Recording LFP signals in the cylinder

The health and nutrition programs of the government have been charted in different plans and implemented by various agencies. The recent health services programs are embodied in the National Health Plan 1995-2000 along with other related initiatives such as the Magna Carta for public health workers, capability building of the decentralized local government health personnel, and the dissemination of the 1995 Field Health Information System. The "Special Law on Counterfeit Drugs" (Republic Act 8203, 1996) was passed in order to put in place a rationalized system of drug procurement, distribution and use (Lachica, 2000).

The country’s compliance to the demands of the International Conference on Nutrition (ICN, 1992) in Rome, Italy, was the making and implementation of the Medium-Term Philippine Food and Nutrition Plan

(MTPFNP) 1993-1998, also known as the Philippine Plan of Action for Nutrition (PPAN), which actually is a part of the Medium Term Philippine Development Plan (MTPDP) under the agenda on human development, and spearheaded by the NNC.

PPAN’s vision to improve the quality of life of the Filipino through improved nutrition goes through the interrelated two-fold strategy: the promotion of household food security, and the prevention, control, and elimination of micronutrient malnutrition. To achieve these, five main programs were implemented: increased own-food production through home and school gardens, including animal raising; micronutrient supplementation and food fortification (e.g. rice, margarine, flour, salt) with related tax incentives in manufacturing; credit assistance to livelihoods; nutrient education to influence nutrition-oriented food practices; and food assistance for the vulnerable groups or households. Recognizing that food security is beyond food supply, the PPAN program has integrated financial capital access to support the livelihoods particularly of the poor households, and improving nutrition knowledge through informal trainings and other communication media. At the local level, PPAN has been implemented through a mix of services within the five impact programs based on the local government’s assessment of the local nutrition situation.

After four years of interagency work led by the NNC, FNRI launched in 2000 the National Guidelines of Food (NGF) for Filipinos. A popularized book aimed as a nutrition education tool, it offers a set of common recommendations of balanced diets and healthy living to enable people to make proper choices. As complementary activity, the Department of Health (DOH), in coordination with Helen Keller International, through its Child Growth Project established weighing posts in the village health centers, which also served nutrition counseling depending on observed change in the child's weight status and related nutritional problems. This has been integrated into the local health program (e.g. regular weighing, Vitamin A and iron supplementation, de-worming, salt-testing of households, pre-natal check-ups, nutrient education, and household health survey and monitoring) undertaken by the village health workers who are already getting regular incentives from the local government. To highlight the fight against micronutrient malnutrition, the National Micronutrient Day (i.e. launched in 1993 and held every October to coincide with World Food Day), and the Pre-schoolers Health Week (i.e. every April 19-23) are celebrated yearly. The former focuses on the targets of reducing malnutrition by 30 percent, IDA by 10 percent, and periodic supplementation of vitamin A and iron for women and children, including the promotion of local nutrient plants and seedlings through home gardens. The latter includes nation-wide activities for children to enrich activities (as above) which many villages are already doing.

The DOH also implemented the Sustansiya Para sa Masa (i.e. Nutrition for the People Program), which provides a program grant of about 1,000-2000 USD a year for a beneficiary community. This is implemented in collaboration with non-government organizations (NGOs) and other funding agencies on a

cost-sharing basis which includes goods in kind (e.g. food supplements, equipment), services and staff time, and other items specified in a memorandum of understanding. To sustain the program, the initiated activities are integrated into the local development plans (i.e. provincial, town, and village).

The DOH micronutrient supplementation programs have had varied success levels. Vitamin A supplementation program has reached a wider coverage, yet its deficiency together with iodine deficiency showed greater differences across regions. Iron supplementation also fell short of target, while the initiatives to fight protein-energy malnutrition (PEM) have been lesser than the micronutrients. Addressing the enormity of the malnutrition problem has been complicated by the number of agencies coordinating and implementing the interrelated problems of food, nutrition and health vis-à-vis a relatively small budget for these social concerns.

Early on in 1978, the state university of the University of the Philippines at Los Baños implemented an action research project, the Barangay Integrated Development Approach for Nutrition Improvement (BIDANI), which in 1984 became a community-based development program with six other state university pilots in the Visayas and Mindanao regions.

Each of the pilot areas implements its four-fold goals of good governance, poverty alleviation, food security, and improved nutrition by mobilizing and capacitating individuals at the village levels in coordination with the local government units. As an integrated development approach, the strategies include components such as the village level information system, home nutrition improvement, income-generating livelihood projects, and a related microfinance support system. The network was strengthened with the support of the Dutch government starting in the 1990-1995 phase which expanded the coverage into 37 state colleges and universities (SUCs), 38 provinces, 109 towns, and 581 villages (Balatibat, 2004). In the early 2000s, the institutionalization of the program within the SUCs began. How effectively the SUCs implement the multi-faceted program depends in large measure on their ability to sustain the fiscal support, harness the capacities developed, and build up the strategies and action already on the way during the institutionalization process.

To improve the effectiveness of national nutrition and health strategies, there is need to review, clarify and reconsider the mandates, roles and responsibilities of the various agencies involved, as well as the different approaches and strategies tried. With the synergies between food, nutrition and health, the resources and capabilities existing at the local levels of implementation, the history of experience of food and nutrition programs, and the clarification of the interrelationships between food supply, access and adequacy can help in streamlining the public structure. The conventional standards of cost effectiveness and facility in the delivery of the services are indeed relevant and important considerations.