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

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

Project Team: 

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)

Objectives of the study: 

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

Objectives of the study: 

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

Objectives of the study: 

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

Objectives of the study: 

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

METHODS: 

METHODS

Conceptual Framework: 

Conceptual Framework

Research Design: 

Research Design Descriptive study and made use of qualitative research methodologies In-depth interviews Focus group discussions Records review and inventory checklist

Schematic diagram of sampling design: 

Schematic diagram of sampling design

Pre-test Areas: 

Pre-test Areas National Level National Nutrition Council Local Level Province: Laguna Municipality: Pagsanjan Barangay: Lambak, Pagsanjan

National Agencies Interviewed: 

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)

National Agencies Interviewed: 

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)

Provinces Included in the Study: 

Provinces Included in the Study

Content of questionnaire at the National level: 

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

Content of questionnaire at the National level: 

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?

Content of questionnaire at the National level: 

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?

Content of questionnaire at the Local level: 

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)

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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.

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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)?

Content of questionnaire at the Local level: 

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?

Content of questionnaire at the Local level: 

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)?

RESULTS : 

RESULTS

National Level: 

National Level

Types of Nutrition Education Activities Implemented at the National Level: 

Types of Nutrition Education Activities Implemented at the National Level Training of implementors and health workers – DOH, HKI Nutrition counseling and mother’s 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

Nutrition Topics Imparted by National Agencies: 

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

Sources of Funds of National Agencies: 

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, Children’s Hour Industry – e.g. Nestle, San Miguel, Unilever, Wyeth, Colgate-Palmolive

Partners of National Agencies in Planning Nutrition Education Activities: 

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

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 Partners of National Agencies in Implementing Nutrition Education Activities

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

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

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

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

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

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

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

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

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

Basis of National Agencies for the Conduct of Nutrition Education Activities Nestle – doesn’t 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)

Local Level: 

Local Level

Types of Nutrition Education Initiatives: 

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

Types of Nutrition Education Initiatives: 

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

Types of Nutrition Education Initiatives: 

Types of Nutrition Education Initiatives Other forms of nutrition education Broadcast media Development and distribution of IEC materials

Characterization of Nutrition Education Activities: 

Characterization of Nutrition Education Activities

Integration of Nutrition Education in Health Services: 

Integration of Nutrition Education in Health Services

School-based nutrition education: 

School-based nutrition education

Integration of nutrition in agricultural programs: 

Integration of nutrition in agricultural programs

Integration of nutrition education in social services: 

Integration of nutrition education in social services

Part of MTPPAN Impact Programs: 

Part of MTPPAN Impact Programs

Part of MTPPAN Impact Programs: 

Part of MTPPAN Impact Programs

Part of MTPPAN Impact Programs: 

Part of MTPPAN Impact Programs

Special Government Project: 

Special Government Project

Nutrition Month Celebration: 

Nutrition Month Celebration

Nutrition Month Celebration: 

Nutrition Month Celebration

Local Government Unit Initiatives: 

Local Government Unit Initiatives

Local Government Unit Initiatives: 

Local Government Unit Initiatives

Local Government Unit Initiatives: 

Local Government Unit Initiatives

Local Government Unit Initiatives: 

Local Government Unit Initiatives

Advocacy: 

Advocacy

Orientation and training of support personnel: 

Orientation and training of support personnel

Other Forms of Nutrition Education: 

Other Forms of Nutrition Education

Summary: 

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.

Slide63: 

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.

Slide64: 

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)

Slide65: 

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

Slide66: 

Nutrition education activities were always intensified during the Nutrition Month celebration

Slide67: 

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

Slide68: 

Channels used were interpersonal communication, print and broadcast media

Slide69: 

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

Slide70: 

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

Slide71: 

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

Slide72: 

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

Slide73: 

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

Nutrition Education Messages: 

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)

Messages and Target Groups: 

Messages and Target Groups

Mothers of undernourished children: 

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

Mothers/Parents: 

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

Mothers/Parents: 

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

Elderly: 

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

School children: 

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

Preschool children: 

Preschool children 3 basic food groups Food pyramid Importance of vitamins and minerals

Farmers: 

Farmers Skills training – farming/gardening Food production Nutritious fruits and vegetables

Other primary target groups: 

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

Pregnant/Lactating Mothers: 

Pregnant/Lactating Mothers Nutritional Guidelines for Filipinos 3 Basic Food groups Importance of breastfeeding Importance of colostrum Proper selection of low cost nutritious foods

Would-be-couples: 

Would-be-couples Importance of breastfeeding Family planning Roles of couples in nurturing a healthy family

Hospital personnel: 

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

Salt producers: 

Salt producers How to iodize salt Health importance of iodized salt

General Public: 

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

IEC Materials developed by National Agencies found at the Local Levels: 

IEC Materials developed by National Agencies found at the Local Levels

FNRI IEC Materials: 

FNRI IEC Materials

FNRI IEC Materials: 

FNRI IEC Materials

NCP IEC Materials: 

NCP IEC Materials

HKI IEC Materials: 

HKI IEC Materials

HKI IEC Materials: 

HKI IEC Materials

DOH IEC Materials: 

DOH IEC Materials

DOH IEC Materials: 

DOH IEC Materials

Enabling Mechanisms: 

Enabling Mechanisms

Enabling Mechanisms: 

Enabling Mechanisms Manpower Support Capacity Building Physical Facilities Funding Support Political Commitment and Support

Key Persons in the Implementation of NE Program (Provincial Level): 

Key Persons in the Implementation of NE Program (Provincial Level)

Key Persons in the Implementation of NE Program (Municipal Level): 

Key Persons in the Implementation of NE Program (Municipal Level)

Selection of Key Persons Implementing NE Programs: 

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

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

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

Roles of Key Persons (Provincial Level),Winner v.s. Non-winner : 

Roles of Key Persons (Provincial Level), Winner v.s. Non-winner

Roles of Key Persons Implementing NE Programs (Municipal Level): 

Roles of Key Persons Implementing NE Programs (Municipal Level) Implementor - trainors, resource person, counselors, lecturers Plan NE activities Coordinate Monitor Evaluate Advocate

Roles of Key Persons ( Municipal Level)Winner v.s. Non-winner : 

Roles of Key Persons ( Municipal Level) Winner v.s. Non-winner

Roles of Support Personnel: 

Roles of Support Personnel

Capacity Building: 

Capacity Building

Trainings on Knowledge enhancement attended by Key NE Implementors : 

Trainings on Knowledge enhancement attended by Key NE Implementors

Trainings on Skill-building enhancement attended by Key NE Implementors : 

Trainings on Skill-building enhancement attended by Key NE Implementors

Facilities Available for NE Activities: 

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

Sources of Funding : 

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

Budget Allocation for NE Program & Activities: 

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

Political Support: 

Political Support

Types of Political Support: 

Types of Political Support

Focus Group Discussions: 

Focus Group Discussions

Nutrition Education Activities at Local Levels: 

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

Nutrition Education Activities at Local Levels: 

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

Nutrition Education Activities at Local Levels: 

Nutrition Education Activities at Local Levels 3. Special events : - Nutrition month celebration (nutrition quiz, essay writing, radio TV guesting, - Patak Day

Common Messages Disseminated at Local levels: 

Common Messages Disseminated at Local levels Basic nutrition : Eating a balanced diet; Preparing nutritious but cheap dishes; Importance of breastfeeding; Why fortified foods

Limitations to Successful Implementation of NE Activities: 

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;;

Limitations to Successful Implementation of NE Activities: 

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.

Recommendations for Improving Implementation of NE Activities : 

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;

Recommendations for Improving Implementation of NE Activities: 

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.

Key roles of NE Implementers: 

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.

KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE IMPLEMENTATION: 

KNOWLEDGE, ATTITUDES AND SKILLS FOR EFFECTIVE NE IMPLEMENTATION Knowledge about (or mastery of): Basic nutrition Breastfeeding Proper feeding of young children Different DOH programs The (attributes) of target client

KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE IMPLEMENTATION: 

KNOWLEDGE, ATTITUDES AND SKILLS FOR EFFECTIVE NE IMPLEMENTATION Attitudes: Patience Sense of humor Integrity Commitment Confidence to face large groups Friendly, approachable Sincerity Must give time

KNOWLEDGE, ATTITUDES AND SKILLSFOR EFFECTIVE NE IMPLEMENTATION: 

KNOWLEDGE, ATTITUDES AND SKILLS FOR EFFECTIVE NE IMPLEMENTATION Skills: Communication skills People’s skills Ability to convince or mobilize

CONCLUSIONS: 

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;

CONCLUSIONS: 

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

CONCLUSIONS: 

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

CONCLUSIONS: 

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;

CONCLUSIONS: 

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

CONCLUSIONS: 

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;

CONCLUSIONS: 

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;