S
S
caling up
against child malnutrition
caling Up Pinoy Nutrition Hub project reached 449 children in 25 barangays across the Philippines in the last 12 months. One in every three of these children or a total of 158 were rehabilitated to normal weight status. One the other hand, 141 gained at least 400 grams of weight during the 12-day PNH sessions.
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ehabilitation from malnutrition has given these under-five children the chance to attain their potentials because of better health condition. Normal nutritional state greatly contributes to the prevention of common childhood diseases that debilitates optimum growth and development. Severe malnutrition can lead to death. Continued to page 2
Under-five children are weighed at the initial stage of PNH to validate their nutritional status as basis for prioritizing enrollment WEIGHING to the 12-day hub sessions that intend to rehabilitate malnourished children. In this photo, a participant to the Training of Facilitators on PNH weighs a child during a community visit in Bohol province.
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OREWORD
The trends in nutrition innovation include maximizing what is available and present in the community while also relying on the behaviors of key players for a more lasting change. For Positive Deviance Hearth, the communities are the experts themselves—having been empowered from the solutions found within rather than without. For World Vision Development Foundation it took a long way to really understand the Filipino way of caring for growing and developing children. WVDF did PD Hearth with the hope to rehabilitate more children, but more learning and discoveries were found on the uniqueness of the Filipino families. Thus Pinoy Nutrition Hub was born from the lessons learned, challenges and effort of the Core Team that were developed during the Nutrition Jumpstart Project in 2010. By 2015, many children and communities have been part of the journey to rehabilitation, journey to lasting and sustainable change. It would have not been possible without the willpower and commitment of the local chief executives, leaders, technical specialists, volunteers and most importantly the fathers and mothers of the growing children. These children were given a chance at life because the community believed that they can, and to which they did! Thank you for making this PNH experience and journey full of learning, discoveries and providing second chances to the undernourished children. As you read this report of 2014, we hope that you find inspiration in the evidences of community empowerment to fight malnutrition through the Pinoy Nutrition Hub model. SuPNH Manager Barangay Sinandigan in Ubay, Bohol, hosted the field exposure of participants to the Training of Facilitators on PNH Pinoy Nutrition Hub, where caregivers SIMULATION from the community and training participants simulated a PNH session.
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Scaling up... Continued from page 1
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ll systems were running for SuPNH project implementation by mid 2014, with 20 local governments signing a memorandum of agreement for partnership with World Vision. The SuPNH became a springboard for a nutrition-focused integration of initiatives supporting sustainable improvement in nutrition. Indicators show attainment of this targetted outcome for the year. Learning positive deviance Community work began with nutrition workers and community volunteers tracing local food sources and good practices of families. These resources ingenous to the community would be utilized for the rehabilitation of malnourished children enrolled in the Pinoy Nutrition Hub. With technical support from World Vision, the resourceful communities cultivated vegetable gardens to sustain free supply of significant sources of nutritious food that the enrolled children needed to gain normal weight and maintain it even after the 12-day hub sessions. To influence caregivers improve their practices and behaviors in raising up healthy children, nutrition classes were incorporated in the hubs. The Pabasa sa Nutrisyon, a
E D I T O R I A L Project management/report advisory Marijo S. Gomez Project implementation/story sourcing Luzon. Berry Demey L. CasiĂąo Visayas. Rueland Mark K. Marapao Mindanao. Zosima T.Tomambo Stories and photos/writing/editing/layout Monalinda B. Cadiz
government intervention, was adopted with localized messages that reiterate good practices from families with well nourished children, otherwise called positive deviants of the community. Spiritual nurture is also part of the caring practice integrated in the rehabilitation process of malnourished children. SuPNH developed the transformational development manual for this purpose, providing modular guidance to facilitate spiritual component in the hub sessions. In the communities where the PNH process was done, positive deviant practices that were recorded to have contributed to the status of healthy children were optimal breastfeeding; provision of snacks and food that are locally available; importance of father’s role in caring; playing with children; regular check up of children and pregnant mothers; handwashing and no open defecation; and backyard gardening. Monitoring improved practices
Within 2014, SuPNH developed a web-based application for the timely reporting, primarily of children’s weight improvement in the hub sessions. The application is set to be fully utilized by implementers through android phones after the ongoing updating and field tests. Key implementers of World Vision and its Area Development Programmes including local health partners were given an overview of the app. While SuPNH itself as a project has barely started, its predecessor Nutrition Jumpstart Project with the Pinoy Nutrition Hub model bear evidence of impact for the past years. SuPNH provided
a forum of sharing of best practices from earlier implementation of PNH model in various areas where World Vision works across the country. The nine abstracts presented at the Good Practices and Lessons Learned Forum (GPLL) each highlighted a component
of positive deviance. Malabon City discussed integration of economic development into its implementation of PNH through participation not only of health workers and community volunteers, but the support of a farmers’ group as well. Good practices on feeding were each presented by Sorso-
gon and Antique delegates. Mothers in hub sessions in Sorsogon provided needed ingredients for food preparation in the hub sessions, and prioritized feeding of their children. Antique as a pilot area shared the many behavioral changes in its caregivers and the enrolled children, on of which is handwashing before and after eating, and praying before meals. Bohol shared experience on caring practices, that brought about decrease in malnutrition rate at 2% from 30% between 2011 and 2013. The integration of key messages resulting from profiling of the community as part of nutrition hub preparation phase, facilitated improvement of caring practices. Misamis Oriental discussed integration of proper hygiene in PNH implementation, and Sarangani shared experience on integrating spiritual nurture. In 2013, implementation areas were initially assesed on their level of implementation whether new, basic, progressive or advance. The reverse in trend by 2014 shows that more areas have grown confident to replicate PNH to more barangays for a wider coverage of malnourished children.
Replicating gains from implementation
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y the end of 2014, 30% of PNH implementation areas across the Philippines were gearing up for replication to reach more communities with high malnutrition incidence. SuPNH staff conducted implementation reviews with partners in potential areas for expansion across the country. These are implementations in Malabon City, Bohol, South Cotabato, Saranggani, Misamis Oriental, Ozamis City, and Oroquieta City. The evaluation tool determines adherence of actual implementation to the PNH process. Local implementers and community officials were interviewed and engaged in discussions during the evaluation process. Case studies were also done to gauge impact of the project basically towards rehabilitating malnourished children to reach their normal status to enjoy overall wellbeing. Good practices that are common in most areas include formalized partnerships with LGUs, local nutrition leads influenced to replicate PNH, capacitated local teams, and nutrition focused integration of economic, spiritual, and caring aspects. Implementation in Malabon City anchored on collaborative work among the local PNH team members composed of nutrition and health workers and volunteers, barangay officials, and the city nutritionist. The involvement of an association of urban farmers in the barangay that cultivates a communal vegetable garden figured as an important contributor. Three of the seven enrolled malnourished children attained normal weight by the end of the 12-day hub session. Barangay Bay-ang in Ubay, Bohol, reached zero malnutrition by 2014, from consistent high incidence before PNH was introduced in 2012. The barangay council passed resolutions supportive to PNH. Interestingy, mothers who had malnourished children who normalized in the first hub sessions volun-
teered in succeeding nutrition hubs. Implementation in South Cotabato covered the indigenous T’boli people of Barangay T’boloc. World Vision’s backyard vegetable gardening model proved useful for the implementation of PNH in South Cotabato as it supplied needed nutritious main ingredients to menus prepared in the hub sessions. Saranggani implementation adhered to complying with PNH standards and this contributed to resulting effectiveness. Innovations included the recognition and integration of good practices of caregivers which others may follow. It was also found out that integrating play right before feeding the children had positive effect. Seven of the 10 enrolled malnourished gained normal weight on the 12th day of the hub sessions. In Misamis Oriental, local church leaders were invited in nutrition hubs for spiritual nurture activities. Menus concocted in the nutrition hubs were also shared to mothers whose children were not enrolled, enabling them to learn new, nutritious dishes that they could prepare for their children. Of 21 enrolled children in three barangays, 16 were normalized. This was sustained up to the 24th day of monitoring at home. PNH implementation in Ozamis City was fully suported by the LGU, especially through the leadership of its city nutritionist who was convinced of the effectiveness of PNH in rehabilitating malnutrition. As a technical person, the nutritionist Continued to page 4
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Replicating gains from implementation Continued from page 3
emphasized on menu planning and testing of menus prior to the actual implementation of the 12-day hub. This ensures that dishes are calorie dense enough to contribute to the fast rehabilitation of malnourished enrolees. Of eight enrollees, five attained normal weight as reported after the 24th day of home visit. Moving forward amidst challenges Like all projects, PNH work is not without challenges. Its heavy reliance on community effort and behavior change as one of its intended results entail a complicated web of factors. Facilitating the Pinoy Nutrition Hub is therefore a very challenging task for a host of reasons. Nonetheless, the challenges that beset most of the areas were not fatal to the point of suspending implementation. Most of the challenges were experienced by more than one evaluated area. There are challenges at the onset, but its impact was felt only at the tail-end of implementation. The limited support of barangay health center or local officials for instance, resulting to dependence on World Vision’s local staff, can be prevented through effective planning with them and all other partners. Another common problem in the implementation of the hub sessions is the incapacity of caregivers to contribute nutritious ingredients to complete the menu, especially protein-rich ones. A popular recommendation is to find alternative protein sources that are inexpensive and available in the community. For areas without backyard vegetable gardens, it is advised that vegetable gardening should be established first before conducting the 12-day hub sessions to ensure availability of free vegetables. This is also important to enable sustainable source for the families with malnourished children to maintain and continue weight gain of the children.
To ensure that the menus served at the 12-day sessions are calorie-dense for immediate catch-up on weight of the malnourished child, it is recommended that PNH teams led by the local nutritionist, should conduct menu calculation and preparation trial. Anthropometric measuring tools should also be accu-
rate to correctly determine the weight of prospect enrolees to be rehabilitated from malnutrition. Other factors to consider before starting the nutrition hub includes availability of potable water source, and the medical condition of children. Severely underweight children should have received the primary health care services like immunization and vitamin A supplementation, and be cleared of any illness that could be causing the malnutrition. Underlying cause of malnutrition like a disease might need medical attention, and PNH will not be the best frist intervention for the child. For facilities in the barangy that needs to be in-place first, the PNH team could opt to advocate to the local govenrment first for provision of the facility before embarking into rehabilitation sessions. During the PNH sessions, it was found out that there needs to be creative ways of presenting key messages. This will enable greater retention of key messages to caregivers, giving it more possibility to affect behavioral change. There should also be a variety of activities for children so they would be more encouraged to eat during the sessions. Effective monitoring is an all-time challenge in most projects. PNH implementation had many good practices that were not documented efficiently mainly because implementers did not find much value in it during actual implementation. However, importance of documentation was realized during monitoring and evaluation phase. Overall, PNH is found to be an effective program to quickly rehabilitated malnourished children, thereby contributing to one of World Vision’s goals toward the wellbeing of children. Thus, PNH will be replicated in nine other provinces where World Vision works in the Philippines, including Camarines Norte, Pangasinan, Leyte, Tacloban City, Cebu, Davao City, North Cotabato, Bukidnon, and Zamboanga del Norte.
IMPROVED FEEDING PRACTICE
Weighing a potent resolve to malnutrition Continued from page 5
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Mother of two Jeny of Malabon City reports that her youngest Kathleen continued to gain weight after the 12-day Pinoy Nutrition Hub they attended in October 2014. Kathleen was rehabilitated from malnutrition through PNH.
NUTRITIONFOCUSED INTEGRATION
The complexities of malnutrition call for an integrative response, not only focusing on adequacy of nutritious diet. Which is why in rehabilitating malnourished children like Princess, PNH integrates proper hygiene, good caring practices and spiritual nurture in the nutrition hub sessions.
Weighing a potent resolve to malnutrition
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here are many residents who are capable to solve their own community’s problems, but they need to know and be assured that they can do it.” Thus concludes Ozamis City’s nutrition officer, Lelit Navarez, from witnessing the transformation of three villages in rehabilitating their malnourished children without depending on government resources. A notable case is that of three year-old Princess who was severely underweight for her age. The only girl among four siblings, her mother thinks that she might have neglected Princess at some point, resulting to her malnutrition. “I was hospitalized when Princess was 10 months old, and so we left her in the care of my brother-in-law,” says Brenda. The mother has an afterthought on it however, “another baby was born soon after Princess, so I focused taking care of my newborn instead.” As Princess’ malnutrition case was severe, it needed immediate intervention. At this time, the barangay chair himself obliged all parents to bring their malnourished children to a 40-day feeding programme, to which Princess was automatically taken to. But the champorado or lugaw with egg usually given as snacks at the daily feeding schedule hardly made a dent into the toddler’s nutritional state. Brenda’s hands are also full taking care of the new baby, sometimes setting aside taking Princess to the feeding schedules at the barangay hall. Along came another programme. “When World Vision presented to us the Pinoy Nutrition Hub model and mentioned that mothers will be asked to bring ingredients for food they will prepare for their malnourished children, even I thought it was an impossibility,” admits Navarez. A decorated, hard working public servant, the city nutritionist thought it was hard enough to sustain attendance of mothers with their chil-
dren to the feeding programme that gave free snacks. Logically, it was challenging even to imagine, to oblige mothers contribute from their own resources for malnutrition rehabilitation. Nonetheless, the local government tried the alternative nutrition programme in three barangays. Pinoy Nutrition Hub followed standard steps religiously. Notable to Navarez as a nutritionist was the menu planning. The food ingredients were weighed to ensure that the major food groups are complete in each meal. Mothers with malnourished chilren enrolled in the 12-day session nutrition hub brought vegetable ingredients they could spare, mostly from their home gardens. “If mothers could not afford to bring protein components, the local government contributed for this.” The team, composed of barangay nutrition workers and volunteer residents, created four measured menus cooked in rotation for the 12-day nutrition hub sessions. “I used to feed Princess with pancit (noodles) which I buy from the neighborhood carinderia (food stall). Now, I prepare for her the nutritious recipe I learned from the hub,” says Brenda. Princess’ favorite is the vegetable patty made from a mixture of squash, eggs, flour, and moringga leaves. Continued to page 11
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Daniel and his mother Juvilyn
When malnutrition
melts village grit in
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aniel’s bright eyes are locked unto the colorful bread wrappings, while munching on the bread sticks and looking very pleased. The youngest of six children, two year-old Daniel was found underweight for his age a few months back. Daniel’s three other siblings were also malnourished when they were his age. “I think it’s my fault that my children were underweight because I was also malnourished when I breastfed them,” laments Daniel’s 30-year-old mother Juvilyn, unaware that her nutritional state would not have lost the nutrients of her breastmilk. She admits her family barely had enough to eat, which is why half of her children had to undergo rehabilitation from malnutrition as toddlers. Of all the nutrition programmes she enrolled her children in, Jovilyn preferred Pinoy Nutrition Hub. Daniel was rehabilitated through the programme. “I learned to cook food that is easy to prepare, nutritious simple meals with ingredients I can easily find nearby.” She cooks recipes she learned from the nutrition hub and the vegetable ingredients are sold right across their hut. A community fighting malnutrition The Pinoy Nutrition Hub was introduced by World Vision, and intended to rehabilitate malnourished under-five children and sustain nutritional improvement through transformed behavior of caregivers. It is currently implemented in 25 barangays in cities and municipalities where World Vision works across the Philippines. Daniel started at 7.6 kilograms which fell short of normal weight for a boy his age, based on the child growth standards. Prompted by Barangay Nutrition Scholars, Daniel
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was enrolled to the first PNH implementation in his village. After the 12 daily sessions, Daniel’s weight increased to 8.4 kilograms. The village workers continued to monitor Daniel at home after the 12-day Pinoy Nutrition Hub where his mother learned caring practices that proved effective to many. By the 24th day when visited at home, Daniel attained the normal weight 8.8 kilograms and was further maintained when the monitoring team recorded his weight at 8.9 kilograms by the third month. “Before I attended the hub, I did not clean Daniel daily, but after I learned that cleanliness is important to his health, I washed him everyday so he won’t catch sickness,” confesses Daniel’s mother. At the hub, caregivers learn more than proper feeding, including caring practices that contribute to the overall well being of the malnourished child. Good hygiene practices are encouraged, ensuring availability of food in the home, and so is nurturing the spiritual practice of the child and the whole family. Challenges of sustaining gains from rehabilitation An important trait of the Pinoy Nutrition Hub is its sustainability so that malnutrition will not recur in a household, and will continue to decrease and be eradicated in the whole community at some point. The key is improved Continued to page 8
“I
’d rather that she behaves very naughty than look feeble just like in the past,” explains Ambrocio, watching her 2-year-old daughter playfully block two bigger kids walking through the 2-feet-wide alley in their neighborhood.
Baby Jane lives in one of the poorest barangays in Malabon City; her city has one of the highest incidences of malnutrition for three consecutive years among cities in Metro Manila. Baby Jane is the youngest daughter of Ambrocio who has one child from a previous marriage, and Fe who has children of her own with a previous husband. Baby Jane is her sixth child at 34 years old. Ambrocio is 59 years old and works in a mechanic shop, traces of long years working with grease evident in blackened nails and callused hands, carrying Baby Jane. There are times when work is scarce. Teary-eyed, Ambrocio recalls his panic whenever Baby Jane would fall sick when she was an infant. “It was difficult to have a sickly child. One time she had a convulsion and we rushed her to the hospital where she was confined for one night. That caused me 1,800 pesos. I only get 500 pesos per day of work, so I had to borrow money to pay the hospital bills, and that’s aside from the needed medicines to buy. I thought then that my (first) wife already
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died; if my youngest were taken from me, that would be too much.” Fear was in Ambrocio’s eyes sharing this bleak episode. “My daughter was sickly so she did not have a good appetite, which is the reason why her weight fell,” recalls Fe. The biggest setback in Baby Jane’s nutritional status was when she had pneumonia before turning two. When she recuperated, Ambrocio was the final decision point when the barangay health workers urged them to enroll their malnourished child to Pinoy Nutrition Hub in October 2014. “I used to feed her Cerelac because I’ve seen on TV that it’s complete food, and besides, she did not want to eat vegetables and fish,” recalls Fe. At the PNH sessions, Fe learned to cook vegetable dishes with fish which Baby Jane ate with gusto. “One of the most important things I learned in PNH is the preparation of vegetables, the proper way of slicing them to entice kids to eat.” Fe is grateful that through PNH, Baby Jane learned to love eating vegetables, and the mother learned to cook the dishes. Like a typical mother in the urban neighborhood, Fe previously bought cooked food. It was then she also realized that if she wanted to have fresh vegetables always available and less expensive, she could sell them herself.
aising Jane in the city slums
STRONGER IMMUNITY
Continued to page 7
For Jane’s very poor family, her improved nutritional status meant that the risk of losing her because of childhood illnesses both as a result and aggrevated by malnutrition, is now lessened.
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Raising Jane in the city slums Continued from page 7
Later with 500 pesos in her purse, she went to the nearest wholesale market and bought vegetables that she later sold in the neighborhood sidewalks. But ofcourse, she first reserved what she needed to cook at home. For Fe, PNH is much more than the intervention that normalized the weight of her youngest child. “When I visited another family enrolled in the PNH, I realized my family did not bond together like them. I thought, my family can also become closer like them.” Fe later strived to do something about the unity in her own family, and so today, she makes sure that her whole family goes to church together. Often, when Ambrocio is at home, they would prepare the family meal together. Ambrocio slices the ingredients and she cooks them. “I showed my husband how to slice the vegetables to encourage baby Jane to eat. My older daughters also asked me to teach them to prepare and cook vegetable dishes. Now, they are capable to prepare and cook the nutritious dishes that I learned from PNH.” Apart from a responsive mother, Baby Jane was lucky to have supportive family members. Her father and older siblings took turns taking Baby Jane for a complete attendance to the 12day PNH sessions conducted in the neighborhood.
“When Baby Jane was still sickly, one of our neighbors became alarmed that my daughter seemed always unhappy and didn’t want to interact with anyone. Now, that same neighbor shares our excitement whenever Baby Jane suddenly stretches her arms to block the road for passing kids, and slaps them repeatedly to get their attention. She appears like a spoiled brat, but it bothers us less than when she was very quiet and unresponsive,” observes Fe. PNH also paved the way for Fe to interact with other mothers of malnourished children who were enrolled at the nutrition hub. Five months after the 12-day hub sessions, Fe still stays in close contact with the mothers because they reside around the neighborhood. They frequently buy her vegetables, too. “We talk about our kids and how they are improving. It feels good to have people around you who have the same interests like yours, and who are going through the same things like what you’re experiencing in your family,” Fe reveals. “I am very thankful that my youngest daughter is now healthy. Because she is not malnourished anymore, her body can now fight illnesses with stronger immunity and defense. Unlike before that she does not have enough strength to fight sickness. Now, I stopped worrying,” beams Ambrocio.
When malnutrition melts in village grit Continued from page 6
caregiver practices and a nutrition-focused local governance. And so various elements intertwine to attain sustainability along the process of Pinoy Nutrition Hub implementation. Caring practices of families that have healthy children in the village are determined at the onset, to be included in lessons taught at the nutrition hub. Called positive deviance, these practices that for generations raised healthy children in the community would more or less ensure that what caregivers with unhealthy children learn will be sustained because resources are available and accessible in their community. Sustaining improvement is likewise demanding the commitment of government officials and workers in the community, which is why World Vision have close working relationships with local officials and health personnel. “Under-five malnutrition increased especially in one of our barangays because migrant families came in droves to work in new huge factories that were opened in our town,” recounts Irma Mar, who heads the nutrition work in Villanueva town in Misamis Oriental. Of its 11 barangays, the local government works with World Vision for PNH in five barangays for the rehabilitation of malnourished children. Pinoy Nutrition Hub started working with three barangays with the highest malnutrition incidence based on the regular weighing of young children. Called Operation Timbang Plus or OPT plus, this is an annual measurement of weight and height of 0 to 71 months old children to determine malnutrition incidence and appropriate interventions. At the Pinoy Nutrition Hub, a maximum of 10 enrollees can be accommodated in each 12-day hub. In the hub done in Villanueva town between July and November 2014, 48 of the 64 malnourished under-five children were rehabilitated. Immediately impressed with the initial result, the municipal nutritionist shares that her town is expanding Pinoy Nutrition Hub implementation in two barangays in 2015. “I appreciate the uniqueness of PNH as it focuses on the rehabilitation of malnourished children by introducing
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learning behaviors to caregivers,” says Mar. “Which makes PNH enjoyable to implement because the caregivers are hands-on and they are actually the ones implementing the intervention and we only guide them,” adds Mar. The vital role of local governance in nutrition While revelling on the rehabilitation of children from mal-
nutrition, Mar also notes some complications in implementation. “It would have been easy to be discouraged and just give up on these children if you will observe the family’s dire poverty- there is no land to plant needed food, parents are jobless,” sighs Mar. But Mar’s town showcased that local officials and the community find ways to innovate implementation of a promising program. “We have hardworking and persistent barangay nutrition scholars, and supportive barangay officials,” begins Chairman Noel Aviola of Barangay Poblacion 3. “This 140 square feet communal vegetable garden you are looking at used to be the Villanueva Public Cemetery a few years back,” the chairman revealed. When the cemetery site was transferred, the lot became vacant. Its conversion to a thriving greenery came about when parents attending the nutrition hub could not bring any more ingredients to share for the meals that were supposed to be cooked for the enrolled children. Literally, they did not have a single square foot of soil in their backyard to plant vegetables in. Houses of various families were joined together in a maze and did not have a space in between. Some households have latrine shared among two to five families, while some don’t and defecate in the open. Some parents who attended the Pinoy Nutrition Hub are planning to develop hanging gardens using upturned plastic bottles to plant vegetables. “We just harvested the first batch of string beans and pechay and we’ve saved up the money, but when the next PNH class begins, we will be serving children the vegetables from this very garden,” proudly shares the barangay nutrition scholars. “Amidst many challenges, basically because of poverty, I am thankful for PNH because it helped improve the behavior of caregivers and this lowered malnutrition count,” concludes municipal nutritionist Mara.
FOOD SOURCE
ends
Rural barangay
The availability of food source should be in place for the continued progress in the nutritional status of a child rehabilitated from malnutrition. In Trescia’s village, the barangay chairman responded to PNH’s call for nutrition sustainability through a policy requiring residents to cultivate backyard vegetable gardens.
child malnutrition
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our-year-old Trescia helps her mother pick eggplants and kangkong leaves in their lush home garden. A wide variety of vegetables that thrive in the community are planted in the garden which was expanded by Trescia’s parents to sustain her rehabilitation from malnutrition two years earlier. Today, there is not one child under the age of five in Trescia’s barangay who is malnourished. “I can’t believe that this day will ever happen to my community,” muses Renildo Valleser, Barangay Chairman of Bay-ang in Ubay, Bohol. When Valleser started office in 2007, Bay-ang was one of the most problematic barangays in the municipality. “During those days, I had to endure taunting by other barangay chairmen during monthly meetings because Bay-ang was always reported as a top problem of the town. We never left the top 10 slot in worst in education issues, malnutrition and also hygiene, mainly because there were only a handful of households that had latrines.” The bullying prompted Valleser to strive to solve the major problems that have put Barangay Bay-ang to shame for so long, and its residents in poverty. When World Vision in its Ubay office introduced Pinoy Nutrition Hub to Barangay Bay-ang in 2012 as a strategy to solve malnutrition problem, the barangay officials instantly agreed to try. “The barangay did not even have to spend anything to implement Pinoy Nutrition Hub, unlike the feeding program we implemented in the past,” says Valleser. The Pinoy Nutrition Hub rehabilitates malnourished under-five children in communities with high malnutrition
rate. It aims to sustain the gains of the community from improved nutrition through better caregiver practices, ensuring accessibility to food source, and nutrition-sensitive local governance. Trescia was enrolled in the nutrition hub as an underweight when she was two years old. Trescia’s mother Richie blamed herself for the malnutrition of her daughter, saying that she was stressed when pregnant of Trescia. “We almost lost her before she turned two because of severe dehydration when she had diarrhea,” recalls Richie who couldn’t control her tears. Diarrhea is a common childhood sickness in Bay-ang because of the problem on potable water. But it was only Trescia among her siblings who was hospitalized and nearly died. Also, Trescia was the only one who has ever been malnourished among her siblings. Afterall, malnutrition is the underlying cause of preventable deaths in children, as it aggrevates childhood illnesses too. “Before I enrolled her to the nutrition hub, she would eat very little but I would shrug it off and thought it was normal for a child to be picky on what to eat. I left her to do what she pleased, and worked on household chores instead.” Continued to page 11
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Capacitating partners to replicate PNH nutrition model
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Village child
hild malnutrition has many faces. They could appear thin, short, light, listless, irritable, or lacking appetite. In 2013, about one in every five children under the age of five was underweight, while one in every three were short for their age. And why is this bothering again? Child malnutrition can affect the physical and mental development of a child, affecting performance in school, susceptibility to diseases, even death, among other things. World Vision’s Pinoy Nutrition Hub is a direct response to child malnutrition, proposing a combination of rehabilitative and preventive strategy. In the recently concluded nine-day training of facilitators, the 27 participants learned hands-on how Pinoy Nutrition Hub enables underweight children to reach their normal weight by involving the community all throughout the process. “Pinoy Nutrition Hub can be part of our strategy for MAM (management of acute malnutrition),” remarks Maria Teresa Ungson lead for the National Nutrition Council in region 11. Acute malnutrition, generally characterized by thinness and is the type of malnutrition that, in its severest form, could cause death. Ungson added that one of the more interesting learnings in the training of most participants is determining calorie-dense menus needed to rehabilitate a malnourished child. Most participants especially partners from the government, have been working on child nutrition for many years. The training of facilitators is a step towards enabling wider adoption of the Pinoy Nutrition Hub for a more practical and sustainable solution to malnutrition. Emphasizing on sustainability, Pinoy Nutrition Hub capacitates the community’s caregivers, nutrition and health workers and its officials to ensure that all children are well nourished and healthy.
Situational analysis
Menu calculation
FGD with caregivers
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Pinoy Nutrition Hub session
Rural barangay ends child malnutrition Continued from page 9
Handwashing
“I am thankful to God for letting me and my daughter participate in the Pinoy Nutrition Hub.” After the 12-day nutrition hub session, Trescia normalized her weight. And aside from rehabilitation, Trescia’s social skills and eating habits improved. Her mother Richie also found out that the best way to encourage Trescia to eat is when there are other children to eat with her just like in the nutrition hub sessions. “I and my husband also improved bonding time with our children, because I learned that giving time to take care of them should be the priority before our household chores.” Even a neighbor noticed the drastic improvement in Trescia’s family, and asked when the next Pinoy Nutrition Hub would be implemented because she was interested to join. Meantime, Barangay Chairman Valleser and the local council did not rest on their laurels when malnutrition vanished from the barangay. “We wanted to maintain the improvement of nutritional status of children in the barangay, especially since there is not one reported malnourished child now here. The barangay council passed an ordinance requiring all households to have a vegetable garden or plant even in pots if they do not have an area.” Lastly,Valleser talks of the potency of leadership to solve a perennial problem like child malnutrition. “If you’re an official you need to have will, to put a brave and authoritative front if you want to solve your community’s problems.”
Weighing a potent resolve... Continued from page 5 Feeding
Feeding by caregivers
“On the first day (of the nutrition hub session), Princess was irritable and did not want to lose sight of her mother,” observed Navares. Later on, Princess learned to be sociable with other children enrolled in the Pinoy Nutrition Hub. Princess gained normal weight from severe underweight within 24 days, which included a 12-day feeding session and a 12-day follow up at home. Her normal weight was sustained on the third month when the community team visited her at home. “We have an 80% success rate in normalizing the weight of 28 children in the three poorest barangays, and that includes Princess,” reports Navarez. But apart from the numbers, Navarez notes of a more lasting impact on the communities. “Mothers are now mindful of what they feed their young children, and they learned to be more patient in caring for them.” “We appreciate PNH (Pinoy Nutrition Hub) because in a brief period, we saw the changes, the improvement,” muses Navarez who accompanies her nutrition workers visit the children and their caregivers at home, 24 days after the nutrition hub sessions. In times like these when Navares mingles with the community, she witnesses the poverty and poor caregiving practices that cause some children to become malnourished. And yet, Navares sees a potent resolve amidst it all. “It needs to be emphasized that the community can solve its own malnutrition problem. A good number of community people can be tapped to do the work well.” Not to mention pool food resources towards a more lasting resolve to malnutrition.
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Where our partners are Partners that signed MOA of implementation San Isidro, Isabela Catmon, Malabon City
The partnership of World Vision with the local governments through local chief executives, their councils, health officials and personnel, community health workers, community volunteers and caregivers, made it possible to reach malnourished children through the Pinoy Nutrition Hub. This map locates our partners in our implementation areas across the Philippines.
Puerto Princesa City, Palawan Pio Duran, Albay Sorsogon City, Sorsogon Casiguran, Sorsogon Tangalan, Aklan Malinao, Aklan Sibalom, Antique Hamtic, Antique Ubay, Bohol Danao, Bohol San Isidro, Bohol Pilar, Bohol Alcantara, Cebu Villanueva, Misamis Oriental Oroquieta, Misamis Occidental Ozamis, Misamis Occidental Tudela, Misamis Occidental Tiboli, South Cotabato Malapatan, Saranggani
Partners that pledged their commitment Cagayan de Oro City Lake Sebu, South Cotabato Banga, South Cotabato Clarin, Misamis Occidental Sinabacan, Misamis Occidental Santa Rita, Samar Tabontabon, Leyte
PLAYTIME
While their parents participate in the community gathering where PNH was introduced to Barangay Sinandigan in Ubay town of Bohol, these children gather and play together in the periphery.