregnancies, including adolescent and family health services
mothers 14. Counseling on nutrition, smoking cessation, and adoption
4. Maternal immunization (tetanus and diphtheria toxoid, others as of healthy lifestyle practices
needed) 15. Philippine Health Insurance Corporation (PhilHealth)
5. Preparation of birthing plan, including plans for obstetric and enrollment and linkage to community-based health and
newborn emergencies and complications, and appropriate nutrition workers and volunteers
plans for breastfeeding and rooming in; including counseling 16. Social welfare support to improve access to health
6. Counseling on maternal nutrition and infant and young child and nutrition services such as, but not limited to,
feeding practices dietary supplementation, healthy food products, and
commodities for nutritionally-at-risk pregnant women
7. Early identification and management of nutritionally-at-risk belonging to poor families, and those with disabilities
pregnant women and provision of dietary supplementation
using Ready-to-Use Supplementary Food (RUSF) or other 17. Maternity protection (upholding the rights of pregnant
nutrient-dense food, as appropriate women at work as stipulated in existing labor, civil service,
and other related laws and regulations)
8. Maternal micronutrient supplementation
(iron-folic acid, calcium, iodine, others) 18. Counseling and support to parents and
caregivers on parent/caregiver-infant/child
9. Promotion of the consumption of iodized interaction for responsive care, and early stimulation
salt and fortified foods for child development
10. Assessment of risk for parasitism and 19. Provision of counseling and psychosocial
provision of anti-helminthic medicines support to parents and caregivers with priority to
high-risk pregnant women and adolescent females
11. Provision of oral health services, including
belonging to the poorest of the poor families
oral health assessment

89
Women about to give birth and immediate post-partum period
1. Adherence to the couple’s birth, breastfeeding, and 8. Counseling on proper handwashing, environmental
rooming-in plans sanitation and personal hygiene

2. Provision of mother-baby friendly practices during labor 9. Counseling on and utilization of modern methods
and delivery of family planning and access to reproductive health
services
3. Monitoring the progress of labor and well-being of both
mother and fetus and provision of interventions to any 10. Maintenance of the non-separation of the mother and
health issue that may arise her newborn and rooming-in for early breastfeeding
initiation
4. Identification of high-risk newborns that will be delivered:
the premature, small for gestational age (SGA) and/or 11. Assurance of women-child friendly spaces during
low birth weight infants and the provision of preventive calamities, disasters, or other emergencies
interventions to reduce complications of prematurity or
12. Provision of support to fathers and caregivers to ensure
low birth weight
their commitment to support the mother and child on
5. Coverage and utilization of PhilHealth benefit packages proper health and nutrition care and provide necessary
for maternal care counseling and positive parenting support interventions

6. Nutrition counseling and provision of nutritious meals 13. Counseling and support to parents and caregivers on
parent/caregiver-infant/child interaction for responsive
7. Provision of lactation management services to support care, and early stimulation for child development
breastfeeding initiation and exclusive breastfeeding for six
(6) months, most especially for caesarian delivery

90
 Post-partum and lactating women
1. Follow-up visits to health facility 11. Promotion of the consumption of iodized salt and
fortified foods
2. Home visits for women in difficult-to-reach areas
12. Provision of oral health services
3. Lactation support and counseling, including women
who will return to work, women in informal economies, 13. Counseling on and utilization of modern methods
and those with breastfeeding difficulties of family planning and access to reproductive health
services
4. Nutrition assessment and counseling to meet the
demands of lactation in health facilities and workplaces 14. Social welfare support for access to health and
nutrition services for nutritionally-at-risk post-partum
5. Identification and management of malnutrition among
and/or lactating women belonging to the poorest of
post-partum and lactating women and provision
poor families
of RUSF in addition to dietary supplementation, as
appropriate 15. Assurance of women-child friendly spaces where
mothers and their infants will be able to continue
6. Organization of community-based mother support
breastfeeding during calamities, disasters, or other
groups and peer counsellors for breastfeeding in
emergencies
cooperation with other health and nutrition workers
16. Provision of support to
7. Maternity protection and lactation breaks for women
fathers and caregivers to
in the workplaces including Micro, Small, and Medium
ensure their commitment
Enterprises (MSMEs).
to support the mother and
8. Availability of lactation stations in workplaces, both in child on proper health and
government and in the private sector, informal economy nutrition care and provide
workplaces, and in public places and public means of necessary counseling and
transportation as stipulated in RA No. 10028, and its IRR positive parenting support
interventions
9. Organization of breastfeeding support groups in
workplaces, in cooperation with occupational health 17. Counseling and support to
workers and human resource managers trained in parents and caregivers on
lactation management for the workplace parent/caregiver-infant/child
interaction for responsive
10. Provision of micronutrient supplements care, and early stimulation for
(iron-folic acid, and vitamin A) child development

91
Birth and newborn period
1. Administration of newborn screening and newborn 8. Assurance of child-friendly space where exclusively
hearing screening breastfed infants will be able to continue breastfeeding
during calamities, disasters, or other emergencies
2. Maintenance of non-separation of the mother and her
newborn from birth for early breastfeeding initiation and 9. Social welfare support for access to health and nutrition
rooming-in for exclusive breastfeeding services for the newborn belonging to poor families,
and those with disabilities
3. Provision of early and continuous skin-to-skin contact
to all full-term babies and continuous kangaroo care for 10. Facilitate the prompt birth and death registration,
small babies born preterm and with low birth weight, in including fetal deaths, restoration and reconstruction
compliance with the newborn protocol of the DOH in all of birth and death registration documents destroyed
facilities providing birthing services. during disasters.

4. Availability of human milk pasteurizer for strategic 11. Counseling and support to parents and caregivers on
level two (2) and level three (3) facilities with Neonatal parent/caregiver-infant/child interaction for responsive
Intensive Care Units (NICU) to ensure breastmilk supply care, and early stimulation for child development
for small babies born preterm and low birth weight within
its facility, the service delivery network it serves, and for 12. Provision of support to parents and caregivers on early
use of infants and young children during emergencies stimulation and responsive care for children
and disasters, in accordance with DOH guidelines

5. Provision of routine newborn care services such as

eye prophylaxis, Vitamin K supplementation, and
immunizations

6. Availment and utilization of PhilHealth benefit packages

for the newborn including the preterm, low-birthweight,
and small babies

7. Provision of early referral to higher level facilities to

manage illness and/or other complications

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 First six months of infancy or 180 days

1. Provision of continuous support to mother and her infant for 8. Social welfare support to improve access to health and
exclusive breastfeeding including referral to trained health nutrition services for the newborns belonging to the
workers on lactation management and treatment of breast poorest of the poor families
conditions
9. Provision of support to fathers and caregivers to ensure
2. Provision of appropriate and timely immunization services their commitment to support the mother and child on
integrated with assessment of breastfeeding, early child proper health and nutrition care and provide necessary
development, growth monitoring and promotion, and infant and counseling and positive parenting support interventions
young child feeding
10. Assurance of women-child friendly spaces during
3. Growth and development monitoring and promotion for all
12 calamities, disasters, or other emergencies where health
infants less than six (6) months old, especially those who had low and nutrition services of children shall be provided
birth weight, are stunted, or had acute malnutrition

4. Counseling of household members on hand washing,

environmental sanitation and personal hygiene

5. Identification and management of moderate or severe acute

malnutrition among infants less than six (6) months old and
provision of lactation management services and management of
medical conditions contributing to malnutrition

6. Provision of early referral to higher level health facilities to

manage common childhood illnesses including acute malnutrition

7. Counseling and support to parents and caregivers on parent/

caregiver-infant/child interaction for responsive care,
and early stimulation for early child development

12 When the law was being drafted the inclusion of “development”

in the service of child monitoring was referring to the monitoring
of child developmental milestones

93
Infants six (6) months up to two (2) years of age
1. Timely introduction of safe, appropriate, and nutrient-
dense quality complementary food with continued
and sustained breastfeeding for all infants from six (6)
months up to two (2) years of age, with emphasis on
the use of suitable, nutrient-rich, home-prepared, and
locally available foods that are prepared and fed safely
11. Availability of potable source of water, counseling of
2. Provision of nutrition counseling on complementary
food preparation and feeding to mothers and caregivers household members on handwashing, environmental
sanitation, and personal hygiene, and support for sanitation
3. Dietary supplementation of age-appropriate and need of households to reduce food, water, and vector-
nutrient-dense quality complementary food borne diseases
4. Growth and development* monitoring and nutrition in 12. Counseling and support to parents and caregivers on
health facilities and at home parents/caregiver-infant/child interaction for responsive
5. Provision of routine immunization based on the latest care and early stimulation for early childhood development,
DOH guidelines and referral for developmental delays and other disabilities
for early prevention, treatment, and rehabilitation
6. Provision of micronutrient supplements (e.g., vitamin A,
micronutrient powder) deemed necessary 13. Social welfare support for access to health and nutrition
services, and referral for developmental delays and
7. Management of common childhood illnesses based on
other disabilities for early prevention, treatment, and
WHO and DOH guidelines
rehabilitation for infants six months and above who belong
8. Identification and management of moderate and to the poorest of the poor families
severe acute malnutrition using national guidelines and
proper referral to higher level facilities, as appropriate, 14. Support for home gardens wherever feasible
for treatment and management, especially those with 15. Provision of locally available grown crops, vegetables, and
serious medical complications fruits in addition to other agricultural products to be used
9. Provision of oral health services including application of in complementary feeding and dietary supplementation
fluoride varnish to prevent dental caries
16. Protection against child abuse, violence against women and
10. Provision of anti-helminthic tablets for children 1-2 years children, injuries, and accidents including the provision of
old as appropriate first aid, counselling, and proper referrals

94
 Adolescent females

1. Assessment of health and nutrition status and identification of

nutritionally-at-risk adolescent females, especially in circumstances
where dietary intakes are suboptimal, micronutrient deficiencies
and anemia are high, and when pregnancy imposes inordinate
demands on the adolescents’ own growth and development, as well
as provision of Ready-to-Use Supplementary Food (RUSF), Ready-
to-Use Therapeutic Food (RUTF), or other nutrient-dense food for
nutritionally-at-risk but non-overweight or non-obese adolescent
females as appropriate
2. Provision of age-appropriate immunization based on the latest DOH
guidelines
3. Provision of oral health services including oral health assessment
4. Provision of anti-helminthic drugs for deworming
5. Counseling on proper handwashing, environmental sanitation, and
personal hygiene
6. Provision of micronutrient supplements according to the
guidelines of the DOH and DepEd (e.g., weekly iron-folic acid
supplementation)
7. Promotion of the consumption of iodized salt, and fortified foods
8. Referral to appropriate health facilities to manage menstruation
irregularities or abnormalities that contribute to anemia and blood
loss, and manage complicated illnesses, including moderate or
severe acute malnutrition
9. Counseling on proper nutrition, mental health, avoidance of risk-
taking behaviors, smoking cessation, adoption of healthy lifestyle
practices, and family health

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 ANNEX 2

Templates For A Local Policy Issuance On An F1KD+ Team

Template 1. For adhoc group 13
Executive Order 12 No. ___
An Order Creating the First 1000 Days Situational Analysis Core Group
WHEREAS, the (name of LGU), recognizes that its children are its prime resource to drive its full development;
WHEREAS, the (name of LGU) is committed to ensure the holistic development of its children;
WHEREAS Republic Act No. 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act aims to ensure the
holistic development of children, with focus on the first one thousand days (F1KD+);
WHEREAS the full implementation of RA 11148 in (name of LGU) is consistent with its vision;
WHEREAS, such full implementation is best undertaken after taking stock of the situation in (name of LGU);
NOW THEREFORE, by the powers vested in me by law, I, (name of mayor). (name of LGU), hereby order
the constitution of the Ad Hoc Technical Working Group (TWG) on the First One Thousand Days (F1KD+)
Situational Analysis, with the following stipulations:
SECTION 1. COMPOSITION
Chairperson: Nutrition Action Officer
Members: Permanent representatives from the following departments/offices:
• Health Office
• Nutrition Office
• Social Welfare and Development
• Agriculture Office
• Non-Government Organization (specify which one)
• Others added as the LGU may decide

13 Adapted from an executive order of the City of San Fernando

96
 SECTION 2. FUNCTIONS OF THE TWG F1KD+ SITUATIONAL ANALYSIS
1. Define the scope of the assessment as well as data requirements and sources
2. Collect, process, and analyze data to establish the situation of the city/municipality with regard to
the F1KD, extending the age group coverage to include the 25–35-month-olds (F1KD+)
3. Prepare and submit to the Office of the Mayor the assessment report that should include the
results of the assessment as well as recommendations to address the findings of the assessment
4. Lead in the dissemination of the results of the situational analysis

SECTION 3. THE DUTIES AND RESPONSIBILITIES OF THE SECRETARIAT

The (name of the LGU) Nutrition Office (if present. Otherwise, the local health office can be
designated as the secretariat) shall provide secretariat services to the TWG F1KD+ Situational
Analysis. It shall:
1. Record and document discussions of TWG meetings
2. Arrange interviews, meetings, consultations, and related activities that the TWG will undertake
3. Arrange meals and travel arrangements that may be needed
4. Perform other functions as may be assigned

SECTION 4. OTHER PROVISIONS

All departments and offices of (name of LGUs), as well as barangay chairpersons are directed
to assist the TWG as may be needed.
SECTION 5. EFFECTIVITY
This Executive Order shall take effect immediately and shall be in force until one month after
the submission of the TWG’s final report.
IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the (name of
LGU) this __th day of (month) (year) in (name of LGU).

97
Template 2. For a more permanent structure 14

Executive Order 13 No. __

An Order Creating the Technical Working Group (TWG) on the First 1000 Days
WHEREAS, the (name of LGU), recognizes that its children are its prime resource to drive its full development;
WHEREAS, the (name of LGU) is committed to ensure the holistic development of its children;
WHEREAS Republic Act No. 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act aims to ensure the holistic
development of children, with focus on the first one thousand days (F1KD);
WHEREAS the full implementation of RA 11148 in (name of LGU) is consistent with its vision;
WHEREAS, such full implementation is best undertaken with a core group;
NOW THEREFORE, by the powers vested in me by law, I, (name of mayor) of (name of LGU), hereby order the
constitution, under the local nutrition committee, the Technical Working Group (TWG) on the First One Thousand
Day (F1KD), extending the age group coverage to include the 25-35 month-olds (TWG F1KD+), with the following
stipulations:
SECTION 1. COMPOSITION
Chairperson: Nutrition Action Officer
Members: Permanent representatives from the following departments/offices:
• Health Office
• Nutrition Office
• Social Welfare and Development
• Agriculture Office
• Non-Government Organization (specify which one)
• Others added as the LGU may decide

14 Adapted from an executive order of the City of San Fernando

98
 SECTION 2. FUNCTIONS OF THE TWG F1KD+
1. Conduct a situational analysis on the F1KD+
2. Facilitate the integration of services across sectors to ensure the delivery of needed services in the F1KD+
3. Formulate and update the local nutrition action plan (LNAP) to integrate concerns of RA 11148,
ensure its integration in the CDP and AIP
4. Monitor the progress of implementation of the LNAP and attend to corrective actions as needed
5. Prepare reports on the F1KD+ for submission to the local nutrition committee quarterly
6. Evaluate the effectiveness of the LNAP

SECTION 3. THE DUTIES AND RESPONSIBILITIES OF THE SECRETARIAT

The (name of the LGU) Nutrition Office (if present. Otherwise, the local health office can be designated as the secretariat)
shall provide secretariat services to the TWG F1KD+. It shall:
1. Record and document discussions of TWG meetings;
2. Attend to the administrative and technical requirements of the TWG F1KD+;
3. Organize and maintain the records of the TWG F1KD+for integration with those of the local nutrition committee
4. Perform other functions as may be assigned

SECTION 5. OTHER PROVISIONS

All departments and offices of (name of LGUs), as well as barangay chairpersons are directed to assist the TWG as may be
needed.
SECTION 4. EFFECTIVITY
This Executive Order shall take effect immediately and shall be in force until rescinded.
IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the (name of LGU)
this __th day of (month) (year) in (name of LGU).

99
 ANNEX 3

Notes on Doing the F1KD+ Situational Analysis

What should the situational analysis cover?
The F1KD+ situational analysis should cover the key The range of questions that assessment should answer could
deprivations that affect children 0-35 months old, the include the following:
reasons for these deprivations, and what are being done 1. What is the situation in terms of outcome indicators,
to address these deprivations. As noted earlier it can nutritional status, mortality situation (maternal, newborn,
cover a specific dimension or it can be comprehensive, infant, and under-five), situation on child development
covering the range of concerns of services for the first (indications of developmental delays, abuse, etc.)?
1000 days.
a. Who are more affected? By age and physiologic
Whether limited in scope or comprehensive, the group? By income classification,By occupational
decisions to be made as a result of the assessment grouping?
should be clear even at the assessment planning stage.
Such decisions could be along one or more of the b. How many are affected?
following concerns: c. Where are they located? Do they cluster in specific
1. Areas, population groups, and persons to prioritize geographic areas? Or ecological settings (upland,
lowland, inland, coastal, island), or in communities of
2. Services to be added, removed, modified,
indigenous people, or in Geographically Isolated and
improved
Disadvantaged Areas (GIDA), or areas affected by
3. Building blocks to focus on for strengthening, natural and human-induced calamities and disasters?
e.g., service delivery, human resource, logistics
d. What has been the trend in the situation?
management, financing, leadership and
governance, information management e. How does the current situation compare with the
targeted situation indicated in the LGU plans?
4. Strategic allocation of human, material, financial,
and other resources f. What are causing this situation, classified as
immediate causes, underlying causes, and basic
5. Priority policies to formulate
causes

100
 2. What services are being delivered for good health? 5. Has the local health system been organized into a
Adequate nutrition? Security and safety? Early city-/province-wide health system? Have Primary Care
stimulation? Responsive caregiving? Provider Networks been organized? Have the Health
a. What is the coverage of each service? Does the Care Provider Networks been organized? Do these
coverage meet the target coverage? What segment networks cover services in the F1KD+ adequately?
of the affected population is not being reached (Answering this question is linked with answering
adequately? question number 3.)
b. Does the service follow quality standards? If not, 6. Is there a system to facilitate integration and
which service is falling below standards? What
specific component of the standard is not being met? coordination among various sectors? Are inter-agency
structures (e.g., local health board, local nutrition
c. Are services being delivered in disaster/emergency committee, local council for the protection of children)
situations? Are those in the F1KD+ being reached by present? Are these structures functional? Do they relate
these services? Are the services being delivered in a
timely manner? and coordinate with each other? If not, why not?

d. To what extent are male members of the family and It is to be noted that the assessment for local nutrition
community engaged? planning and for local investment planning for health already
e. Are the services being provided by more than one cover those related to health and nutrition services. These
agency? If so, are the initiatives harmonized? assessments can be referred to. In addition, the DOH has
developed templates that can help in the assessment of the
3. What explains the deficiencies in services being supply side of health care. These templates are contained in
delivered? Is it because the targets are not accessing the MNCHN MOP.
the service or is it because there is no or limited service?
What is causing the situation? Lack of funds? Lack of However, there is a need to purposely look into what is
supplies? Poor management of the supply chain? Lack of being done along ensuring child security and safety, early
human resources in terms of number and capacity? Lack stimulation, and responsive caregiving.
of physical facility in terms of number and capacity?
In addition, the assessment usually looks into the situation
Lack of good quality data for informed decision-making?
among children 0-59 months old. Thus, there is a need for the
Lack of policy, guidelines, or tools? Lack of information
assessment to zero in on children 0-35 months old.
on services? Others?
While national government agencies will eventually modify
4. What are good practices in delivering services? In
their related guidelines, the LGU should already include these
generating demand and use of services? In improving
concerns in their assessments even while waiting for national
the quality of services?
guidance.

101
How can questions of the situational analysis be answered?
There are many ways of analyzing information generated for the assessment.
These can include:
1. Comparing against a certain standard. An important aspect of analyzing information is on
a. For instance, stunting rates can be compared to standards determining why a particular situation exists. In this
set by the WHO for public health significance. regard, asking a series of whys is important to determine
the chain of causality. This can, in turn, be helpful in
b. Adequacy of the number of human health resources can be identifying appropriate intervention responses.
expressed in relation to the population and compared to
The assessment should make value judgements if a
DOH standards.
problem or situation is good or bad, if a service is
c. Coverage of immunization can be benchmarked against adequate or inadequate, or based on objective measures.
the 80% coverage indicative of the achievement of herd In some instances, there may be no hard data support,
immunity. in which case wisdom and experience would have to be
tapped into.
d. Coverage of nutrition services can be assessed against
the target of 90% coverage of needy population; the 90% In some instances, organizing the chain of causality in a
coverage has been identified as the level of coverage that problem tree can help to further understand the situation.
can impact on nutrition outcomes. Annex Table 1 shows an example for analyzing and
making a statement on a nutrition problem, using the
e. Primary care facilities can be compared against standards as
prevalence of stunting as example.
per the DOH Manual of Standards for Primary Care Facilities.
Annex Figure 1 shows a sample problem tree for an
2. Comparison with the national, regional, provincial, city, and
F1KD+ situational analysis, and how it can be turned
municipal data to make a judgement if something is high or low. into a solution tree and give insights on possible
3. Observation of trends over the years or across climate seasons interventions.
in a year or critical events in a year (e.g., lean months). Annex Table 1 shows an illustration of how data for
4. Mapping of certain characteristics to see clustering in a F1KD+ situational analysis can be analyzed.
particular area or ecologic type.
5. Cross-tabulating two indicators. For example, prevalence of The following shows a sample analysis for data on
stunting can be cross-tabulated with average household size. prevalence of stunting among children 0-3 years old.
The analysis can be adapted for the other indicators.

102
 SAMPLE ANALYSIS SAMPLE STATEMENT
What is the nature of the nutrition problem? The prevalence rate of stunting among children 0-35 months old in
Compare with known standards and WHO Municipality Ganda is 5%. This is low compared to the WHO cut-off for
definition of public health significance public health significance and the provincial prevalence rate of 8%.
However, even if the prevalence is low, it still translates to 1000 children
Stunting Wasting/
whose future is already compromised.
prevalence Overweight
prevalence Over the past three years, the trend has been increasing.
Very low <2.5 <2.5
Low 2.5 to <10 2.5 to <5 WHAT AREAS ARE MORE AFFECTED?
Medium 10 to <20 5 to < 10 1. Rank barangays by prevalence of stunting. Get the top 25% (or any
High 10 to <30 10 to < 15 top portion), observe if these barangays tend to cluster in a part of the
municipality and if these parts share some common characteristics, e.g.,
Very High ≥30 ≥15
upland, or coastal.
2. Map prevalence of stunting by barangay
WHO ARE MORE AFFECTED?
a. Assign color codes, e.g. red for municipalities with high level of the
Compare prevalence by age group or by problem, yellow for those with medium level and green for low level.
occupation group or by some other characteristic.
b. Using a municipal map, color the barangays according to the color
The prevalence rate of stunting among children code.
0-35 months old is highest among children
c. Observe if similar colored-barangays tend to cluster in a part of the
12-23 months old, girls, and in households with
municipality and if these parts share some common characteristics,
4 or more in Municipality Ganda.
e.g., upland, or coastal.

Characteristic Prevalence 3. At the barangay level, using a spot map, mark households with stunted
of stunting children. Observe if households with stunted children tend to cluster in
Age group certain parts of the barangay.
- Infants 0.0
The top 10 barangays with the highest prevalence of stunting are: (List the
12-23 months old 4.5 barangays here). Almost all these barangays are by the coastal area.
24-35 months old 5.0 Note: Sample maps can be inserted here.

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 ANNEX FIGURE 1

Problem Tree for F1KD+ Situational Analysis15

Poor resistance Poor learners Low functional Unemployment and
Consequence Death Illnesses
to infection in school literacy underemployment

Identified Nutrition Problem Stunted children

(First Level)

Immediate Causes Inadequate food intake Poor health status/

presence of illness
(Second Level)

Food insecurity Inadequate care for Insufficient health services,

Underlying mothers and children unhealthy environment, poor
Nutrition personal hygiene
Problem • No food gardens in • Use of milk formula at age
of 2 months
community/household • Open defecation
(Third Level) • Late introduction of
• No money to buy food • Source of water is far
because of unemployment complementary foods
• Health center is far
• Poor farm output due to • Complementary food given
poor seeds lacking in nutrients • Mother/caregiver has
limited time to clean the
• Large family size • Mother does not know house and environment
what foods to give to baby
• Child is left on his/her
• Lack of caregiver time own most of the time
and patience to feed child
responsively

15 Adapted from the NNC eLearning Course on Nutrition Program Management

104
 ANNEX FIGURE 2

Solution Tree for F1KD+ Situational Analysis16

Able to resist Better learner Functional
Survival Health Employment
infections in school literacy

Well-nourished children

Adequate food intake Less frequent and less

severe sickness

Sufficient health care,

Food security Adequate care for mothers and children
healthy environment,
good personal hygiene
✔ Sustained food ✔ Exclusive breastfeeding for the first six
gardens in home and months of life
✔ Zero open defecation
community ✔ Complementary foods given at the 6th ✔ Water system built to be closer
✔ Decent employment month with continued breastfeeding
to households
to buy food and other
basic needs
✔ Complementary food given comes from ✔ Regular community outreach
different food groups
✔ More productive farm ✔ Improved knowledge and skill of mothers on ✔ Transport support to go to
✔ Smaller family size what foods to give to baby health center provided through

✔ Father and other household members help in community action

✔ Father and other members of
household chores and in caring for children
✔ Mother, father, caregiver able to provide the household work together to
have a clean and safe home
responsive care
✔ Mother, father, caregiver talks, sings, plays
with children more often

16 Adapted from the NNC eLearning Course on Nutrition Program Management

105
 ANNEX 3

Integrating F1KD Concerns in Comprehensive Development Planning17

C DP PR EPA R AT ION C DP PR E PA R AT ION C DP PR E PA R AT ION C DP PR E PA R AT ION C DP PR E PA R AT ION
S T EP 1 S T EP 2 S T EP 3 S T EP 4 S T EP 5
Revisit existing Organize and mobilize the Prepare ecological Prepare the Local Prepare needed
plans & review planning team profile & structured Development implementation
LGU vision PPAs Investment Plan instruments
• Include the LNAP and LIPH in the (LIDP)
inventory of existing local plans for • Ensure that F1KD+
• Know who are the • Prepare project Advocate and
review by the CDP Planning Team. indicators (nutrition,
representatives of briefs for secure integration
the local health, • Review the existing LGU vision health, child
proposed F1KD+ in the following:
nutrition, social statement with members of the development) are
related PPAs.
welfare and local nutrition committee or the integrated in the • F1KD+-related
development LDIS/RaPIDS with • Advocate for PPAs in the
F1KD+ team, see how it can be
data disaggregated support from key Annual Investment
office in the CDP made more responsive to F1KD+
by sex and age. members of the Program (AIP).
Planning Team. and present to CDP Planning Team
These indicators CDP Planning
for consideration. Team and the LCE • F1KD+ concerns
• If not yet a can be picked up
for the inclusion in the legislative
member, request • Consider working for inclusion from Table 5. agenda, e.g.,
for the inclusion of words like “healthy,” “well- of F1KD+-related
• Advocate and PAPs in the Ranked ordinance on
of the NAO in nourished,” “secure,” “food-secure.” the F1KD+ as
secure support List of PPAs
the CDP Planning discussed
• Review the LNAP and LIPH and from key members for investment
Team. on page ___.
check consistency with existing of the CDP planning.
• Orient the CDP plans, and adjust as needed. Planning Team and • Participate actively • F1KD+ concerns
Planning Team on the LCE for the in the prioritization in the capacity
the importance of • Ensure that F1KD+ PPAs are inclusion of PPAs building agenda.
included in the list of CDP PPAs. of PPAs, and
actions on F1KD+. related to F1KD+ be ready with
A possibility is suggesting a PPA • F1KD+ indicators in
in the Structured arguments for the monitoring and
on “F1KD+ Program” that will List of PPAs. prioritizing F1KD+. evaluation strategy.
cover programs related to the
components of the NCF. DEC E M BER
AUGU S T - OF ELECTION YEAR UP TO NOT L AT E R T H A N
J U LY AUGU S T NOV E M BER J A NUA RY M A RC H OF YEAR
OF E L EC T ION Y E A R OF E L EC T ION Y E A R OF E L EC T ION Y E A R OF FOL LOW I NG Y E A R AFTER ELECTION

17 Adapted from Ensuring Nutrition Priorities in Local Development Plans and Budgets:
A Thematic Guide and companion document to the CDP Illustrative Guide, National Nutrition Council, 2021
106
 ANNEX 4

ECCD Community Risk Targeting

ECCD Community Risk Targeting involves the For the prescreening, the following should be done:
mobilization of frontline workers and parents to 1. The BNS, BHW, and CDW, under the mentorship of the midwife, can
watch out for signals of developmental delays, and work together (e.g., each one can be assigned to assess a number of
when needed, refer the child to the Rural Health children) in assessing the risk of ALL children 0-35 months old using the
Unit (RHU) for further assessment (Annex Figure 3). tool in Annex Figure 5.
At the RHU, the doctor or nurse should administer 2. The BNS, BHW, CDW, under the mentorship of the midwife, can work
the full ECCD Checklist, specifically Child Record 1. together (e.g., each one can be assigned to assess a number of children)
As needed, children should be referred to higher in assessing the achievement of core developmental milestones using
levels of care. The PhilHealth Package Z for CWDs the Developmental Milestones Chart shown in Annex Figure 5.
can be used for financing the needed care.
3. Parents and caregivers take part in monitoring the development of their
children. They can use the tool in Annex Figure 6 for this purpose.

Community
Patient identification by members of CHT
Primary Health Facility Referral
using ANY of the following Prioritization
Higher level of care
or Pre-screening Criteria: Administration of ECCD Checklist
1. Known Risk Factor using Child’s Record 1
The Nurturing Care Risk by Health Center Staff
Factor Checklist for ECD (RHU Physician, Nurse, Midwife)
2. Findings in the Core
Developmental
Milestones Chart
3. Expressed concern
from primary caregivers
especially with reference
to the EC List of Red Flags

107
 ANNEX FIGURE 3

Flow for ECCD Community Risk Targeting Legend:

LEVEL

Actors Tools

CO M M U N I T Y
Nurturing Care Risk
Community- Factors Checklist 
level
Workers Development
Milestones Chart
FAC I L I T Y L E V E L 1
H E A LT H CE N T E R
HOUSEHOLD Healthcare Physician ECCD
Checklist
Midwives Child’s
Primary EC List of
Caregivers Red Flags Record 1
Nurses

108
 ANNEX FIGURE 4

109
ANNEX FIGURE 4

Nurturing Care Risk Factor Checklist for ECCD

FILIPINO VERSION (ADAPTED)

PAALALA SA GAGAMIT:
1. Ang listahang ito ay maaaring hindi kompleto at ginawa 2. Ang checklist na ito ay pupuwedeng gamitin bago o pagkatapos ng Core
para magamit ng mga health workers sa komunidad lakip Developmental Milestones Chart. Panuto:
ang Core Developmental Milestones (tignan sa likod nito) a. Lagyan ng “X” ang mga kahon na nag-aaply
para silang matukoy ang mga batang 0-3 taong gulang na b. I-refer ang bata sa health o daycare center kapag:
mangangailangan ng referral sa health center o sa daycare i. Merong marka kahit isang kahon sa pahinang ito.
upang mapangasiwaan ng ECCD Checklist Child’s Record 1. ii. Mayroong pag-aalala o pag-aalinlangan ang magulang,
tagapangalaga, o ang health/day care worker sa
development ng bata.
iii. Ang linyang ginuhit sa Core Developmental Milestones Chart
(sa likod nito) ay hindi diretso o hindi tugma sa edad ng bata.

GOOD HEALTH

F Pagkakaroon ng malubhang sakit o sakit mula pagkapanganak F Mababa ang APGAR Score o hindi umiyak agad ang bata
pagkapanganak
F Pagkakaroon ng kapansanan sa bata o sa pamilya: pisikal, paningin, pandinig, etc.
F Premature o kulang sa timbang
F Mag kamag-anak ang mga magulang ng bata
F Positibo sa Newborn Screening
F Delikadong Pagbubuntis:
F Positibo sa Newborn Hearing Screening
F Edad ng magulang <18 o >35 taong gulang
F Nagkaroon ang bata ng matinding paninilaw o
F Sakit/impeksyon/kamatayan ng nanay
kombulsyonna nangangailangan i-ospital lalo na sa unang
F Pagkaexpose sa alak, yosi/tobacco, at droga ng nanay buwan nang pagkapanganak

F Hindi naalagaan ang pagbubuntis

OPPORTUNITIES FOR EARLY

EDUCATION
ADEQUATE NUTRITION

F Labis na kapayatan (Wasted) F Bihirang kausapin at kalaruin ang

bata ng nag-aalaga
F Pagka-bansot
F Madalas na iniiwang mag-isa
F Kasaysayan ng micronutrient habang nanonood ng TV o
deficiency sa bata: gumagamit ng gadget sa bahay
Vit A, Iron, or Iodine
F Madalas na inaalog, pinapagalitan,
F Ang nanay ay COMPONENTS sinisigawan, o pisikal na sinasaktan
nanganaganib ang kalusugan ang bata.
habang nagbubuntis OF
F Hindi nakatanggap ng NURTURING
suplementong micronutrient
ang nanay habang siya ay CARE
nagbubuntis SAFETY AND SECURITY
F Nagkaroon ng labis na katabaan
(obesity) ang nanay o ang bata F Pagka-expose sa karahasan sa
bahay/domestikong karahasan

F Hindi maipaliwanag/kaduda-dudang
pasa/pinsala, (pwedeng may bukol
sa ulo o pamumula sa paligid ng
mata)
RESPONSIVE CAREGIVING
F Pinaghihinalaang naabuso ang bata
o pinapabayaan
F Hindi planado/gustong pagbubuntis lalo na kapag ito ay dahil sa rape/inses
F Labis na pagka-takot sa nagbabantay
F Solong Magulang/Solo-Parent o sa ibang matatanda

F Ang Magulang/Tagapag-alaga ay may kasaysayan ng: F Ang bata ay kadalasan iniiwan mag-
isa o sa pangangalaga ng isa pang
F Pang-aabuso noong kanyang kabataan bata (<10 taong gulang) lagpas isang
oras.
F Naakusahan o napatunayang nang- aabuso ng mga bata o karahasan sa
bahay/domestikong karahasan F Kasaysayan ng malubhang pinsala
sa bata (pagkalunod, naaksidente sa
F Pang-aabuso ng mga bawal na sangkap (alak, droga)
kalsada, nahulog, nalason, atbp.)
F Pagkalulong sa sugal
 ANNEX FIGURE 4

110
 ANNEX FIGURE 6. SIGNALS OF POSSIBLE DEVELOPMENTAL DELAY

t
ANG MGA MAAGANG PAMAMARAAN NG PAGSUSURI SA BATA

Adapted from Coordinator’s Notebook, an International Resource for ECD PANANALITA (TALKING) – kung ang inyong anak:
Hindi nagsasalita ng mama/mommy/nanay sa edad na isang taon at kalahati (18
 Ikaw at ang iyong asawa o iba pang mga tagapangalaga na buwan)
na bahagi ng pang araw-araw na buhay ng bata ay Hindi masabi ang ngalan ng mga pangkaraniwang bagay o tao sa edad na 2 taon
maaaring gawin ang mga ganitong antas ng pagsusuri. Hindi magaya ang mga simpleng kanta o himig sa edad na 3 na taon
 kung sakaling ipinamamalas niya ang alin man sa mga Hindi nagsasalita ng maiksing pangungusap sa edad na 4 na taon
sumusunod na palatandaan o pag-uugali. Hindi maintindihan ang mga taong hindi niya kapamilya sa edad na 5 na taon
 Kung ang inyong anak ay nakitaan ng mga problema o Kakaibang magsalita kung ihahalintulad sa mga batang kasing edad niya
diperensya, dapat mong ipasuri ito agad sa mga doctor o
health worker. PANG-UNAWA (UNDERSTANDING) – kung ang inyong anak:
Hindi kumikibo kapag tinatawag ang kanyang pangalan sa edad na 1 na taon
Ang mga sumusunod ay isang simpleng pamamaraan ng pagsusuri na maaaring Hindi masabi ang mga bahagi ng mukha sa edad na 3 na taon
gamitin mo, ng iyong asawa o sino mang tagapangalaga. Lagyan ng markang tsek Hindi makasagot sa mga simpleng tanong sa edad na 4 na taon
(√) ang naayong kahon kung nakikitaan ninyo ang inyong anak na nagtataglay ng Hindi makasunod sa mga simpleng kwento sa edad na 5 na taon
ganitong problema. Tandaan na agad kumonsulta sa doctor o health worker kung Nahihirapan sa pag-unawa ng mga bagay na sinasabi mo kung ihahambing sa
nakitaan ng deperensya. ibang bata na kasing edad niya

PANDINIG (HEARING) – kung ang inyong anak:

PAGLALARO (PLAYING) – kung ang inyong anak:
Hindi lumilingon sa mga pinagmumulan ng tunog o boses
Hindi nasisiyahan sa mga laro, gaya ng pagkaway-kaway sa kanya sa edad na 1
Madalas may impeksyon ang tainga (may tumutulo/lumalabas
taon
o masakit ang tainga)
Hindi naglalaro ng mga pangkaraniwang bagay (tulad ng kutsara at palayuk-
Hindi tumutugon kapag tinatawag maliban na lamang kung makita kayo
palyokan) sa edad na 3 na taon
Tinitingnan ang inyong mga labi habang ika’y nagsasalita
Hindi sumasali sa mga laro ng ibang bata (tulad ng habulan, taguan) sa edad na
Nagsasalita na ubod ng lakas o mahina ang tinig
4 na taon
Ayaw makipaglaro sa mga batang kasing edad niya
PANINGIN (SEEING) – kung ang inyong anak:
Kadalasan ay hindi nakikita ang mga maliliit na bagay na nalaglag
PAGGALAW (MOVING) – kung ang inyong anak:
May pamumula o matagal ng may lumalabas sa mata (tubig, nana, dugo),
Hindi makaupo ng mag-isa sa edad na 10 buwan
parang may anyong ulap sa mata o kadalasan ay kinukusot o masakit
Hindi makalakad ng walang tulong sa edad na 2 na taon
Madalas na nababangga sa mga bagay na nasa paligid sa kanyang pagkilos
Hindi makatayo sa isang paa kahit na sandali sa edad na 4 na taon
Ang ulo ay wala sa tamang posisiyon kapag may tinitingnang bagay
Kakaiba ang pag galawa kung ihahalintulad sa mga batang kasing edad niya
Minsan o kadalasang naduduling ang isa o dalawang mata (makalipas ang
edad na 6 na buwan

111
 ANNEX 6

Notes On Promoting Responsive Caregiving And Early Stimulation

Early childhood psychosocial stimulation refers to sensory (seeing, hearing, and touch) and emotional stimulation provided
through an affectionate mother-child or caregiver-child bond.
Thus, parents and caregivers can be encouraged to maximize opportunities and manifestations on responsive caregiving
and early stimulation. Such encouragement can be integrated in contacts with parents and child caregivers, e.g., during
consultation visits in health facility, home visits, and group gatherings, etc.
The following points, from the Idol Ko si Nanay Learning Sessions can be shared during these contacts.

1. The mother-child or caregiver-child bond begins 4. Examples of play and communication activities:
at birth and provides warmth and affection,
a. Playing peek-a-boo helps mother and child pay
and sensitivity and responsiveness to the needs
attention to each other
of the child. It facilitates the child’s learning to
develop physical, cognitive, emotional, social and b. During breastfeeding, a mother can encourage her
other skills. baby to learn by looking at him/her and respond to his/
her movements and sounds with gentle touches and
2. Play and communication activities between talking to the baby
mother/caregiver and child provide opportunities c. A mother/caregiver playing with a child on how to stack
for psychosocial stimulation. Play and bowls of different sizes, stimulate several child skills like
communication can happen during feeding, motor, cognitive, communication, and emotional
dressing, and other daily tasks. Play gives
children opportunities to think, test ideas, and
solve problems. 5. WHO recommendations for childcare and development
are shown in Figure 7.18 While there are still no guidelines
or tools on promoting responsive caregiving and
3. Paying attention to babies, playing with them
psychosocial stimulation in the first 1000 days, the city/
and seeing how they respond to the attention
municipality can adapt these recommendations.
will also help mothers/caregivers become more
active and confident in their child caring role.
18 Source: WHO, WHO - Recommendations for Care for Child Development

112
 ANNEX FIGURE 7

WHO Recommendations for Care for Child Development

113
 ANNEX 7

A Way Of Discussing Agenda On The Status Of F1KD+ Services

In Meetings Of The Local Nutrition Committee
Discussions in meetings of the LNC on the status of 4. Analyze the report and identify which services are doing well.
F1KD+ services aim to determine if the LGU is on The consolidated report can then be recast by regrouping
track in delivering related services. It aims to identify services that are on track, services that are lagging. The
bottlenecks in implementation and specific action lines latter can be further broken down by level of performance,
that should be pursued to address these bottlenecks. e.g., ≥75% and <90%, ≥50% and <75%, <50%. The cut-offs
could vary depending on the quarter covered by the report.
To make discussions more directed and effective the
following are suggested: 5. Prepare the PowerPoint presentation that for this agenda
item could include
1. Collect and collate reports a. Purpose of the presentation:
from agencies concerned. b. Method of collecting and validating data
c. Agencies with inputs for the report
2. Review each report and validate with the
agency concerned. Validation is needed if d. Results
the target numbers are not consistent across i. Overall performance
(can be an average of all performance scores)
reporting periods. Validation is also need for ii. Services that are doing well
accomplishments that are low and the agency (smileys could be used to convey the message)
could be asked on possible reasons for the low iii. Services that are lagging
accomplishment. If validation is not possible, notes and indicative reasons for the lag
on points for validation should be prepared and e. Recommendations - Discussions should result in clear
discussed in the meeting, if needed. action lines, to be done by whom, and within what period.
Action on these agreements can then be the starting
3. Prepare the consolidated report point for discussions in the next meeting.
(see below for a possible template.)

Life Total
stage/ estimated Annual Accomplishment Percent of target Remarks
service/ number target accomplished
indicator

For the quarter As of the quarter For the quarter As of the

quarter

114
 ANNEX 8

Possible Action Lines For Observed Gaps And Deficiencies In Service Delivery
Observed gap or deficiency Possible corrective actions
1. Service is available, but targets not availing of services due to:
a. Distance 1) Organize outreach activities 4) Use existing structures that are closer to targets as point
2) Organize and mobilize network of transportation of service delivery
providers 5) Build new structures
3) Strengthen scheme for home visits

b. Not knowing of the 6) Tap the barangay council and community-based 7) Use social media and other forms of media (e.g.,
available services organizations and leaders to inform the community on posters, billboards in public places) to communicate
services available services available

c. Service providers or 8) Define behavioral parameters for friendly service

point of service delivery delivery and build capacity of workers to achieve these
not friendly to users standards

2. No or limited supply of services because:

a. No funds 9) Include in budget proposal, identify savings that can be 10) Find partners from the NGO community, private sector
used and re-channel budget of non-moving projects/ (watch out for conflict of interest), and development
activities partners

b. Problems in supply chain 11)Improve procedures for estimating requirements, 13) Procure early, e.g., consider when supplies are needed
e.g., review history of use of supplies and the turn-around time for procurement process
12) Set, review, and revise threshold levels to trigger 14) Improve inventory recording processes
procurement of stocks to replenish
15) Have additional storage space

c. Inadequate number of 16) Advocate for hiring of additional staff 17) Find partners from the NGO community, private sector
service providers (watch out for conflict of interest), and development
partners that can provide additional human resources or
funds for additional human resources

d. Limited capacity of 18) Build capacity of service providers through trainings,

service providers refresher courses, provision of job aids, supportive
supervision

3. Lack of coordination among workers and agencies

19) Define and clarify roles, responsibilities, and 20)Dialogue with head of office
accountabilities
21) Institute a system for regular sharing of information

115
 ANNEX 9

Illustration of the use of the ABCDE framework for advocacy

Situation. The F1KD+ situation is far from optimum and services to addresses the situation are challenged by lack of funding
support. Working for a local ordinance on F1KD+ and adapting RA 11148 in the LGU can address this situation.

1. A - Identify and characterize the audience or the person, 4. D - Determine the design of the advocacy or how the
institution or stakeholder that can act on the issue. information will be communicated to the target audience.
 LCE, the vice-mayor, a member of the Sanggunian This can be through:
who will introduce and champion for the ordinance, a. Face-to-face meetings with the target (mix of one-on-
the other members of the Sanggunian, the one and group) to present the case for the ordinance
community and other stakeholders
b. Sending letters of support to the members of the
2. B - Determine and be clear on the specific behavior Sanggunian and asking others to do so
 LCE – have an issuance indicating that an ordinance c. Participation in hearings to provide technical
on the F1KD+ is a priority concern assistance as needed
 A member of Sanggunian – introduce and champion d. Radio and television interviews on the importance
for the ordinance on F1KD+ of the F1KD
 Vice-mayor: Schedule the proposed ordinances in e. Distribution of policy briefs for the audience that
deliberations highlight why there is a need for the ordinance
 Other members of the Sanggunian – Vote yes for f. Any other method to reach out to the target.
the ordinance Whatever the channel of communication, the message
should be clear, consistent, constant, and actionable
 Community and stakeholders – Tell your kagawad
that the proposed ordinance is important and
should be passed, send letters of support for the 5. E - Evaluate the advocacy effort by determining if it
ordinance on F1KD+ resulted in the desired behavior.
3. C - Determine information that needs to be conveyed to  Monitor if the desired behavior has been done.
the target audience. If not, assess why not and take action accordingly.
For example, if the vice-mayor has not scheduled
 Information that can be shared can come from the
situational analysis, e.g., nutrition situation, mortality the draft ordinance on the F1KD+ for deliberations,
and morbidity, low outreach of services due to a quick one-on-one meeting can be held to
funding constraints. In many instances, highlighting convince the vice-mayor to include the proposed
the impact of the F1KD+ on brain development is F1KD+ ordinance in the agenda.
convincing.

116
The First 1000 Days
MANUAL OF PROCEDURES