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Republic of the Philippines MUNICIPAL GOVERNMENT OF CULION Culion, Palawan

MUNICIPAL NUTRITION COMMITTEE MUNICIPAL NUTRITION ACTION PLAN 2012 – 2014 1. INTRODUCTION

Culion is one of the municipalities in the Calamianes group of islands. It is a class municipality composed of 14 barangays. Seven barangays are in the poblacion area while the remaining barangays are in rural areas. Young municipality, being one of the two newly created municipalities in the Province of Palawan (1995). 3rd

Historical Background On 22 August 1904, Civil Governor Luke E. Wright issued an Executive Order # 35 declaring Culion as a leper Colony and a government Stock Farm. By 1906, the first batch of Hansenites arrived, coming from the different parts of the country.


The place was administered by the Secretary of Health thru a Chief of Hospital. The mandate was so broad that it compassed not only medical needs but also other sectors such as, agriculture and environment, public works and others. In 1992, R.A. # 7193 was passed by the Congress and Approved by then President Corazon C. Aquino creating the Municipality of Culion. In 1995, the constituents elected the first set municipal Officials. On 12 March 2001, President Gloria Macapagal Arroyo signed R.A. # 9032, “ An Act Expanding the Area of Jurisdiction of the Municipality of Culion, Province of Palawan, Amending for the Purpose R.A. # 7193�. Physical Features Culion is one of the biggest islands in the Calamines Group of Islands. It lies about 200 nautical miles southwest of the City of Manila. Base on the NAMRIA 1997 LandSat Imagery Records; it has approximately 51,306.08 mountains and flat lands and a coastal are of 39,980.00 has. Hence is has about 91,286.08 has. of resources base. The Municipality has two (2) types of climate, the dry and the wet seasons. The former usually starts by November and lasts up to May while the rest of the period is considered rainy. As a small islands community, the soil is considered acidic. Demography The unofficial result of the 2010 National Census of Population showed that it has a total population of 19,421 and 4,141 households and 4,348 families. Social Services The Municipal Health Office has a doctor, two nurses, a pharmacist, a medical technologist, 8 midwives, a sanitary inspector. In the pipeline are the Municipal Health Office located in Barangay Balala and 4 Barangay Heath Stations to facilitate the service delivery of Public Health Programs. Said BHS are located in Barangay Malaking Patag, Galoc, Binudac, Luac, Halsey and De Carabao.


At present the Municipal Health Office is sharing with the other offices in the old PIADP Building. The MHO is a PhilHealth Accredited Health Care Provider under the Out-Patient Benefit Package. The MHO is planning to accredit the same to the Malaria Package and as TB DOTS Center. The Culion Sanitarium and General Hospital, a retained DOH hospital is operating in the municipality. The nutrition program implementation has been transferred from the MSWDO to the Municipal Health Office last April 2010, the Municipal Health Officer being designated as the Municipal Nutrition Action Officer. The Municipal Nutrition Committee usually meets every month of June basically to plan for the Nutrition Month Celebration. The formulation of MNAP is being done by the Municipal Health Office. Economy Source of income: agriculture, fishing, wage earners - government employee 2. THE NUTRITION SITUATION Table1. Summary table on what forms of malnutrition exist, who are malnourished, how many are malnourished and where are they located

Population Group Newborn

0 – 71 months old School children

Adolescent

Forms of Malnutrition LBW Undernutrition

Number 30 431

Prevalence 7.4 17.15

Overnutrition

8

0.31

Undernutrition Thin Stunted Overnutrition Thin Stunted

472

19.48 20.2% 75.5% 3.1 16.1% 35.6%

87

Location All barangays All barangays Binudac, Culango, Halsey, Luac, M. Patag, Osmena All barangays -do-doAll barangays -do-do-


Adult Pregnant Women

CED

15.1%

-do-

Anemia

59.2%

-do-

a. , b. , c., d.: Undernutrition as well as overnutrition exist in the municipality. The undernutrition prevalence among 0-71 months old children accounts for 17.15 while those among school children is much higher at 19.48. It is also worth noting the high prevalence of overnutrition among school children at 3.1. Of the total 405 live births for 2010, 7.4% have low birth weights. e. Causes of Malnutrition The Problem Tree (depends on identified vulnerable malnourished groups) Consequences of Malnutrition

Underweight children, 0-5 years old

Poor health status/ Presence of Illness

Inadequate food intake

Food insecurity

-Inadequate food production -Limited food purchases -Limited takers of FP among IP’s -Pests occurrence -Soil acidity -Large family size

Inadequate care for mothers & children

-Poor infant and young child feeding practices -Low prevalence of BF -Teenage pregnancy

Insufficient health services, unhealthy environment

-Poor environmental sanitation -Limited supply of potable water -Unsanitary toilet facility -High incidence of infectious diseases


f. What have been done to address malnutrition? How effective have these been? The Municipal Nutrition Committee had come up with the following activities: 1. Through the BEANS Workers, conducted re-weighing of all 0-71 months old to determine the extent of the problem. 2. Advocacy meetings among the MNC members and discuss the problem on high MPR. 3. Mobilized the MNC during the conduct of Nutrition Month Celebration by conducting Barangay Nutrition Month Celebration to create awareness among the community. 4. Allocation of budget for nutrition for 2011. 5. Purchased 25 salter type weighing scales for the BEANS Workers 6. Conducted 3 months Supplemental Feeding among the identified undernourished children. 7. Four (4) personnel attended and completed the TOT for IYCF 8. Conducted IYCF Training among BHW and BEANS Workers 9. Conducted Pabasa sa Nutrisyon 10. Promotion of Breastfeeding 11. Implementation of Health Impact Programs g. What are the resources available to address malnutrition? Table 2. Summary Table on Resources Available to address malnutrition

Resources Nutrition Office Fulltime MNAO Trained Nutrition Staff Trained BNS per brgy MNC Structure MNC Planning Group Nutrition budget Resources from NGO’s, PO’s, Private Entities Other resources

Present/Absent

Remarks

Present Absent Present Present Present Absent Present

Added to MHO Designation Now lang 35 Inactive No EO yet

Present

Limited


h. What constraints could affect the effective implementation of interventions? Table 3. Summary Table on Forms of Malnutrition (questions e, f, g, and h)

Forms of Malnutrition

Causes of Malnutrition

Efforts to address them Family Planning counselling

Large family size

Undernutrition

Poor health knowledge of mothers.

Poor environmental sanitation

Inadequate food production

Provision of family planning commodities Responsible Parenthood Seminar Advocacy on FP Pabasa sa Nutrisyon Advocacy on proper health maintenance Capability building of Sanitary Inspector Hiring of VBSI Regulation of food establishments Provision of toilet bowls Advocacy on chlorination and boiling of drinking water

Resources available to address them Manpower, IEC materials Pills, DMPA, BTL supplies Manpower, IEC materials Manpower, budget, IEC materials, Manpower, IECmaterials Manpower, IEC materials Manpower, budget, Budget from brgy & mun. Manpower, Sanitation Code Budget, toilet bowls Manpower, IECD materials

Supplementary feeding,

Manpower, Budget,

Provision of seeds

Seeds, Manpower

Constraints in addressing them Indigenous People’s culture Lack of Budget, Contraindications, misconceptions Indigenous People’s culture Insufficient budget

Fuel supply Inconsistency in advocating due to multi-tasking Budget

Lack of trainings Non-compliance to regulations by the owners Budget

Budget Budget , geographical location Insufficient budget for purchase of seeds


Low prevalence of Exclusive Breastfeeding

Uncoordinated efforts of line agencies in addressing malnutrition BNC are organized however not functional

Incidence of acute respiratory infections and diarrhea, parasitism

Low OPT coverage/poor monitoring of weight of children

Incidence of Primary complex

Advocacy on backyard gardening IYCF Training among BEANS and BHW Advocacy on Breast Feeding IYCF Training of Trainers Organization of MNC MHO formulated the MNAP Coordinated with the MLGOO

Manpower Manpower, Budget, IEC materials Manpower, IEC materials Manpower, budget Manpower, supplies

Manpower,

Manpower, medicines,

Regular deworming

Manpower, medicines

TB in Children Program Immunization Program

Limited funds Fuel, budget, geographical location

Some members are inactive

Manpower, time

Integrate management of childhood illnesses

Hiring and deployment of additional BEANS Workers Purchase/ Provision of salter type weighing scales Capability building – training of BEANS Workers

Insufficient seeds

Awareness of BNC regarding their mandates Insufficient budget for medicines and fuel, geographical location, weather condition Indigenous People, lack of budget for fuel, geographical location, weather condition,

Budget

Budget

Manpower, budget

Manpower, medicines Manpower, vaccine

Lack of PPD Indigenous People, lack of budget for


Low birth weight

Low PNV4 coverage

Anemia in pregnancy Teenage pregnancy

Maternal and Child Health Care Program

Manpower, TT, Ferrous sulfate

Fertility Awareness Campaign

Manpower,

fuel, geographical location, weather condition, Indigenous People, lack of budget for fuel, geographical location, weather condition,

Classify the existing interventions according to decision criteria based on assessment Continue without Continue with Stop modification modification Family Planning counselling

Pabasa sa Nutrisyon

Hiring of VBSI

Provision of family planning commodities Responsible Parenthood Seminar

Advocacy on proper health maintenance Regulation of food establishments Provision of toilet bowls

IYCF Training of Trainers

Advocacy on FP Provision of seeds Advocacy on backyard gardening Advocacy on Breast Feeding Coordinated with the MLGOO Integrate management of childhood illnesses Regular deworming Capability building – training of BEANS Workers TB in Children Program Immunization Program Maternal and Child Health Care Program Fertility Awareness Campaign

Advocacy on chlorination and boiling of drinking water Supplementary feeding IYCF Training among BEANS and BHW Organization of MNC

MHO formulated the MNAP Hiring and deployment of additional BEANS Workers Purchase/ Provision of salter type weighing scales


Goal

:

Improved nutritional and health status of Culionaires

Outcome 1 : Reduced prevalence of underweight among 0-71 months old children from 17.15% to 5% by year 2014. WORK PLAN: Annex 1. Identifying nutrition interventions

PROBLEM/CAUSE Large family size

Poor health knowledge of mothers.

Poor environmental sanitation

Inadequate food production

Low prevalence of Exclusive Breastfeeding

Uncoordinated efforts of line agencies in addressing malnutrition

STRATEGIES/INTERVENTION Family Planning counselling Provision of family planning commodities Responsible Parenthood Seminar Advocacy on FP Pabasa sa Nutrisyon Advocacy on proper health maintenance thru mothers classes Regulation of food establishments Provision of toilet bowls Advocacy on chlorination and boiling of drinking water Supplementary feeding, Provision of seeds Advocacy on backyard gardening IYCF Training among BEANS and BHW Advocacy on Breast Feeding Organize support groups IYCF Training at brgy level

ENABLING MECHANISM Adopt PD 652

Enact Municipal Sanitation Code

Ordinance on Exclusive Breastfeeding

Organization of MNC

Issuance of Executive Order Reorganizing the MNC

Formulation of MNAP by the MNC

Adoption of MNAP by the Sangguniang Bayan


BNC are organized however not functional Incidence of acute respiratory infections and diarrhea, parasitism

Low OPT coverage/poor monitoring of weight of children

Incidence of Primary complex Low PNV4 coverage Teenage pregnancy

Training of BNC Integrate Management of childhood illnesses Regular deworming Zinc supplementation Hiring and deployment of additional BEANS Workers Purchase/ Provision of salter type weighing scales Capability building – training of BEANS Workers TB in Children Program Immunization Program Maternal and Child Health Care Program Fertility Awareness Campaign

Annex 2. Selecting and Prioritizing nutrition interventions. Intervention

Family Planning Counselling Provision of family planning commodities Responsible Parenthood Seminar Advocacy on FP Pabasa sa Nutrisyon Advocacy on proper health maintenance thru mothers classes Regulation of food establishments Provision of toilet bowls Advocacy on chlorination and boiling of drinking water Supplementary feeding, Provision of seeds, Food production Advocacy on backyard gardening IYCF Training among BEANS and BHW Advocacy on Breast Feeding Organize support groups IYCF Training at brgy level Organization of MNC Formulation of MNAP by the MNC Training of BNC Integrate Management of childhood illnesses

Criteria 4 5 4 5

Total

Rank

6 5

7 3

32

4

5

3

3

29

4

5

5

3

32

4

4

4

5

4

32

4

5

5

5

4

4

33

3

5

5

4

4

5

3

31

5

4

5

4

4

4

3

4

28

5

5

5

5

5

3

4

32

5

5

5

4

4

3

3

29

5

5

5

5

5

3

5

33

3

5

5

5

5

5

3

5

33

3

5

5

4

5

5

3

4

31

5

5

5

5

5

5

3

4

32

4

5

5

5

5

5

5

4

34

2

5

4

5

4

5

4

4

31

5

5

5

5

5

5

5

4

34

2

5

5

5

5

5

5

5

35

1

5

5

5

5

5

5

5

35

1

5

5

5

5

5

4

4

33

3

5

5

5

5

5

3

5

33

3

1 5

2 5

3 5

5

3

5

5

5

5

5

5

5

5

5

5

5

4


Regular deworming Zinc supplementation Hiring and deployment of additional BEANS Workers Capability building – training of BEANS Workers TB in Children Program Immunization Program Maternal and Child Health Care Program Fertility Awareness Campaign

5

5

5

5

5

3

4

32

4

5

5

4

4

4

3

4

31

5

5

3

5

5

5

3

3

29

5

5

5

5

5

3

4

32

4

5

5

5

5

4

3

4

31

5

5

5

5

5

5

4

4

33

3

5

5

5

5

5

3

4

32

4

4

4

4

4

4

4

4

28

Legend: 1. 2. 3. 4. 5. 6. 7.

Relevance to the identified nutritional problem Feasibility of implementing the intervention Effectiveness Ease in targeting Ease in evaluation Cost effectiveness Willingness of beneficiaries to participate in the intervention

Scoring System 5 – very high

4 – high

3 – medium

2 – low

1 – very low

Table 4. Formulation of specific objectives and target setting for each intervention Interventions

IYCF Training at barangay level

Supplementary Feeding

Specific Objective

At the end of 2014, 140 mothers have been trained on IYCF Reduction of MPR by 4 % yearly

Baseline

Target 2012

2013

2014

0

40

50

50

17.15%

13%

9%

5%


Pabasa sa Nutrisyon

Training of BNC Provision of seeds, Food production

At the end of 2014, at least 1,575 families have been conducted Pabasa sa Nutrition By end of 2013, all BNC have been trained on NPM Provision of seeds to 500 families yearly

525

0

14

300

500

525

525

500

500


Table 5. Work Plan (one row per intervention) __________________________________________________________________________________________________________________________________________

Program/ Project

IYCF Training at barangay level

Target 2013

2012

2014

Location

Grp

No

Grp

No

Grp

No

mothers

40

mothers

50

mothers

50

Supplemental Feeding

UW

60

Pabasa sa Nutrisyon

Families

525

Training of BNC

BNC

14

Provision of seeds, Food production

Families

500

Prepared by the:

UW

Families

60

525

UW

Families

60

525

C U L I O N

Sector/ Person Incharge MHO, MNAO, Nut Prog Coor. BEANS, RHM, BNC BEANS, BHW, RHM

MNC, MNAO,

Families

500

Families

500

Culion Municipal Nutrition Committee

MAO

Schedule

Estimated fund requirement

Source of Fund

Expected Result

Jan - Dec

5,000.00 yearly

GAD, Brgy.

140 mothers completed the 5 day training

Oct – Dec

120,000.00 yearly

GAD, Brgy.

Jan - Dec

10,000.00 yearly

Brgy, MOOE

Jan - Dec

70,000.00

GAD, Brgy.

March May

50,000.00 yearly

20% DF, Brgy.

4% reduction in MPR yearly All target families counseled on Pabasa sa Nutrition 14 BNC trained on NPM All target families provided with seeds


5.

MONITORING AND EVALUATION SCHEME

Table 6. Monitoring and evaluation indicators

Level

Type of indicator

Goal:

Impact:

Improved nutritional and health status of Culionaires

Under five mortality

General Outcome/ Outcome Objective:

Outcome Indicator:

How to collect data

Person in-charge

Frequency of data collection

MHNO

documentation

MHO

Monthly

MHNO

OPT

MNAO,RHM,BEANS

Monthly

MHNO

Reporting/Documentation

MNAO

On scheduled training

Reporting/Documentation

MNAO

On scheduled training

Weighing of underweight

MNAO/BEANS

Every Month

RHM,BNC,BEANS

Every Month

Data Source

Re

Prevalence of underweight Reduction on prevalence of underweight among 0-71 months old children from 17.15% to 5% by year 2014. Specific/Output Objective 1:

Output:

At the end of 2014, 140 mothers have been trained on IYCF Intervention 1

140 mothers completed the 5 day training Input

IYCF Training

Specific/Output Objective 2:

Funds for training Training Staff Materials for training Venue Output Indicator:

Reduction of MPR by 4 % yearly

5% reduction in MPR yearly

Intervention 2:

Input Indicator:

Training Report

OPT Report

Supplemental Feeding

-

Food supplies Materials for feeding

Monthly Weighing Report

Reporting


-

Feeding Staff

Specific/Output Objective 3:

Output Indicator:

At the end of 2014, at least 1,575 families have been conducted Pabasa sa Nutrition

All target families counselled on Pabasa sa Nutrition

Intervention 3:

Input Indicator:

BEANS Report

Reporting/Documentation

BEANS

Every scheduled PABASA

Reporting/Documentation

BEANS

Every scheduled PABASA

Training Report

Reporting/ Documentation

MHNO

Every Scheduled training

Training Report

Reporting/ Documentation

MHNO

Every Scheduled training

MAO

Reporting

MAO

Quarterly

MAO

Reporting

MAO

Quarterly

BEANS Report Pabasa sa Nutrisyon

-

Pabasa Kit Time of families and BNS

Specific/Output Objective 4:

Output Indicator:

By end of 2013, all BNC have been trained on NPM

14 BNC trained on NPM

Intervention 4:

Input Indicator:

Training of BNC

Specific/Output Objective 4:

Funds for training Materials for training Trained staff Output Indicator:

Provision of seeds to 500 families yearly Intervention 4:

All target families provided with seeds Input Indicator:

Provision of seeds, Food production

-

Seeds MAO staff


6.

BUDGETARY REQUIREMENTS

Personnel Services Item

Amount

MNAO Incentive BEANS Incentive

72,000 756,000

Maintenance, Operations, and Overhead Expenditure (MOOE) Item Training/Seminars Expense Office Supplies Expense Feeding Supplies Expense Nutrition Month Celebration Expense Seeds Fuel Supply Expense

Capital Outlay

Total

Amount 105,000 90,000 360,000 300,000 150,00 90,000

Furniture and Fixtures 50,000.00

1,097,300.00


Attachment 1 Three-year Local Development Plan of _________ Year 2012-2014 Performance Area: Goal:

Social Services

Improved nutritional and health status of Culionaires

Objective Reduction on prevalence of underweight among 0-71 months old children from 17.15% to 5% by year 2014.

Program/ Project/ Activity

Nutrition Program

Prepared by the Local Nutrition Council: ___________________________

Lead Agency MNC/MHNO

Period of Implementation and Program/Project Cost 2012 701,000.00

2013 661,000.00

2014 611,000.00


Attachment 2

Annual Investment Plan (AIP) According to Program/Project/Activity by Performance Area

Province/City/Municipality:

CULION

Performance Area: HEALTH AND NUTRITION AIP Reference Code

Program/ Project/ Activity Nutrition Program

Lead Agency

MNC MHNO

Period of Implementation Starting Ending date date Jan 2012

Dec 2012

Expected Result

Reduction in MPR

Source of Funds

LGU

Personnel Services 296,000

Period of implementation and Project Cost Capital MOOE Outlay 400,000

25,000

TOTAL 701,000


Attachment 3

Three-year evaluation of LNAP Level

Expected Result

Year 1 Target

Year 2 Actual

Target

Year 3 Actual

Target

General/ Outcome Objective Reduction on prevalence of underweight among 0-71 months old children from 17.15% to 5% by year 2014.

9%

5%

40

50

50

13%

9%

5%

525

525

525

500

500

13%

Specific Objectives: At the end of 2014, 140 mothers have been trained on IYCF Reduction of MPR by 4 % yearly At the end of 2014, at least 1,575 families have been conducted Pabasa sa Nutrition By end of 2013, all BNC have been trained on NPM Provision of seeds to 500 families yearly

140 mothers completed the 5 day training 4% reduction in MPR yearly All target families counseled on Pabasa sa Nutrition 14 BNC trained on NPM All target families provided with seeds

14 500

Actual


Attachment 4 Three-year monitoring program/project of LNAP Program/ Project IYCF Training at barangay level Supplemental Feeding Pabasa sa Nutrisyon

Training of BNC Provision of seeds, Food production

1.

Expected Result 140 mothers completed the 5 day training 4% reduction in MPR yearly All target families counseled on Pabasa sa Nutrition 14 BNC trained on NPM All target families provided with seeds

Involve NCIP in MNC

Target

Year 1 Accomplishment No. %

Target

Year 2 Accomplishment No. %

Target

40

50

50

13%

9%

5%

525

525

525

500

500

14

500

Year 3 Accomplishment No. %


MNAP Culion, Palawan