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SEVENTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
First Regular Session )

HOUSE OF REPRESENTATIVES

BY:
2,
Introduced by Representative Maximo B. Rodriguez, Ji

House Bill No. 3643

EXPLANATORY NOTE

The development of a child is very much dependent on the diet and nutrition sine
receives at an early age. According to UNICEF, the first 1000 days of children from
conception to until 2 years of age is very important and the proper nutrition during these first
1000 days can have an enormous impact on the child's ability to grow and learn.

‘The WHO has repeatedly stressed the importance of exclusive breastfeeding during
the first 6 months of a baby's life. According to The Nutritional Status of Filipino Children and
Selected Population Groups Survey: 2011 of the Food and Nutrition Research Institute of the
Philippines (FNRI) of the Department of Science and Technology, among the 0-5 month
infants (equivalent to the WHO standard measurement of 0-6 months) who were exclusively
breastfed, an increasing trend was observed from 29.7% in 2003 to 35.9% in 2008, to about
46.7% in 2011. The duration of breastfeeding also increased from 4.9 months in 2008 to 7.7
months in 2011 while duration of exclusive breastfeeding increased from 2.3 months to 3.7
months in the same period. Percentage of age-appropriate breastfeeding among children 0-
23 months also reached 48.8%, The authors seek to further promote and protect these gains
in breastfeeding practice in filing this bill

Hence, this bill which institutionalizes the promotion of exclusive breastfeeding and
counseling for all pregnant and lactating mothers on proper nutrition for their children during
the first 1000 days.

In view of the foregoing, immediate approval of this measure is earnestly requested.

MAXIMO'B. RODRIGUEZ, JR.


SEVENTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
First Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Maximo B. Rodriguez, Jr.
House Bill No, 3643

AN ACT
STRENGTHENING AND ENHANCING NATIONAL AND LOCAL HEALTH AND
NUTRITION PROGRAMS FOR PREGNANT AND LACTATING WOMEN, INFANTS AND.
YOUNG CHILDREN THE FIRST 1000 DAYS

Be it enacted by the Senate and House of Representatives of the Philippines in Congress
assembled.

SECTION 1. Title. — This Act shall be known as the “First 1,000 Days Act’.

Sec. 2. Declaration of Policy. — The right to health is a fundamental principle guaranteed
by the State. Section 15, Article 2, of the 1987 Constitution emphasizes that “The State shall
protect and promote the right to health of the people and instill health consciousness among
them.” Moreover, pursuant to various intemational human rights instruments and
agreements that the State adheres to, the State guarantees the right to adequate food, care
and nutrition to children, specially those from zero to five-years old.

The State likewise declares its determination to eliminate hunger and to reduce all
forms of malnutrition, The State further maintains that nutrition is both an end-goal and a
means to achieve sustained development. It is a multi-faceted issue requiring committed
inputs from all sectors. As such, nutrition shall be a priority of the government to be
implemented by all its branches in collaboration with non-government organizations and the
private sector, in an integrated manner.

The State furthermore allocates its resources in a sustainable manner thereby
eradicating malnutrition of women of reproductive age, pregnant women, and children from 0
to 24 months

The State finally refocuses the intervention program on malnutrition to the first 1,000
days of a child's life, i.e, the nine months in the womb and the first 24 months of his/her life
which are crucial in preventing malnutrition

Sec. 3.Objectives.—This Act specifically aims to

a) Provide a more comprehensive, sustainable and multisectoral approach to address
malnutrition;

b) Provide a policy environment conducive to nutrition improvement;

c) Provide mechanisms, strategies and approaches in implementing programs and
projects to improve nutritional status and to eradicate malnutrition and hunger;

d) Strengthen the National Nutrition Council (NNC) as the policy-making body on
nutrition; and

e) Ensure the meaningful and active participation, partnership and cooperation of NNC-
member agencies, other National Government Agencies (NGAs), Local Government
Units (LGUs), Non-Government Organizations (NGOs), and the private sector, in an
integrated and holistic manner, for the promotion of the nutritional well-being of the
population,

Sec. 4. Types and Definition of Malnutrition. - The following types of malnutrition are
hereby defined:


a) Low birth weight refers to weight at birth of less than 2500 grams or 6.5 pounds;

b) Micronutrient deficiency refers to a deficiency of substances required by the body
in small amounts for vital physiological functions. These include vitamin A, iron,
folic acid, iodine and zinc, The deficiency of these micronutrients may result in:
vitamin A deficiency (VAD), iron deficiency anemia (IDA), iodine deficiency
disorders (IDD)

c) Overweight refers to weight above normal for height, which is greater than positive
2 standard deviations (SD) of the WHO Child Growth Standard median;

d) Stunting refers to low height-for-age which is less than negative 2 SD of the WHO
Child Growth Standard median and which is an indicator of long standing or
chronic malnutrition;

e) Underweight refers to low weight-for-age which is less than negative two (2) SD of
the WHO Child Growth Standard median; and,

1) Wasting refers to low weight-for-height which is less than negative 2 SD of the
WHO Child Growth Standard median,

SEC. 5. The First 1,000 Days Strategy for Health and Nutrition of Women, Infants and
Young Children. - There shall be a comprehensive and sustainable strategy to address the
health and nutrition problems in the country affecting pregnant and lactating women, infants
and young children. This shall be formulated by the Department of Health (DOH) and the
NNC as a program to operationalize the Philippine Plan of Action for Nutrition (PPAN) which
integrates short, medium and long term plan of the government in response to the global
call to eradicate hunger and mainutrition. The strategy shall be formulated in cooperation
with other agencies, LGUs, the private sector, relevant health professional and civil society
organizations, within three (3) months from the effectivity of this Act. The health and nutrition
programs shall focus on pregnant and lactating women as well as the health and nutrition of
newborns, infants and young children.

Sec. 6, Coverage. - This Act covers all Filipinos who are nutritionally at risk, giving priorities
to women of reproductive age most specially adolescent girls, pregnant and lactating
women, particularly teen-age mothers, and alll Filipino children from birth to age 24 months
who reside in geographically isolated and disadvantaged areas (GIDA), ie. areas that are
isolated due to distance, weather conditions and transportation, unserved and underserved
communities and other areas identified to have high incidences of poverty, presence of
vulnerable sector, communities in or recovering from situation of crisis or armed conflict and
recognized as such by a government body.

Sec. 7. Health and Nutrition Services and Interventions for Women, Infants and Young
Children in the First 1000 Days. - Health and nutrition services and interventions offered
are the following

a. Pregnant Women — Prenatal care services at the barangay level of each local
government unit shall Include: pregnancy tracking and enrollment to prenatal care
services; regular follow up to complete minimum of four (4) prenatal care visits;
identification of nutritionally-at-risk pregnant women; provision of nutrition counseling,
social welfare support for access to nutritious and healthy food products and
commodities for nutritionally-at-risk pregnant women belonging to poorest of the poor
families; provision of micronutrient supplements with ferrous sulfate-folic acid; use of
iodized salt and fortified-rich foods; iodized oil capsules in areas with low utilization of
iodized salt and high incidence of iodine deficiency disorders; provision of tetanus
toxoid vaccine for the prevention of neonatal tetanus; oral health assessment;
empowering women on the preparation of birth, breastfeeding and rooming-in plans;
breastfeeding counseling; PhilHealth enrollment and linkage to community health
workers and volunteers;


b. Women about to give birth ~ Health and nutrition services shall include, at the facility
level, the availment of PhilHealth benefit packages for delivery. provision of mother-
friendly practices during labor and delivery in compliance with the Mother-Baby-
Friendly Hospital Initiative (MBFHI) and current intrapartum protocols of the DOH;
nutrition counseling and provision of nutritious food and meals at the facility; support
at birth on breastfeeding initiation, most especially for caesarian deliveries;
maintenance of non-separation of the mother and her newborn for early
breastfeeding initiation

c. Postpartum and lactating women - Health and nutrition services at the community
level shall include: follow-up visits to health facilities where they gave birth; home
Visits for women in difficult to reach communities; lactation support and counseling
from birth up to two years and beyond, including those women who will retum to
work; nutrition counseling to meet the demands of lactation; lactation breaks for
women in the workplace; organization of community-based mother support groups
and/or peer counselors for breastfeeding in cooperation with other health and
nutrition workers; availability of lactation stations in the workplace and in public
places; social welfare support for access to nutritious and healthy food products and
commodities for nutritionally at-risk post-partum and lactating women belonging to
poorest of the poor families.;

d. Newborn infants up to first 6 months (180 days) of age - Health and nutrition
services shall include, at the facility level, the provision of baby-friendly practices
during delivery in compliance with the Mother-Baby-Friendly Hospital Initiative
(MBFHI) and current newborn care protocols of the DOH in all birthing faciilties:
maintenance of non-separation and observance of rooming-in of the mother and her
newborn for early breastfeeding initiation and exclusive breastfeeding: provision of
kangaroo mother care for small babies born preterm and low birth weight: provision
of routine newborn care services such as eye prophylaxis and vitamin K; availability
of human milk pasteurizer for tertiary level facilities with neonatal intensive care units
to ensure breast milk supply for the small babies born preterm and low birth weight:
availment of PhilHealth newborn care packages, appropriate immunization services
integrated with assessment of breastfeeding, growth and development promotion;
provision of early referral to higher level facilities to manage illness or malnutrition:
provision of social welfare services to the poorest of the poor families of infants in
need of support to avail access to health and nutrition services and interventions:
assurance of a child-friendly space where exclusively breastfed infants will be able
to continue breastfeeding during calamities, disasters or other emergencies;

e. Infants 6 months up to 2 years of age - Health and nutrition services at the
community level shall include: timely introduction of safe, appropriate and nutrient
dense quality complementary food with continued and sustained breastfeeding for all
infants from six months up to 2 years of age; micronutrient supplementation with
vitamin A capsules, iron sulfate drops or syrups, and/or micronutrient powder;
management of childhood illnesses Including acute malnutrition; growth and
development monitoring and promotion; provision of oral health services including
application of fluoride varnish to prevent dental caries; provision of deworming tablets
for children at 1-2 years of age; availability of potable source of water; local
government support for sanitation needs of households to reduce food-and-water-
borne diseases, provision of nutrition counseling on complementary feeding to
mothers and caregivers; social welfare support for access to nutritious and healthy
food products and commodities for families belonging to poorest of the poor; support
for home kitchen gardens; livelihood assistance for parents of families belonging to
poorest of the poor.


Sec. 8. Strategy/ Program Components - The strategy or program on Health and Nutrition
shall include the following components

se-esaoce

Health human resource and capacity development
Health and nutrition investment planning and financing

Service Delivery

Sectoral collaboration and partnerships

Logistics and supply management

Knowledge management and information technology

Health promotion and education, social mobilization and community organization
Monitoring and evaluation

Sec. 9. The National Nutrition Council. - The composition of the NNC Governing Board as
stipulated in Executive Order No, 234 is hereby amended and the same shall now be
composed of the following

a)
b)

Secretary of Health (Chairperson);
Secretary of the Department of Interior and Local Government (Vice
Chairperson)

Secretary of Agriculture

Secretary of the Department of Social Welfare and Development;

Secretary of the Department of Education;

Secretary of the Department of Science and Technology - Food and Nutrition
Research Institute (FNRI);

Secretary of the Department of Budget and Management;

Secretary of the Department of Trade and Industry;

Secretary of the Department of Finance;

Secretary of the Department of Labor and Employment

Chairperson of the Philippine Commission on Women

Secretary of Economic Planning and Director General of the National
Economic and Development Authority;

President of the Union of Local Authorities of the Philippines (ULAP)

Chair, National Anti-Poverty Commission

Three representatives from the private sector to be appointed by the President
of the Philippines who shall come from any of the following: 1) health and
nutrition sector, 2) women sector, 3) food and nutrition industry sector: 4. urban
poor, 5) organization of association of community health workers or barangay
nutrition scholars, respectively. Said representatives shall serve for a term of
two (2) years.

The heads of departments may be represented by their duly designated
representatives who shall be of a rank not lower than an assistant secretary.

The composition of the NNC's Secretariat and Technical Committee as defined in
Executive Order No, 234, Series of 1987 shall be maintained

SEC. 10. Functions of NNC.--The NNC shall have the following functions and powers:

(a)

Formulate national nutrition policies, plans, strategies and approaches for
nutrition improvement in accordance with the Philippine Plan of Action for
Nutrition which include the strategy on women, infant and young child
nutrition;

Oversee and serve as a focal point in the integration of nutrition policies and
programs of all member agencies and instrumentalities charged with the
implementation of existing laws, policies, rules and regulations conceming
nutrition

Coordinate, monitor and evaluate programs and projects of the public and
private sectors and LGUs relative to women, infant and young child nutrition,
hunger-mitigation, food fortification and national salt iodization programs,
among others, and ensure their integration with national policies;


(d) Receive grants, donations and contributions, in any form, from foreign
governments, private institutions and other funding entities for nutrition
programs and projects: Provided, That no conditions shall be made contrary
to the policies or provisions of this Act;

(e) Coordinate the release of public funds for the promotion of the nutritional
well-being of the country in accordance with the approved programs and
projects; and

(f) Call upon any government agency and instrumentality for such assistance as

may be required to implement the provisions of this Act

Sec, 11. Role of Member-Agencies. - The DOH and the NNC, as lead implementing
agencies, shall establish the framework for monitoring the overall implementation of the
program and lead in the distribution of supplements, administration of check-ups and
vaccinations in the different barangays nationwide with the assistance of the DSWD, the
DILG, state universities and the local government units (LGUs).

The DSWD, in furtherance of any of its programs, shall help and coordinate in the
implementation and monitoring of the program in all barangays nationwide

The DILG, in cooperation with the Union of Local Authorities of the Philippines, shall
ensure that local government units, and their respective health and nutrition departments
and offices personnel and staff, their barangay health workers (BHWs), barangay nutrition
scholars (BNS), other community-based volunteers and community health members, shall
jointly implement the First 1000 Days Program with the technical assistance and guidance of
the DOH. The LGUs shall likewise endeavour to provide sustained human resource
development to their health human resources, including BHWs and BNSs, in support of local
health and nutrition programs,

The consortium of State Universities and Colleges (SUCs) shall intensify health and
nutrition-related training, research and extension support activities to support the First 1000
Days Program through the Barangay Integrated Development Approach for Nutrition
improvement (BIDANI) Network Program of the Rural Poor and other relevant approaches,
thereby strengthening delivery systems in partnership with the LGUs.

NGOs shall align their related programs to the priorities and directions of the
Philippine Plan of Action for Nutrition and the Strategy for Women, infant, and Young Child
Nutrition, NGOs shall also be encouraged to undertake health and nutrition-related
researches in line with the First 1000 Days in collaboration and coordination with the
Philippine Council for Health Research and Development of the DOST and to recommend
procedures and guidelines promotive of the same to encourage good health and nutrition
practices among employees of agencies or members of NGOs.

The business community shall also be encouraged to provide technical and financial
assistance to community-based health and nutrition projects though their corporate social
responsibility programs, as their participation in the country’s bid to enhance human
development and human capital formation.

To guarantee the highest integrity and public confidence in its activities, member
agencies and entities shall disclose any circumstance that can give rise to any potential
conflict of interest related to their functions and the activities in which they are involved in
In case a declared interest shall be determined as potentially or clearly significant, the NNC.
by a majority vote, may (a) allow full participation of the member agencies and entities, with
public disclosure of the interest; (b) permit partial exclusion (i.e., the member agencies and
entities will be excluded from that portion of the meeting or work related to the declared
interest and from the corresponding decision making process); or (c) mandate. total
exclusion (i.e., the member agencies and entities will not be able to participate in any part of
the meeting or work)

‘Asummary of all declarations and actions taken by the NNC to manage any declared
interest will be published in a subsequent report.


Sec. 12, Nutrition in the Aftermath of Natural Disasters and Calamities. - Areas that are
struck by disasters must be prioritized in the delivery of health and nutrition services and
interventions. National, regional, and local governments are mandated to immediately
provide emergency services, food supplies for proper nourishment of pregnant, lactating
mothers and children, specifically those from zero to two (2) years old

Donations or assistance of private sector in emergency situations shall be allowed
immediately in the aftermath of natural disasters and calamities. The National Disaster Risk
Reduction and Management Council (NORMMC) is hereby mandated to formulate
guidelines in pursuit of this Section with guidance from the DOH. _ National and local
disaster risk reduction and management councils are hereby enjoined to involve women in
the decision-making process, allowing them to take part in implementing disaster
preparedness, recovery and rehabilitation programs

Sec. 13. Implementing Rules and Regulations — Within ninety (90) days from the
effectivity of this Act, the Secretary of the DOH shall, in coordination with the Secretarles of
the DILG, the DSWD and the Executive Director of the NNC, in consultation with concerned
stakeholders in the public and private sectors, promulgate rules and regulations necessary
for the effective implementation of this Act.

Sec. 14. Repealing Clause. ~ All laws, decrees, executive orders, administrative orders or
parts thereof inconsistent with the provisions of this Act are hereby repealed, amended or
modified accordingly.

Sec.15. Effectivity. This Act shall take affect fifteen (16) days after its publication in the
Official Gazette or in a newspaper of general circulation

Approved,