Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

Seventeenth Congress
First Regular Session

3564

HOUSE BILL NO.

Introduced By REP. TEDDY BRAWNER BAGUILAT JR

EXPLANATORY NOTE

An Act for Supporting Scaling Up Nutrition during the First 1000 Days of Life
by Strengthening and Protecting Primary Health Care Workers

Malnutrition is a pervasive problem in the Philippines with the steadily increasing
incidence of underweight, wasting and stunting among children. Addressing a
problem of this magnitude requires local solutions to ensure the direct and efficient
delivery of services and information to the key population in most need.

The Local Government Code of 1991 devolved the delivery of critical social services
such as health to local government units. At the front lines of primary health care
delivery are the barangay health workers (BHWs) and barangay nutrition scholars
(BNS).

Barangay Health Workers act as primary health care providers, health educators and
community mobilizers. Republic Act 7883 or the Barangay Health Workers’ benefits
and Incentives Act mandated the institutionalization of renumeration for BHWs but
the amounts are outdated. BHWs still receive monthly honorarium depending on the
discretion of local leaders.

Barangay Nutrition Scholars were included as part of the primary health care system
by virtue of Presidential Decree No. 1569 of 1978 which sought to provide one BNS
per barangay. BNS are responsible for monitoring and caring for the malnourished
children especially 0-2 year old children in recognition of the First 1,000 Days of life
as the crucial window of opportunity. They conduct regular weighing, nutrition
counseling services especially on exclusive breastfeeding and appropriate
complementary feeding and organizing mothers’ classes on community nutrition
education among many other roles to promote the nutrition of the community. They
are currently entitled to a training stipend, kit and travel allowance of at least One
hundred twenty pesos (P 120.00) a year, and in addition to other allowances that the
municipality may grant but not exceeding One hundred fifty pesos (P 150.00) a
month


Primary health workers such as BHWs and BNS have the most direct impact on the
health and nutrition of community members, particularly pregnant mothers and
children 0-2 years old. They are the first point of contact in the health system and are
most capable of reaching out to individual community members through various
means such as consultations at the health center, home visits and grassroots health
promotion activities. They also have a strong stake and concern for the overall
welfare of their community because they too are members of the community.

Resolving the problem of mainutrition entails that these health workers are properly
compensated, sufficiently capacitated, and effectively protected. Although both
BHWs and BNS are categorized as volunteers, the measly and discretionary
amounts they receive as allowances and honoraria do not give them the dignity and
recognition they deserve for their indispensable work. They also do not receive
continuous learning opportunities to enhance the quality of their services aside from
the initial training prior to deployment. Furthermore, the security of their tenure is
constantly at risk because their stay is determined by local chief executives. The
sustainability and efficiency of service delivery could then be hampered due to the
constant turnover or appointment of unqualified health workers.

The bill aims to address such gaps by protecting the security of tenure of BHWs and
BNS as and providing additional in recognition that they are crucial partners in
promoting health and nutrition of mothers and children for the First 1,000 Days
program, Strengthening BHWs and BNS into skilled health workers will contribute to
the achievement of Sustainable Development Goals on ending hunger and
promoting healthy lives. It will also support the State's objective of responding to the
growing health needs of local communities, especially those in the poorest and far-
flung areas

The passage of this bill is urgently sought.



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Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

Seventeenth Congress
First Regular Session

HOUSE BILL NO.8564

Introduced By REP. TEDDY BRAWNER BAGUILAT JR

‘An Act for Supporting Scaling Up Nutrition during the First 1000 Days of Life
by Strengthening and Protecting Primary Health Care Workers

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

SECTION 1. Title. — This Act shall be known as the “Strengthening and
Protection of Primary Health Workers 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.” Further, as party to international human rights
agreements such as the Universal Declaration of Human Rights, International
Covenant on the Economic, Social and Cultural Rights, the United Nations
Convention on the Rights of a Child and to the Scaling Up Nutrition Movement, the
State commits to its obligations that guarantee the right to adequate food, care and
nutrition to pregnant and lactating mothers and children, specially those from zero to
two-years old.

Title 1, Section 17 of the Local Government Code states the responsibilities of
local government units like the barangay to ensure the provision of health and social
welfare services which entails the deployment of community health workers or
Barangay Health Workers (BHWs). Presidential Decree No. 1569 of 1978 stated the
provision of one barangay nutrition scholar to every barangay to addres malnutrition
with the National Nutrition Council as the lead agency.

The State shall recognize, respect and protect the rights of ICCs/IPs to
preserve and develop their cultures, traditions and institutions. It shall consider these
rights in the formulation of national laws and policies

The State recognizes its obligations to respond to the strong expression of the
ICCs/IPs for cultural integrity by assuring maximum ICC/IP participation in the
direction of education, health, as well as other services of ICCs/IPs, in order to
fender such services more responsive to the needs and desires of these
communities.


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Furthermore, the State further commits to the Philippine Development Plan and
the Philippine Plan of Action on Nutrition (PPAN) to contribute to the improvement of
the quality of human resource in the country, and the reduction of child and maternal
mortality.

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.

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

(a) Strengthen the the primary health care system especially towards the
efficient and culturally-responsive implementation of the First 1,000 Days
program

(b) Strengthen policies on health human resources for primary health care such
as Barangay Health Workers’ Benefits and Incentives Act of 1995 (Republic
‘Act Number 78833) and Presidential Decree 1569 of 1978, the Barangay
Nutrition Program

(©) Protect and support the Barangay Health Workers and Barangay Nutrition
Scholars as the primary health care workers mainly tasked to implement the
First 1000 Days Act

Sec. 4. Definition of Terms. — For the purposes of this Act, the following shall
refer to:

a) Geographically isolated and disadvantaged areas (GIDA) are 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

b) Indigenous Cultural Communities/Indigenous Peoples — refer to a group of
people or homogenous societies identified by self-ascription and ascription
by others, who have continuously lived as organized community on
communally bounded and defined territory, and who have, under claims of
ownership since time immemorial, occupied, possessed and utilized such
territories, sharing common bonds of language, customs, traditions and
other distinctive cultural traits, or who have, through resistance to political,
social and cultural inroads of colonization, non-indigenous religions and
cultures, became historically differentiated from the majority of Filipinos.
ICCs/IPs shall likewise include peoples who are regarded as indigenous on
account of their descent from the populations which inhabited the country, at
the time of conquest or colonization, or at the time of inroads of non-


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indigenous religions and cultures, or the establishment of present state
boundaries, who retain some or all of their own social, economic, cultural
and political institutions, but who may have been displaced from their
traditional domains or who may have resettled outside their ancestral
domains

°)

Barangay Nutrition Scholars as defined by PD No. 1569 of 1978 are
responsible for delivering nutrition services and other related activities such
as community health, backyard food production, environmental sanitation,
culture, mental feeding and family planning to the barangay. Their
qualifications include a) being a resident for at least four years; b)
possession of leadership potentials; c) willingness to learn and serve
barangay for at least a year; d) primary school graduate

d) Barangay Health Workers as defined by RA 7883 (Barangay Health
Workers’ Benefits and Incentives Act of 1995) refers to a person who has
undergone training programs under any accredited government and non-
government organization and who voluntarily renders primary health care
services in the community after having been accredited to function as such
by the local health board in accordance with the guidelines promulgated by
the Department of Health (DOH).

SEC. 5. Provision of Barangay Health Worker and Barangay Nutrition
Scholar. There shall be provided one (1) barangay health worker and one (1)
Barangay Nutrition scholar in every barangay throughout the country. Such health
workers such be under the control and supervision of the Department of Health in
close coordination with the Local Government Health Officer and the Local Chief
Executive.

SEC. 6. Provision of Culturally-Responsive Health Care. In indigenous
cultural communities and Geographically-Isolated and Disadvantaged Areas, the
Department of Health will ensure that at least one (1) health worker will be a member
of the indigenous cultural communities and they will be allowed to practice
indigenous traditions and beliefs as long as these are not contradictory to the
policies of the Department of Health.

SEC 7 Qualifications- These include: resident of the barangay for at least 3
years; can speak the dialect; possesses leadership potentials; has the initiative and
willingness to serve the barangay for at least three (3) years; willingness to learn,
and teach what he/she has learned to the barangay people; at least a high school
graduate; physically and mentally fit; and at least eighteen (18) years old but not
more than sixty (60) years old.

SEC 8 Benefits - Barangay Health Workers (BHWs) and Barangay Nutrition
Scholars (BNS) receive monthly allowance and benefits equivalent to second grade
civil service eligibility and salary grade appropriate, pursuant to Compensation and
Position Classification System.

They shall likewise be entitled to the incentives and benefits provided under the
Magna Carta for Public Health Workers, and shall be covered by all existing statutory


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benefits such as PAG-IBIG, GSIS and Philhealth. In addition, they shall be given
burial and disability assistance in case of death or if the BHW is afflicted by illness
which results in disability especially if such occurs in the duration of his service, A
regular adjustment in monetary and non-monetary incentives shall be made to
improve the living conditions of Barangay Health Workers and Barangay Nutrition
Scholars

Incentives and benefits for Barangay Health Workers as prescribed by Republic Act
7883 and Barangay Nutrition Scholars as determined by Presidential Decree 1569 of
1978 will be increased upon review and approval of the Department of Health and
after considering among others, present Consumer Price Index as published by the
National Statistics Office.

SEC 9. Mandatory Continuing Community-based Health Education - The
Department of Health in cooperation with TESDA shall formulate a program for
Mandatory Continuing Community-based Health Education (MCCHE). Each
accredited BHW and BNS will be required to undergo an MCCHE at least every
three (3) years of active service or as warranted by the DOH.

SEC 10. Security of Tenure — The services of BHW and BNS who have
served for at least three (3) years shall not be terminated except for cause provided
by law and after due process: Provided, that the barangay health worker or barangay
nutrition scholar is found by the Civil Service Commission to be unjustly dismissed
from work, he/shall be entitied to reinstatement without loss of seniority rights and to
his/her back allowances with twelve percent (12%) interest computed from the time
his/her compensation was withheld from him/her up to the time of reinstatement.

SEC 11. Discrimination Prohibited — The barangay health worker and
barangay nutrition schoiar shall not be discriminated against with regard to gender,
civil status, creed, religious, or political beliefs and ethnic groupings in the exercise of
his/her profession

‘SEC. 12 Duties and Obligations

In fulfillment of the First 1,000 Days program, the respective roles of the Barangay
Nutrition Scholars and Barangay Health Workers are rationalized as not to overlap
and duplicate and are stated as follows:

Barangay Nutrition Scholar

1. Care for the malnourished through a community survey. This survey involves
weighing all preschoolers and interviewing mothers to determine how the child
is cared for, and the resources available in the family for their participation in
nutrition and related interventions

Community mobilization and linkage-building

Identification of nutritionally-at-risk pregnant women

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;

5. Provision of micronutrient supplements with ferrous sulfate-folic acid

BON


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6. Nutrition counseling services to pregnant women and their family, especially
on their nutrition needs and preparation for early initiation of breastfeeding
and support services on age-appropriate, safe and adequate complementary
food to mothers and caregivers;

7. Management of community-based feeding programs under the supervision of
a nutritionist-dietitian;

8. Organization of community-based mother support groups and/or peer
counselors for breastfeeding in cooperation with other health and nutrition
workers

9. Distribution of seeds, seedlings, and small animals from the local agriculture
office and other government organizations and nongovernment organizations
to promote home or community food gardens

Barangay Health Workers

1. Monitoring and tracking of any incidence of disease or health cases
2. Communication and coordination with the community to participate in center-
based and community-based health promotion activities
3. Conduct of health visits at the community
4. Health community profiling
5. Assistance to the Municipal Health Officer, Midwife and/or Community Health
Nurse in the provision of the following services
© Pregnancy tracking and enrollment to prenatal care services
* Regular follow up to complete minimum of four (4) prenatal care visits
and follow-up visits to the health facilities of the mother with her new
born
+ Ensuring mother-friendly practices during labor and delivery in
compliance with the Mother-Baby-Friendly Health Facility Initiative
(MBFHFI) and current "Unang Yakap” protocols of the DOH
* Home visits for women in difficult to reach communities
* management of childhood illnesses including acute malnutrition and
severe acute malnutrition using national protocols and special
feeding during illness at facility and community level
immunization, 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

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 Secretaries of the DILG, the DSWD and the Executive Director of the NNC, in
consultation with stakeholders in the public and private sectors, promulgate rules
and regulations necessary for the effective implementation of this Act.

Sec. 14. Appropriation. —The amount necessary to carry out the provisions
of this Act shall be included in the General Appropriations Act of the year of its
enactment into law. Thereafter, the expenses for its continued implementation shall
be included in the subsequent General Appropriations Act.


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

Approved,