( HOUSE OF REPRESENTATIVES:
RECEIVED

Republic of the Philippines j

DATE:
TINE:,

SEVENTEENTH CONGRESS BY:
First Regular Session

1805

REGISTRATION UNIT
BILLS AND INDEX SERVICE
HOUSE BILL NO.

Introduced by HON. SANDRA Y. ERIGUEL, M.D.

EXPLANATORY NOTE

This Bill, which was previously filed in the 16% Congress and approved in the
committee level, seeks to establish a comprehensive and sustainable strategy to address the
health and nutrition problems affecting pregnant and lactating women, infants and young
children.

The Constitution in Section 15 of Article II provides that “the State shall protect and
promote the right of health of the people and instill health consciousness among them.” It also
provides in Section 12 of Article II that “The State recognizes the sanctity of family life and
shall protect and strengthen the family as a basic autonomous social institution. It shall equally
protect the life of the mother and the life of the unborn from conception.”

The first one thousand (1000) days of a child’s life,

from the time of conception
through the nine months of pregnancy until the child reaches two years of age, is proven to be
the most crucial time in human life. Nutrition during pregnancy and the first two years of the
child’ life is the foundation for a person’s lifelong health and provides the essential building
blocks for his long-term development.

In answer to this concern, this Bill shall provide for strategies or programs that shall

answer our country’s problems in malnutrition, prenatal care, and newborn care by providing
for health and nutrition services and interventions for women, infants, and young children. The
program shall include human health resource and capacity development, and sectoral

collaboration and partnerships. More importantly, this Bills aims to strengthen the National


Nutrition Council as the primary policy-making body on nutrition, and shall ensure the

‘meaningful and active participation of other national government agencies, local government

units, non-government organizations, and the private sector in the promotion of the nutritional

wellbeing of the country’s populace.

In view of the foregoing, the passage of this Bill is earnestly sought.

rows B bregncl
SANDRA Y. ERIGUEL, M.D.
Second District, La Union


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

SEVENTEENTH CONGRESS
First Regular Session

House Bill No. 1805

Introduced by HON. SANDRA Y. ERIGUEL, M.

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 I. 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, 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,
which are crucial in preventing malnutrition,

. the nine months in the womb and the first 24 months of his/her life

SEC. 3. Objectives. —This Act specifically aims to:
., sustainable and multisectoral approach to address

a) Provide a more comprehensi

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;

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

¢) 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 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;


4d) 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;

¢) 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-
WHO Child Growth Standard median.

for-height which is less than negative 2 SD of the

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 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), 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 interver

offered are the follo



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;

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

mm;
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 postpartum 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 facilities; maintenance

of non-separation and observance of rooming-in of the mother and her newborn for
carly 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 paste

1 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 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 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 gardens; and

livelihood assistance for parents of families belonging to poorest of the poor.

SEC. 8. Program Components - The strategy or program on Health and Nutrition shall

include the following components:



Health human resource and capacity development

oP

Health and nutrition investment planning and finaneing

Service Delivery

ee

Sectoral collaboration and partnerships
Logistics and supply management
Knowledge management and information technology

Health promotion and education, social mobilization and community organization

FR moe

Monitoring and evaluation

n of the NNC Governing

Board as stipulated in Executive Order No. 234 is hereby amended and the same shall now

SEC. 9. The National Nutrition Council. - The composi

be composed of the following:

a) Secretary of Health (Chairperson);

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

©) Secretary of Agriculture

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

€) Secretary of the Department of Education;

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

2) Secretary of the Department of Budget and Management;

h) Secretary of the Department of Trade and Industry;

i) Secretary of the Department of Finance;

) Secretary of the Department of Labor and Employment;

k) Chairperson of the Philippine Commission on Women

1) 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) Chair, National Anti-Poverty Commission

©) Three representatives from the private sector to be appointed by the President of the
Bail

profession sector, 2) women sector, 3) food and nutrition industry sector; 4. urban

ippines who shall come from any of the following: 1) health and nutrition

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 ofa 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, Funetions 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 integr

n 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

and projects: Provided, That no conditions shall be made contrary to the policies or
provisions of this Act;

€) 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

) Call upon any government agency and instrumentality for such assistance as may be

required to implement the provisions of this Act.

See. 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



(ie., the member agencies and entities will not be able to participate in any part of the

meeting or work).
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.

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 (NDRMMC) is hereby mandated to formulate

jidelines 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 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. Effectivit
in the Official Gazette or in a newspaper of general circulation.

This Act shall take affect fifteen (15) days after its publication

Approved,