THE DOH NUTRITION PROGRAM

GROUP 1

GOALS

Investing to our people, reducing poverty and building national competitiveness;

Advancing and protecting public health
Building of capacities and creation of opportunities among the poor and;
Increasing social protection

MICRONUTRIENT PROGRAM

Micronutrient deficiencies can cause inter-generational consequences. The level of health care
and nutrition that women receive before and during pregnancy, at childbirth and immediately
post-partum has significant bearing on the survival, growth and development of their fetus and
newborn. Undernourished babies tend to grow into undernourished adolescents. When
undernourished adolescents become pregnant, they in turn, may give birth to low-birth weight
infants with greater risk of multiple micronutrient deficiencies.

Micronutrient deficiencies have considerable impact on economic productivity, growth and

national development. Widespread iron deficiency is estimated to decrease the gross domestic
product (GDP) by as much as 2% per year in the worst affected countries. Conservatively, this
translates into a loss of about Php 172 per capita or 0.9% of GDP.

Productivity losses for anemic manual laborers have been documented to be as high as 9% for
severely stunted workers and 5% and 17% for workers engaged in moderate and heavy physical
labor respectively (Micronutrient Supplementation Manual of Operations)

Mandate: AO 36, s. 2010

Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos Kalusugan
Pangkalahatan

Goal of Micronutrient:

Achievement of better health outcomes, sustained health financing and responsive health
system by ensuring that all Filipinos especially the disadvantaged group (lowest 2 income
quantiles)have equitable access to affordable health care.
Objectives:

1. Contribute to the reduction of disparities related to nutrition through a focus on

population groups and areas highly affected or at risk to malnutrition

2. To provide vitamin A capsules, iron and iodine supplements to treat or prevent specific
micronutrient deficiencies

3. Go to scale with key interventions on micronutrient supplementation, food fortification,

salt iodization and nutrient education.

4. Revive, identify, document and adopt good practices and models for nutrition
improvement.

5. Build Nutrition human resource in relevant departments/ agencies.

Scenario:

1. Child Under nutrition

The 2008 National Nutrition survey, FNRI-DOST showed a significant decline in the prevalence
of underweight-for-age under five children since 1990. However, the overall decline was not
fast enough. In 2008 a 20.6% prevalence rate was recorded which is equivalent to an average
annual percentage point decrease of 0.37%, however, it is lower than the targeted 0.55 annual
percentage point reduction from 2000 to achieve one of the targets of Millennium
Development Goal I. In addition, stunting (32.2%) among under fives (an indication of
prolonged deprivation of food and frequent bouts of infections) and wasting indicative of a lack
of food or infection or both on the hand, remained at bout the 6% from 2003 to 2008.

Maternal Under nutrition

For the past 10 years, the nutritionally-at-risk pregnant women gradually decreased since 1998,
with an average change of 0.44% per year. (FNRI National Nutrition surveys 2008)

2. Micronutrient Deficiencies

The 2008 National Nutrition Survey reported significant gains as levels of Vitamin A deficiency
among 6-months infants to 5 years old children, pregnant and lactating women but still is a
public health problem based on WHO cut off 15%. Furthermore, the prevalence rate of Iron
deficiency anemia among children decreased significantly. However, percentage levels of IDA
among infants 6 years old (55.7%) and pregnant women (42.5%) remain at levels that are
considered high as per WHO classification of <40% public health problem.
Iodine Deficiency is a public health problem among pregnant and lactating women. In 2008, the
median UIE among 6-12 year old children was 132/ug/L, indicating adequate iodine status and
only <20% of the children had UIE less than 50 ug/L. The elimination of iodine deficiency has
been sustains from 2003-2008.

Among pregnant women, the median UIE was 105 ug/L represents insufficient iodine intake.
Iodine deficiency in this group persists. While lactating women the median UIE was 81 ug/L
represents mild iodine insufficiency.

INTERVENTIONS/ STRATEGIES EMPLOYED OR IMPLEMENTED

1. Micronutrient Supplementation- is the provision of pharmaceutically prepared vitamins &

minerals for treatment or prevention of specific micronutrient deficiency.

2. Food Fortification- the addition of essential micronutrients to widely consumed food

product at levels above its normal state.

3. Improving diet/ dietary diversification- the adoption of proper food and nutrition
practices thru nutrition education food production & consumption.

4. Growth monitoring and promotion- is an educational strategy for promoting child health,
human development and quality of life through sequential measurement of physical growth
and development of individuals in the community.

STATUS OF IMPLEMENTATION/ ACCOMPLISHMENT

The following policies were formulated and implemented:

AO No. 2010-0010: revised Policy on Micronutrient Supplementation to support achievement

of 2015 MDG Targets to reduce under-five and maternal deaths and micronutrient needs of
other population groups

AO No. 2007-0045: Zinc Supplementation and reformulated Oral rehydration salt in the
Management of diarrhea among children

ASIN Law- R.A. 8172, An act promoting salt iodization nationwide and for other purposes,
signed into law on Dec. 20, 1995

Food fortification law, R.A. 8976, An act establishing the Philippine Food Fortification Program
and for other purposes mandating fortification of flour, oil and sugar with Vit A and flour and
rice with iron by November 7, 2004 and promoting voluntary fortification through the SPSP,
signed into law on November 7, 2000
Department Memorandum No. 2011-0303 Micronutrient powder supplementation for
children 6-23 months

Micronutrient supplementation manual of operations was developed to guide local, regional

and national managers and implementers in providing good quality micronutrient
supplementation services to targeted populations nationwide

ACCOMPLISHMENT

Vitamin A Supplementation 2011 Coverage

FUTURE PLAN / ACTION

1. Focus on population groups and areas affected or at-risk to micronutrient malnutrition

2. Scale up with key interventions such as micronutrient supplementation, food fortification

7 dietary diversification through food based approach

3. Development & formulation of strategic plan 2012-2016

OTHER SIGNIFICANT INFORMATION

Micronutrient supplementation is a crucial for child survival, it significantly reduces:

1. The risk from mortality by 23-34%

2. Deaths due to measles by about 50%

3. Deaths due to diarrhea by about 40%

UNIVERSAL HEALTH CARE (UHC) or Kalusugan Pangkalahatan

What is Universal Health Care (UHC) or Kalusugan Pangkalahatan (KP)?

focused approach to health implementation ensuring that all Filipinos especially the poor
receive the benefits of health reform. It is a delicate focus on the poor to ensure that they are
given financial risk protection through enrolment to Philhealth and they are able to access
affordable and quality health care and services in times of need."

What are Goals of UHC or KP?

1.Better health outcomes

2.More responsive health system

3.Equitable health care financing

What are three (3) strategic thrusts of UHC or KP?

1. Financial risk protection through expansion in NHIP enrolment and benefit delivery

2. Improved access to quality hospital and health care facilities

3. Attainment of the health-related mid decade goals (mdgs)

What are the six (6) components of UHC or KP?

1. Health Financing

2. Health Service Delivery

3. Health Human Resource

4. Health Regulation

5. Health Information System

6. Good Governance

Implementation of KP shall be undertaken in three (3) phases:

Launch Phase (August December 2011)

A. Financial risk protection through improvements in NHIP benefit delivery shall be achieved by:

Redirecting PHILHEALTH operations towards the improvement of the national and

regional benefit delivery ratios
Expanding enrolment of the poor in the NHIP to improve population coverage
Promoting the availment of quality outpatient and inpatient services at accredited
facilities through reformed capitation and no balance billing arrangements for
sponsored members, respectively
Increasing the support value of health insurance through the use of information
technology upgrades to accelerate PHILHEALTH claims processing, etc
Continuing study to determine the segments of the population to be covered for specific
range of services and the proportion of the total cost to be covered/supported

B. Improves access to quality hospitals and other health care facilities shall be achieved by:

A targeted health facility enhancement that shall leverage funds for improved facility
preparedness to adequately manage the most common cause of mortality and
morbidity including trauma
 Provision of financial mechanism drawing from public-private partnership support the
immediate repair, rehabilitation and construction of selected priority health facilities
Fiscal autonomy and income retention schemes for government hospitals and health
facilities and health facilities
Unified and streamed lined DOH licensure and PhilHealth accreditation for hospitals
. Regional clustering and referral networks of health facilities based on their catchment
areas to address the current fragmentation of health services in some regions as an
aftermath of the devolution of local health services

C. Health related mdgs shall be attained by:

Deploying community Health Teams that shall actively assist families in assessing and
acting on their health needs
Utilizing the life cycle approach in providing needed services , namely family planning;
ante-natal care; delivery in health facilities ; essential new-born and immediate
postpartum care; and the Garantisadong Pambata package for children 0-14 years of
age
Aggressively promoting the healthy lifestyle changes to reduce non-communicable
diseases
Enduring public health measures to prevent control of communicable diseases, and
adequate surveillance and preparedness for emerging and re-emerging diseases
Harnessing the strengths of inter-agency and inter-sectoral to health especially with the
Department of Education and Department of Social Welfare and the Department of
Interior and Local Government.

Copyright 2017 . All Rights Reserved.

Center for Health Development Cagayan Valley

FOOD FORTICATION PROGRAM

Objectives:

1. To provide the basis for the need for a food fortification program in the Philippines: The
Micronutrient Malnutrition Problem

2. To discuss various types of food fortification strategies

3. To provide an update on the current situation of food fortification in the Philippines

Fortification as defined by Codex Alimentarius

the addition of one or more essential nutrients to food, whether or not it is normally
contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of
one or more nutrients in the population or specific population groups

Vitamin A, Vitamin A Deficiency (VAD) and its Consequences

Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth,
reproduction and immune competence
Vitamin A deficiency - a condition characterized by depleted liver stores & low blood
levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor
absorption or utilization of vit. A in the body
VAD affects childrens proper growth, resistance to infection, and chances of
survival (23 to 35% increased child mortality), severe deficiency results to blindness,
night blindness and bitots spot

Iron and Iron Deficiency Anemia (IDA) and its consequences

Iron - an essential mineral and is part of hemoglobin, the red protein in red blood cells
that carries oxygen from the lungs to the cells
Iron Deficiency Anemia - condition where there is lack of iron in the body resulting to
low hemoglobin concentration of the blood
IDA results in premature delivery, increased maternal mortality, reduce ability to
fight infection and transmittable diseases and low productivity

Iodine and Iodine Deficiency Disorders (IDD)

Iodine -a mineral and a component of the thyroid hormones

Thyroid hormones - needed for the brain and nervous system to develop & function
normally
Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy
of dietary iodine for the thyroid hormone resulting into various condition e.g. goiter,
cretinism, mental retardation, loss of IQ points

Policy on Food Fortification

ASIN LAW

Republic Act 8172, An Act Promoting Salt Iodization Nationwide and for other purposes,
Signed into law on Dec. 20, 1995
Food Fortification Law

Republic Act 8976, An Act Establishing the Philippine Food Fortification Program and for other
purposes mandating fortification of flour, oil and sugar with Vitamin A and flour and rice with
iron by November 7, 2004 and promoting voluntary fortification through the SPSP, Signed into
law on November 7, 2000

Status of the Philippine Food Fortification Program

Status and Recommendations for the Sangkap Pinoy Seal Program

There are 139 processed food products with Sangkap Pinoy Seal with 83% with vitamin A, 29%
with iron and 14% with iodine (2008)

37% of the products are snack foods

Most of the products FDA analysed are within the standard

Based on 2003 NNS Households awareness of SPS- and FF-products is 11% and 14%,
respectively, in 2008 awareness is 11.6%

Although awareness is low, usage of SPS-products is 99.2%

Recommendations:

Review voluntary fortification standards as standards were developed prior to mandatory

fortification

Conduct in-depth analysis of the coverage of Sangkap Pinoy Seal of the 2008 NNS

Update list of Sangkap Pinoy Seal products as some companies have stopped using the seal in
their products

Intensify promotions of Sangkap Pinoy Seal

Status and Recommendation on Flour Fortification with Vitamin A and Iron

Status:

Based on FDA monitoring all local flour millers are fortifying with vitamin A and iron

94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A and iron
respectively while 77% and 99% were fortified with vitamin A and iron respectively. In 2010
decrease in vitamin A due to non-fortified imported and market samples flour.
 58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified
according to standards.

Recommendations:

Review fortificants for iron and possible other micronutrients to be added to wheat flour

Continue monitoring wheat fortification

Assist flour millers to improve quality of fortification

Need to show impact of flour fortification

Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A

Status:

Non fortification by industry due to the unresolved issue of who will bear the cost of
fortification brought about by the quedan system of transferable certificates of sugar
ownership.

Lack of premix production

Fortification of refined sugar would benefit mainly those in the high income group.

Recommendations:

Continue discussions with sugar industry to explore a compromise for fortification ie.
fortification of washed sugar

Review policy on mandatory fortification of refined sugar

Status and Recommendations on Rice Fortification with Iron

Status:

NFA is fortifying 50% of its rice in 2009 and 2010

With the non fortification of NFA rice, private sector has an excuse for non fortification of
its rice.

There is limited commercial/private sector iron rice premix and iron fortified rice production
and distribution mostly in Mindanao (Region XII and XI) with Gen San having the only
commercial iron rice premix plant in the Philippines and Davao City implementing mandatory
rice fortification in food outlets
 NFA conducted communications campaign for its iron fortified rice thru the so called I-rice
campaign though issues remain on the acceptability of its product

Recommendation:

Review of mandatory fortification of rice with iron

Status and Recommendations on Cooking Oil Fortification with Vitamin A

Status:

Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in
2009 and 94% in 2010)

Samples monitored were labeled and packed

FDA is not monitoring "takal"

Recommendations:

To increase frequency of monitoring by FDA and other agencies such as PCA and LGUs, to
ensure all oil refiners and repackers are monitored at least once a year

Monitoring of takal oil, use of test kit

Monitoring imported oil, FDA and BOC to coordinate

Review policy of mandatory fortification of oil to possibly limit to those mostly used by at risk
population (coconut and palm oil)

Status and Recommendations on Salt Iodization

Status:

Based on the 2008 NNS, 81.1% of households were positive for iodine using Rapid Test Kit (RTK)

In the same survey for Region III, 55.7% were positive for RTK but only 34.2% and 24.2% have
iodine content >5ppm and >15ppm respectively using WYD Tester

For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm

FDA started implementing localization of ASIN Law with General Santos City as the 1stto have a
MOA with FDA on localization