HOUSE °F REPRESENTATIVES
RECEIVED

pare 25 AUG 2016
siwe___F00M

BY: ev

REGISTRATION UNIT
ILLS AND INDEX SERVICE

Republic of the Philippines

HOUSE OF REPRESENTAT!
Quezon City, Metro Manila

Seventeenth Congress
First Regular Session

3358

HOUSE BILL NO.

Introduced by REPRESENTATIVE SHARON S. GARIN

EXPLANATORY NOTE

The nutritional status of Filipino children especially those under five years old is a very
urgent public health and social concern. According to the 8" National Nutritional Survey
released in 2013, approximately 1 out of 10 children under five years old is wasted (too
thin for age), 2 out of 10 children is underweight and 1 in 3 children is stunted (too
short for age).

It is in this light that UNICEF, World Health Organization and various government and
development agencies have emphasized the importance of addressing malnutrition and
its destructive effects in the crucial window of the First 1,000 Days of life (from
conception to 2 years of age).

A policy brief of the Philippine Legislators’ Committee on Population and Development
(PLCPD) highlighted the benefits of this initiative: Proper nutrition in the first 1,000
days is critical for the physical and mental growth of a child and can serve as a pathway
out of poverty for poor households. It prevents more than one-third of child deaths per
year, improves school attainment and increases wages by 5 to 50 percent and
eventually, break the intergenerational cycle of poverty.

If we invest now in the First 1,000 Days of life, the profound impact of programs which
address that key window of opportunity is much more beneficial compared to how
devastating the effects of malnutrition and stunting can be on the child and eventually,
the productivity of our country.

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The right to health of every Filipino is espoused in the Constitution specifically in
Section 15, Article 2: "The State shall protect and promote the right to health of the
people and instill consciousness among them."

The Philippines under the Convention on the Rights of the Child to which it is a party
assures the right of children to good quality health care, nutritious food, a clean and safe
environment, and information to help them stay healthy. The Philippines also
committed to achieving the Sustainable Development Goals such as SDG 3 (Good health
and well-being) and fulfilling the Scaling Up Nutrition Movement which aims to end
hunger and malnutrition in all its forms.

Malnutrition is a pervasive problem in our country which has many long-term social
and economic effects but it is a problem that can still be resolved. There are many
government and civil society initiatives which aim to address malnutrition such as
feeding programs and micronutrient fortification but implementing these interventions at
older ages is too late and do not address the full spectrum of necessary maternal and child
health services. It is imperative to redirect programs towards the First 1,000 Days of life.

The bill seeks to streamline and specify basic services to be provided at each key stage
of the First 1,000 Days through a comprehensive, sustainable and multi-sectoral
approach which will be implemented in all local government units. It will ensure
sufficient financial and health human resources and meaningful participation of
government agencies, civil society organizations and the private sector towards
eradicating malnutrition of women of reproductive age, pregnant women, and children
0 to 2 years old.

The State owes it to its children and the future generations to ensure that the
opportunity at a brighter and more productive future is well within their reach. That
starts with good nutrition in the First 1,000 days.

‘Thus, the passage of this bill is earnestly sought.

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Republic of the Philippines

HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

Seventeenth Congress
First Regular Session

HOUSE BILL NO. 3358

Introduced by REPRESENTATIVE SHARON S. GARIN

An Act for Scaling Up Nutrition during the First 1000 Days of Life

Be it enacted by the House of Representatives and Senate 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.” 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.

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

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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 adolecent girls, pregnant and lactating women, and
children from zero to two-years old

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 is considered to be the critical window of opportunity to prevent
malnutrition and life-long consequences.

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

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

(b) Ensure adherence to the commitments and obligations such as the
International Covenant on the Economic, Social and Cultural Rights international
Convention on the Rights of the Child (CRC), A Promise Renewed, Scaling Up
Nutrition (SUN), and the 2016 Sustainable Development Goals, particularly Goal 2
which states that it aims to end hunger, achieve food ‘security and improved nutrition
for all. And also Goal 3 which states that it aims to ensure healthy lives and promote
well-being for all

(c) Provide nutrition specific and nutrition sensitive mechanisms, strategies,
programs and approaches in implementing programs and projects to improve
nutritional status and to eradicate malnutrition and hunger.

(d) Strengthen the role of the Department of Health, the National Nutrition
Council (NNC) and other agencies tasked to implement the First 1000 Days Act.

(e) Ensure the meaningful, active and sustained 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.

(f) Strengthen enforcement of the Milk Code (Executive Order Number 51), and
the Expanded Breastfeeding Promotion Act (Republic Act Number 10028) to protect,
promote, and support optimal infant and young child feeding,

(g) Strengthen other nutrition related policies, guidelines and laws such as the
ASIN Law and Food Fortification Laws, promote good nutrition under the
Accelerated Hunger Mitigation program and the DOH Administrative Order 2015-055
entitled the National Guidelines on the Management of Acute Malnutrition under 5
years old

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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) Low birth weight refers to weight at birth of less than 2500 grams;

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

4) Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health. Body mass index (BMl) is a simple
index of weight-for-height that is commonly used to classify overweight and
obesity in adults. It is defined as a person's weight in kilograms divided by
the square of his height in meters (kg/m?). According to the WHO, a BMI
greater than or equal to 25 is overweight. While a BMI greater than or equal
to 30 is obesity.

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

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

9) Wasting or thinness indicates in most cases a recent and severe process of
weight loss, which is often associated with acute starvation and/or severe
disease. However, wasting may also be the result of a chronic unfavorable
condition. Wasting refers to low weight-for-height which is less than
negative 2 SD of the WHO Child Growth Standard median.

h) Anemia, as defined by the World Health Organization is a condition in
which the number of red blood cells or their oxygen-carrying capacity is
insufficient to meet physiologic needs, which vary by age, sex, altitude,
smoking, and pregnancy status. Iron deficiency is thought to be the most
common cause of anemia globally, although other conditions, such as
folate, vitamin B12 and vitamin A deficiencies, chronic inflammation,
parasitic infections, and inherited disorders can all cause anemia. In its

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severe form, it is associated with fatigue, weakness, dizziness and
drowsiness. Pregnant women and children are particularly vulnerable.

i) Chronic Energy Deficiency or CED or acute undermutrition, as defined by the
World Health Organization, results from negative energy balance due to
inadequate food and nutrient intake, problems in absorption (relatively rare)
or excessive nutrient loss (e.g. due to infections and malignancies)
Undernutrition can be acute as in famine, natural disasters or man-made.
This is one of the major public health problems in SEA Region countries.

j) Severe Acute Malnutrition (SAM), as defined by World Health Organization,
having a very low weight for height (below -3z scores of the median WHO
growth standards), by visible severe wasting, or by the presence of
nutritional oedema. Decreasing child mortality and improving maternal
health depend heavily on reducing malnutrition.

k) Nutrition-specific interventions and programmes, as termed by the Scaling
Up Nutrition Movement, refer to interventions or programmes that address
the immediate determinants of fetal and child nutrition and development—
adequate food and nutrient intake, feeding, caregiving and parenting
practices, and low burden of infectious diseases

!) Nutrition-sensitive interventions and programmes, as termed by the Scaling
Up Nutrition Movement, refer to interventions or programmes that address
the underlying determinants of fetal and child nutrition and development—
food security; adequate caregiving resources at the maternal, household
and community levels; and access to health services and a safe and
hygienic environment—and incorporate specific nutrition goals and actions,
Nutrition-sensitive programmes can serve as delivery platforms for nutrition-
specific interventions, potentially increasing their scale, coverage, and
effectiveness

SEC. 5. Scaling Up Nutrition in the first 1000 days. - 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 latest 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 malnutrition

The strategy shall be formulated, within three (3) months from the effectivity of
this Act, in consultation and cooperation with other agencies, LGUs, relevant health
professionals, civil society and the private sector excluding milk companies and their
representatives, in compliance with Section 4.i. of the Revised Implementing Rules
and Regulations of the Milk Code. The health and nutrition programs shall focus on

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pregnant and lactating women as well as the health and nutrition of newborns,
infants and young children.

Sec. 6. Coverage. - This Act covers all children covered in the First 1000 days
of life from conception to age 24 months including adolescent girls, pregnant and
lactating women, particularly teen-age mothers.

This coverage prioritizes those who reside in geographically isolated and
disadvantaged areas (GIDA) and hazard/conflict-prone areas identified by DSWD
and DOST / NDRRMC respectively,

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. First 270 days (Pregnancy until birth)

Antenatal 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 to pregnant women and their family
especially on their nutrition needs and preparation for early initiation of
breastfeeding:

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;

use of iodized oil capsules in areas with low utilization of iodized salt
and high incidence of iodine deficiency disorders;

routine deworming;

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 counselling;

counseling on avoidance of tobacco smoke exposure, illicit drug use
and alcohol intake, and high-risk behavior; and

PhilHealth enrollment and linkage to community health workers and
volunteers.

Women about to give birth — Health and nutrition services shall include,
at the facility level,

* provision of mother-friendly practices during labor and delivery
in compliance with the Mother-Baby-Friendly Health Facility
Initiative (MBFHF!) and current “Unang Yakap” protocols of the
DOH;

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* uninterrupted skin-to-skin contact and non-separation of the
mother and her newborn for early breastfeeding initiation with
family support;

* nutrition counselling and provision of nutritious food and meals
at the facility; support at birth on breastfeeding initiation, most
especially for caesarian deliveries; and

+ PhilHealth benefit packages for delivery.

b. Next 180 days

(Postpartum and lactating women) - Health and nutrition services at the
community level shall include

follow-up visits to health facilities of the mother with her new born;
home visits for women in difficult to reach communities;

lactation support and nutrition counseling from birth up to two years
and beyond, including those women who will return to. work;

paid lactation breaks for women in the workplace;

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

1 day to 6 months — 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 Health Facility Initiative (MBFHFI) and
current newborn care protocols of the DOH in all birthing facilities;
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,
vitamin K, and birth doses of vaccines after the first breastfeed is
completed;

availability of human milk storage facilities for health facilities with
special newborn care units to ensure breastmilk supply for the small
babies born preterm and low birth weight;

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 marginalized and impoverished
families of infants in need of health and nutrition services and
interventions; and

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* assurance of a women-infant-child-friendly and safe space where
exclusively breastfed infants will be able to continue breastfeeding
during calamities, disasters or other emergencies.

c. Next 550 Days (6 to 24 months)- 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 at completion of six months up to 2 years of age or beyond;

* micronutrient supplementation with vitamin A capsules, iron sulfate
drops or syrups, and/or micronutrient powder;

* 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;
availability of potable source of water;

* local government support for sanitation needs of households to reduce
food-and-water-bome diseases;

* provision of nutrition counseling and support services on age-
appropriate, safe and adequate complementary food to mothers and
caregive

* social welfare support for access to nutritious and healthy food
products and commodities for families belonging to marginalized and
impoverished families;

‘* support for home kitchen gardens; and

* livelihood assistance for parents of marginalized and impoverished
families.

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

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, evaluation, accountability and learning

Advocacy and Policy development

-s @>ea0CcD

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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

Five (5) representatives from the private sector appointed by the
President of the Philippines who shall come from any of the following
(1) Civil Society Organizations coalitions, (2) academe, (3) Women or
youth groups, (4) food and nutrition industry sector, (5) urban poor, (6)
national federation of barangay health workers or barangay nutrition
scholars. Said representatives shall only serve for a term of two (2)
years

Representatived from the private sector with conflicts of interests
especially as stated in EO 51, will be inhibited from being members of the

Council.

The heads of departments may be represented by their duly designated
representatives who shall be of a rank not lower than an Assistant Secretary or
officials with the second highest relevant position in the organization or agency

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 this act with the latest
Philippine Plan of Action for Nutrition which include the strategy on
women of reproductive age, infant and young child nutrition;

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Sec.

(b) 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 concerning nutrition;

(c) 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 contrary to the
Policies or provisions of the Executive Order No. 51: "National Code of
Marketing of Breastmilk Substitutes, Breastmilk Supplement and Other
Related Products” or The Milk Code shall be made;

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

() Call upon any government agency and instrumentality for any
assistance as may be required to implement the provisions of this Act.

11. Role of Member-Agencies. - Member agencies based on their respective

mandates shall establish the framework for the overall implementation of the
program and ensure the following:

Full enforcement of Executive Order No. 51 or The Milk Code by:
strengthening the Monitoring and Reporting Mechanism of the Food and Drug
Administration, strengthening the technical capacity of the members of the
Inter Agency Committee of the Milk Code, expediting resolution of cases on
violations of the Code by the Food and Drug Administration and ensure that it
is not subjected to needless and potentially harmful ammendments
(proposed by UNICEF)

Distribute information, education and communication materials, distribute
supplements, administer check-ups and vaccinations in the different
barangays nationwide (proposed by UNICEF).

Create a plantilla position for frontline health service delivery providers such
as Municipal/City Nutrition Action Officer, Barangay Health workers and
Barangay Nutrition Scholars. LGUs shall engage other community-based
volunteers, civil society organizations and faith-based organizations and
provide adequate honoraria.

Provide sustained human resource development to health human resources,
including BHWs and BNSs, in support of local health and nutrition programs.
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)

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Network Program of the Rural Poor and other relevant approaches, thereby
strengthening delivery systems in partnership with the LGUs

* Align 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

+ Improve quality of data collection, data analysis and disaggregation and
include other available data for analysis such as Operation Timbang Plus.

The business community, with no conflict of interest with respect to good
nutrition including optimum infant and young child feeding, shall also be encouraged
to provide technical and financial assistance to facility- and community-based health
and nutrition projects though their corporate social responsibility (CSR) programs, as
part of their social accountability and participation in the country's bid to enhance
human development and human capital formation.

This type and level of participation which shall be subject to review and
approval of the NNC governing board.

To guarantee the highest integrity and public confidence in NNC, and its
activities, member agencies and entities shall disclose and manage 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, governing board
shall deliberate and decide on the appropriate course of action

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

Sec. 12. Nutrition in the Aftermath of Natural and Human-Induced
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 children specifically those from zero to two (2)
years old, and pregnant and lactating women.

No milk formula donations or products covered by the National Code of
Marketing of Breastmilk Substitutes and Breastmilk Supplements shall be allowed in
order to protect the health and nutrition of pregnant, lactating women, infants and
young children before, during and after a disaster. A joint statement by the DOH
through the Nutrition Cluster shall be issued and distributed.

In emergency situations, donations or assistance form the private sector, with
no conflicts of interest or those not covered by the Milk Code, shall be allowed
immediately in the aftermath of natural disasters and calamities. Strict compliance

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with the E.O. No. 51 or the Milk Code and its revised implementing rules and
regulations shall be observed and options for mothers with breastfeeding problems
will be provided.

The DOH and other departments, in coordination with the National Disaster
Risk Reduction and Management Council (NDRRMC), shall formulate guidelines and
mechanisms in pursuit of this Section taking into consideration Republic Act 10821
or the Children’s Emergency Relief and Protection Act.

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.

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

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