HOUSE oI

RECEIVED
Republic of the Philippines j
HOUSE OF REPRESENTATIVES pare:_04 Jul 2016
Quezon City we: 7

SEVENTEENTH CONGRESS BY. te
First Regular Session
833 RESISTRATION UNIT
HOUSE BILLNO. OV | Bit s aNv INDEX SERVICE

Introduced by: Hon. Angelina “Helen” D.L. Tan, M.D.

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

EXPLANATORY NOTE
The 1987 Constitution enshrines the right to health of every Filipino. Specifically, in

Section 15, Article 2, it emphasizes that "The State shall protect and promote the right to health
of the people and instill health consciousness among them."

‘The 2011 Nutritional Status of Filipino Children conducted by the Food Nutrition and
Research Institute reveals that 20 percent of children zero to five years old are underweight.
Meanwhile, 33 percent of this age group are stunted, and about two percent are overweight.
‘There is no significant difference whether the household head is a man or a woman. In absolute
terms, data according to the UN Report on the State of Food Insecurity in the World 2012, six
(©) million Filipino children are malnourished. The FNRI states that the country's progress
towards achieving the Millennium Development Goal of reducing undernutrition in children by
50% in 2015 is behind schedule.

The United Nations has estimated that six million Filipino children are malnourished
and around 66 % under the age of six do not have childcare. A survey of the Social Weather
Station (SWS) for the Third Quarter of 2012 citing that 21% or at least 4.3 million households
experienced having nothing to eat in the last three months prior to the survey period.
Malnutrition has long been a serious concern in Mindanao where a significant number of
children are already undernourished, as cited by the UNICEF.

In the last three years, the national government expenditure for social services has gone
up by an annual average of 19.2 percent. The share of social services to the total budget has also
increased, from 28.2 percent in 2010 to 34.8 percent in 2013.

‘This is mainly due to the increase in the funding for social security welfare and
employment, particularly the Pantawid Pamilyang Pilipino Program (4Ps). In 2013 alone, the
budget for social services is nearly PhP700 billion. While the budgets for health and education
also saw a substantial increase, they are still well below international standards. The World
Health Organization (WHO) recommends 5 percent of GDP for health spending.

‘A good indicator of the government's under-investment in human capital formation is
malnutrition, which has long been a perrenial problem in the country. This demonstrates the
quality and state of delivery of public services in the country and the magnitude of the poverty
situation.

The country's quest for inclusive growth will not be realized unless malnutrition is
sustainably addressed. The FNRI emphasizes that the first 1,000 days of a child's life is crucial
in preventing malnutrition. Otherwise, the child's health and educational outcomes
be compromised. What this means is a generation of Filipinos unable to contribute to the
country's competitiveness in the local and global labor markets. Undoubtedly, the situation is
urgent and calls for a comprehensive policy that will seek to sustainably address program,
budgetary and policy gaps, and complement earlier initiatives.

The first 1,000 days of a child’s life is most critical for growth and development within
which hunger and poor nutrition can have irreversible consequences. The first 1,000 days is the
period that begins with day one of a woman's pregnancy until her child's 2nd birthday. The
brain and nervous system development begins early in pregnancy and is largely complete by the



time the child reaches the age of two (2).

Malnutrition during this critical period of development for a child has not been
adequately addressed in the Philippines. Although there are supplementary feeding programs
which are undertaken by the DSWD and the DepED, these programs target children of two years
and older, when children are already in either Day Care or Elementary school.

It is obvious that poverty is one of the driving causes for this situation. Hence, what is
needed is a program to combat malnutrition during the first 1,000 days, specifically targeting
the vulnerable sectors.

‘This bill seeks to establish a mother and child health care program in every barangay in
order to protect mothers and children from malnutrition. Maternal nutrition is vital because the
health to the mother while pregnant, affects the development of the fetus. There is an imperative
need to provide prenatal and postnatal maternity care service to a pregnant woman in order to
protect her health as well as ensure the nutritional diet of her newborn child to eradicate
malnutrition.

Though hunger and malnutrition in children of any age are alarming public health
issues, intervention during the 1,000-day window is critical and deserves our urgent attention,
hence, approval of this bill is earnestly sought.

(Gin

ANGELINA “HELEN” D.L. TAN, M.D.
4th District, Quezon


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

838
HOUSE BILL NO, _ Ove

Introduced by: Hon. Angelina “Helen” D.L. Tan, M.D.

AN ACT STRENGTHENING THE NATIONAL AND LOCAL HEALTH AND
NUTRITION PROGRAMS FOR PREGNANT AND LACTATING WOMEN, INFANTS
AND YOUNG CHILDREN IN 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 international human rights instruments and agreements
that the State adheres to, the State guarantees the right to adequate food, care and nutrition to
children, especially 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, specifically, the nine months in the womb and the first twenty-four (24)
months of his/her life, which are crucial in preventing malnutrition.

SEC.

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;

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

(a) Strengthen the
nutrition; and

tional Nutrition Council (NNC) as the policy-making body on

(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 5.5 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 zine, The deficiency of these micronutrients may result in: vitamin A deficiency (VAD), iron
deficiency anemia (IDA), iodine deficiency disorders (IDD);

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

@) _ Stunting refers to low height-for-age which is less than negative two (2) 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; and,

f) 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 NC
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 malnutrition. ‘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 all Filipino children from birth to age 24 months
who reside in geographically isolated and disadvantaged areas (GIDA) such as those 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 counselling; 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
counselling 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;


‘ey 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 counselling from birth up to two
years and beyond, including those women who will return to work; nutrition counselling 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 familie

4. Newborn infants up to first six (6) months or one hundred eighty days (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 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 and vitamin K; availability of human milk pasteurizer for tertiary level
facilities with neonatal intensive care units to ensure breastmilk 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 familie 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 counselling 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 garden:
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:

a. Health human resource and capacity development

b. Health and nutrition investment planning and finaneing

©. Service Delivery

Sectoral collaboration and partnerships

e. Logistics and supply management

f. Knowledge management and information technology

8. Health promotion and education, social mobilization and community
organization

h. 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) Secretary of Health as the Chairperson;

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

(c) Secretary of Agriculture;


(d) Secretary of the Department of Social Welfare and Development;

(c) Secretary of the Department of Education;

(f) Secretary of the Department of Science and Technology ~ Food and Nutrition
Research Institute (FNRD;

(g) Secretary of the Department of Budget and Management;

(h) Secretary of the Department of Trade and Industry;

(i) Secretary of the Department of Finance;

G)__ Secretary of the Department of Labor and Employment;

(k) Chairperson of the Philippine Commission on Women;

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

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

(n) Chairperson of the National Anti-Poverty Commission;

(0) 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

profession 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 shail 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;

(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;

(©) 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

(Q) Call upon any government agency and instrumentality for such assistan
required to implement the provisions of this Act.

as may be

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 shalll 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 (BIDANT) 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, 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 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 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; or (c) mandate total exclusion

A summary 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.

No milk formula donations or products covered by the National Code of Marketing of
Breastmilk Substitutes and Breastmilk Supplements shall be allowed to protect the health and
nutrition of pregnant, lactating women, infants and young children,

Donations or assistance of private sector, with no conflict of interest or those not covered
by the Milk Code, in emergency situations shall be allowed immediately in the aftermath of
natural disasters and calamities. The National Disaster Risk Reduction and Management
Council (NDRMMC) is hereby mandated to formulate guidelines in pursuit of this Section with
guidance from the DOH. National and local disaster tisk 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 Secretaries 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 (15) days after its publication in the
Official Gazette or in a newspaper of general circulation.

Approved,