An Assessment of the Implementation of Nutrition Education Program at the National and Local Levels

1
An Assessment of the Implementation of Nutrition
Education Program at the National and Local
Levels

• Department of Food Science Nutrition
• College of Home Economics
• University of the Philippines
• Diliman, Quezon City

2
Project Team

• Demetria C. Bongga, Ph.D.
• (Project Leader)
• Milagros P. Querubin, Ph.D.
• (Study Leader 1)
• Ma. Veritas F. Luna, Ph.D.
• (Study Leader 2)
• Carleneth P. Fernandez
• (Study Leader 3)
• Cecile Leah T. Bayaga, MSN
• (Study Leader 4)

3
Objectives of the study

• Describe the key nutrition education programs in
  terms of policy directive, support activities,
  availability of resources

4
Objectives of the study

• Characterize implementation of nutrition
  education/activities in terms of

• Level of implementation
• Forms and usage
• Target group
• Messages
• Channels
• Key players or sources of messages

5
Objectives of the study

• Describe the essential enabling mechanism for
  support activities for the implementation of
  nutrition education identified in objective 1.

6
Objectives of the study

• Determine the strengths, weaknesses,
  opportunities and challenges of nutrition
  education activities/programs.

7
METHODS
8
Conceptual Framework
9
Research Design

• Descriptive study and made use of
• qualitative research methodologies

• In-depth interviews
• Focus group discussions
• Records review and inventory checklist

10
Schematic diagram of sampling design
11
Pre-test Areas

• National Level
• National Nutrition Council
• Local Level
• Province Laguna
• Municipality Pagsanjan
• Barangay Lambak, Pagsanjan

12
National Agencies Interviewed

• Department of Health (DOH)
• Food and Nutrition Research Institute (FNRI)
• Department of Social Work and Development (DSWD)
• Department of Education
• Nutrition Center of the Philippines (NCP)

13
National Agencies Interviewed

• Nutrition Foundation of the Philippines (NFP)
• Helen-Keller International (HKI)
• Nestle Corporation
• CODHEND Schools (UP-Los Banos, Benguet State
  University, Centro Escolar University)

14
Provinces Included in the Study
15
Content of questionnaire at the National level

• What are the existing nutrition education
  activities/programs being implemented?
• Were there department orders/memos/directives
  issued by these agencies regarding the
  implementation of these activities

16
Content of questionnaire at the National level

• Who were involved in the planning for such
  activities?
• Was it a sole initiative of the agency or in
  collaboration with other agencies?

17
Content of questionnaire at the National level

• What were the sources of the funds to implement
  the activities?
• What are the available or existing materials
  utilized by these agencies to implement such
  activities?

18
Content of questionnaire at the Local level

• What were the orders/memos/ directives that
  emanated from the regional agencies regarding the
  implementation of nutrition education activities?
• What were your actions in response to the
  orders/memos/directives? (it may be through
  issuance of a memo, order or ordinances)

19
Content of questionnaire at the Local level

• What are the existing nutrition education
  activities/programs being implemented in your
  region? (Province? Municipality/City? Community/
  Barangay?)
• Does the Region (municipality, community/barangay)
  have the manpower to implement the activity? If
  yes, who implement(s) the nutrition activities?

20
Content of questionnaire at the Local level

• Does/Do the implementor(s) have the training to
  implement the activity? If yes, what capability
  building activities were undertaken to train
  provincial or city nutrition officers in the
  implementation of such activities? Who initiated
  or funded the capability building activities?

21
Content of questionnaire at the Local level

• What are the available or existing materials
  utilized to implement such activities?
• Are there facilities/venues available in your
  region (or province, municipality,
  community/barangay) for the implementation of the
  NE activities?

22
Content of questionnaire at the Local level

• What types of support were extended to you by the
  municipal/city council (or Barangay Nutrition
  Committee) for the implementation of such
  activities? Please specify the type and nature of
  support provided.

23
Content of questionnaire at the Local level

• What was the involvement of other sectors (i.e.
  schools, NGOs, business enterprise, civic groups,
  church organizations, private citizens, etc.) in
  the region (or province, municipality,
  community/barangay) during the implementation of
  the NE activities?

24
Content of questionnaire at the Local level

• Who were the attendees/ participants in the NE
  activities?
• Who monitors and evaluate the implementation of
  NE activities?

25
Content of questionnaire at the Local level

• What do you think are the strengths of the
  nutrition education activities/ programs in your
  region (or province, municipality,
  community/barangay)?
• What do you think are the weaknesses of the NE
  programs/ activities in your region (or province,
  municipality, community/barangay)?

26
Content of questionnaire at the Local level

• What were the challenges encountered in your
  region (or province, municipality,
  community/barangay) in the implementation of NE
  programs/ activities?
• How were these challenges addressed?

27
Content of questionnaire at the Local level

• What opportunities are available for the
  improvement of NE programs/ activities in your
  region (or province, municipality,
  community/barangay)?

28
RESULTS
29
National Level
30
Types of Nutrition Education Activities
Implemented at the National Level

• Training of implementors and health workers
  DOH, HKI
• Nutrition counseling and mothers class
  CODHEND, DOH
• Development of IEC materials CODHEND, DOH,
  DSWD, FNRI, HKI, NCP, NFP
• Printing of IEC Materials - Nestle
• Distribution of IEC Materials HKI, DOH

31
Nutrition Topics Imparted by National Agencies

• Basic nutrition e.g. proper nutrition for the
  different life stages, foundations of good
  nutrition, and meal planning
• Advocacy on healthy lifestyle and nutrition month
  theme
• Food processing production
• Food safety sanitation
• Others e.g. Nutritional Guidelines

32
Sources of Funds of National Agencies

• Own agency funds or National government
  allocation
• International funding institutions UNICEF, WHO,
  USAID, JICA
• Civic Organization e.g. Zonta Club of Manila,
  Childrens Hour
• Industry e.g. Nestle, San Miguel, Unilever,
  Wyeth, Colgate-Palmolive

33
Partners of National Agencies in Planning
Nutrition Education Activities

• Agency and its subunits e.g. DepEd,
  DOH, DSWD, FNRI, NCP
• Collaboration with other agencies e.g. DOH with
  FNRI/HKI
• Collaboration with sub-national units e.g. NCP
  with LGUs

34
Partners of National Agencies in Implementing
Nutrition Education Activities

• LGUs e.g. HKI, NCP, NFP
• Schools and school teachers e.g. DepEd
• Local Centers e.g. DSWD
• Divisions within agencies e.g. DOH, FNRI
• Other government or agency units e.g. DOH

35
Basis of National Agencies for the Conduct of
Nutrition Education Activities

• DOH Has various banner programs and initiatives
  such as
• Garantisadong Pambata campaign based on DOH
  Circular 33-C s2001
• Healthy Lifestyle Promotion through DOH order
• Food Fortification Campaign is intended to step
  up implementation of the Asin Law enacted in 1995
  and the Food Fortification Act of 2000
• Food safety program is anchored on the WHO
  guideline on food safety and operationalizes the
  9th message in the Nutritional Guidelines for
  Filipinos

36
Reasons of National Agencies for the Conduct of
Nutrition Education Activities

• FNRI by mandate it must disseminate nutrition
  information and develop IEC materials
• DSWD being a member of NNC governing board, it
  assists in the communication of relevant
  nutrition messages

37
Basis of National Agencies for the Conduct of
Nutrition Education Activities

• DepEd intensifies nutrition health education
  in public elementary schools through TCPA (based
  on DECS Memorandum No. 211 series 1991)
• NCP one of its major thrust is to develop IEC
  materials on health nutrition

38
Basis of National Agencies for the Conduct of
Nutrition Education Activities

• NFP based on the directives of the Board, one
  of these is establishment of nutrition health
  kiddie classes
• HKI undertakes nutrition education activities
  to enhance the implementation of DOH programs

39
Basis of National Agencies for the Conduct of
Nutrition Education Activities

• Nestle doesnt implement nutrition education
  activities its role is limited to provision of
  funds for printing of materials
• CODHEND part of its curriculum (nutrition
  education and practicum)

40
Local Level
41
Types of Nutrition Education Initiatives

• Integration in existing programs in response to
  national directives
• Health agriculture, social services
• Elementary school curriculum
• Part of the implementation of selected MTPPAN
  programs
• Special projects of incumbent President

42
Types of Nutrition Education Initiatives

• Special events
• Local Initiatives
• LGU special programs
• Stand-alone nutrition education activities
• Specific health and nutrition campaigns
• Advocacy Activities
• Orientation and training of support personnel

43
Types of Nutrition Education Initiatives

• Other forms of nutrition education
• Broadcast media
• Development and distribution of IEC materials

44
Characterization of Nutrition Education Activities
45
Integration of Nutrition Education in Health
Services
46
School-based nutrition education
47
Integration of nutrition in agricultural programs
48
Integration of nutrition education in social
services
49
Part of MTPPAN Impact Programs
50
Part of MTPPAN Impact Programs
51
Part of MTPPAN Impact Programs
52
Special Government Project
53
Nutrition Month Celebration
54
Nutrition Month Celebration
55
Local Government Unit Initiatives
56
Local Government Unit Initiatives
57
Local Government Unit Initiatives
58
Local Government Unit Initiatives
59
Advocacy
60
Orientation and training of support personnel
61
Other Forms of Nutrition Education
62
Summary

• Nutrition education activities in response to
  directives of national agencies involved with the
  MTPPAN.
• Nutrition education initiatives of LGUs as part
  of local health campaigns or part of a special
  program of the LCE.

63

• The provincial level provides the directions of
  the nutrition education activities in terms of
  form and focus, planning was done at the
  municipal level but implementation was always at
  the barangay level.

64

• Provincial level personnel seldom go down to the
  barangay to directly teach the primary target
  groups (e.g. mothers, preschool children, school
  children).
• Interaction with primary groups only during
  special events (e.g. specific health campaigns,
  Nutrition Month Celebration)

65

• Frequency of conduct of nutrition education
  activities varies

e.g. Yearly - information dissemination
drive Quarterly or monthly nutrition counseling
during home visits Weekly group lectures to
clients of the health center
66

• Nutrition education activities were always
  intensified during the Nutrition Month celebration

67

• Forms of nutrition education

• Provision of nutrition information during
• health campaigns
• Nutrition counseling during home visits
• Group lectures for mothers of
• undernourished children and other target
• groups
• Distribution of flyers
• Posting of signages

68

• Channels used were interpersonal communication,
  print and broadcast media

69

• Nutrition education activities could be community
  based, school based or health center based

70

• Nutrition counseling during home visits done by
  BNS and BHWs

Group lectures usually done by midwives or other
guest lecturers from municipal or provincial
offices
71

• Target group of most nutrition education
  activities was mainly mothers of undernourished
  children
• Other target groups

• whole family
• elderly
• school children
• preschool children
• General public

72

• High profile nutrition education activities were
  usually part of special events (i.e. Nutrition
  Month, launching of new health and nutrition
  programs)

73

• Advocacy activities allowed them to get support
  for nutrition programs (i.e. PNAO or MNAO
  informing the LCEs about the result of annual OPT)

74
Nutrition Education Messages

• Nutrition education messages or topics are often
  related to, in support of or complement nutrition
  activities or projects (i.e. OPT, micronutrient
  supplementation, food production)

75
Messages and Target Groups
76
Mothers of undernourished children

• Wastong pagkain para sa undernourished na bata
• Dagdag pagkain para sa sa undernourished na bata
• Consumption of green leafy vegetables
• Addition of oil

77
Mothers/Parents

• Messages related to nutritional care
• 3 basic food groups
• Importance of breastfeeding
• Micronutrient supplementation
• Significance of Vitamin A
• Importance of supplementary feeding
• Use of iodized salt
• Utilization of products with SPS

78
Mothers/Parents

• Messages related to improving food availability
• Income generating projects
• Backyard gardening
• Livestock raising
• Messages related to promotion of health practices
• Family planning
• Ligtas buntis
• Dengue awareness
• Clean and green
• Immunization

79
Elderly

• Different lifestyle diseases
• Nutrition for the elderly
• Information on diabetes and how it can be managed

80
School children

• 3 basic food groups
• Nutritional Guidelines for Filipinos
• Use of SPS and Diamond Seal Product
• Use of iodized salt
• Proper food choices
• Vegetable gardening
• Importance of vitamins and minerals
• Basic nutrition as related to nutrition month
  theme

81
Preschool children

• 3 basic food groups
• Food pyramid
• Importance of vitamins and minerals

82
Farmers

• Skills training farming/gardening
• Food production
• Nutritious fruits and vegetables

83
Other primary target groups

• Highschool students
• - Basic nutrition concepts incorporated in the
  school curriculum and as related to Nutrition
  Month theme
• College students
• - Importance of food
• - Proper food choices
• - Use of iodized salt
• - Use of SPS products
• Out-of-school youth
• - Basic nutrition

84
Pregnant/Lactating Mothers

• Nutritional Guidelines for Filipinos
• 3 Basic Food groups
• Importance of breastfeeding
• Importance of colostrum
• Proper selection of low cost nutritious foods

85
Would-be-couples

• Importance of breastfeeding
• Family planning
• Roles of couples in nurturing a healthy family

86
Hospital personnel

• Fortified flour utilization
• Iodized salt and products with SPS utilization
• Milk Code implementation
• Baby friendly hospitals

87
Salt producers

• How to iodize salt
• Health importance of iodized salt

88
General Public

• Nutrition Month theme
• Waste segregation
• Proper garbage disposal
• Promotion of Garantisadong Pambata
• Promotion of iodized salt and SPS products
• Benefits of iodized salt utilization

89
IEC Materials developed by National Agencies
found at the Local Levels
90
FNRI IEC Materials
91
FNRI IEC Materials
92
NCP IEC Materials
93
HKI IEC Materials
94
HKI IEC Materials
95
DOH IEC Materials
96
DOH IEC Materials
97
Enabling Mechanisms
98
Enabling Mechanisms

• Manpower Support
• Capacity Building
• Physical Facilities
• Funding Support
• Political Commitment and Support

99
Key Persons in the Implementation of NE Program
(Provincial Level)
100
Key Persons in the Implementation of NE Program
(Municipal Level)
101
Selection of Key Persons Implementing NE Programs

• Appointing or Selecting Authority
• Governor
• Mayor
• Head of Local Offices
• Basis of Selection
• Educational background Nutritionist
• Physician
• Nurse
• Work experience
• Choice of Local Chief Executive

102
Roles of Key Persons Implementing NE Programs
(Provincial Level)

• Coordination of NE activities
• Advocates for NE activities
• Echoes and initiates training of local level
  implementors
• Orients local level implementors on national
  programs that will be implemented at the
  municipal and barangay levels
• Serves as resource person of nutrition
  information
• Prepares syllabi for NE in mothers classes

103
Roles of Key Persons (Provincial Level),Winner
v.s. Non-winner
104
Roles of Key Persons Implementing NE Programs
(Municipal Level)

• Implementor - trainors, resource person,
  counselors, lecturers
• Plan NE activities
• Coordinate
• Monitor
• Evaluate
• Advocate

105
Roles of Key Persons ( Municipal Level)Winner
v.s. Non-winner
106
Roles of Support Personnel
107
Capacity Building
108
Trainings on Knowledge enhancement attended by
Key NE Implementors
109
Trainings on Skill-building enhancement attended
by Key NE Implementors
110
Facilities Available for NE Activities

• Venue government, private and commercial
  establishments spaces
• AV equipment OHP, LCD, Slide projector, sound
  system, TV, VCD/DVD Player
• Computer desktop, laptop

111
Sources of Funding

• LGU allocation
• NGOs and Religious organizations
• International Funding Institutions
• Private Donors
• Civic organizations
• Industry and local businesses
• Local Clubs and Cooperatives

112
Budget Allocation for NE Program Activities

• 10 to 23 of social development fund used for
  nutrition program
• Actual cost for NE activities not indicated in
  action plans

113
Political Support
114
Types of Political Support
115
Focus Group Discussions
116
Nutrition Education Activities at Local Levels

• 1. Stand alone activities
• Mothers classes
• Pabasa
• Bench conferences
• One-on-one counseling during home visits
• Teacher-Child-Parent Approach

117
Nutrition Education Activities at Local Levels

• 2. Integrated into existing programs
• - Center-based supplementary feeding programs
• - Pre-marriage counseling
• - GP campaigns
• - OPT or growth monitoring
• - Elementary school curriculum
• - Milk feeding programs
• - Parenting Effectiveness Service

118
Nutrition Education Activities at Local Levels

• 3. Special events
• - Nutrition month celebration
• (nutrition quiz, essay writing, radio TV
  guesting,
• - Patak Day

119
Common Messages Disseminated at Local levels

• Basic nutrition
• Eating a balanced diet
• Preparing nutritious but cheap dishes
• Importance of breastfeeding
• Why fortified foods

120
Limitations to Successful Implementation of NE
Activities

• Lack of or no political support
• Lack of funds
• Lack of volunteers/ personnel
• Inadequate IEC materials
• Lack of food supplies and nutrient supplements

121
Limitations to Successful Implementation of NE
Activities

• IEC materials not in the dialect
• Lack of interest among target clients
• People have no money to apply what is learned.

122
Recommendations for Improving Implementation of
NE Activities

• Advocacy among political leaders or LGU
  officials
• Health and Nutrition program included in DILG
  seminars for new local chief executives
• Use of multi-media
• IEC available in the local dialect
• Make food available in the home through home
  gardening

123
Recommendations for Improving Implementation of
NE Activities

• Training on nutrition education delivery
• Adequate IEC materials
• Training guide for use of trainers and resource
  persons
• Additional trained manpower support
• More supplies (food, nutrient supplements)
• Restore home economics in Dep Ed curriculum.

124
Key roles of NE Implementers

• Resource person / lecturer
• Advocate
• Monitor/supervisor
• Prepare IEC materials
• Give advice or counseling (during home/bgy
  visits)
• Organizing women for classes and other community
  activities.

125
KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE
IMPLEMENTATION

• Knowledge about (or mastery of)
• Basic nutrition
• Breastfeeding
• Proper feeding of young children
• Different DOH programs
• The (attributes) of target client

126
KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE
IMPLEMENTATION

• Attitudes
• Patience
• Sense of humor
• Integrity
• Commitment
• Confidence to face large groups
• Friendly, approachable
• Sincerity
• Must give time

127
KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE
IMPLEMENTATION

• Skills
• Communication skills
• Peoples skills
• Ability to convince or mobilize

128
CONCLUSIONS

• Types of NE activities
• A number of NE activities or programs are
  initiated at the national level (e.g. Pabasa,
  PES, GP)
• Selective implementation of some national NE
  activities at local level
• Many IEC materials developed at national
  agencies
• Copies of IEC materials developed have limited
  availability at local level or for end users

129
CONCLUSIONS

• Several messages emanating from national
  agencies
• Messages recalled at local level are limited

130
CONCLUSIONS

• Presence of NE activities initiated at local
  level
• Most NE activities are integrated in existing
  programs (health, school curriculum, agriculture,
  PES)

131
CONCLUSIONS

• Policy instruments
• Mandates or policies re- NE activities clear at
  national level
• National policy directives not clearly
  articulated at local level
• NE activities often not part of NAP at local
  level

132
CONCLUSIONS

• Enabling mechanisms
• Inadequate manpower capability to implement NE
  activities at local level (both in number and
  competence) esp. at bgy level)
• Inadequate funding support for NE activities)
• Basic nutrition concepts the mainstay of NE
  messages

133
CONCLUSIONS

• Funding support for NE at local level are
  considered inadequate
• Other sources of logistical support at local
  level (NGOs, IFIs, private or commercial
  institutions, civic religious organizations,
  etc) are available
• Facilities, equipment and venue generally
  available at local level

134
CONCLUSIONS

• Political support or commitment for NE activities
  (or nutrition in general) need strengthening at
  local level
• Definition of what constitutes nutrition
  education activity not clear-cut at local level

135
Thank You!