| RSME
Republic of the Philippines DATE:

HOUSE OF REPRESENTATIVES [aT
Quezon City, Metro Manila rime __t700M

SEVENTEENTH CONGRES
First Regular Session

iS

RESISTRATION UNIT
BILLS AND INDEX SERVICE
House Bill No, 831.0

Introduced by DIWA Party-list Representative Emmeline Y. Aglipay - Villar

EXPLANATORY NOTE

In the Philippines, ninety five children die every single day due to malnutrition, The state
of a child’s health depends on a healthy mother during pregnancy and even prior to conception.
‘Thirty-two million babies are born Small for their Gestational Age and fetal growth restrictions

cause more than 800,000 deaths each year in the first month of life, which accounts for more
than 25% of all newborn deaths. Many of these tragedies could be prevented if mothers are
given proper care during pregnancy. During pregnancy mothers should be receiving optimum
amounts of folic acid, protein, calcium and other micronutrients in order to ensure the proper
growth and development of the fetu

rictions are at an increased risk of being stunted at
twenty-four months and developing non-communicable diseases in adulthood, Undernutrition
due to fetal growth restrictions, suboptimum breastfeeding or total absence of breastfeeding, and
vitamin and mineral deficiencies, among others, causes 45% of all deaths of children below five
years of age. This strengthens the case for particular attention to be given during the first 1000
sdoys.o€a childs lisp. fom cavepationstatilitbe.secand year

Newborns with fetal growth res

From conception in the womb until the first two years of a child's life are vital for the
child's future mind and body development. It can be difficult for parents, especially new parents.
to navigate the recommendations from literature, the media, friends, and family, with regard to
the proper nutrition for the child, Without the proper guidance and support, malnutrition is a real
Uireat to many Filiprio children,

This bill is the output of a series of consultations with stakeholders such as civil service
organizations, international agencies (including UNICEF), developing partners and government
agencies like Department of Health. The bill seeks to assist parents in providing the best possible
nutrition for the mother and her children by establishing a staggered, primarily community
based, nutrition education and support program for the first thousand days of life of each child,
from conception until two years of age.

ee as
EMMELINE Y. AGLIPAY — VILLAR
Representative, DIWA Party-list

HOUSE YF R<PRESENTATIVES


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

SEVI TH CONGRESS.

irst Regular Session

3105

House Bill No,"

Introduced by DIWA Party-list Representative Emmeline Y. Aglipay ~ Villar

AN ACT

"ALING UP NUTRITION DURING THE FIRST 1000 DAYS OF LIFE,

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

SECTION 1. Tide. ~ This Act shall be known as the “First 1,000 Days Act”,

See. 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 Economie, Social and Cultural Rights, the United Nations
Convention on the Rights of a Child and to the Sealing 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
‘ned development, It is a multi-faceted issue requiring committed inputs from all
all be a priority of the government to be implemented by all its

achieve st
sectors. As such, nutrition s
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-
is old

yea

The State finally refocuses the intervention program on malnutrition to the first 1,000 days of a
child’s life, ie, the nine months in the womb and the first 24 months of his/her life which is
considered to be thecritical window of opportunity to prevent malnutrition and life-lony
consequences.



See. 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 Intemational Covenant on
the Beonomie, Social and Cultura Rightsinternationat Convention on the Rights of the Chitd
(CRC), A Promise Renewed, Sealing 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 alsoGoal 3 which states that it aims to ensure
healthy lives and promote well-being for al.

(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 Couneil (NNC) and
other agencies tasked to implement the First 1000 Days Act,

(c) 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,

(#) Strengthen enforcement of the Milk Code (Executive Order Number $1), 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 $ years old

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

a) Geographically isolated and disadvantaged areas(GIDA) areareas that ate isolated due

to distance, weather conditions and transportation, unserved and underserved
identified to have high incidences of poverty, presence of
or armed

communities and other are:
vulnerable sector, communities in or recovering from situation of cris
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), iton deficiency anemia (IDA), iodine deficiency
disorders (IDD) among others;

d) Overweight and obesity are defined as abnormal or excessive fat accumulation that
may impair health, Body mass index (BMI) is a simple index of weight-for-height that

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e)

h)

kK)

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

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

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

‘Wasting or thinness indicates in most eases 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

for-height which is less than negative 2 SD of the WHO Child Growth Standard

weight
median,

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
severe Form, its associated with fatigue, weakness, dizziness and drowsiness, Pregnant
women and children are particularly vulnerable

Chronic Energy Deficiency or CED or acute undernutrition, as defined by the World
Health Organization, results from negative energy balance due to inadequate food and

) oF excessive nutrient loss (

nutrient intake, problems in absorption (relatively rau
due to infections and malignancies). Undernutrition ean be acute as in famine, natural
ide. This is one of the major public health problems in SEA Region.

disasters or man-m
countries,

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,

Nutrition-specific interventions and programmes, as termed by the Sealing 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 Sealing Up
Nutrition Movement, refer (o interventions or programmes that address the underlying
determinants of fetal and child nutrition and development— food security; adequate
Is; and access to

caregiving resources at the maternal, household and community |
health services and a safe and hygienic environment—and incorporate specific
nutrition goals and actions, Nutrition-sensitive programmes can serve as delivery

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platforms for nutrition-specific interventions, potentially increasing thei scale,
coverage, and effectiveness

Sed. 5, Scaling Up Nutrition in the first 1000 days.~ Ther
sustainable strategy to address the health and nutrition problems in the country affecting

shall be a comprehensive and

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 Actin
consultation and cooperationwith other agencies, LGUs, relevant health professionals
society and the private sector excluding milk companies and their representatives, in compliance
with Section 4., of the Revised Implementing Rules and Regulations of the Milk Code. 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

civil

s 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_
respective

See. 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 (Pregnaney until birth)

i, Antenatal care services at the barangay level of each local government unit shall
inchide:

1. pregnaney tracking and enroliment to prenatal care service

regular follow up to complete minimum of four (4) prenatal care visits;

3. identification of nutritionally-at-risk pregnant women;

4, provision of nutrition counseling to pregnant women and their family especially
on their nutrition needs and preparation for early initiation of breastfeeding,

5, 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 familie

6. provision of micronutrient supplements with ferrous sulfate-folic aci
7. use of iodized salt and fortified-rich foods;

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

routine dewormin,

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

breastfeeding counsellinj

plans

. counseling on avoidance of tobacco smoke exposure, illicit drug use and aleohol

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,

1, provision of mother-thiendly practives during fabor and defivery in
compliance with the Mother-Baby-Friendly Health Facility Initiative
(MBFHFI) and current “UnangYakap” protocols of the DOH:

uninterrupted skin-to-skin contact and non-separation of the mother and

her newborn for early breastfeeding initiation with family support;

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

4, PhilHealth benefit packages for delivery,

b, Next 180 days

i

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 communit

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

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N
shall

1

organization of community-based mother support groups and/or peer counselors
for breast

ing in cooperation with other health and nutrition workers,

1" day to 6 months ~ Health and nutrition services shall inelude, at the facility
level

the provision of baby-friendly practices during delivery in compliance with the
Mother-Baby-Friendly Health Facility Initiative (MBFHEI) and current newborn,
care protocols of the DOH in all birthing f

cilities;

naintenance 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
newbom care units to ensure breast milk supply for the small babies born preterm
and low birth weight;

PhiltLealth 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 welfure servives to margit
infants in need of health and nutrition services and interventions; and

ized and impoverished families of

assurance of a women-infant

hild-friendly and safe space where exclusively
breastfed infants will be able to continue breastfeeding during calamities,
disasters or other emergencies.

550 Days (6 t0 24 months)~ Health and nutrition services at the community level
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 powders

‘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;

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6. provision of deworming tablets for children at 1-2 years of age;
7. availability of potable source of water;

8. local government support for sanitation needs of households to reduce food-and-
water-borne diseases;

9. provision of nutrition counseling and support services on age-appropriate, safe
and adequate complementary food to mothers and caregivers;

10. social welfare support for

to nutritious and healthy food products and
commodities for families belonging to marginalized and impoverished famili

11. support for home kitehen gardens; and

12, livelihood assistance for parents of marginalized and impoverished families,

See. 8. Program Components - ‘The strategy or program on Health and Nutri
the following component

jon shall include

a. Health human resource and capacity development
bb, Health and nutrition investment planning and financing
©. Service Delivery

d, Sectoral collaboration and partnerships

Logistics and supply management

£ Knowledge management and information technology

4 Health promotion and education, social mobilization and community organization
h, Monitoring, evaluation, accountability and learning,

i, Advocacy and Policy development

See. 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 (Chairperson);

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

(c) Secretary of Agriculture

(4) Secretary of the Department of Social Welfare and Development:

(e) Secretary of the Department of Education;

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retary of the Department of Scien
Research Institute (FNRI);

e and Technology ~ Food and Nutrition

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 Ei
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 Seeretary or off

Is with the second highest relevant

positionin 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.

See, 10. Functions of NNC.--The NNC shall have the following functions and powers

(a)

(b)

(cc)

Formulate national nutrition poticies, plans, strategies and approaches for
nutrition improvement in accordance this act with the latest Phifippine Plan of
Action for Nutrition which include the strategy on women of reproductive age,
infant and young child nutrition;

Oversee and serve as 4 focal point in the integration of nutrition policies and
programsof 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, hung

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mitigation, food fortification and national salt iodization programs, among others,
and ensure their integration with national policies;

(Receive grants, donations and contributions, in any form, from foreign
governments, private institutions and other funding entities for nutrition
progeams 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 publie funds for the promotion of the nutritional well-
being of vulnerable groups in accordance with the approved programs and
projects; and

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

See, 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

(a) Full enforcement of Executive Order'No. 51 or’ The Mitk 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 eases 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)

(b) 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,

(d) Provide sustained human resource development to health human resource
BHWs and BNSs, in support of local health and nutrition programs,

neluding

(c) Intensify health and nutrition-related

ining, research and extension support
activities 10 suppor the First 1000 Days Prograin 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

(1) Align related programs to the priorities and directions of the Philippine Plan of

Action for Nuttition and the Strategy for Women, Infant, and Young Child Nutrition.
NGOs shall also be encouraged to undertake health and nutrition-related researches in
Jine with the First 1000 Days in collaboration andeoordination 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

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(g) 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 ‘participa
governing board

jon which shall be subj

ct to review and approval of the NNC

‘Yo guaramee the highest imegrity and public confidence in NNC, and its activities, memiver
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

‘A summary 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 Breastmnitk Supplements shall be allowed in order to protect the
health and nutrition of pregnant, lactating women, infants and young childrenbefore, 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 with the E.0. No. $1 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 guidetines and mechanisms in pursuit of this
Section taking into consideration Republic Act 10821 or the Children’s Emergency Relief and
Protection Act.

See. 13. Implementing Rules and Regulations ~ Withia. 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

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See. 14. Appropriation. The amount necessary 10 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

See. 15. Repealing Claus
lent with the provisions of this Act are hereby repealed, amended or modified

All laws, decrees, executive orders, administrative orders or parts

thereof incon
accordingly.

16. Effectivity, This Act shall take al
Gazette or ina newspaper of general circulation,

n (15) days after its publication in the Official

Approved,

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