Ipnap Report Final Version 30April2018F

Prepared for
INFANT AND PEDIATRIC ASSOCIATION OF THE PHILIPPINES, INC. (IPNAP)
Prepared by
PHILIPPINE NGO SUPPORT PROGRAM, INC. (PHANSUP)

April 2018
CONTENTS
Title Page i
Contents ii
Acronyms iv
Executive Summary vii
A. Introduction 1
A.1 Background 1
A.2 Purpose and Objectives 2
A.3 Scope of Work and Deliverables 2
A.4 Methodology and Analytical Framework 3
A.5 Limitations 7
B. Assessment Findings 8
B.1 Review of Library and Online Documents 8
B.1.1 Global and National Situation on Child Nutrition 8
B.1.2 Approaches in Promoting Community Health and Nutrition 13
B.1.3 Role of Information Management System in Nutrition Programs 16
B.1.4 Considerations in the Design and Development of Information 18
Management Systems
B.1.5 Overview of Past, Current and Future Initiatives on Health 19
Information Management Systems
B.2 Key Informant Interviews 22
B.2.1 Provincial Level Key Informants (System Users) 22
B.2.2 National Level Key Informants (System Developers) 35
B.3 Focus Group Discussion 43
C. Discussion and Analysis 48

C.1 Child Nutrition Situation 48
C.2 Health Information Management Systems 49
C.3 Health and Nutrition Interventions and Approaches 53
D. Conclusions, Implications and Recommendations 55

D.1 Conclusions and Implications 55
D.1.1 On Contextual Factors 55
D.1.2 On Stakeholders’ Needs 57
D.2 Recommendations 59
E. Annexes 62
Annex 1: List of KII and FGD Participants 62
Annex 2: eHATID Electronic Medical Record Data Sets 64
Annex 4: Description of Nutrition and Nutrition-related Information 73
Systems in Negros Oriental
Scoping Assessment on the Design and Development of an Electronic Child Nutrition Information
ii Management Module for Negros Oriental: Final Report
Annex 5: Description of Health and Nutrition-related Information Systems 76
Developed by National Agencies
Annex 6: Programmatic Recommendations to Enhance NegOr’s Nutrition 80
Interventions
Annex 7: Composition of the PHANSUP Consulting Team 85
F. References 86
List of Tables
Table 1. Scope of work and deliverables. 3
Table 2. Respondents at national and provincial levels. 4
Table 3. Mandates, functions and roles of some PNC members in relation 23
to nutrition programs.
Table 4. Information-related initiatives on nutrition. 26
Table 5. Experiences, challenges and recommendations of key 27
informants in nutrition and nutrition-related programs.
informants in nutrition and nutrition-related information
systems.
informants in the implementation of local nutrition programs
and information systems in Tayabas City.
Table 8. Organizational mandates and nutrition information systems of 35
selected national agencies.
Table 9. Experiences, challenges and recommendations of national 38
agency key informants on nutrition-related information systems.
Table 10.Proposed intermediate outcomes of the Provincial Nutrition 46
Program.
Table 11.Comparative nutrition data in Negros Oriental. 48
Table 12.Expressed needs vis-à-vis functions of identified stakeholder 58
groups.
List of Figures
Figure 1. Framework of analysis. 6
Figure 2. Prevalence of undernutrition among children, less than five (5) 12
years old, 2013 vs. 2015.
Figure 3. Prevalence of undernutrition among children, 5-10 years old, 12
2013 vs. 2015
Figure 4. Prevalence of undernutrition among children, 10-19 years old, 13
2013 vs. 2015
Figure 5. WHO health system ‘building blocks’ and desired outcomes. 45
Figure 6. Key elements of IPNAP’s recommended development 60
assistance package.
iii Management Module for Negros Oriental: Final Report
ACRONYMS
ADMU Ateneo de Manila University
ANC Ante Natal Care
BHW Baragay Health Worker
BNAP Barangay Nutrition Action Plam
BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
CDD Control of Diarrheal Diseases
CEST Community Empowerment through Science and Technology
CHC City Health Center
CHITS Community health Information Tracking System
CHO City Health Officer
CHT Community Health Team
CNAO City Nutrition Action Officer
CNC City Nutrition Committee
CROWN Consistent Regional Outstanding Winner in Nutrition
DBM Department of Budget and Management
DCC Day Care Center
DCW Day Care Worker
DepEd Department of Education
DICT Department of Information and Communication Technology
DILG Department of the Interior and Local Government
DOH Department of Health
DOST Department of Science and Technology
DSWD Department of Social Welfare and Development
DTTB Doctor to the Barrios Program
EBEIS Enhanced Basic Education Information System
EBF Exclusively Breast Feeding
ECCD Early Childhood Care and Development
EFR Emergency Food Relief
E-HATID E-Health Tablet for Informed Decision-making of LGUs
EMR Electronic Medical Record
EPI Exocrine Pancreatic Insufficiency
E-OPT Electronic Operation Timbang
F1K First 1,000 Days
FGD Focus Group Discussion
FHSIS Field Health Services Information System
FNRI Food and Nutrition Research Institute
FP Family Planning
GAA General Appropriations Act
GIDA Geographically Isolated and Disadvantaged Area
iv Management Module for Negros Oriental: Final Report
GPAK Gulayan at Palayan Alay sa Kabataan
HUC Highly Urbanized Cities
I-CLINICSYS Integrated Clinic Information System
ICT Information and Communication Technology
IPC Institute of Popular Culture
IPHO Integrated Provincial Health Office
IPNAP Infant and Pediatric Nutrition Association of the Philippines, Inc.
IT Information Technology
IYCF Infant and Young Child Feeding
KAP Knowledge, Attitude, Practice
KI Key Informant
KII Key Informant Interview
KMITS Knowledge Management and Information Technology Service
LGU Local Government Unit
LNAP Local Nutrition Action Plan
LIS Learner Information System
M&E Monitoring and Evaluation
MAPE Music, Arts and Physical Education
MELLPI Monitoring and Evaluation of Local Level Plan Implementation
MCH Maternal and Child Care
MNC Municial Nutrition Committee
NCR National Capital Region
NEDA National Economic and Development Authority
NegOr Negros Oriental
NEHP National Electronic Health Program
NOFDC Negros Oriental Federation of Dairy Cooperatives
NNC Nationaal Nutrition Council
NNS National Nutrition Survey
OPT Operation Timbang
PAO Provincial Agriculturist’s Office
PCB Primary Care Benefit
PCHRD Philippine Council for Health Research and Development
PHADP Public Health Associate Deployment Program
PHANSUP Philippine NGO Support Program, Inc.
PHIC Philippine Health Insurance Corporation
PHIE Philippine Health Information Exchange
PHILHEALTH Philippine Health Insurance Corporation
PHO Provincial Health Office
PNAO Provincial Nutrition Action Officer
PNC Post Natal Care
PNC Provincial Nutrition Committee
v Management Module for Negros Oriental: Final Report
PPAN Philippine Plan of Action for Nutrition
PSA Philippine Statistics Authority
PSWDO Provincial Social Welfare and Development Office
RHU Rural Health Unit
SDG Sustainable Development Goals
SHINE-OS Secured Health Information Network and Exchange
SGLG Seal of Good Local Governance
TB Tuberculosis
TLE Technology and Livelihood Education
TOR Terms of Reference
TSEK-AP Tamang Serbisyo Para sa Kalusugan ng Pamilyang Pilipino
UNICEF United Nations Children Fund
WAH Wireless Access for Health Initiative
WB World Bank
WHO World Health Organization
4Ps Pantawid Pamilyang Pilipino Program
vi Management Module for Negros Oriental: Final Report
EXECUTIVE SUMMARY
The scoping assessment was initially intended to determine the ‘considerations’ in the design and
development of the proposed LGU-based electronic child nutrition information management
module in Negros Oriental Province. However, after initial key informant interviews, it was
apparent that an information management module is not a key priority as the province is already
using information management systems (i.e., iclinicsys and eOPT+) as mandated by the national
government. This was subsequently confirmed by the focus group discussion participated in by
members of the Provincial Nutrition Committee (PNC) where they articulated key actions to
address the province’s malnutrition problem. As such, the purpose of the assessment was
expanded to also determine the most appropriate assistance package that may be provided by
IPNAP considering its own organizational mandate, capabilities and program strategies.
The Philippines is one of the countries with high prevalence of stunting and wasting of children
under five (5) years old. Micronutrient deficiencies in Vitamin A, iron and iodine among children
below five (5) is also an urgent public health concern. The prevalence of underweight and stunting
in Negros Island is significantly higher than the Philippine average. Underweight is observed to be
more pronounced in rural areas among the poorest population. Underweight and stunting is of
high magnitude and severity in rural areas. During the Focus Group Discussion (FGD) with PNC
members, they acknowledged that Negros Oriental is ranked as the second highest in terms of
malnutrition (i.e. at 6.6%) when the Province was reverted to the Central Visayas Region (or
Region 7, composed of NegOr, Cebu, Bohol and Siquijor). This is ironical given the economic
status of NegOr as a first class province.
Child malnutrition has indeed become an alarming problem of public health importance not only
in the world but most especially in the Philippines particularly in the rural areas. It requires urgent
action that is effective, efficient and sustainable. For interventions to be strategic, LGUs should
prioritize and focus on children in their formative years in rural communities.
With health information systems seemingly in disarray, there is a growing need to generate
timely, reliable data and information for evidence-based decision-making, programming and
action especially at the local level, i.e., at the service delivery touch points. This requires a
nutrition program-specific platform that can track not only program progress (in terms of inputs,
activities or processes, outputs and outcome) but also to share relevant program information for
specific groups of personnel in the program/project management and execution loop. Such
platform should be able to capitalize on existing systems such as the eOPT+, iclinicsys and eHATID,
among others.
The SDGs and the PPAN provide the official framework in addressing malnutrition at the local
level. This government-sanctioned framework formalizes the inclusion and prioritization of
nutrition actions in the development plans of national agencies and local government units. It lays
the legal basis in the promulgation of LGU policies and in the allocation of public funds; and in
soliciting the substantive support of the private sector. The availability of working models and
vii Management Module for Negros Oriental: Final Report
good practices in community-based nutrition programming as well as the potential of linking with
on-going government programs will make it easier for the PNC and its members to innovate and
improve their interventions.
The stakeholder groups (i.e., the system users and system developers) articulated the imperatives
(issues and needs) and identified actions that may be pursued to better respond to the child
malnutrition challenge not only in NegOr but in other areas as well. On one hand, the PNC -- as
the identified system user in this assessment -- expressed strong interest to pilot a community-
based and –driven child nutrition management project. This proposed initiative provides the
necessary ecosystem in the development of a child nutrition information management system.
On the other hand, prospective system developers stressed the need to align local initiatives,
whether public or private, with national programs and to comply with relevant laws, regulations
and standards. This will ensure the proposed information system’s relevance, acceptability and
integration into the national health information infrastructure.
Given IPNAP’s commitment to “play a constructive role through meaningful partnerships with
other stakeholders in the areas of research, information and education” to address the country’s
critical and urgent malnutrition challenge, the following are the recommended essential elements
of its proposed strategic development assistance package in Negros Oriental:
1) Element#1: advocacy campaign and capability development. This element will address
two (2) main challenges identified in this scoping assessment: i) the lack of support from
LGUs, including from other stakeholders such as the private sector, due to low
understanding and appreciation of the importance, magnitude and complexity of
malnutrition especially among children; and ii) the poor knowledge, attitude, skills and
behaviours or practice of parents and those involved in the development and
implementation of nutrition programs. Social marketing approaches and tools will be used
for specific target groups.
2) Element#2: development and deployment of an integrated electronic nutrition

information management system, which is the initial intention under this scoping
assessment. This element responds to the need to collect, consolidate, analyse, store,
share/disseminate and use appropriate data in a timely manner for evidence-based
programming, decision-making and learning.
3) Element#3: piloting of community-based nutrition management project as an action

research. This third element serves as the situs where elements 1 and 2 will be carried
out. Targeting under-5 children consistent with IPNAP’s clientele focus, a pilot project
covering several towns and barangays (i.e., communities) serves as both context and
vehicle for advocacy and capability development, and for the development of an
information system for tracking project performance and for other purposes as discussed
above.
When undertaken as logically sequenced components of a medium-term development program to

be implemented jointly by PNC and IPNAP, these elements are expected to generate basic
outputs, viz:
viii Management Module for Negros Oriental: Final Report
a) Output 1: competent and committed “leaders” at various levels working in community-
based child nutrition initiatives. These “leaders” refer to LGU officials and personnel, PNC
member-organizations’ personnel involved in nutrition program implementation including
DCWs and BN scholars, project staff, and parents of children enrolled in DCCs.
b) Output 2: interoperable information management system linked with ‘official’ systems

tracking the progress and performance of the pilot child nutrition project. The system
should enable personnel involved in managing nutrition programs to track progress and to
make evidence-based decisions. Dashboards as well as reports for specific level of users
should be incorporated in the design of the system.
c) Output 3: web-based knowledge management and social marketing platform for child
nutrition leader-managers and workers. This system is for advocacy and learning
purposes. This may take the form of a website where information, learning materials and
experiences in managing or implementing community-based nutrition programs are
promoted and shared. Competency development courses, which may be accredited to
earn formal credits with local universities, may also be developed and made available for
nutrition personnel. These courses may be accessed online or offline by allowing the
materials to be downloaded when there is internet access.
These outputs envisaged under the proposed community-based and –driven nutrition initiative in
Negros Oriental will contribute to the ultimate outcome of ‘well-nourished under 5 year-old
children’ thereby ensuring the health and wellbeing of the next generation of Filipinos.
ix Management Module for Negros Oriental: Final Report
A. INTRODUCTION
A.1 Background
Based on the 2015 National Nutrition Survey of the Food and Nutrition Research Institute (FNRI),
3.8 million children or 33.4% are stunted while 807,057or 7.1% are considered wasted in the
Philippines. The government’s strategy to reduce malnutrition is outlined in the Philippine Plan of
Action (PPAN). The PPAN is anchored on the Philippine Development Plan 2017-2022 and the
Duterte Administration’s 10-point economic agenda. It contributes to the Philippine commitment
to the United Nations Sustainable Development Goals (SDGs), particularly SDG#2, which aims to
end hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
One of the pillars of an effective, efficient and sustainable health system is a well-functioning
health information management infrastructure. Due to its prohibitive cost, however, the
Department of Health (DOH) has hesitated to invest in building national health information
systems, although it has a policy for automating information systems since 1974. 1 Decision-making
for information systems infrastructure in the Philippines is devolved to the local health facilities 2.
Most health facilities recognize the value of information technology. Computers are procured
regularly and increasingly and internet connectivity is finding its way into annual operating and
investment plans. Notwithstanding this growing awareness among stakeholders of the value of
information and communications technology in health, only a few rural health units have invested
in the procurement and installation of electronic medical records 3.
Recognizing the need for a functional health information management system in the country, the
website eHealth Philippines was formed by the DOST Philippine Council for Health Research and
Development (PCHRD), and Ateneo de Manila University (ADMU) Institute of Philippine Culture
(IPC) to create an internet-linked community that allows interaction on health issues and access to
research databases 4. Part of this initiative is the eHATID or the e-Health Tablet for Informed
Decision-Making of LGUs Project -- a software application in an android tablet that offers real-time
access to information among LGUs and medical doctors which will integrate an electronic version
of the PhilHealth's Primary Care Benefit 1 (PCB 1). The system can map out, update and check the
eligibility status of all PhilHealth members.
With its focus on nutrition, the Infant and Pediatric Nutrition Association of the Philippines, Inc.
(IPNAP) intended to explore the possibility of integrating a LGU-based electronic child nutrition
information management module into the eHATID platform. The aim is to assist LGU staff,
medical practitioners and health sector managers come up with an electronic database on
nutrition that can provide appropriate, reliable and timely information useful for planning, service
delivery and M&E activities. Towards this end, IPNAP sought the services of the Philippine NGO
Support Program, Inc. (PHANSUP) to undertake a scoping assessment for the design and
1
Philippine Health System Review, page 98.
http://www.wpro.who.int/philippines/areas/health_systems/financing/philippines_health_system_review.
pdf.
2
Ibid, page 99.
3
Ibid, page 98.
4
http://www.ehealth.ph/index.php/blogs/category/announcement
1 Management Module for Negros Oriental: Final Report
development of the proposed LGU-based electronic information management module on child
nutrition.
A.2 Purpose and Objectives
The consultancy engagement aims to determine the “considerations” (i.e., parameters, scope and
requirements) in the design and development of the LGU-based electronic child nutrition
information management module in Negros Oriental (NegOr). The objectives are to:
1) Compile a comprehensive set of information on similar initiatives locally and globally;

2) Identify “user” needs, terms and specifications; and
3) Identify “developer” needs, terms and conditions.
However, after the interviews with members of NegOr Provincial Nutrition Committee (PNC) it
became apparent that the development of an information management system should consider
the entire ecosystem in which it operates to ensure the system’s functionality, relevance and
sustainability. As NegOr is already using a data management system prescribed by the DOH and
the National Nutrition Council (NNC), PNC members emphasized more the need to address
pressing operational or service delivery issues related to nutrition program implementation and
explore how the experience in piloting the eHATID Project may be used to develop an electronic
information management module on nutrition. Hence, the purpose of the scoping assessment was
expanded to also determine the most appropriate assistance package that may be provided to
Negros Oriental by IPNAP given its own organizational mandate, capabilities and program
strategies.5
A.3 Scope of Work and Deliverable
The Terms of Reference (TOR) included six (6) key activities with corresponding outputs as shown
in Table 1. The final deliverable is the consultancy report. It was initially intended to be conducted
from the last week of December 2017 until the second week of February 2018 but was extended
5
The Infant and Pediatric Nutrition Association of the Philippines (IPNAP) is composed of industry leaders in
infant and child nutrition, whose members include Abbott, Alaska Milk, Mead Johnson, Nestle and Wyeth.
The association was formed in 2008 to establish the industry’s collective approach to improving nutrition
and supporting the goals and principles of the World Health Organization’s International Code of Marketing
of Breast-milk Substitutes. These goals and principles drive our commitment to improving the health and
nutrition of infants and young children, promoting responsible business practices and ethics among our
members, and advocating for the highest standards of safety and quality for infant and pediatric food
products. IPNAP believes that breastmilk is best for infants, and that promoting breastfeeding coupled with
evidence-based information on optimal and appropriate complementary feeding practices will drastically
improve infant and young child nutrition by enabling mothers to make an educated choice on nutritious
feeding methods and products for their children. As such, IPNAP aims to play a constructive role through
meaningful partnerships with other stakeholders in the areas of research, information and education, policy
and legislation, and Corporate Social Responsibility. http://www.ipnap.org.ph/about-us/ Accessed: 22 April
2018.
until the second week of April 2018 to cover additional key informants and provide more time to
process the assessment results.
Table 1. Scope of work and deliverables.
Activity Output/ Deliverable

1 Inception meeting with IPNAP Detailed work plan
2 Web and library research Electronic list of papers/articles
3 Review of literature Write-up of literature
4 Conduct of KII and FDG KII and FDG guide
5 Data analysis and synthesis Documentation of results
6 Prepare and submit report Consultancy report
The assessment was conducted by a consultancy team composed of a Team Leader, a Research
Specialist, a Research Assistant and an Administrative Assistant from the Philippine NGO Support
Program, Inc. -- also known as the Partnerships for Health Action, Nation Building, and Socio-
economic UPliftment (PHANSUP), a national NGO involved in community health systems
strengthening, social health entrepreneurship, and learning events management.
Negros Oriental (NegOr) was selected as the focus of the assessment as the province was involved
in the successful piloting of the eHATID platform, a LGU-based electronic health information
system developed by the Ateneo de Manila University (AdMU) and the Department of Science and
Technology (DOST).
A.4 Methodology and Analytical Framework
The consultancy team developed a descriptive data and information gathering plan that covered
literature sources as well as individual respondents using purposive and snowball sampling
techniques. Relevant documents were searched online or taken from relevant offices or agencies.
Individual respondents were involved in key informant interviews (KIIs) and in the focus group
discussion (FGD). The KII was intended to surface individual perspectives while the FGD aimed
primarily to develop some degree of consensus. The FGD was used to validate the results of the KII
and to determine the features of a possible pilot project in which the proposed electronic
nutrition information system will be developed.
Types of Respondents
Respondents were identified based either on their possible involvement in the proposed
electronic child nutrition information management module or in their organization’s current role
in promoting nutrition or health information management systems. These respondents were
categorized into three (3) types: prospective system users, prospective system developers, and
prospective system supporters.
Prospective System Users are defined in this assessment as individuals or organizations most likely
to use or implement the information management system on nutrition in their work. These
individuals or organizations are currently involved or participating in nutrition activities and
appreciate the need for an information management system to further goals in nutrition. The
prospective System Users are the members of the NegOr Provincial Nutrition Committee (PNC)
headed by the Integrated Provincial Health Office (IPHO).
Prospective System Developers are defined in this assessment as individuals or organizations with
a direct hand in the development of the information system. Information systems developed
usually pass through a pilot testing stage prior to its roll-out to and adoption by System Users. The
Prospective System Developers refer to organizations who developed (or built) and managed the
information system for adoption and implementation by System Users.
Prospective System Supporters are defined in this assessment as individuals or organizations

providing financial or technical support to System Developers or System Users in order to develop
or build or implement the information system. No System Supporters were identified and
interviewed.
Key Informant Interviews (KIIs) for System Users were conducted with members of the Provincial
Nutrition Committee of Negros Oriental. PNC members and representatives from the Department
of Science and Technology (DOST), Integrated Provincial Health Office (IPHO), Silliman University,
Department of the Interior and Local Government (DILG), Provincial Social Work and Development
Office (PSWDO) and the Provincial Agriculturist’s Office (PAO) participated in the Key Informant
Interviews. Another set of interviews (though at a very limited scope) in Tayabas City, Quezon
was done to get further information on LGU nutrition and nutrition-related activities and
processes in the context of the national government’s plan on nutrition.
Key Informant Interviews for System Developers mainly consisted of focal point persons from
selected national agencies with a direct mandate to develop information systems on health.
Technical officers and staff from the Department of Health Knowledge Management and
Information Technology Service (DOH-KMITS), the National Nutrition Council (NNC) and the
Philippine Council for Health Research and Development (PCHRD) composed the KII for this group.
A total of 15 key informants were interviewed in the study and a total of 17 participants attended
the Focus Group Discussion. Table 2 lists the participants of these KII and FGD activities.
Guide questions were prepared for each type of informant. Essentially, the KIIs gathered data on
respondent’s previous and current involvement in information management systems, on their
experiences and challenges in the development or use of such systems and on their
recommendations.
Table 2. Respondents at national and provincial levels.
Level Respondents Respondent Type Venue of Interview

A. Key Informant Interviews
National Knowledge Management Information System Developer DOH

Level Technology Service (KMITS-DOH)
National Nutrition Council (NNC) System Developer NNC Office
Level Respondents Respondent Type Venue of Interview
Philippine Council for Health Research System Developer DOST -CO
Development (PCHRD)
ADMU Institute of Philippine Culture (IPC) System Developer UP Campus
eHatid Project
Food and Nutrition Research Institute System Developer DOST-CO
(FNRI)
Provincial Department of Science and Technology System User Negros Oriental
Level (DOST)
Silliman University (SU) System User Negros Oriental
Integrated Provincial Health Office (IPHO) System User Negros Oriental
Department of the Interior and Local System User Negros Oriental
Government (DILG)
Provincial Social Welfare and System User Negros Oriental
Development Office (PSWDO)
Provincial Agriculturist Office (PAO) System User Negros Oriental
B. Focus Group Discussion
Provincial Provincial Nutrition Committee (PNC) System User Negros Oriental

Level
Interview Questionnaires
Three (3) semi-structured KII instruments were used as guide to the interviews with key
informants. Specific KII questionnaires were used based on the interviewee’s role in the health
information system. These questionnaires consisted of the following: (a) guide questionnaire for
system developers; (b) guide questionnaire for system users; and (c) guide questionnaire for
system supporters.
To better understand the context by which health information systems operated and supported
the nutrition program, the consultancy team prepared several questions which focused on
respondents’ nutrition and nutrition-related initiatives, experiences with nutrition information
systems, challenges in its implementation and recommendations for improvements. The general
outline of the KII questionnaires included the following:
a) For prospective system developers: (a) brief information about the interviewee, contact
details, name of the interviewer/s and date of the interview; (b) similar previous/current
work; and (c) system for child nutrition information management.
b) For prospective system users: (a) brief information about the interviewee; (b) background;
(c) general data and information management system; (d) electronic database and
information management system; (e) data collection and utilization of child nutrition
database and information management system; and (f) design, development and
deployment of an electronic database and information management system on child
nutrition.
c) For prospective system supporters: (a) brief information about the interviewee, (b)
previous/on-going health information management-related programs/projects and (c)
system for child nutrition information management.
In addition to the questions prepared on health information system, information and experiences
related to the key informant’s role and involvement in the implementation of nutrition programs
and activities were also explored.
Framework of Analysis
With the expanded purpose of the scoping assessment, a broader ecosystem or programmatic
perspective was taken to carry out the KIIs and FGD, and to analyse their results. The data and
information collected were thus grouped into three (3) general categories, namely: (a) child
nutrition situation; (b) health information management systems; and (c) health and nutrition
interventions and approaches (Figure 1).
All data related to child nutrition were brought together to describe the current status of child
nutrition. Similar procedures were applied to the data collected on the health information
management systems and on health and nutrition interventions and approaches. Experiences of
system developers and system users were also analyzed to describe challenges in the
development and implementation of nutrition and nutrition-related information systems.
Recommendations for improvement of NegOr’s nutrition program as suggested by key informants
were noted under interventions and approaches. Inter-relationships of the three (3) components
were analyzed to determine gaps in the system and recommend measures to address them.
Figure 1. Framework of analysis.
Specific themes were identified at the interface or nexus of the three (3) data and information
categories as shown above: i) electronic child nutrition information management systems,
general child nutrition programs, and information-driven and evidence-based child nutrition
programs. At the core is the proposed goal of IPNAP’s program strategy under its strategic
assistance package for NegOr.
The analytical perspectives used, where appropriate and applicable, were that of prospective
system users, developers and supporters; and that of IPNAP as the organization which
commissioned this scoping assessment.
A.5 Limitations
The following are the limitations of the scoping assessment:
a) Due to the short period of time allocated for field interviews in NegOr, the consultancy
team was not able to individually interview all the members of the Provincial Nutrition
Committee. However, some time was allocated to allow other members of the PNC to
discuss their activities on nutrition during the focus group discussion.
b) Key Informant interviews conducted in Negros Oriental among members of the PNC
included additional questions on nutrition program implementation to put into context
the discussion and experience on the local health information system.
c) Schedule of key informant interviews among System Developers took some time to
finalize due to the necessary permissions/authorities that needed to be secured from
heads of agencies.
d) Due to time and scheduling constraints, planned interviews with key informants from the
Department of Health (DOH) Child Nutrition Program did not materialize.
B. ASSESSMENT FINDINGS
B.1 Review of Library and Online Documents
The review of library and online documents delved on the global, national and local (NegOr)
situation on child nutrition, particularly the prevalence of various forms of malnutrition. The
review also looked into the role and importance of health information systems for nutrition
promotion as well as good practices in implementing community health programs as they relate
to nutrition management at the community level.
B.1.1 Global and National Situation on Child Nutrition
Global Nutrition Situation
Good nutrition is one of the crucial determinants of good health and well-being. However, the
prevalence of malnutrition for vulnerable population (women and children) worldwide continues
to be of serious concern. The prevalence of stunting among children under five (5) years globally is
22.9% with 40% of stunted children in Southeast Asia.6 Globally, the overweight prevalence is 6 %,
with the number of overweight under five (5) years old increasing in Africa and Asia. Data on
wasting prevalence worldwide is 7.7% with more than half of all wasted children in the world in
South Asia.7
The pervasive and alarming malnutrition problem, particularly in the most affected countries
worldwide, prompted the 65th World Health Assembly to pass a resolution to aggressively address
malnutrition and agreed on six (6) global nutrition targets for 2025.8 These targets are:
1) 40% reduction in the number of children under five ( 5) who are stunted
2) 50% reduction of anemia in women of reproductive age
3) no increase in childhood overweight
4) 30% reduction in low birth weight
5) increase rate of EBF in the first 6 months up to 50%
6) reduce and maintain childhood wasting to less than 5%
The Sustainable Development Goals (SDG) Agenda includes as one of its 17 indicators the
eradication of all forms of malnutrition by 2030, aside from achieving the six (6) global targets set
for 2025.9 The SDG presents an opportunity where nutrition goals can be achieved through an
integrated approach. The following actions are recommended:
6
WHO/UNICEF/WB Team, Levels and trends in child malnutrition: Joint Child Malnutrition Estimates, Key
findings of the 2017 edition, Accessed, https://data.unicef.org/wp-content/uploads/2017/05/JME-2017-
brochure.pdf
7
Loc cit
8
WHO/UNICEF/EU, Global Target 2025: what is measured gets done, Accessed 9 April 2018,
http://www.who.int/nutrition/globaltarget_indicators_flyer_en.pdf?ua=1
9
Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs), Statistical Commission pertaining to the
2030 Agenda for Sustainable Development A/RES/71/313, Global indicator framework for the Sustainable
Development Goals and targets of the 2030 Agenda for Sustainable Development ,p.2, Accessed January 23,
1) The world faces a grave malnutrition situation but the SDGs present an opportunity to
change this. This implies focusing on inequities in low, middle and high-income countries
and delivering multi-sectoral goals through a shared action.
2) Improving nutrition will be a catalyst for achieving goals throughout the SDGs. Nutrition
can contribute towards the achievement of SGDs in five (5) core areas namely: sustainable
food production, strong systems of infrastructure, health systems, equity and inclusion,
and peace and stability.
3) Tackling underlying causes of malnutrition through the SDG will help end malnutrition.
Nutrition is an important component of the SDG that requires dealing with other
important factors that contribute to malnutrition as well.
4) The SDG presents an opportunity for financing a more integrated approach to improving
nutrition universally. Malnutrition has a high economic and health cost that require huge
investments. There is a need to explore opportunities for innovative financing
mechanisms and a more integrated approach to investing in nutrition.
5) There is a need to change the way data is completed, analyzed, and used. Better, more
regular, detailed and disaggregated data is needed for all forms of malnutrition in all
countries to ensure that no one is left behind. Changing the way data is used to develop
better choices, advocate decision making at policy level, build dialogues, partnerships,
actions and accountabilities is imperative to improve nutrition universally.
6) Ensure that commitments are concrete pledges that are acted upon. Political
commitments to nutrition should be rooted in the way governments govern, multilateral
agencies coordinate, civil society engages and businesses are run. Accountability
mechanisms should be designed to ensure that they deeply promote these commitments.
7) “Double duty” or “triple duty” actions provide an opportunity to achieve nutrition targets.
Tackling more than one form of malnutrition increases the effectiveness and efficiency of
time, energy and resources in improving nutrition. Taking on “triple duty” actions that
tackle malnutrition and other development challenges can result to multiple benefits
across the SDGs.
The global situation on nutrition indicates a high burden of malnutrition in spite of previous
efforts to address these. However, the SDGs present an opportunity to improve nutrition through
integrated actions contributing to other development efforts as well. Inadequacies in data are
recognized and call to change the way data is collected and used to improve nutrition is a
challenge.
The Philippine Nutrition Situation
The Philippines is one of the countries with high prevalence of stunting and wasting of children
under five (5) years old. In 2015, the prevalence of stunting among Filipino children under five (5)
2018
,https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework_A.RES.71.313%20Annex.pdf,
years old was 33.4%, while wasting was 7.1%. 10 The high levels of stunting and wasting had
remained unchanged since 2008. In addition, the prevalence of stunting in children from birth to
three (3) years continued to indicate an increasing trend from 0-5 months old, 0-11 months, and 1
– 3 years old children.
Micronutrient deficiencies in Vitamin A, iron and iodine among children below five (5) and among
pregnant and lactating mothers remained an urgent public health concern.11 In 2013, 20.4% of
children six (6) months to six (6) years old had Vitamin A deficiency and 11.7% of women of
reproductive age (20-39 years old) had anemia. Iodine deficiency was also noted in pregnant and
lactating women.
Among pregnant women, 39.6% of pregnant women below 20 years of age were found to be
nutritionally at risk. In addition, about 49% of pregnant mothers with less or no education and
29.7% of pregnant mothers among the poorest households were also found to be nutritionally at
risk.12 It was noted that the prevalence of nutritionally-at-risk women did not improve over the
years since 2008. Adolescent pregnant women, those with low educational attainment, come
from the poorest wealth quintile and are not working also showed higher levels of undernutrition.
Maternal nutrition could affect the nutrition of the growing fetus.
In terms of hunger and food insecurity, the 2015 National Nutrition Survey (NNS) also indicated
that 68.3% of Filipino household did not meet their caloric requirements.
The Philippine Plan of Action (PPAN) 2017-2022 was developed to improve the nutrition situation
in the country. It is an integral part of the Philippine Development Plan 2017 – 2020 and is
consistent with President Duterte Administration’s 10 point Economic Agenda. It aims to improve
the quality of human resource in the country, reduce inequality in human development and
reduce child and maternal mortality.
The PPAN 2017-2022 aims to achieve the following final outcomes by 2022:
a) 21.4% prevalence of stunted children under 5 years

b) <5% prevalence of under 5 years old and 6-10 years old wasted children
c) <15% prevalence of children 6 months – 5 years old with Vitamin A deficiency
d) 6% prevalence of anemia among women of reproductive age
e) For iodine deficiency disorders, targets:
i. >100 median urinary iodine concentration among children 6-12 years old
ii. >150 median urinary iodine concentration among pregnant women
iii. > 100 median urinary iodine concentration among lactating women
iv. <20 percent with urinary iodine concentration among children 6-12 years old
and lactating women
Strategic thrusts were outlined in the PPAN 2017-2022 to achieve the outcome targets, as follows:
10
National Nutrition Council-DOH. The Philippine Plan of Action for Nutrition ( PPAN), Accessed January 3,
2018, p.3, https://www.nutritionintl.org/.../final_PPAN2017_2022Executive-Summary- 3.pdf
11
Ibid, pp.3-4
12
Ibid , p.5
a) Focus on the first 1,000 days of life
b) Complementation of nutrition-specific and nutrition-sensitive programs
c) Intensified mobilization of local government units
d) Reaching geographically isolated and disadvantaged areas (GIDA) communities of
indigenous peoples, the urban poor especially those in resettlement areas
e) Complementation of actions of national and local governments
The PPAN involved the implementation of eight (8) nutrition-specific programs, 11 nutrition-
sensitive programs and three (3) enabling programs to address the immediate and underlying
causes of malnutrition. These programs target 90% of population groups relevant to nutrition-
specific interventions to reduce mortality and stunting of significant levels. Target of obesity
though is set at 50%.
Operationalization of the PPAN will include a National PPAN Implementation Plan that will cover
specific activities to be undertaken for each program. This plan will be annually updated and will
also include an estimate of needed resources and a resource mobilization plan. Regional Plan of
Actions (RPAN) will be formulated that will reflect regional initiatives of member agencies of the
Regional Nutrition Committees. At the local level, local nutrition action plans (LNAP) will be also
be developed or revised in line with the PPAN programs but will consider local nutrition problems
and causes. The LNAP will cover a 3-year period corresponding to the term of the Local Chief
Executive.
The NNC Governing Board will oversee the implementation of the PPAN 2017-2022 assisted by the
NNC Technical Committee and technical working groups for each program. Monitoring will be
undertaken and involve reporting on physical and financial accomplishment of stakeholders.
Regional and Provincial Nutrition Situation13
Based on the National Nutrition Survey (2015) 14, for malnourished children less than five (5) years
old in the Negros Island Region (NIR), one (1) out of four (4) children are underweight (25.6%);
four (4) out of 10 are stunted (41. 7%); six (6) out of 100 (5.8%) are wasted or thin and is
considered to be a public health problem. Three (3) out of 100 (2.5%) are overweight for their
height. Generally, underweight and stunting increased while wasting and overweight for height
decreased in this age group. The prevalence of underweight and stunting in Negros Island is
significantly higher than the Philippine average. Underweight is observed to be more pronounced
in rural areas among the poorest population. Underweight and stunting is of high magnitude and
severity in rural areas. Negros Oriental performed better than Negros Occidental across all
indicators (Figure 2).
Among school children 5-10 years old (Figure 3), four (4) out of 10 (36.1%) are underweight, four
(4) out of 10 (36.8%) are stunted; and nine (9) out of 100 (9.1%) are wasted and is considered to
be a public health problem. Seven (7) out of 100 (6.5%) are overweight for their height.
Underweight and stunting generally increased in the Negro Island Region. Wasting generally
13
Figures and graphs presented in this report are lifted from the Powerpoint presentation of FNRI during
the 2016 Dissemination Forum for Negros Island Region..
14
National Nutrition Survey 2015, Double Burden of Malnutrition in the Philippines, Negros Island Region
http://www.fnri.dost.gov.ph/images/sources/Dissemination/NutritionSituationNegrosIsland.pdf
decreased except for Negros Oriental province. Overweight for height generally increased except
also for Negros Oriental province. For this age group, prevalence of children who were
underweight, stunted and wasted was higher than the national average.
Figure 2. Prevalence of undernutrition among children, less than five (5) years old, 2013 vs. 2015.
Figure 3. Prevalence of undernutrition among children, 5-10 years old, 2013 vs. 2015.
For children 10-19 years old (Figure 4), prevalence of stunting seemed to have decreased from
37.6% (2013) to 31.6% (2015). However, there was a slight increase in the prevalence of wasted
children from 10.8% (in 2013) to 11.2% (in 2015). In 2013, stunting among children in this age
group was higher than the national average. However, in 2015, stunting and wasting presented a
slightly lower prevalence than the national average.
Figure 4. Prevalence of undernutrition among children, 10-19 years old, 2013 vs. 2015.
Based on IPHO program data, the trend of malnutrition rate in the province from 2006-2015 was
decreasing over a period of 10 years. From a malnutrition rate of 11.4 in 2006, malnutrition rate
decreased to 6.4 in 2015. However, it is noted that the program data in 2015 of 6.4% malnutrition
rate (underweight) is low and does not coincide with the 2015 National Nutrition Survey (NNS)
data of underweight of 23.9%, which is considered high based on the WHO cut-off point (20%-
29%) to show high severity and magnitude.
While the program data shows low severity and magnitude of wasting at 4.7% in 2016 and 5.7% in
2017, still the actual numbers of children who are wasted is high with 4,935 children wasted in
2016 and increasing with 6,039 children who are identified as wasted in 2017. Severely wasted in
2016 are 2,633 children and 2,788 children in 2017.
Provincial program data also shows that the severity and magnitude of stunting is low since it is
below the cut-off point of <20%. However, the rate increased from 14.5% in 2016 to 17.2% in
2017 or by 3%. In actual numbers, there are 8,829 children below five (5) years old who are
severely stunted in 2017.
During the Focus Group Discussion (FGD) with PNC members, they acknowledged that NegOr is
ranked as the second highest in terms of malnutrition (i.e. at 6.6%) when the Province was
reverted to the Central Visayas Region (or Region 7, composed of NegOr, Cebu, Bohol and
Siquijor).
B.1.2 Approaches in Promoting Community Health and Nutrition
Community Health Promotion
Promoting health at the community level is a complex undertaking owing to the multifaceted
issues involved. A team of experts from the University of Kansas15 came up with some principles,
assumptions, and values guiding the work of understanding and improving community health and
development as follows:
1) Improvement in community health and development involves the population as a whole,

not merely individuals at risk for specific physical, mental, or social conditions.
2) Community health and development requires changes in both the behaviors of large
numbers of individuals and the environment and broader conditions that affect health
and development.
3) A healthy community is a local product with priority issues and strategies best determined
by people most affected by the concern.
4) Achieving health and development for all requires attention to key social determinants, in
particular: income disparities, social connectedness, and efficacy or the ability to influence
one's environment.
5) Since health and development outcomes are caused by multiple and interrelated factors,
single interventions are likely to be insufficient.
6) The conditions that affect a particular health or development outcome are often
interconnected with those affecting other concerns.
7) Since the behaviors that affect health and development occur among a variety of people
in an array of contexts, community improvement requires engagement of diverse groups
bringing about change in multiple sectors of the community.
8) Community health and development involves interdependent relationships among
multiple parties in which none can function fully without collaboration with others.
9) Collaborative partnerships, support organizations, and grantmakers work together as
catalysts for change; they convene, broker relationships, and leverage resources for those
doing the work of community change and Improvement.
10) The aim of support organizations is to build capacity to address what matters to people
over time and across concerns.
Likewise, they also enumerated some factors and conditions affecting community change and
improvement in the context of health and development, namely: clear vision and mission, action
planning, leadership, responsible community organizers, documentation and feedback on
intermediate outcomes, technical assistance, and making outcome matter. They noted that “more
targeted community efforts, such as those addressing substance abuse or nutrition, are associated
with higher rates of change than diffuse efforts such as those addressing ‘healthy communities’".
On the documentation and feedback on intermediate outcomes, the expert team shared their
experience as follows:
15
Understanding and Improving the Work of Community Health and Development. Fawcett, Stephen B., et
al. https://communityhealth.ku.edu/sites/communityhealth.drupal.ku.edu/files/files/R22.pdf Accessed: 17
April 2018.
“To provide a functional measure of intermediate outcome, we supported
ongoing documentation of the unfolding of community change over time; and
feedback, in the form of time series graphs of cumulative rates of change that are
annotated to show factors (e.g., change in leadership) associated with
discontinuities. Since documentation and feedback are integral to the
measurement system, we cannot tease out their separate effects on rates of
community change. Functionally, such information may permit ongoing learning,
adjustments, and accountability in the effort.16”
Community-based Nutrition Programming
Documented experiences indicate that community-based nutrition programming is effective in

addressing malnutrition on a large scale.17 Examples of these experiences were seen in
community-based nutrition projects implemented in Kenya, Tanzania and Uganda, as well as in
Indonesia, Zimbabwe and Thailand, to mention a few. Community-based nutrition programs
include activities such as growth monitoring, breastfeeding promotion, nutrition education,
promotion of better weaning, micronutrient programs and deworming, as well as supplementary
feeding of malnourished children. To make the program comprehensive and integrated, these
activities may be supported by other programs such as immunization, diarrhea case management,
family planning, nutrition surveillance and links to local food production.
In Japan, a school-based nutrition program that integrates school gardening has been reported to
be very successful.18 The program is more of a ‘values formation’ activity emphasizing ‘life skills’
that is integrated in the school system where young kids are fully involved in garden activities 19
and in preparing their meals for lunch with the guidance of their teachers. They are also taught
personal hygiene, cleanliness and waste management, and team work and other social skills.
Success in community-based nutrition programs is often defined as the achievement of objectives,

as it relates to the processes and outcomes of reducing malnutrition in the community and
sustaining these efforts without external funding. The achievement of objectives is, however,
influenced by a combination of contextual (socio-political), programmatic (technical) and financial
factors.20 Socio-political factors describe the power arrangements and social relations affecting
the nutrition programs, as well as decision-making to initiate or support the program. Contextual
factors also provide an enabling or supportive environment. Technical factors include two
components: (1) materials necessary for implementation such as buildings, equipment and
transport; (2) technical capacity of personnel to design, initiate, manage and evaluate nutrition
16
Op. cit., pp 24-225.
17
Successful Community-Based Nutrition Programming: Lessons from Kenya, Tanzania and Uganda.
https://reliefweb.int/report/world/successful-community-nutrition-programming-lessons-kenya-tanzania-
and-uganda Accessed: 14 April 2018.
18
We Love What These Japanese Schools Are Doing For Lunch
https://www.marthastewart.com/1513498/japanese-schools-lunchtime-educational Accessed: 18 April
2018.
19
School Gardens Can Help Kids Learn Better and Eat Healthier. So Why Aren’t They Everywhere?
https://www.huffingtonpost.com/2015/04/29/school-gardens_n_7119898.html Accessed: 18 April 2018.
20
Success Factors in Community-based Nutrition Programmes.
http://journals.sagepub.com/doi/pdf/10.1177/156482659902000307 Accessed: 14 April 2018.
programs. Financial factors include both internal and external fund sources, capacities and
reliability.
Socio-political factors. Genuine community participation or involvement was identified as a key

element in community-based nutrition programs that work. Community participation included the
full engagement of the community in the programming cycle of assessment, analysis and action.
Participation was said to have positive benefits such as increase in the community’s sense of
ownership leading to sustainability, decrease resistance to project innovations, assist in the
dissemination of nutrition education messages, attendance to activities, reduce dependence on
external funding and promotes self-help. It was observed to provide interventions that were more
appropriate for the community. With the popular democracy brought on by community
participation, it was said to also influence government’s response and sensitivity to popular
demands. Successful community-based nutrition program, according to studies, tended to have a
combination of political will at the central level, decentralized middle-level district, administrative
support and community-level organizational capacity.
Technical factors. Several technical factors were noted in the implementation of successful
community-based nutrition programs. The implementation of effective community-based
nutrition programs was done in phases - problem definition, design, initiation and management. A
rational and comprehensive program design is based on a situational analysis, where the
prevalence, distribution of the nutrition problem, its causes, identification of potential resources
and actions were made. After the assessment, participatory analysis follows, where a conceptual
framework is introduced. The conceptual framework explains the immediate, basic and underlying
causes of malnutrition, and used as a tool of analysis. Participatory analysis facilitates multi-
sectoral cooperation, outlining the roles of stakeholders involved. It allows representatives to
articulate their situation and ideas in the development of the plan;
Central to the successful implementation and proper management of nutrition programs are also
the personnel. Community level workers were primarily responsible for group implementation. In
most cases, the workers were selected from the local community. Training was also an important
success factor in community-based nutrition programs. Support, supervision and provision of
resources including transport of supervisors and provision of equipment for village-level workers
were also important in ensuring programme success. Monitoring project progress which used
management information systems was also indicated as a factor for success. For example,
monitoring was performed through the maintenance of local level registers recording children’s
growth, food production and other data. Effective program designs are based on an analysis of
multi-level causation of the nutrition problem, deliberately creating a sequenced interventions
and activities that address the proximal causes of malnutrition.
Financial factors. Community-based nutrition programs were initially funded by external sources.
However, effective programs enjoyed substantial financing from their respective governments so
that funding continues to be provided even as donor contributions diminished. Financial
commitments depended on the government’s political will, which is determined by their
responsiveness to community demands.
B.1.3 Role of Information Management Systems in Nutrition Programs
The importance of health information systems to effective implementation of health programs
cannot be underrated. Studies had emphasized its importance in increasing the effectiveness of
health services.21 There are evidences which link improved management system to improved
health systems. For information to influence management in an optimal way, it has to be used by
decision makers at each point of the management cycle. Changing the way information is
gathered, processed and used for decision making implies changing the way an organization
operates.
The ultimate objective of a health information system is to improve action. Information system is
defined as activities that provide specific information support to the decision-making process at
each level of the organization. A health information system integrates data collection, processing,
reporting and use of the information necessary for improving health service effectiveness and
efficiency through better management at all levels of health services.
The Global Nutrition Report 2017: Nourishing the SDGs, emphasizes the role of information
system in the success of the nutrition program and the importance of addressing malnutrition in
achieving many of the SDG indicators. The information system for nutrition should be able to
cover the data gaps identified such as:22
1) Data gaps remain to be a significant obstacle in tracking progress of the multiple burdens
of malnutrition. Disaggregated data is needed to ensure no one is left behind due to their
geography, age, ethnicity or gender. This data is missing, as is data on adolescents and
dietary intake.
2) There is a need for better data coordination, its interpretation and use by decision makers
as part of national priority setting to track progress against global nutrition targets.
3) At the national level, there are many data gaps to robust assessment of stunting, wasting,
overweight and exclusive breastfeeding. New methods are needed to assess progress
towards global nutrition targets developed by WHO and UNICEF.
4) Data is needed for tracking progress - knowing who is included in the progress; knowing
how well high income as well as middle and low income are doing; knowing what progress
had been made in addressing risk factors in nutrition across sectors so as to ensure
integration.
5) Filling data gaps to track nutrition in adolescents, specifically anemia and obesity is
critically important.
6) Diet quality data gaps – tracking indicators would be transformative for health and
nutrition. Readily interpretable indicators will raise its visibility and enable informed policy
debates and actions. Clear information on what diet looks like will move towards
improving them.
It was recommended by the same Expert Group that in order to address the data gaps in the
nutrition programs and interventions in countries, the following actions are needed:23
21
Lippeveld, Sauerborn, Bodart. Design and Implementation of Health Information Systems, WHO 2000.
22
Development Initiatives, Global Nutrition report 2017: Nourishing the SDGs, Bristol, UK., pp. 9-15.,
https://www.globalnutritionreport.org/files/2017/11/Report_2017.pdf, accessed 01-02-2018
23
Ibid., pp26-43
a) Identify data priorities and gaps, invest in nutrition survey capacity, ensure that high-
income countries provide comparable data for inclusion in progress tracking, invest in
databases to facilitate accountability.
b) Transform how we think about data - a wholistic horizontal view for nutrition data that
spans from priority setting to collection, analysis, interpretation and use of information by
decision-makers.
c) Build capacity, support, strengthened data and information system, as well as
disaggregated data reflecting information about specific vulnerable populations.
B.1.4 Considerations in the Design and Development of Information Management

Systems
In the manual on Framework and Standards for Country Health Information Systems published by
the WHO in 2008 (reprinted 2012), responsive health information systems will need the following
considerations and components:24
1) At present, health information systems in many low- and middle-income countries tend to
be “data-rich” but “information-poor”. This is a consequence of the belief that data can be
used directly for decision-making without the value-added approach. In reality, raw data
alone are rarely useful. The point of a health information system is not just to generate
high-quality data and hope that it will be used, but to convert it into credible and
compelling evidence that informs local health system decision-making. High-quality data
stored in a well-structured repository is of little value if it cannot be accessed by users to
generate information for decision-making.
2) If data are extracted and then integrated into a data repository, they can be synthesized
and triangulated with other sources and compiled into usable statistics and information
for deeper analysis and comparison. A key aspect of this is the integration, synthesis,
analysis and interpretation of information from multiple sources, examining
inconsistencies, identifying and accounting for biases, and summarizing health situations
and trends. Such analysis provides estimates (such as knowledge of disease burden, risk-
behaviour patterns, health service coverage, trends in indicators, and health system
performance). These can then be made available through user dashboards, reports,
queries and alerts.
3) The formatting or packaging of information for decision-makers is a core function of the

health information system in demonstrating the value of the data it contains. There have
been many recent ICT innovations in preparing complex information and evidence in
formats that can catch the attention of decision- makers and effectively communicate the
messages embodied in information. Some approaches takes advantage of web- or
computer-based access to repository or observatory data served in an interactive format.
Some new computerized analysis tools generate standardized reports rich in graphical
(and even cartographical) representation of information. Standardized reporting formats,
24
Health Metrics Network, World Health Organization, Framework and Standards for Country Health
Information Systems, – 2nd ed. World Health Organization 2008. Reprinted 2012. pp, 42-43,
http://www.who.int/healthinfo/country_monitoring_evaluation/who-hmn-framework-standards-
chi.pdf?ua=1, accessed February 07, 208
profiles and briefs are also highly effective. Such formats should guide decision-makers by
providing interpretations based on the potential consequences of alternative decisions
and scenarios. Information can also be disseminated through workshops, medical
journals, peer meetings and the media.
B.1.5 Overview of Past, Current and Future Initiatives on Health Information

Management Systems in the Philippines
The Field Health Service Information System (FHSIS)
Created by the Department of Health (DOH) in 1987, the FHSIS25 served as a major component in
the network of information sources that enabled the DOH to manage and monitor its nationwide
health service delivery activities. It was intended to address the short term data needs of DOH
personnel who had supervisory functions in each of the health program areas and local health
facilities.
The FHSIS provided summary data on health service delivery and selected program
accomplishment indicators at the barangay, municipal, district, provincial, regional and national
levels. Combined with other data sources, it provided information for program monitoring and
evaluation purposes. The FHSIS also provided standardized facility level database which could be
used for in-depth studies. It helped local government units identify public health priorities and
used as basis for planning, budgeting, logistics, M&E and other decision-making at local levels. It
was also a source of data to detect unusual occurrence of diseases and helped midwives follow-up
clients.
The FHSIS was composed of individual/family treatment records, target/client lists, reporting
forms and output reports. It focused on several programs such as MCH, EPI, CDD, Nutrition, FP,
Reproductive Health, TB, Malaria, Schistosomiasis, Leprosy Control, Dental Health and
Environmental Health. It also included vital statistics on Natality, Mortality and Notifiable
Diseases.
With the passage of the Local Government Code, the management and provision of basic health
services was transferred to the local government unit. While the main elements of the system
remained unchanged, there were new challenges to the appreciation and use of the information
system for local decision making.26 This brought to fore the need to make FHSIS an effective tool
for use of the Local Chief Executive setting local health priorities, ensure accuracy and quality of
health data, timely submission and linkage to the national health information system.
LGU-based Health Information Systems
Following the devolution of powers to local government units (LGUs), several health information
systems using various applications were developed to assist LGUs in data collection, consolidation,
25
Field Health Service Information System (FHSIS) https://www.scribd.com/doc/27872414/The-field-health-
service-information-system-FHSIS
26
Manuel Sta, Maria, The FHSIS: Its Role in Decentralizing Health Services in the Philippines, Management
Sciences for Health, http://pdf.usaid.gov/pdf_docs/PNABR934.pdf Accessed: 14 April 2018
analysis and use of health data for local decision making and prioritization. Some of these systems
include the following:
a) Community Health Information Tracking System (CHITS), an extensible, modular, open

source information system for Rural Health Units, which collects health data from FHSIS
and integrates them into a unified, comprehensive, computerized information system.
b) Wireless Access for Health Initiative (WAH), a digital health platform developed by an LGU
in 2009. It is a clinic-centered health information platform which helps RHUs to improve
health care service delivery. It features an Electronic Health Record (EHR) system and
features digital health scorecards for health facilities.
c) Secured Health Information Network and Exchange (SHINE OS+), a web and mobile based
system which address the data management needs of doctors, nurses, midwives and
other allied health professionals in the country. It is an Electronic Medical Record (EMR)
and referral system initiated by Smart Communications.
d) eHealth Tablet for Informed Decision Making of LGUs (eHATID LGU Project) is one of the
eHealth and Community Empowerment through Science and Technology (CEST) projects
of the Philippine Council for Health Research and Development (PCHRD) of the
Department of Science and Technology (DOST) with Ateneo De Manila University. It
provides health Information system and decision-making support to LGUs through an
Electronic Medical Record (EMR) that generates particular health reports that may be
used for analysis ad decision-making for the LGU/RHU, the Department of Health (DOH)
and the Philippine Health Insurance Corporation (PhilHealth). It aims to improve efficiency
and transparency among stakeholders using an enhanced health information system (HIS)
model that promotes health information convergence and informed decision-making. The
project supports and is compliant with the information technology requirements of the
PhilHealth Outpatient Benefit Package Plus (OPB+) otherwise known as the TSeKAP –
Tamang Serbisyo para sa Kalusugan ng Pamilyang Pilipino. The TSeKAP cater primarily to
the Pantawid Pamilyang Pilipino Program (4Ps) beneficiaries. eHATID EMR data sets and
reporting features are presented in Annex 2.
e) iclinicsys was developed by the Department of Health as an integrated clinic information

system designed to generate the required national health statistical requirements. It is an
Electronic Medical Record and health information system that supports the functions of
Primary Health Care Units. It automates service delivery processes in order to effectively
and efficiently monitors patient care in the facility.
f) E-OPT or OPT-PLus27 was developed by the Food and Agriculture Organization (FAO) for
the National Nutrition Council (NNC) to come up with an Excel-based automated or
electronic information system to capture the data generated through the Operation
Timbang or OPT being conducted annually by the Barangay Nutrition Scholar (BNS) at the
barangay level. It aims to generate LGU-based data for nutrition assessment, planning,
27
http://www.nnc.gov.ph/phocadownloadpap/6thNationalConference_of_DCNPCs/e-
OPT%20Plus%20Tools_DCNPC_17Aug2017.pdf and http://www.nnc.gov.ph/downloads/category/39-opt
Accessed: 17 April 2018.
management, and evaluation of nutrition programs at various levels: barangay,
municipal/city, and regional. The data generation is done by the BNS during their annual
OPT usually during the first quarter of the year. However, some municipalities conduct
monthly weighing especially to monitor progress of interventions for malnourished
children. The BNS first used the forms provided for the OPT and encode the data in the
information system. The system then computes for the nutrition status of the children
weighed as to the wasted, stunted, severely malnourished and overweight. The systems
checks for double entry and out-of range values due to entry error. The encoded data can
be easily printed in a report format provided for by the system.28
National Health Information Systems on Nutrition
Currently, the country has two (2) major monitoring tools on nutrition. These are:
a) MELLPI- Monitoring and Evaluation of Local Level Plan Implementation. This is used to
assess the progress of the implementation of local level Plan of Action for Nutrition at
barangay, municipal and city as well as provincial levels. This is conducted by the regional
and national NNC offices based on recommendations by the province for the barangays
and municipalities. This annual assessment, with support from the Department of the
Interior and Local Government (DILG)29, also becomes the avenue to provide incentives
and rewards to best performing BNS and local nutrition committees. The sources of data
for filling out the MELLPI forms are provincial/city/municipal nutrition action plans, PPAN
quarterly reports, provincial/city/municipal evaluation wall charts, minutes of meetings,
attendance sheets of meetings, master list of clients for various programs, progress
reports, Provincial/City/Municipal Annual Investment Plan or Annual Budget Report,
correspondences and other records. Interview with the local chief executives, members of
the nutrition committees as well as other functionaries especially at the barangay level
shall be conducted by the Team to provide qualitative data that will complement and
supplement the information attained from the score sheets and reference documents30.
b) National Nutrition Survey. The Food and Nutrition Research Institute (FNRI) is mandated
by law to conduct the National Nutrition Survey (NNS) every five (5) years. The NNS
includes 10 major data sets on the following: anthropometry, biochemical, clinical and
health, dietary, socioeconomic, food security, participation of individuals and households
on government programs, maternal health and nutrition, infant and young child feeding,
and household awareness and use of iodized salt and nutrition labelled nutrition facts.
FNRI conducts a digital survey using the tablet and netbook in field interviews and
validation. It uses the PSA list for survey sample households and data is disaggregated by
regions. A national dissemination of data for national and regional agencies is conducted a
year after results are released.
28
FAO, Improving Food and Nutrition Security in the Philippines., http://www.fao.org/in-action/improving-
food-and-nutrition-security-in-the-philippines/pt/. Accessed January 3, 2018.
29
http://www.dilg.gov.ph/PDF_File/issuances/memo_circulars/dilg-memocircular-2015310_ac8ac7c444.pdf
30
National Nutrition Council, Guidelines on the Monitoring and Evaluation of Implementation of the PPAN
at Provincial, City and Municipal Levels (PPAN IG No. 010).
B.2 Key Informant Interviews
Results of Key Informant Interviews (KIIs) are presented in this sub-section. It covers information
about nutrition and nutrition-related programs implemented by each agency as well as the
information systems used to support the implementation of nutrition programs. Two (2) sets of
KII results pertaining to System Users and System Developers are summarized in tables below. No
System Supporters were identified and interviewed. This sub-section also outlines the
corresponding mandates and functions of each agency, their respective roles in the
implementation of nutrition programs, their achievements thus far in achieving objectives in
nutrition improvement. Moreover, it also outlines the initiatives on nutrition and nutrition-related
information systems, general tools used and achievements in the use of these systems.
Experiences, challenges encountered and recommendations for program or system improvement
are also presented in the section.
B.2.1 Provincial Level Key Informants (System Users)
System users interviewed were some members of the Provincial Nutrition Committee (PNC) who
were available during the field visit: Department of Social Science and Technology (DOST), Silliman
University, Integrated Provincial Health Office (IPHO), Department of Interior and Local
Government (DILG), Provincial Social Welfare and Development Office (PSWDO), Provincial
Agriculturist’s Office (PAO), Department of Education (DepEd) and the Provincial Veterinarian’s
Office (PVO). The PNC is organized to manage and coordinate the planning, implementation,
monitoring and evaluation of local hunger-mitigation and nutrition action plan as a component of
the local development plan 31.
Nutrition and Nutrition-related Programs in Negros Oriental
Table 3 presents a general description of the nutrition or nutrition-related programs as well as

achievements of some PNC member-organizations based on their respective mandates.
Each member of the PNC provides an important role in the implementation of nutrition and
nutrition-related programs in the province. The DOST and Silliman University both produced food
packs to ensure availability of nutritious foods during disasters and relief operations. Health
services related to nutrition improvement are provided by the IPHO to communities through the
RHUs. Feeding programs are conducted by the PSWDO and the DepEd. The PSWDO feeds
malnourished pre-schoolers aged 3-5 years old in Day Care Centers while the DepEd feeds
malnourished school children in schools. Occasional support is provided by the PAO and PVO by
ensuring the availability of vegetables through school gardens and milk in communities. Other
members such as the DILG, support the implementation of nutrition improvement through
monitoring of LGU accomplishments.
The full description of nutrition and nutrition-related initiatives undertaken by PNC member
agencies are discussed in Annex 3.
31
http://www.nnc.gov.ph/14-transparency/about-us Accessed: 15 April 2018.
Table 3. Mandates, functions and role of some PNC members in relation to nutrition programs.
Role in Nutrition
Organization Mandate and Functions Achievements
Programs
1 Department of Provides direction, Manages regional food Provided food packs
Science and leadership and coordination laboratory and for relief operations
Technology of scientific and produces food packs during calamities such
(DOST) technological efforts in the as the Haiyan (2013)
province; and Sendong (2012)
typhoons
Ensures that results are
maximized for economic
and social benefits of the
population
2 Silliman Founded in 1901, private Manages food Provided food packs
University Christian higher education laboratories and for relief operations
institution produce food packs; during calamities such
Deployed 1st – 3rd year as the Haiyan (2013)
Mission: Infuse Christian students to and Sendong (20102)
faith into academic learning communities as part of typhoons;
a 3-year immersion
program
3 Integrated Responsible for the Monitors health Reduced malnutrition
Provincial integration of promotive, services of the LGUs on rate (2016);
Health Office preventive, curative and ANC,PNC, EBF, EPI,
(IPHO) rehabilitative components Micronutrient Provided height charts
of health care delivery to supplementation, IYCF, and weighing scales to
ensure adequate health OPT, including RHUs;
services to the population nutrition programs
Granted additional
Acts as the Provincial incentives for BNS
Nutrition Action (P500)
Committee Secretariat;
Coordinate Nutrition
Programs in the
province
4 Department of Promotes peace and order, Monitors LGU Awarded LGUs with
Interior and public safety and strengthen performance in seal of good
Local local government governance governance
Government capabilities towards
(DILG) effective delivery of basic
services to citizens;
5 Provincial Social Leads the formulation, Monitors Day Care Provided additional
Welfare and implementation and Centers and DCCs and incentives for DCWs
Development coordination of social DCWs (P300); CROWN
Office (PSWDO) welfare and development Awardee; Hall of
policies and programs for Famer for Pabasa sa
and with the poor, Nutrition
vulnerable and
disadvantaged;
Role in Nutrition
Programs
6 Provincial Responsible for the delivery Distributes vegetable Galing Pook Awardee
Agriculturist of basic agricultural seedlings to
Office (PAO) services; develops constituents
agriculture and fisheries
plans, strategies, programs
and projects
7 Department of Formulates, implements and Implements school- Integrated the GPAK
Education coordinates policies, plans, based feeding program program into the
(DepEd) programs and projects in in elementary and high school curriculum
areas of formal and non- school levels
formal basic education
8 Office of the Responsible for the Provides technical Pilot tested milk
Provincial performance of veterinary assistance to dairy feeding program;
Veterinarian functions for the provincial farmers producing milk Managed milking
(PVO) government as mandated in for the community facility in the province
the Local Government Code
Achievements in the Implementation of Local Nutrition Programs
The implementation of nutrition and nutrition-related interventions had brought about various
achievements in addressing malnutrition in the province through the efforts of the PNC. Members
of the PNC were able to achieve the following in the implementation of their local nutrition and
nutrition-related programs:
1) Improvement of Negros Oriental’s rank in malnutrition. Through efforts of the various

agencies in the implementation of nutrition programs, the rank of Negros Oriental the
province as having the 2nd highest malnutrition rate in 2016 in the region was reduced.
2) Active, functional PNC with multidisciplinary expertise. Negros Oriental has an active
Provincial Nutrition Council. It is headed by the Assistant Provincial Health Officer as the
Provincial Action Officer. Members of the PNC include permanent representatives from
the DOST, PCWD, PAO, PVO, Siliman University, DepEd, PPDO, and DILG. Regular meetings
are held by the PNC and monitoring activities and assessments are conducted in
partnership with other members. The PNC provides for an effective mechanism to
coordinate nutrition activities in the province.
3) Proven, award-winning program on gardening (known as Gulayan at Palaisdaan Alay sa

Kabataan or GPAK) linked with schools and households. Implementation of the GPAK
program garnered a Galing Pook Award32 for Negros Oriental in 2006. The program was
commended for its effective backyard food production aimed at increasing food security
by sustaining freshwater fish and vegetable production in school gardens. The program
was adopted for province-wide implementation and received recognition from the
national government.
32
Philippine Information Agency: “Massive food production campaign now underway in Negros Oriental
http://archives.pia.gov.ph/?m=12&sec=reader&rp=5&fi=p090129.htm&no=42&date=
4) Approval of PHP 300/DCW/month and PHP 500/BNS/month provincial subsidy. The PSWD
and DOH had been successful in allocating additional incentive for the Day Care Workers
and Barangay Nutrition Scholars (BNS) from their respective GOP budgets. An additional
amount of PHP 300 and PHP 500 per month was received by the DCW and BNS,
respectively.
5) EFR food and complimentary food packs developed. Both the DOST and Silliman
University had the technical capabilities to produce complementary food packs for
emergency food relief. Both had food laboratories and the necessary technology to
produce food packs necessary for nutrition. Silliman University also had a water filtration
facility which could be tapped for nutrition programs.
6) Sustained student immersion program. Silliman University also has a sustained student
immersion program with learning laboratories in selected communities. The program runs
for 3 years and includes provision of services to the communities such as nutrition
education, community diagnosis and planning community based interventions. The
program can provide sustained nutrition services to the community.
7) Institutionalized recognition systems for Day Care Centers (DCCs) and Day Care Workers
(DCWs). The PSWDO has a well-established assessment system for accreditation of DCCs
and DCWs. These programs ensure that facilities are up to par and DCWs are competent
to provide day care services for early childhood care and development. Incentives were
likewise provided for outstanding performances of LGUs.
8) Consistent national awardee of the CROWN Award. The Province has consistently excelled
in local nutrition program implementation as shown by various recognition it received
from the national government such as the Monitoring and Evaluation of Local Level Plan
Implementation (MELLPI) Program33 which awarded the province with the Consistent
Regional Outstanding Winner in Nutrition (CROWN) award.
9) Hall of Famer (national) in Pabasa sa Nutrisyon. The Province was also recognized as a Hall
of Famer awardee in the Pabasa sa Nutrisyon, a nutrition education approach to fight
hidden hunger and malnutrition to target population groups promoted by the National
Nutrition Education Program. The approach calls for the use of participatory discussions
to learn about nutrition and share experiences on various health and nutrition topics.
Information Systems on Nutrition
The KI interviews of PNC members revealed the use of several information systems to support
nutrition and nutrition-related initiatives in the province. Table 4 summarizes some of the
information-related initiatives as follows:
33
Monitoring and Evaluation of Local Level Plan Implementation (MELLPI) http://www.nnc.gov.ph/plans-
and-programs/philippine-food-and-nutrition-surveillance-system/monitoring-and-evaluation-of-local-level-
plan-implementation-mellpi Accessed: 10 March 2018.
Table 4. Information-related initiatives on nutrition.
Organization Initiatives Tools Achievements

1 DOST eHATID Project Tablets; eHATID Pilot-tested the e-HATID
guidelines for LGUs LGU System in Negros
Oriental
2 Silliman University Not specified Not specified Served as assessors/
evaluators of nutrition
related programs/
projects; Acted as
resource persons on
nutrition
3 IPHO Operation Timbang OPT forms Adoption of iclinicsys in
(OPT) Iclinicsys online/ RHUs
Iclinicsys Electronic offline applications
Medical Records (EMR)
with PHIC related
information
4 DILG Assessment of the PPAN Established a database
Philippine Plan of Action Accomplishment on LGUs through the
(PPAN 2017 – 2022) Report Form various monitoring
activities
Assessment of Municipal
Nutrition Committees NNC Forms
5 PSWDO Assessment of DCCs and Assessment forms for Institutionalized the
DCWs DCCs, DWCs and assessment of DCCs and
Assessment of ECCD ECCD DCWs in the province
6 PAO Not specified Uses nutrition data Not specified
to identify project
sites for GPAK
7 DepEd EBEIS and LIS Uses online
application of the
EBEIS and LIS
8 PVO Not specified Not specified
Several nutrition and nutrition-related information systems were implemented in the province.
These systems include the eHATID LGU application, the iclinicsys, the OPT system, the PPAN
accomplishment reporting system, the DCC and DCW assessment forms, as well as the ECCD
assessment systems. In addition, PNC member agencies also implements nutrition-related
assessment systems such as the SGLG (Seal of Good Local Governance), LIS and the EBIS
developed by the DILG and DepEd, respectively.
Implementation of the information systems covered a range of data collection activities

conducted through weight and height measurements as well as assessments and evaluations.
Implementation also included the consolidation and analysis of data related to OPT, DCC, DCWs
and ECCD monitoring. However, not all data are analyzed at the provincial level. Information
related to PPAN accomplishments are directly submitted to the NCC regional offices.
All data and information collected from municipal/city levels are submitted and reported to the
national agencies through the regional offices of each respective agency. A ranking system is often
used by the national agencies to determine the status of provincial performance on nutrition
program implementation and extent of malnutrition in the province. National incentive systems
are also in place to recognize performing LGUs.
The description of information systems on nutrition used by PNC member agencies are discussed
in Annex 4.
Achievements in Information-related Activities
Several achievements in the use of information system for nutrition and nutrition-related
activities were also noted as follows:
1) Pilot and initial (yet brief) adoption of eHATID. Although short lived, Negros Oriental was
able to pilot the use of the eHatid application in several RHUs. Training on the use of the
application was conducted for RHU personnel, introducing the use of tablets or electronic
devices in service delivery transactions.
2) Availability of monitoring and assessment tools linked to national surveys. The province
has several tools available for monitoring and evaluating nutrition programs as well as
LGU performance in the implementation of nutrition plans. These include the assessment
tools for Seal of Good Local Governance, eBEIS, functionality of local nutrition councils,
accreditation of DCCs and DCWs; ECCD implementation and PPAN accomplishments. The
PNC has likewise shown active participation of other agencies in the conduct of data
gathering for assessment or evaluation of nutrition activities. These data gathered from
the use of the assessment tools serve as inputs to regional or national surveys. These
surveys also serve to provide inputs to provincial level databases maintained by the
province.
3) Availability of online and web-based systems for i-clinicsys and OPT operations. The
availability of online and web-based systems for nutrition provides access and real-time
information on the implementation status for quick response and decision-making.
Experiences, Challenges and Suggestions in Nutrition and Nutrition-Related Programs
Table 5 presents some of the experiences of PNC members in the implementation of nutrition and
nutrition-related programs. It also outlines the challenges they faced and some recommendations
they made to improve nutrition program implementation.
Table 5. Experiences, challenges and recommendations of key informants

in nutrition and nutrition-related programs.
Organization Experience Issues/Challenges Recommendations

1 DOST Provision of food packs Food pack products Food packs may be a
during disasters and disseminated were not linked component of
emergencies to nutrition programs as a continuing nutrition
strategy to address services.
Provision of funding malnutrition in the province.
support for the Develop a targeted
establishment of food Nutrition Program for
lab as well as for the 3 or 10 LGUs and
conduct of researches involving extraction of
(from PCHRD). data from e-HATID and
provision by IPNAP of
Partnership with tablets to BNS for
ADMU in developing baseline data
34
and piloting eHATID. gathering .
2 Silliman Provision of food packs Observed that knowledge and University can share
University during disasters and practices of mothers about technology on food
emergencies good nutrition was limited. packs or produce as
food source.
Extension services to Good nutrition was not a
selected communities priority of mothers at home University faculty can
through student and not particular about food serve as resource
immersion programs fed to children. person for nutrition
topics.
Provided resource Barangays did not appreciate
persons on nutrition the importance of nutrition in University can conduct
the community and but they researches on
Participated in are supportive of nutrition nutrition, monitor and
nutrition program interventions. evaluate nutrition
assessments and programs.
evaluations
3 IPHO Led the coordination Large gap between national Ensure regular
of nutrition programs targets and achievement of calibration of weighing
in the province. actual targets due to the use scales for accurate
of projected populations as measurements.
Monitored local baseline for target setting.
nutrition programs and Ensure availability and
provided advice on Absence of a functional the right number of
nutrition services. community-based nutrition height boards for RHUs
program. to facilitate the OPT.
Inaccurate measurement of
weights and heights of Provide strong
children due to the use of incentive system to
uncalibrated scales. motivate BNS and
DCWs in the conduct
Limited supply of height of their tasks.
charts and inadequate
manpower for conduct of Require counterpart
OPT. resources from the
LGUs.
Irregular weighing of children
due to difficult of the terrain,
migration and poverty.
34
As per email communication from Dir. Gilbert Arbon, 21 December 2018.
Inadequate budget support
from LGUs for the nutrition
program.
4 DILG Served as a conduit for Observed that Nutrition Ensure financial
the NNC in gathering Committee meetings were counterpart of LGUs to
data on LGU not regularly conducted at support nutrition
implementation of municipal and barangay interventions.
nutrition programs. levels.
Provide technical
Nutrition is not a top priority assistance to LGUs so
of LGUs. that they appreciate
the importance of
nutrition programs to
people’s health.
Consider how nutrition

policy or plans may be
effectively
implemented.
Provide incentives to
nutrition workers to
increase interest in
work.
5 PSWD Monitored Delayed procurement of food Educate mothers on
performance of 1,158 supplements for the feeding good nutrition
Day Care Centers (DCC) program due to stringent practices at home
and Day Care Workers government procurement (especially mothers of
(DCW) in the province. systems. the 4Ps children) in
tandem with
Monitored the 120 Inadequate budget to feed supplemental feeding
days supplemental the children. Allocation was activities.
feeding programs only set at 10 pesos per child
undertaken through per day for the 120 days Request LGUs to
the DCCs for 3 – 5 feeding. augment technical and
years old children. financial resources at
Many of the DCCs did not the municipalities for
Monitored Early meet standards for LGUs. the feeding program.
Childhood Care and DCWs were affected by
Development (ECCD) changes in LGU Officials Intensify the feeding
program. during local elections. and ECCD programs at
the locality to
Inadequate technical appropriately address
capabilities of DCWs to malnutrition.
effectively manage nutrition
education and child Provide additional
development requirements. incentives for Day Care
Officers and Workers.
Ensure availability of
budget allocations for
the management of
the DCCs and work of
DCWs.
7 PAO Led the Malnourished children were Implement feeding/
implementation of the identified yearly and nutrition programs in
“Gulayan at Palayan rehabilitated through the communities where
Alay sa Kabataan” school feeding program. pupils/students reside.
program or the GPAK.
Proper nutrition is not Integrate vegetable
Supported the School- practiced at home and gardening (GPAK
based Feeding feeding programs are not Program) as a part of
Program for wasted conducted in communities the feeding program of
and severely wasted except in DCCs. Day Care Centers.
children among Grades
1 – 6 students with Seedlings distributed were Create a list of
supply of vegetable not based on an essential list vegetable seedlings
seeds. of nutritious foods. critical for proper
nutrition of
malnourished children.
Results of the KII interviews noted a range of experiences in the implementation of nutrition and
nutrition-related interventions as follows:
a) The DILG, DOST and PNAO in Negros Oriental expressed concerns about the accuracy of
the data gathered from the OPT. They indicated that weighing scales were not regularly
calibrated to obtain exact measurements. They also pointed out to the lack of height
boards for accurate measurement of children’s heights.
b) The BNS, Day Care Workers (DCW) and teachers as well as clinic nurses in schools, all
measured the weights (OPT) of children under their care. Targeted children often
overlapped since the BNS and Day Care Workers weighed children from the same age
group. The BNS and BHWs weighed children 0-71 months (or below 6years old), while the
DCW weigh children 4-6 years old. It was suggested that joint weighing by BNS and DCW
be conducted for the same age group to avoid duplication. This is expected to facilitate
the collection of similar data. In addition, only one information system is suggested to be
used in the collection of OPT data, with different agencies having access to the data.
c) Feeding of malnourished children was usually done at the Day Care Centers. Feeding was
funded by the DSWD with the budget augmented by the LGU. The use of the DSWD
budget is subject to tedious government procurement procedures which delays
implementation of activities. Concerns were also raised by the respondents on the lack of
or inadequate incentives for BNS and DCWs. They also mentioned the low priority given
by LGUs to the nutrition program.
d) Malnourished school children were also weighed and fed in schools. The CNAO has the
DepEd as a member of the committee and assigned the agency to weigh and feed
malnourished children from the K-12 levels. In addition, tapping technical and financial
resources from the private sectors especially the academe and research institutions for
the nutrition program was recognized as an important strategy to maximize existing
resources and technologies in the locality.
e) Nutrition interventions were implemented at normal and emergency periods. As

evidenced by the experiences of DOST and Silliman University in providing food packs to
disaster victims, the province had the ability to quickly respond to emergency situations
needing immediate nutrition interventions. Moreover, experiences of the PSWDO and
DepEd also indicated the province’s ability to provide regular and continued nutrition
services for preschool and school children. This seems to indicate that the province has
the capacity to respond to different situations needing nutrition interventions.
f) Nutrition interventions such as feeding and gardening were widely implemented in the
province. Feeding programs were conducted at selected facilities such as the Rural Health
Units, Day Care Centers and schools. These facilities were selected because they provided
an area for cooking and feeding under the close supervision by nutrition workers and
volunteers. A substantial number (1,158) of the Day Care Centers were reported to have
feeding programs for preschoolers. The DepEd also reported a wide coverage of
elementary and high schools with vegetable gardens. Apparently, the province possessed
the necessary structure, facilities and manpower to widely implement nutrition and
nutrition-related programs. In addition, it was also reported that milking facilities and
water filtering facilities are available to support nutrition interventions.
g) Nutrition interventions were implemented by experienced and technically competent PNC

member-agencies having different roles. They provided direct services such as feeding,
and micronutrient supplementation. They also provided advice on agricultural and animal
technology, as well as coordinated committee activities and monitored compliance to
standards and nutrition plans.
Issues expressed pointed to the following categories (1) lack of linking mechanisms to address
malnutrition in a more comprehensive manner; (2) inadequate facility and equipment (including
inaccurate or defective weighing scales) to ensure accurate and quality measurement of weight
and height; (3) inadequate support of LGUs at the municipal, city and barangay levels; (4) lack of
compliance to DCC standards and required DCW qualifications; (5) delayed procurement of food
supplements and (6) poor knowledge, attitude, skills and practice of the community on nutrition.
Recommendations presented by respondents include: (1) conduct of joint activities and sharing of
expertise; (2) regular calibration and supply of equipment (scales and height boards); (3) require
adequate LGU counterparts (in terms of personnel and funding) in the implementation of
nutrition interventions; (4) provide guidelines or plan of actions for the effective implementation
of nutrition programs; (5) conduct nutrition education and use behaviour change approaches; (6)
increase community participation in the implementation of nutrition programs.
Experiences, Challenges and Recommendations in Nutrition and Nutrition-related Information

Systems
Table 6 presents the experience, challenges and recommendations in the implementation of
health nutrition-related information systems in Negros Oriental:
Table 6. Experiences, challenges and recommendations of key informants in

nutrition-related information systems.
Organization Experience Challenges Recommendations

1 DOST Pilot tested the e-HATID Incomplete eHATID to provide a
system in Negros Oriental implementation and system aimed at
with partners (Ateneo de expansion of the eHATID integrating information
Manila University). system due to the at the LGU level for
required use of iclinicsys. nutrition management.
eHATID was effective in
providing an electronic eHATID application Ensure a system that can
medical record (EMR) of obtained only data from provide correct and
patients in the province. patients going for reliable data
consultations at RHUs
2 Silliman No experience in the use Nutrition data was not
University of nutrition or nutrition- readily available; quality of
related information nutrition data was
systems. doubtful.
Participated in nutrition Use of nutrition data

program assessments and collected was not
evaluations. maximized for planning of
community nutrition
interventions.
3 IPHO Skilled in the use of Field Limited access to internet Provide technical
Health Service Information and unstable sources of assistance to
System (FHSIS) which electrical power made it stakeholders in the
included nutrition difficult to upload monitoring and analysis
indicators on nutrition data in online of OPT results.
micronutrient applications.
supplementation. Ensure timely
submission of OPT
Trained in the use of the reports.
iclinicsys for RHUs.
Determined malnutrition
status of children based on
OPT results.
4 DILG Collected information on Inadequate LGU support Develop capacities of
LGU accomplishments in for data gathering on local nutrition workers
the implementation of the nutrition and in giving and officers (BNS,
PPAN. priority to nutrition. MNAOs and PNAOs).
Inaccurate data on Provide technical

nutrition; unvalidated data assistance in the
and delayed submission of installation and
nutrition reports. management of
nutrition information
Unstable sources of power systems.
and access to the internet.
Validate nutrition data
collected.
5 PSWDO Experienced in monitoring Lack of LGU budgetary Require LGU counterpart
and assessment of DCCs support for feeding to support nutrition
and performance of programs. programs.
DCWs.
Difficulty of LGUs to meet
Experienced in the DCC standards and hire
management of feeding qualified DCWs.
programs for pre-school
children. Delayed procurement of
food supplements for the
Skilled in the assessment national feeding program
of ECCD. due to strict regulations
under the Procurement
Law.
6 PAO No experience in the use Proper nutrition is not Implement GPAK
of information-related practiced at home and in program (vegetable
systems on nutrition. the community. gardening) in
However, PAO used communities where
nutrition data to identify Vegetable seeds students reside so that
project sites for GPAK. distributed were not nutrition interventions
based on an essential list are sustained.
of nutritious foods.
Several nutrition and nutrition-related information systems were seen being implemented or used
in Negros Oriental. These were as follows: (1) eHATID LGU, (2) iclinicsys, (3) Learner Information
System (LIS), (4) Seal of Good Local Governance (SGLG), (5) Philippine Plan of Action for Nutrition
(PPAN) evaluation tools), (6) DCC and DCW assessment tools, and (7) Early Child Care and
Development (ECCD) assessment tool.
Tables 6 highlights the following:
a) The IPHO, the PNAO, the DILG, the DOST and PSWDO all had-information system which
they utilized to generate and analyze data needed in the performance of their functions as
well as in generating reports and statistics. The PHO used the FHSIS system and the PNAO
used the e-OPT/or online OPT information system. These information systems were not
interoperable but generated similar data such as socio economic profiles of families under
the 4Ps or target clients for nutrition feeding programs. In addition, the PAO relied on
DepEd’s database for their Gulayan at Palayan Alay sa Kabataan (GPAK) program. DepEd
had their own information system.
b) The use of eHATID in Negros Oriental stopped after the pilot phase as the DOH required
the use of the iclinicsys in RHUs for their information system. However, the use of the
iclinicsys is being hampered by slow internet connection according to some of the
respondents.
To supplement some health information-related findings in Negros Oriental, KIIs were also
conducted in Tayabas City in Quezon Province. System users interviewed were the City Health
Officer (CHO) and City Nutrition Action Officer (CNAO). KII results revealed similar experiences in
the implementation of nutrition interventions and nutrition-related information systems. Table 7
presents the experiences, issues or challenges and recommendations of the key informants in
Tayabas City in the conduct of nutrition related activities.
Table 7. Experiences, challenges and recommendations of key informants in the implementation

of local nutrition programs and information systems in Tayabas City.
Key Informant Experience Challenges Recommendations

1 City Health Supervised the City Random schedule of Weigh 0-71 months from
th th
Officer Nutrition Office in the weighing at different the 25 -30 of the
implementation of barangays affected the month to capture
nutrition programs. accuracy of nutrition children advancing to
data. the next age group on
their birthday for the
month.
2 City Nutrition Experienced in the use of Slow internet connection LGUs to ensure internet
Action Officer DOH-FHSIS forms. at the RHU. access and support the
purchase of hardware
Trained in the use of Constant re-training of (computers/ internet
iclinicsys. However, staff due to changes in access).
system is not yet the versions of the
operating due to weak information system. Allow LGUs to submit
internet access. data directly to national
offices requesting for
Experienced in the use of information.
the Philhealth online
reporting system Deploy IT staff to LGUs
as well to encode data
Experienced in the use of on nutrition.
OPT online reporting.
Information systems to
include an alert system
for outbreaks/ notifiable
diseases.
Mobilize barangays,
LGUs, MNAO, CNAO and
PNAO to validate data.
Respondents in Negros Oriental and in Tayabas City raised the issue of slow or lack of internet
connection that contributes to the difficulty in using the iclinisys in spite of the availability of
computers provided to them.
B.2.2 National Level Key Informants (System Developers)35
Key personnel of four (4) national agencies were interviewed as key informants in the
development of health information systems for nutrition. Key informants included unit heads or
technical officers of the Knowledge Management and Information Technology Service (KMITS)
from the Department of Health, Nutrition Surveillance Division of the National Nutrition Council
(NNC) and eHealth Technical Working Group of the Philippine Council for Health Research and
Development (PCHRD), and the Food and Nutrition Research Institute (FNRI). In addition, an
unstructured interview with the head of ADMU Institute of Popular Culture (IPC), the co-developer
of the eHATID Project, was done.
Health and Nutrition-related Information Initiatives
Four (4) national agencies were directly involved in the development and implementation of
national electronic information systems on nutrition. Table 8 presents their respective mandates
the nutrition information systems they developed and managed as well achievements in their
implementation thus far.
Table 8. Organizational mandates and nutrition information systems of

selected national agencies.
Role in Nutrition
Information Systems
1 DOH - Knowledge Formulates plans, policies, Developed and manages 65% of RHUs
Management and programs and standards the iclinicsys; trained on the
Information for systems and process iclinicsys
Technology Service improvement and systems Trains RHU staff on the information
(KMITS) development. Electronic Medical system.
Record (EMR) system.
Establishes and maintains
information and
communication
technology solutions.36
Develops and manages the

MIS and knowledge
systems of the DOH.
2 Philippine Council Formulates policies, plans, Coordinates activities of eHATID for LGUs
for Health Research programs, projects and the TWG for the eHealth application
and Development strategies for health S&T Masterplan operational in 3%
(PCHRD) development.37 implementation. of RHUs; pilot
tested in Negros
35
The consultancy team did not have the opportunity to interview key informants from the Department of
Health (DOH) Child Nutrition Program due to time and scheduling constraints. However, data on the
program were obtained from secondary sources such as the Department of Health website and the PPAN
documents from the NNC. Information is incorporated in this report as literature review. In view of this
limitation, the report focuses on the nutrition and nutrition-related information systems.
36
Knowledge Management and Information Technology Service http://www.doh.gov.ph/orgchart-kmits
37
PCHRD, http://www.pchrd.dost.gov.ph/index.php/about-us-aux
Role in Nutrition
Information Systems
Programs and allocates Commissioned the Oriental but
government funds for Ateneo de Manila discontinued in line
R&D. University to develop the with the use of the
e-HATID application iclinicsys.
Monitors R&D projects. program for LGUs.
Plans to develop an
Generates external funds. Directs and manages the IMS similar to the
PHIE. national PHIE to
integrate services
at the LGU level.
3 National Nutrition Mandated by law as the Monitors LGU Developed the
Council (NNC) highest policy-making and implementation of the PPAN 2017 – 2022
coordinating body on PPAN and nutrition with partners.
38
nutrition. programs through the
“Monitoring and Monitored PPAN
Formulates national food Evaluation of Local Level implementation of
and nutrition policies and Plan Implementation” or LGUs through the
strategies; MELLPI. MELLPI
Coordinates planning, Consolidates data from Assessed

M&E of the national Operation Timbang malnutrition status
nutrition program. (OPT) and determines of LGUs.
malnutrition rates of
Strengthens competencies LGUs. Assessed and
and capabilities of awarded LGUs for
stakeholders through Ranks performance of best practices in
public education, capacity LGUs in the the implementation
building and skills implementation of of nutrition
development. nutrition programs and programs.
recognizes good
performers.
4 Food and Nutrition Undertakes researches Conducts the National Completed the
Research Institute that define the country’s Nutrition Survey (NNS) 2016 NNS
(FNRI) nutritional status, with every five (5) years.
reference to the
malnutrition problem, its
causes and effects39.
Develops and
recommends nutrition
policy options, strategies,
programs and projects for
implementation by
appropriate agencies.
Disseminates knowledge
38
National Nutrition Council, http://www.nnc.gov.ph/about-us
39
FNRI-DOST http://www.fnri.dost.gov.ph/images/sources/fnri_mandate.pdf
Role in Nutrition
Information Systems
in food and nutrition as
well as provide S&T
services to relevant
stakeholders.
All four (4) national agencies had mandates to formulate policies, plans and programs for the
development of national information systems on health and nutrition. They were also mandated
to conduct researches, monitor nutrition status and assess performance of LGUs in the
implementation of nutrition and nutrition-related programs through these systems.
Based on their mandates and functions, the national agencies developed and managed
information systems such as the iclinicsys, the Philippine Health Information Exchange (PHIE),
Monitoring and Evaluation of Local Level Plan Implementation (MELLPI) and the National Nutrition
Survey (NNS). The national Information systems included mechanisms for data gathering,
consolidation, analysis and dissemination. The system covered all provinces, municipalities, cities
and barangays of the country.
It was observed that national information systems had different purposes, methods of collection
and analysis. For example, the iclinicsys was basically developed to monitor service delivery at the
field level, focusing on the provision of micronutrient supplementation. The MELLPI on the other
hand evaluated LGU performance in the implementation of local nutrition programs. Although
they included data sets on malnutrition, the system investigated program efficiency and
effectiveness. FNRI surveys looked into the nutrition situation of regions, focusing on identifying
the prevalence of different types of malnutrition among children.
Mechanisms for data gathering in the information system usually involved routine collection of
data from the barangays, municipalities, cities and provinces. However, data consolidation and
analysis varied and depended on the level where the task was assigned by the national agency.
For example, the iclinicsys was designed to be used by the RHUs and thereby allowed information
to be accessed by health workers at that level. However, consolidation and analysis of patient’s
data sought permission at the national office were done at the national level. All information were
required to be submitted to the PHIE which acts as its repository.
Similarly, MELLPI forms are distributed to the Provincial DILG for data collection from
municipalities. However, consolidation of data and ranking of LGU performance are done at the
national level. In other systems such as the assessment of DCCs and DCWs, the PSWDO is allowed
to consolidate and analyze data for planning and management purposes.
Most of the information systems go through agency structures to collect and disseminate data
except for FNRI. For example, forms are distributed by the national offices to regional offices who
in turn distribute forms to their provincial counterparts. Forms are completed by municipalities or
cities and are submitted back to the provincial offices and regional offices before they are
consolidated and analyzed at the national level. FNRI, however, collects data directly at the
municipal or city level, and consolidates and analyzes the data at the national level.
Description of the nutrition and nutrition-related information systems developed by the national
agencies to support the implementation of national nutrition programs are discussed in Annex 5.
Interviews with national agencies also revealed current efforts to implement an eHealth Master
Plan to automate government information systems. Technical Working Groups had been
established led by the DOST-PCHRD to implement the Master Plan and ensure interoperability of
these systems. Although plans had been started, implementation is still on-going. Agencies have
recognized the need to build their technical capabilities for systems and software development.
Experiences, Challenges and Suggestions
Table 9 outlines the experiences, challenges and recommendations of the four (4) national
government agencies on the development of information systems for the National Nutrition
Program.
National agencies have a broad experience in the development, pilot-testing, dissemination and
management of information systems for nutrition, including the publication of survey results.
There are currently initiatives at disaggregating nutrition information for vulnerable populations,
localities and highly urbanized cities. Data sets seem to be comprehensive especially with surveys.
New technologies and applications are used to facilitate data gathering.
Table 9. Experiences, challenges and recommendations of national agency key Informants on

nutrition-related information systems.

1 DOH-KMITS Developed and managed Resistance to change in Information systems by
the electronic health the use of digital private organizations
information system - the applications in some need to comply with
integrated clinic system RHUs and LGUs. government standards
(iclinicsys) to improve data and coordinated with
quality and synchronize System is not yet able to the DOH to avoid
information as a “one stop track defaulters. duplication.
shop.”
Information from and New or proposed
Pilot-tested the iclinicsys, use by private health indicators on child
particularly the Electronic organizations are not yet nutrition would need
Medical Record (EMR) and included. clearance from DOH
installed the system in Programs before it can
almost 65% of the RHUs. Unstable electrical be included in the
power and inadequate iclinicsys.
Trained RHU staff on the access to the internet.
iclinicsys. Include DOH Program
Limited indicators on representatives in the
child nutrition; based development of
only on what DOH information modules.
programs approve.
2 PCHRD Experienced in managing Conflicting policies Create a local PHIE (all
and coordinating activities among partner agencies sectors model) to
of the eHealth Technical in the implementation of integrate all LGU data
Working Group (TWG) to the e-Government sets with the following
implement the e- Master Plan. features:
Government Master Plan Interoperability of PHIE
on automation of PHIE not yet fully system at the local
government information functional (operating level for LGU needs/
systems only at 10% of its services.
capacity); delayed Allow for commercial
Developed the Philippine procurement of the PHIE use of the system for
Health Information system due to tedious LGUs to take
Exchange (PHIE) which government ownership.
served as a national procurement Include data from the
repository of health data. procedures. National Nutrition
Survey.
Private Electronic
Medical Reporting (EMR) Develop a Community
systems such as CHITS Empowerment through
(UP Manila), iclinicsys Science and
(DOH), Wireless Access technology (CEST)
Health (WAH) in Tarlac, program for GIDA
SHINE-OS (Smart) and areas.
eHATID (Ateneo) use
different applications Pass the eHealth Bill to
(eg. tablet, cloud) but mandate policy
have the same data sets. development efforts of
the Joint Committee
Not all health standards
and registries are Include DSWD, CHED
included in the iclinicsys. and the Population
Weak internet access Commission as
and unstable power members in the TWG.
sources at the RHUs.
Strong support from the Possible areas for
national government is participation of IPNAP:
needed to to sustain Provide capacity
collaboration. building/ expertise on
systems development
and architecture for
PHIE development
Develop standards for
health; provide new
data sets
Educate users in the
use of computers;
Build technical
knowledge of RHUs on
electronic information
systems
3 NNC Experienced in the Some LGUs do not Possible areas for
development and use of submit plans or reports collaboration with
several electronic health on nutrition creating a partners:
information management gap in nutrition NNC projects with FAO
systems such as: a) information; data and UNICEF on child
Monitoring and Evaluation collected are not nutrition is due for
of Local Level Plan accurate. expansion to other
Implementation (MELLPI), regions involving 48
b) Operation Timbang NNC information LGUs for 2018 and will
(OPT) , c) systems in the field are target 10 more LGUs.
PPAN Accomplishment not yet linked with the
Report, and d) National iclinicsys. NNC is the sole
Nutrition Survey through implementor of the
the FNRI Need to strengthen data MDG Funds in
collection on nutrition at collaboration with the
Have incentive systems in the LGU level to serve as LGUs (F1K areas).
place to monitor and a warning system. Assistance in
award good performance mentoring and follow-
of LGUs in the Some health indicators ups are needed at the
implementation of local are not yet included in LGU level. NNC can
nutrition programs. the MELLPI (stunting and collaborate with
wasting); Online OPT partners in F1K areas
Mandated by law to includes only for programs
establish Provincial and information on implementation.
Municipal Nutrition overweight and
Councils headed by a underweight. Possible areas of
designated Nutrition collaboration with
Action Officers, Absence of IPNAP:
interoperability Database and system
mechanisms to integrate development for
nutrition information tracking the status of
from various levels and nutrition activities/
sources: services at the LGU
a) Data on malnutrition level (preferably with a
collected by FNRI at the warning/alarm
national level mechanism).
Weight and height Systems development
measurements collected for nutrition program
at the local levels. management (eg.
b) Case studies collected development of
through Terms of training manuals,
References. supervisory manuals
c) Compendium on and M&E tools;
actions on nutrition conduct training for
collected by the NNC. system users and
provide TA)
For new systems, the

NNC Nutrition
Surveillance Unit
approves
systems/tools for child
nutrition information
and can conduct
consultations with
LGUs to pilot test the
product.
Involve the Nutrition

Information and
Education Division and
DILG in capacity
building programs for
BNS, as well as
capacity building of
LGUs for service
delivery and program
management.
4 FNRI FNRI is mandated by law Delayed submission of Ensure the quality of
to conduct the National data due to weak data collection using a
Nutrition Survey every 5 internet signals or system that has built-in
years. access. checking for
consistency and
Currently conduct digital Some of tablets completeness.
survey using tablets and malfunction or crash
netbook for field during data collection For new data sets on
interviews and validation. activities. child nutrition,
determine first the
Use 10 major data data needs of LGUs
sets/components in the and apply simple
NNS: anthropometry, statistical analysis for
biochemical, clinical and LGU use. Provide
health, dietary, socio- linkages of nutritional
economic, food security, status to data on
government program maternal care, poverty,
participation of individuals education and other
and households, maternal aspects whose data
health and nutrition, can be collected at the
infant and young child local levels.
feeding, household
awareness and use of DOST may provide
iodized salt. technical assistance
and maybe DOH may
Has capacity to provide provide funds for
data by province and information system
highly urbanized cities. initiatives.
Experienced in the
conduct of national
dissemination activities for
national agencies and
regions.
Can release NNS official

results to stakeholders at
6 months and publish NNS
results after 1 ½ years.
NNS data issued are

usually used for policy
formulation and program
planning.
Various challenges encountered by these agencies in the implementation of information systems

include:
1) resistance of RHU staff and LGUs to automation;

2) inconsistent policies among partnering national agencies;
3) lack of LGU cooperation in program implementation;
4) incomplete and limited capacity of the information system to provide required data and
summaries;
5) lack of inter-operability of information systems;
6) lack of power supply and poor internet access at localities.
Their key recommendations include: (1) establishment of interoperability mechanisms to

integrate information systems at the LGU level; (2) develop information systems that target
vulnerable sectors such as geographically isolated and disadvantaged areas (GIDA); and (3)
stronger mandate for use of inter-agency approach for information systems development. For
organizations willing to participate or assist in the implementation of information systems,
national agencies are open to partnerships provided clearance from national agencies are
obtained and compliance to government policies and programs are made. Areas for collaboration
identified are as follows: (1) capacity building or provision of expertise in system development and
architecture; (2) standards development for new data sets; (3) education of information system
users; (4) development of tracking systems and data quality checks; and (5) systems for nutrition
program monitoring and management.
Interview with the eHATID Co-developer (ADMU Institute of Popular Culture or IPC)
As the proposed electronic child nutrition information module being proposed is envisaged to use
the eHATID platform, an interview with the IPC head, Dr. Dennis Batangan, was done to get basic
information about the platform, his insights from the pilot project in NegOr, and his
recommendations in developing the nutrition module.
The key highlights of the interview are the following:
1) Some basic data (e.g., name, age, contact details, height, weight, etc) relevant to nutrition
are already in the eHATID system, which is designed not only to keep the patient’s record
but to serve as a management tool for sector managers (i.e., the RHU physician and the
local chief executive) and policy makers. The system is fully compliant with the
requirements and standards of DOST, DOH and PHIC. The full eHATID data sets are
presented in Annex 2.
2) The eHATID platform, though designed primarily for maternal health purposes in relation
to PHIC benefit claim requirements, may be used as the platform for the nutrition
module. However, IP (intellectual property) rights including some requirements under
the Technology Transfer Act should be clarified and settled with both IPC and PCHRD.
3) The IT (information technology) development component of eHATID was outsourced by

IPC and PCHRD from an IT service provider. Developing a similar system will take about
six (6) months inclusive of scoping and negotiation, design and programming, and trial
run and debugging of the system. Cost will vary depending on the scope and complexity
of work to be carried out.
4) The challenges encountered during the development and piloting stages of the system
include sensitivity issues, legal requirements, and difficulty in mainstreaming the
technology into the current health information architecture.
5) A comprehensive child nutrition data or information management system should cater to

the needs of any or all of the following prospective users: service providers, program
managers and policy makers. It must be compliant with the Data Privacy Act and with all
relevant laws on child welfare and development.
6) The pilot experience generated some insights and lessons: a) the buy-in of the target users
and other key stakeholders must be secured at the onset of the project; b) the
development of an LGU-based and –driven information management system must be in
the context of an existing program ecosystem that can provide full contextual relevance
and support; c) LGU ownership may be enhanced by encouraging them to provide some
counterpart or investment, and by engaging them as co-manager of the project in a
meaningful way; d) the interest and involvement of LGU teams and personnel in the
project may be sustained by providing them timely technical support as well as
recognition for good performance.
B.2 Focus Group Discussion
Following the key informant interviews with selected officers and representatives of the Negros
Oriental Provincial Nutrition Committee, a Focus Group Discussion (FGD) was conducted with
more members of the PNC. The FGD participants included representatives from the following
organizations: IPHO, DOST, PSWD, DILG, PAO, POV, DepEd, Silliman University and the PPDO. The
list of FGD participants are presented in Annex 1.
The FGD was preceded by the presentation of the initial results of the KII. The presentation
covered the on-going initiatives, gains, issues and challenges, opportunities and potentials, and
imperatives in addressing malnutrition in NegOr. The FGD aimed to a) validate and enrich initial
results of the interviews; b) based on validated interview findings, develop a consensus on an
innovative PNC strategy to address NegOr’s child malnutrition challenge; and c) identify next
steps.
The FGD participants validated and enriched the results of the KII particularly on their respective
organizations’ a) role, mandate and programs or activities related to nutrition; b) gains or
achievements; and c) general and information-specific issues and challenges. These are discussed
in the foregoing sub-sections and presented in Annex 3.
On general opportunities and potentials, the FGD validated the following: 1) availability of DOST-
PCHRD grants; 2) interest of IPNAP to provide support; 3) emphasis on SDGs as basis in
prioritization of interventions; 4) GPAK’s replicability at the barangay/household level; 5)
availability of organizations/personnel that can be tapped for nutrition interventions; 6)
availability of WHO recommended health systems strengthening approaches/tools as well as good
practices in other areas; 7) availability of academe-based research capability as the province is a
host to a number of universities; and 8) presence of DOH Public Health Associate Deployment
Program (PHADP) and Doctor to the Barrios Program (DTTBP). On nutrition information
management, opportunities include the i) availability of the eHatid as a platform for integrated,
seamless, real-time data collection and analytics; and ii) availability of tools and indicators as basis
in designing an integrated data and information management system.
Moreover, using the PNC context and perspective, the FGD confirmed the following development
imperatives to address the prevalence of malnutrition in Negros Oriental:
1) General or cross-cutting imperatives:
a. Need for unified/harmonized and transdisciplinary40 nutrition-focused approach/strategy

to manage child nutrition at the barangay/household level
b. Need to solicit/mobilize resources for nutrition interventions
c. Need to capacitate and improve the condition of DCWs, BNs and BHWs /CHTs (as “foot
soldiers”) and other actors in “community-focused nutrition management”.
2) Information-related imperatives:
a. Need to develop a reliable, robust, real-time information management system for service
delivery, program management and decision-making and policy development.
b. Need to have a common platform for sharing information/knowledge with relevant
stakeholders for learning and improved programming.
c. Need to track program performance on a periodic basis to come up with evidence-based
based reports for management purposes.
40
The concept of Transdisciplinary Approach: “A transdisciplinary model of care includes a treatment team
that shares the responsibility for the continual care of patients and views their roles as overlapping as they
work together to determine the appropriate treatment for the patient. It is important to form the team
based on the needs of the community and to include community members as part of the team.” In: A
Transdisciplinary Approach to Improve Health Literacy and Reduce Disparities by Johnston Lloyd, L., et. al.
https://pdfs.semanticscholar.org/4db0/19b23760e9af89f355c1c8cc59f5df444cf9.pdf Accessed: 21 April
2018.
After validating the results of the key informant interviews with PNC members, the FGD
participants were asked to reflect on and answer the following basic questions based on the
World Health Organization (WHO) Health System Building Blocks as applied to community-based
nutrition promotion and management:
a) What desired outcomes you (as PNC) wants to realize in the next 3-5 years?
b) What specific actions should be done to realize the desired outcomes?
c) What can your organization do/contribute to implement such actions?
d) What steps should be taken after this meeting?
Figure 5 shows the six (6) important elements of the WHO health system building blocks 41, which
should lead to improved health (level and equity), responsiveness, financial risk protection and
improved efficiency.
Figure 5: WHO health system ‘building blocks’ and desired outcomes.
The FGD participants were encouraged to share their answers by writing them in metacards,
which were later processed by the facilitator.
Desired Outcomes
The FGD participants listed several outcomes they wish to achieve in a span of 3-5 years. These
were process into ultimate and intermediate desired outcomes, viz: i) decreased malnutrition rate
(i.e., well-nourished children); ii) empowered parents and BNS/health workers assisting in the
implementation of nutrition-related activities; and iii) stronger institutional infrastructure to
manage nutrition (i.e., nutrition committees, day care centers, etc.)
Table 10 presents the intermediate outcomes vis-a-vis the WHO building blocks for an effective
health system.
41
WHO Health Systems Framework.
http://www.wpro.who.int/health_services/health_systems_framework/en/
Table 10. Proposed intermediate outcomes of the Provincial Nutrition Program.
Building Blocks Immediate Outcomes

1 Leadership and More informed decision-making based on reliable data and
governance information.
Enhanced policy-making.
2 Financing Increased and more focused investments (by LGU, etc.) in
malnutrition reduction programs.
3 Workforce Enhanced knowledge, attitude and practice of BNS, BHW, DCW and
RHU staff to provide nutrition service to children
IT-capable BNS/BHW/DCW and other frontline staff.
4 Products and Availability of food and nutrition supplements for children.
technologies Effective nutrition information management system (software and
hardware).
Improved transportation system for health workers to reach remote
areas.
5 Information & Functional IPHO/LGU and academe partnerships for R&D.
research Increased information sharing and evidence-based programming.
6 Service delivery Engagement of parents, volunteers and local officials in the
barangays in service delivery.
Key Actions to Realize the Desired Outcomes
The FGD participants identified key actions to realize the desired intermediate outcomes as
follows:
1) Provide all-terrain vehicles to be used exclusively for nutrition-related activities to

improve the mobility and response capability of nutrition personnel especially in remote
areas.
2) Conduct capacity development trainings and learning events to equip stakeholders with
the right knowledge, attitude and skills. These may include i) training for parents on meal
management, gardening, cooking, home management (linked with DSWD’s 4Ps Family
Development Sessions); ii) training of health workers on info management software; iii)
training of BHW/BNS and parents regarding data reporting; and iv) study tour to see good
practices in other provinces that the PNC may adopt.
3) Conduct information campaign and research to address health/nutrition equity.
4) Design and develop a web-based information database, sharing and analytics platform
including provision of IT hardware/equipment.
5) Promote organic backyard vegetable garden in the homes for improved health and
nutrition (of child and family).
6) Organize livelihood programs linked with nutrition for Day Care Center parents.
7) Harmonize and intensify nutrition programs of all government instrumentalities both at
the national and local levels.
8) Develop and ensure availability of micronutrient supplements for children.
9) Mobilize adequate resources (funds, technology, tools and equipment, personnel and
systems including appropriate nutrition policies).
10) Develop and institutionalize an awards and recognition system to motivate nutrition
management stakeholders.
11) Develop a comprehensive and integrated community-based provincial nutrition

management program, which must be embedded in all units of the Provincial Government
and in other relevant government agencies to ensure continuity and sustainability. The
management of such program should be under the responsibility of the PNC.
Initial Contributions of PNC Members to Implement Actions Identified
The following organizations presented some of the actions they could take to implement some of
the actions identified:
a) DOST: conduct trainings, undertake equipment calibration, provide technology support,

research funding through PCHRD.
b) PPDO: ensures that the nutrition plan will be incorporated in the provincial development
and investment plans, assistance in monitoring and evaluation activities of the PNC.
c) Silliman University: conduct research and trainings, provide assistance in monitoring and
evaluation.
d) PSWDO: conduct capability trainings for DCWs during summer.
e) IPHO: manage the provincial nutrition program.
Next Steps and Way Forward
The IPHO committed to initially discuss with the Provincial Governor the development and
implementation of a Community-based Nutrition Development and Management Program, with
DCCs as entry points, to be supported by an appropriation ordinance.
C. DISCUSSION AND ANALYSIS
This section covers the discussion and analysis of data obtained from the KII and FGD using the
analytical framework presented in the methodology. The framework has three (3) components,
namely: (a) the child nutrition situation (i.e., Component A); (b) health information management
systems (i.e., Component B), and the (c) health and nutrition interventions and approaches (i.e.,
Component C). At the interface or nexus of these components are: i) A + B = electronic child
nutrition information management systems; and ii) A + C = general child nutrition programs; and
iii) B + C = info-driven and evidence-based child nutrition programs.
C.1 Child Nutrition Situation
The literature review indicated a very high global prevalence of stunting (22.5%) and wasting
(7.7%) among under five (5) years old children in the world. 40% of stunted children were found in
Southeast Asia and more than half of all wasted children in the world were found in South Asia. In
the Philippines, the prevalence of stunting in children is higher at 33.4% (2015) prevalence rate,
while wasted children are slightly lower in prevalence at 7.1%. The high prevalence of stunting in
under five (5) years old children and wasted children is also reflected at the local level.
A higher prevalence than the Philippine average of stunted and wasted children is reflected at the
local level. The 2015 NNS survey indicated a 25.6% prevalence rate of underweight children less
than five (5) years (i.e., the children’s formative years) old in the Negros Island Region. The
prevalence of stunted children was 41.7% and of wasted children was 5.8%. Underweight and
stunting is observed to occur more in the rural areas among the poorest populations. This 2015
NNS data show that NegOr has generally higher rates than the national average in terms of
underweight and stunting (Table 11). For children under five (5) years old, NegOr posted 23.%
underweight children and 40% stunting children.
Table 11. Comparative malnutrition data in Negros Oriental.
Age Group Coverage Underweight Stunting Wasting

Under 5 years old National 21.5 33.0 7.1
NegOr 23.9 40.0 5.6
5-10 years old National 31.2 31.1 8.4
NegOr 32.7 34.5 11.5
10-19 years old National 31.9 12.5
NegOr 31.6 11.2
Source of Data: DOST-FNRI graph.
Using IPHO program data, the trend of malnutrition rate in the province from 2006-2015 was
decreasing over a period of 10 years. From a malnutrition rate of 11.4 in 2006, malnutrition rate
decreased to 6.4 in 2015. However, it is noted that the program data in 2015 of 6.4% malnutrition
rate (underweight) is low and does not coincide with the 2015 National Nutrition Survey (NNS)
data of underweight of 23.9%, which is considered high based on the WHO cut-off point (20%-
29%) to show high severity and magnitude. This may be due to the OPT coverage of the program
in 2015 of only 81%. This may also be due to some concerns raised by the key informants on the
data quality (i.e., due to non-calibration of instruments, and lack of training of volunteer workers)
and lack of validation of the data submitted by the BNS and Day Care Workers who are the
frontliners in the nutrition program. The NNS data is considered more valid source of nutritional
status data.
While the program data shows low severity and magnitude of wasting at 4.7% in 2016 and 5.7% in
2017, still the actual numbers of children who are wasted is high with 4,935 children wasted in
2016 and increasing with 6,039 children who are identified as wasted in 2017. Severely wasted in
2016 are 2,633 children and 2,788 children in 2017. The increasing number of children who are
wasted are not acceptable on a client-centered point of view and still needs to be addressed
appropriately.
Provincial data also shows that the severity and magnitude of stunting is low since it is below the
cut-off point of <20%. However, the rate increased from 14.5% in 2016 to 17.2% in 2017 or by 3%.
In actual numbers, there are 8,829 children below five (5) years old who are severely stunted in
2017. This is still a problem that needs to be addressed since these children are considered at risk ,
especially when they get sick.
During the Focus Group Discussion (FGD), PNC members acknowledged that notwithstanding its
recorded decreasing malnutrition rate, NegOr is still ranked as the second highest in terms of
Region 7, composed of NegOr, Cebu, Bohol and Siquijor). The high rank of the province in terms of
malnutrition vis-à-vis other provinces in Region 7 is ironical considering the economic status of
NegOr as a first class province.
C.2 Health Information Management Systems
Health information systems are important to the effective implementation of nutrition programs.
It is critical especially in the use of data for support to program management decisions and
improved actions. For information to influence management in an optimal way, it has to be used
by decision makers at each point of the management cycle.
The 2017 Global Nutrition Report emphasized the important role of information systems to the
success of nutrition programs and to addressing malnutrition. The report likewise indicated that
data gaps remained to be an obstacle in tracking the progress of multiple burdens of malnutrition
and disaggregated data is needed to identify vulnerable populations in need. There is need for
better data coordination, interpretation and use by decision makers for priority setting.
The report also pointed out the many data gaps in the assessment of stunting, wasting,
overweight and exclusive breastfeeding. There is a need for new methods to assess progress
towards the achievement of global nutrition targets. To address these gaps, expert groups
recommended the following actions: identification of data priorities and gaps, investments in
nutrition survey capacities, investment in databases that provide for a holistic view of nutrition
data. They also recommended building capacities to support and strengthen data and information
systems including disaggregation of data for information on specific vulnerable populations.
In the Philippines, the national information systems on nutrition are coordinated by a Technical
Working Group (TWG) composed of the DOST-PCHRD, DOH, NNC, FNRI and the PHIC. Following
the Philippine eGovernment Master Plan, the TWG developed an eHealth Strategic Plan for 2017-
2020 where they planned to harmonize the National eHealth Program to align and provide
interoperability mechanisms among eHealth initiatives, programs and projects. The main platform
for this system is the Philippine Health Information Exchange (PHIE) being developed by the
PCHRD. The PHIE aims to integrate various components of the health care delivery system and
serve as a national repository of health data. It ensures a secure electronic access and efficient
exchange of health data/information among government agencies for public health purposes.
The PHIE serves to integrate and harmonize data from different electronic medical record (EMR)
systems and hospital systems. At present, there are five (5) EMRs which the PHIE serves, namely
the iclinicsys, CHITS, WAH, SHINE-Os and eHATID. Two of the EMRs were developed and managed
by academic institutions, one (1) by a private telecommunications agency and two by a national
and local government unit. However, the integrating system is not yet in place due to delays in
procurement. The PHIE also collects and keeps information on primary care benefits as a pilot
activity in collaboration with PHIC and DOH. Together with the ADMU, the PCHRD TWG has also
pilot-tested the eHATID application in several provinces. To ensure interoperability of the different
EMR systems and maximize the PHIE as a repository of health and nutrition data, the use of similar
indicators and registration with the PHIE was required. About 65% of the RHUs received training
on iclinicsys. Thus far, the iclinicsys collect information on micronutrient supplementation and
PHIC primary care benefits. Data from this system is submitted to the PHIE for the national data
repository and to facilitate access by other systems.
The scoping assessment also revealed the presence of other national information systems on
nutrition. The purpose of these systems is to monitor nutrition status and implementation of
nutrition programs. The FNRI conducts a National Nutrition Survey (NNS) every five (5) years to
monitor nutrition status of Filipinos. It deploys its own pool of field researchers to collect data
using agency resources. Data is analyzed by the institute and disseminated by them to the public.
Recently, surveys conducted by the agency were made by field researchers with the aid of tablets
and netbooks to facilitate data recording. The NNS has become a useful source of reliable data on
nutrition status of the country. Data produced by the FNRI is used by various agencies in
monitoring and planning their own activities.
The National Nutrition Council (NNC) conducts an evaluation of provincial/city nutrition programs.
Local nutrition program efficiency and effectiveness is measured by this evaluation. Each year,
LGUs are required to submit nutrition plans to the NNC as part of the PPAN implementation. The
NNC evaluates LGU nutrition program accomplishments using several indicators of
program/project efficiency and effectiveness. Through this system, NNC is able to collect data on
the implementation status of nutrition programs and progress of interventions. The tool is
disseminated to Local Nutrition Councils of LGUs through the Department of the Interior and Local
Government (DILG). After completion of the tool, the form is submitted back to DILG which
forwards the forms directly to the Regional Nutrition Councils/DILG. Data is consolidated at the
regional level but data analysis is made at the NNC. The NNC provides for an incentive system to
encourage LGUs to prioritize nutrition and continue to submit data. Local nutrition programs and
projects are assessed and recognized with annual monetary awards.
At the local level, several information systems on nutrition and nutrition-related programs were
observed to be used by the PNC. These information systems were run by national agencies and
implemented by their provincial counterparts. Particularly for Negros Oriental Province, health
and health-related information systems implemented were the eHATID for LGUs (ADMU),
iclinicsys (DOH) for electronic medical records; Operation Timbang (DSWD/DOH/NNC); the
evaluation of provincial/city nutrition programs (NNC), assessment of Day Care Centers and Day
Care Workers including the ECCD (PSWDO). Other information systems also included the Seal of
Good Local Governance (DILG) and the Learner Information System and the Enhanced Basic
Education Information System (DepEd).
In terms of the status of implementation, the OPT, evaluation of provincial/city nutrition

programs, assessment of Day Care Centers and Day Care Workers including the ECCD, Seal of
Good Local Governance (SLGL), Learners Information System (LIS) and the Enhanced Basic
Education Information System (EBIS) were fully implemented in the province. The eHATID for LGU
application was pilot-tested in the province but its implementation was discontinued due to the
implementation of the iclinisys in RHUs. The iclinicsys is currently being used in the province.
All of the nutrition and nutrition-related information systems implemented in the province
involved data gathering at the municipal/city level. This was true for the eHATID LGU, iclinicsys,
OPT, evaluation of local nutrition programs, assessment of day care centers and day care workers
as well as the ECCD programs. Similarly, the Seal of Good Local Governance, LIS and EBEIS also
gathered data from municipalities.
However, not all of the data collected from the municipalities were consolidated and analyzed at
the provincial level. Information systems involving data consolidation and analysis at the
provincial level included the eHATID LGU, OPT, assessment of DCC/DCWs/ECCD. Data from these
systems were collected, consolidated and analyzed by the DOST, IPHO and PSWDO, respectively.
Especially for the PSWDO, data from assessment of Day Care Centers and Day Care Workers were
analyzed to identify status of compliance by LGUs to Day Care standards and qualifications of Day
Care Workers. ECCD data were also collected and analyzed by the PSWDO to determine status of
child growth and development, identify inconsistencies in child behaviours and recommend
interventions to LGUs. Gaps were also identified to serve as an input to program improvement.
OPT data were collected and consolidated by the IPHO to determine the status of malnutrition
rate in the province. The Operation Timbang (OPT) system, which measured underweight,
stunted, wasted and overweight children were routinely collected and submitted to the IPHO for
consolidation and summary. Quarterly data were collected and submitted to the NNC for ranking
on malnutrition.
Although data from the iclinicsys was accessed by the RHU, dashboards were generated at the
national level by the KMITS. Data for the evaluation of local nutrition programs was likewise
directly submitted by the DILG to the Regional or National Nutrition Council in charge of
monitoring these programs and providing awards for good performance. No analysis was made by
DILG on the information collected. They do take note, however, and extract pertinent information
for monitoring of their respective programs.
Information systems on child nutrition are linked to a number of national-level health information
systems through a system of data collection and reporting from barangays to municipalities/cities
to provinces, regions and national levels. Data are routinely collected through the system at
various levels (national, regional, provincial, municipal and barangays) for planning, monitoring
and evaluation purposes. Consolidation and analysis, however, are not all bestowed on the
Provincial Nutrition Council or Committee. Some of the consolidation and analysis of data are
made at the national level.
Data sets on child nutrition collected from these systems were observed to vary and target
different ages of children. For example, OPT collects data on the weight and height of 0-71 months
old children. These measurements were used to estimate the malnutrition rate among normal,
underweight, severely underweight, overweight, stunted, wasted and obese children. Data
collected through the iclinicsys include information on micronutrient supplementations provided
to mothers and children.
Evaluation of provincial/city nutrition programs managed by the NNC collect data on home, school
and community food production, micronutrient supplementation, food fortification, food
assistance given to preschoolers and school children, nutrition education, nutrition for mothers
and children, livelihood assistance, human resource development and enabling mechanisms.
The PPAN Implementation Accomplishment Report indicates quarterly accomplishments of annual

program, project and activity targets and indicators. The assessment of DCCs and DCWs provides a
different set of data to be collected.
The above description of existing data and information management systems show a vast array of
systems managed by different agencies at various levels, some are intended to track specific
nutrition and nutrition related indicators (e.g., OPT+ and NNS) and others track broader health
concerns but also include some useful data on nutrition (e.g., eHATID and iclinicsys). The PPAN
reporting system tracks program progress and accomplishments using reporting forms prepared
and collected at various levels of the so-called ‘nutrition program management loop’ involving
several stakeholder organizations with varied mandates and roles. No system, whether manual or
electronic, that specifically tracks progress and performance along the entire program or project
cycle at the LGU level, from inception to implementation and evaluation, was identified during the
scoping assessment.
Existing data and information systems are faced with challenges such as: a) lack of inter-
operability, b) difficulty of synchronizing and harmonizing data gathering activities, c) lack of or
defective equipment and tools, d) disjointed tracking capability, e) lack of interest in automation
and low capability (either in terms of competence or mobility, or both) of personnel to do data
gathering and analysis, f) lack of personnel and lack of focus due to multitasking responsibilities, g)
absence or lack of power supply and/or internet connectivity, h) incomplete and limited capacity
of the information system to provide required data and summaries, and i) delayed or incomplete
submission of reports.
Finally, based on KIIs, the design and development of any information management system by any
public or private organization must be aligned and consistent with national plans and agency
regulations or standards and compliant with any applicable law or regulation. This implies that the
entire design and development process will entail i) substantive consultations with concerned
entities, ii) approvals or sign-offs on essential features of the system, and iii) additional investment
in terms of time, effort and costs.
C.3 Health and Nutrition Interventions and Approaches
Some good practices in designing and implementing health and nutrition programs or projects in
developed and developing countries were identified during the scoping assessment.
Documented experiences indicate that community-based nutrition programming is effective in

addressing malnutrition on a large scale. Whether in villages or in schools, the engagement of key
stakeholders including the children is paramount to the success of a nutrition program. Indeed,
success of a nutrition program is influenced by a combination of contextual (socio-political),
programmatic (technical) and financial factors. And, as discussed above, the role of a well-
functioning data and information system that provides appropriate and reliable information in
real-time to decision-makers and implementers is key.
Several health and nutrition interventions and approaches were observed in NegOr. Notable
among these interventions were the food packs, immersion program for nutrition students, the
Gulayan at Palayan Alay sa Kabataan (GPAK), school based feeding program, feeding program for
pre-schoolers, the milk feeding program, micronutrient supplementation, DCC and DCW
assessment and the ECCD assessment as presented in the in the previous section of this report.
Just recently, though not mentioned in the field interviews, the DSWD required its 4Ps
beneficiaries nationwide to actively participate in the government’s Gulayan sa Barangay Program
by establishing either individual or communal bio-intensive gardens.
Negros Oriental Province attained several achievements in the implementation of local nutrition
and nutrition-related programs. The Province has an active and functional PNC composed of
various government agencies and partners who met regularly. IPHO serves as the PNC Secretariat.
A number of initiatives have received national recognitions. These were the GPAK Program
(initiated by the PAO) recognized as an exemplary project and was bestowed with a Galing Pook
Award. The Province had also consistently excelled in local nutrition program implementation and
received the Consistent Regional Outstanding Winner in Nutrition (CROWN) award from the NNC.
Likewise, one of the municipalities is a Hall of Fame Awardee for the Pabasa sa Nutrition.
Notwithstanding the above gains, the PNC recognizes the gaps and challenges that require
immediate attention in order to address and reverse the malnutrition of thousands of children,
especially those in their formative years, in Negros Oriental.
Several challenges were noted by PNC members in the implementation of local nutrition
programs:
a) Lack of mechanisms to link successful agency interventions with other initiatives in the
province in order to provide for a more comprehensive, integrated and effective strategy
to address malnutrition. For example, food packs produced by the DOST and Silliman
University were not maximized for use in feeding programs and other nutrition
interventions in the communities.
b) Inaccurate measurement of weights and heights. IPHO personnel have raised the concern
about the accuracy and quality of data for underweight, severely underweight, stunted,
wasted and obese children. According to them, accurate measurements could not be
obtained due to a number of uncalibrated or defective scales used for weighing children
and the limited supply of height boards.
c) Lack of LGU support to nutrition interventions. Several agencies noted the lack of budget
allocations from LGUs to support the feeding program, incentives for Barangay Nutrition
Scholars (BNS), management of DCCs and work of the DCWs. According to some key
informants, a number of LGUs were unable to provide adequate leadership and support in
addressing malnutrition in their areas.
d) Substandard DCC facilities and low competence of most DCWs. Compliance of DCC
facilities to standards set by the government was also seen as a challenge. LGUs have
inadequate investments in these facilities as a means to address malnutrition in the
community. With the low pay provided to DCWs, it was hard to attract qualified workers
to operate the DCCs. Moreover, since the budget for incentives of the DCWs were
provided by the LGUs, hiring of DCWs were adversely affected by conduct of local
elections and changes in local officials.
e) Delay in procurement of food supplements. The PSWDO expressed difficulty in providing

appropriate and timely supply of food supplements for the feeding programs in DCCs due
to stringent government procedures in the procurement of food supplements, which
often delayed distribution of these products. Moreover, the budget was inadequate to
appropriately feed children with only an allocation of P10 per child for 120 days. As a
consequence feeding was either not done on time or children were not appropriately fed.
f) Inadequate knowledge of mothers on nutrition coupled with poor feeding practices.

Mothers were often found to have limited knowledge about proper nutrition and had
poor feeding practices. Thus, nutrition interventions such as feeding programs conducted
to rehabilitate malnourished children often were not effective because these practices
were not carried on at home or in the community. Nutrition education and changes in
feeding habits and practice of families, especially the mothers, was seen as an important
factor to ensure that malnourished children are continuously and consistently provided
with the proper nutrition to improve their status. Participation of the family and support
of the community to the implementation of nutrition programs were seen as critical to
sustain efforts and achieve nutrition goals in the province.
During the FGD, the PNC has expressed its determination to act on these challenges by harnessing
the strengths of its members and by tapping opportunities to intensify existing programs and to
initiate interventions with potential partners. The PNC members identified their collective desired
outcomes with corresponding actions to achieve them. One of the key actions identified is the
design and development of a “web-based information database, sharing and analytics platform
including provision of IT hardware/equipment.” This means that the PNC members are open to an
even higher level of electronic information management system that goes beyond the initial idea
of a module to be piggy-backed in the eHATID platform.
Finally, they committed to embark on a three-year strategic project to pilot or demonstrate a

comprehensive, integrated and innovative approach to address malnutrition at the barangay level
in collaboration with public and private organizations.
D. CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS
This section presents the consulting team’s conclusions, synthesis and recommendations to both
PNC and IPNAP. The conclusions were derived from the key results of the documents review, KIIs
and FGD conducted. Their implications to the design and development of an LGU-based electronic
child nutrition information management system and to community-based nutrition management
initiatives are also presented, where appropriate. Recommendations are meant to guide the PNC
and IPNAP on possible actions to take in pursuit of their respective organizational mandates.
D.1 Conclusions and Implications
The following contextual factors and expressed needs of concerned stakeholders form part of the
“considerations” in the design and development of the LGU-based electronic child nutrition
information management system in NegOr.
D.1.1 On Contextual Factors
Child Nutrition Situation
There is a pervasive and alarming nutrition problem both globally and nationally. This problem is
of public health importance and affects especially the vulnerable populations. A higher prevalence
than the Philippine average of stunted and wasted children is reflected at the local level. The 2015
NNS survey indicated a 25.6% prevalence rate of underweight children less than five (5) years (i.e.,
the children’s formative years) old in the Negros Island Region. The prevalence of stunted children
was 41.7% and of wasted children was 5.8%. Underweight and stunting is observed to occur more
in the rural areas among the poorest populations. This 2015 NNS data show that NegOr has
generally higher rates than the national average in terms of underweight and stunting (Table 11).
For children under five (5) years old, NegOr posted 23.% underweight children and 40% stunting
children. These figures are disturbing.
NegOr IPHO local data nevertheless shows a declining trend of malnutrition rates over a 10-year
period (2006-2015)42. However, the Province is still ranked as the second highest in terms of
Region 7, composed of NegOr, Cebu, Bohol and Siquijor). The high rank of the province in terms of
malnutrition vis-à-vis other provinces in Region 7 is ironical considering the economic status of
NegOr as a first class province.
Implications: Child malnutrition has become an alarming problem of public health importance not
only in the world but most especially in the Philippines particularly in the rural areas. Hence, there
is critical concern to address this problem in every village or community in view of its magnitude
and impact to the health of children particularly those in their critical, formative years. It requires
urgent action that is effective, efficient and sustainable from health and local government
42
However, it is noted that the program data in 2015 of 6.4% malnutrition rate (underweight) is low and
does not coincide with the 2015 National Nutrition Survey (NNS) data of underweight of 23.9%, which is
considered high based on the WHO cut-off point (20%-29%) to show high severity and magnitude.
officials. For interventions to be strategic, LGUs should prioritize and focus on children in their
formative years in the rural communities.
Health and Nutrition Information Management Systems
There are several national information systems in place to support and monitor the progress of
national nutrition programs. These are the eOPT+, iclinicsys, NNS surveys, etc. However, these
information systems have different objectives, data sets and data collection methodologies. In
addition, the interoperability of these systems is non-existent. There is no known system that can
track activities, outputs and outcomes along the program or project management cycle at the
local level except the reporting forms being used by PPAN, which are sometimes submitted late or
incomplete and lacking in analysis. Mandate for TWG joint implementation of e-health plans that
will integrate these systems is inadequate. The integrating system is not yet in place due to delays
in procurement. The eHATID system was recently piloted in NegOr but was not sustained with the
directive to instead use iclinicsys. The said system has a number of data sets relevant to nutrition
and that its design concept may be adopted for LGU-led nutrition management activities.
Information systems implemented in the province are extensions of national information systems
on nutrition, vertically run by national agencies. Although the province participates in data
gathering and monitoring of LGU nutrition program implementation, consolidation and analysis
are often made at the national level. Information systems operating in the province have
interoperability features to maximize its use for analysis and input to LGU decision-making on
nutrition. Moreover, data gathering is also a serious concern due to lack of or defective
gadgets/tools, lack of mobility of personnel to supervise frontline workers, and poorly equipped,
multi-tasking personnel.
Implications: With health information systems seemingly in disarray, there is a growing need to
generate timely, reliable data and information for evidence-based decision-making, programming
and action especially at the local level, i.e., at the service delivery touch points. This requires a
nutrition program-specific platform that can track not only program progress (in terms of inputs,
activities or processes, outputs and outcome) but also to share relevant program information for
specific groups of personnel in the program/project management and execution loop. Such
platform should be able to capitalize on existing systems such as the eOPT+, iclinicsys and eHATID,
among others.
Health and Nutrition Interventions and Approaches
There are current efforts at the global and national levels to address malnutrition problems under
the SDG Agenda. The WHO agreed on six (6) global nutrition targets for 2025. The SDG presents
an opportunity to address malnutrition using an integrated approach. It addresses the vulnerable
sectors, proposes changes in the way data is completed, analyzed and used, and ensures that
commitments are acted upon. At the national level, the Philippine Plan of Action on Nutrition
(PPAN) 2017-2022 was developed to improve the nutrition situation in the country. These
initiatives are in the early stages of implementation and require further elaboration of strategies
and activities to effectively address malnutrition at the local level.
Community-based nutrition programming has been proven in developed and developing countries
as an effective approach in addressing malnutrition on a large scale. Whether in villages or in
schools, the engagement of key stakeholders including the children is paramount to the success of
a nutrition program. Indeed, success of a nutrition program is influenced by a combination of
contextual (socio-political), programmatic (technical) and financial factors.
GPAK is a promising initiative that has the potential to address nutrition issues at the community
level especially when it is linked and integrated with schools and Day Care Centers (DCCs) as well
as with DSWD’s Bio Intensive Gardening (BIG) initiative for 4Ps beneficiaries under the
government’s Gulayan sa Barangay Program.
The PNC is active in implementing and coordinating efforts to reduce malnutrition in the province.
NegOr has several nutrition and nutrition-related initiatives, many of which have been widely
recognized. However, several challenges hamper its efforts to address malnutrition. These
include: a) lack of mechanisms to link successful agency interventions with other initiatives in the
province in order to provide for a more comprehensive, integrated and effective strategy to
address malnutrition; b) inaccurate measurement of weights and heights; c) lack of LGU support
to nutrition interventions; d) substandard DCC facilities and low competence of most DCWs; e)
delay in procurement of food supplements; and f) inadequate knowledge of mothers on nutrition
coupled with poor feeding practices. In the FGD, the PNC has outlined its aspirations and plan of
action to address the urgent, critical malnutrition problem in NegOr.
Implications: The SDGs and the PPAN provide the official framework in addressing malnutrition at
the local level. This government-sanctioned framework formalizes the inclusion and prioritization
of nutrition actions in the development plans of national agencies and local government units. It
lays the legal basis in the promulgation of LGU policies and in the allocation of public funds; and in
soliciting the substantive support of the private sector. The availability of working models and
good practices in community-based nutrition programming as well as the potential of linking with
on-going government programs (e.g., DSWD’s 4Ps, LGU DCCs, etc.) will make it easier for the PNC
and its members to innovate and improve their interventions. PNC’s strong interest to pilot a
community-based and –driven child nutrition management project involving DCCs provides the
necessary ecosystem in the development of a child nutrition information management system in
NegOr.
D.1.2 On Stakeholders’ Needs
The design and development of a nutrition data and information management module or system
involves two (2) key groups of stakeholders – the System Users (SUs) and System Developers
(SDs). It should be noted however that, if seen at the meso/intermediate and macro levels, the
government agencies and instrumentalities categorized under this scoping assessment as SDs are
actually SUs, too. Nonetheless, from the context of IPNAP’s intention to support LGU-based
nutrition initiatives, the delineation of the said groups neatly fits with the idea that NegOr PNC
member-organizations, including the Secretariat/IPHO, are the System Users. System Developers
or SDs are those organizations based in Metro Manila. No System Supporters (e.g., funding
agencies) were identified and interviewed.
The willingness and commitment of the PNC to address NegOr’s critical malnutrition challenge is
apparent based on the needs the members expressed as culled from KIIs and the FGD, as listed in
Table 12. For System Developers, the concerned government agencies interviewed emphasized
alignment, consistency and compliance in any endeavour to develop an electronic data and
information management system. It goes without saying then that they need to be involved in the
design and development process. For ADMU, it needs clarity of its Terms of Reference (TOR), and
adequate time of at least six (6) months to undertake the entire design and development process.
Table 12. Expressed needs vis-a-vis functions of identified stakeholder groups.
STAKEHOLDER EXPRESSED
FUNCTION/S
GROUP NEED/S
1 System Users: 1.1 Implement programs that are A three-year strategic project to pilot
PNC and its responsive to the provincial or demonstrate a comprehensive,
Members malnutrition situation in an effective, integrated and innovative approach to
efficient and sustainable manner. address malnutrition at the barangay
level.
Vehicles, equipment and tools to be
used exclusively for nutrition-related
fieldwork.
1.2 Take the lead in managing all local Full support of all LGUs in terms of
nutrition initiatives. policies, personnel and funding.
1.3 Prepare and submit data and A web-based information database,
reports that are compliant with sharing and analytics platform that can
directives, regulations and standards streamline and take advantage of
under the PPAN and other applicable existing data collection (e.g., eOPT+,
laws in the implementation of iclinicsys, eHATID, etc) and reporting
nutrition programs. mechanisms.
2a System 2a.1 Ensure that all data and Involvement in the design and
Developer/s: information management systems, development process of the proposed
Government whether for public or private use, are data and information management
responsive to the sector’s needs and system.
compliant with directives, regulations
and standards under the PPAN and
other applicable laws (e.g., Data
Protection Act, Children and Women
Protection Act, etc).
2b System 2b.1 Develop data and information Clear Terms of Reference specifying
Developer/s: management systems that are desired features and functionalities of
Private (i.e., responsive to the user’s needs and the proposed data and information
ADMU) compliant with directives, regulations system. Minimum of six (6) months
and standards under the PPAN and design and development period
other applicable laws. inclusive of debugging activities.
Adequate budget for IT personnel who
will be outsourced, which depends on
the scope of work and deliverables.
Address intellectual property rights
(IPR) issues on the use of eHATID by
third party entities.
Implications: Knowing these varied and interrelated needs of various stakeholders is essential in
understanding the ecosystem of the proposed electronic child nutrition information management
system. The PNC’s strong interest to embark on an LGU-driven community-based nutrition
project provides an appropriate, unique setting for such information system -- which is envisaged
to be used by LGUs themselves in the first place -- to be designed, developed and sustained.
Involving relevant national agencies in this endeavour will ensure the system’s relevance,
acceptability and integration into the national health information infrastructure. ADMU’s
disclosure that its IT capability is outsourced is a good input in determining partnership
arrangements and in crafting its Terms of Reference.
D.2 Recommendations
IPNAP “aims to play a constructive role through meaningful partnerships with other stakeholders
in the areas of research, information and education”, among others. Given such organizational
goal and the realization that a health information management system has to be designed and
developed based on the requirements of a particular ecosystem in which it can be effectively and
sustainably deployed, the following are the recommended essential elements of IPNAP’s strategic
development assistance package in Negros Oriental:
4) Element#1: advocacy campaign and capability development. This element will address
two (2) main challenges identified in this scoping assessment: i) the lack of support from
LGUs, including from other stakeholders such as the private sector, due to low
understanding and appreciation of the importance, magnitude and complexity of
malnutrition especially among children; and ii) the poor knowledge, attitude, skills and
behaviours or practice of parents and those involved in the development and
implementation of nutrition programs. Social marketing approaches and tools will be used
for specific target groups. The capability development for parents should be linked with
the family development sessions under 4Ps of DSWD.
5) Element#2: development and deployment of an integrated electronic nutrition

information management system, which is the initial intention under this scoping
assessment. This element responds to the need to collect, consolidate, analyse, store,
share/disseminate and use appropriate data in a timely manner for evidence-based
programming, decision-making and learning. The system should take advantage of existing
nutrition data gathering, monitoring and reporting systems at the local level particularly
the OPT, iclinicsys, NNS and PPAN performance trackers. The system will have two (2)
components: one for PCM or project cycle management (from baselining to
implementation and evaluation), and another for advocacy and learning targeting
stakeholders with access to the internet. The PCM component may take-off from the
gains and features of the e-HATID while for advocacy and learning a platform that can
harness vast internet resources may be developed.
6) Element#3: piloting of community-based nutrition management project as an action

research43. This third element serves as the situs where elements 1 and 2 will be carried
43
“Action research involves the researcher working closely with practitioners to systematically monitor the
issues and problems of changing practice and aims to improve professional practice and standards of service
provision. It is seen to bridge the gap between theory, research and, given the current climate of constant
change, is seen to be an extremely useful approach to research in health care and social care settings.” See
Action Research in Health Care by Lucy Gilson.
https://www.tandfonline.com/doi/pdf/10.1080/09650799700200032 Accessed: 27 April 2018.
out. Targeting under-5 children consistent with IPNAP’s clientele focus, a pilot project
covering several towns and barangays (i.e., communities) serves as both context and
vehicle for advocacy and capability development, and for the development of an
information system for tracking project performance and for other purposes as discussed
above. The community-based pilot project will use the network of barangay DCCs as the
locus of all program interventions. These DCCs will in turn be linked with individual
households. The design of the pilot project will be informed by the results of this scoping
assessment, particularly by the results of the FGD with PNC members, and will employ
proven approaches, tools and good practices in managing health and nutrition programs
as presented in foregoing sections of this report.
When undertaken as logically sequenced components of a medium-term development program to

be implemented jointly by PNC and IPNAP, these elements are expected to generate basic
outputs, which will contribute to the ultimate outcome of ‘well-nourished under 5 year-old
children’ as shown in Figure 6.
Figure 6. Key elements of IPNAP’s recommended development assistance package.
d) Output 1: competent and committed “leaders” at various levels working in community-

based child nutrition initiatives. These “leaders” refer to LGU officials and personnel (i.e.,
at the provincial, municipal and barangay levels), PNC member-organizations’ personnel
involved in nutrition program implementation including DCWs and BN scholars, project
staff, and parents of children enrolled in DCCs.
e) Output 2: interoperable information management system linked with ‘official’ systems

tracking the progress and performance of the pilot child nutrition project. This refers to
the project management cycle or PMC performance tracker described under Element#2
above. The system should be able to both import from and export data and information to
other systems. For instance, the OPT data may be uploaded to the system to establish
baseline and progress data. Likewise, the processed data from the system may also be
exported to the PPAN performance tracking system. This system should enable personnel
involved in managing nutrition programs to track progress and to make evidence-based
decisions. Dashboards as well as reports for specific level of users should be incorporated
in the design of the system.
f) Output 3: web-based knowledge management and social marketing platform for child
nutrition leader-managers and workers. As discussed above, this system is for advocacy
and learning purposes. This may take the form of a website where information, learning
materials and experiences in managing or implementing community-based nutrition
programs are promoted and shared. Competency development courses, which may be
accredited to earn formal credits44 with local universities such as Silliman University, may
also be developed and made available for nutrition personnel. These courses may be
accessed online or offline by allowing the materials to be downloaded when there is
internet access. It will also use social media tools such as Facebook and Twitter to
disseminate information intended to a wider public.
Other programmatic recommendations to enhance NegOr’s nutrition program for the

consideration of both IPNAP and PNC are listed in Annex 6.
44
These learning modules may be accredited for Continuing Professional Education (CPE) units or for
masteral units in a cooperating University.
E. ANNEXES
Annex 1: List of KII and FGD Participants
Name Position Organization/Affiliation
A Prospective System Users: Negros Oriental Provincial Nutrition Committee
1 Atty. Gilbert R. Arbon Provincial S&T Director – Department of Science and

Negros Oriental Technology, Central Visayas
Region
2 Henrissa Calumpang, M.D. Provincial Health Officer II Integrated Provincial Health

Office
3 Liland Ziola B. Estacion, RN, Assistant Provincial Health Integrated Provincial Health
M.D. Officer & Provincial Nutrition Office
Action Officer
4 Ms. Antonieta Delfino Nutrition Coordinator Integrated Provincial Health

Office
5 Dr. Michele Naranjo Assistant Professor and Chair Nutrition and Dietetics
Department, College of
Education, Siliman University
6 Ms. Frances Evangeline Yap Provincial Agriculturist’s

Office
7 Ms. Rosalinda Villegas Local Government Officer V Department of Interior and

and Permanent DILG Local Government (DILG)
Representative to the
Provincial Nutrition Council
8 Ms. Marianita Ebrole Programme Coordinator Department of Social Welfare

and Development
9 Ms. Emma Sojor-Mate, PhD, Senior Education Program Social Mobilization and
MPH, RN Specialist Networking
Department of Education
Negros Oriental Division
10 Ms. Erlinda Vilan Provincial Veterinarian Provincial Veterinary Office
11 Ms. Nanette Tindoc Provincial Planning and Provincial Planning and

Campion Development Officer Development Office
B Prospective System Developers: National Agencies and Private Institutions
12 Dr. Dennis Batangan Research Associate Institute of Philippine

Culture, School of Social
Sciences
Name Position Organization/Affiliation
Ateneo de Manila University,

Loyola Heights, QC
13 Mr. Vincent John Tumlos Science Research Specialist Philippine Council for Health
Research and Development
(PCHRD)
14 Ms. Emily Razal Information Technology Knowledge Management and

Officer Information Technology
Service (KMITS), DOH-Central
Office
15 Mr. Jade Cruz Computer Programmer Knowledge Management and

Information Technology
Office
16 Ms. Cherry Estaban Information Systems Analyst III Knowledge Management and
Information Technology
Office
17 Ms. Hygeia Ceres Catalina B. Nutrition Officer V and Chief of Nutrition Surveillance
Gawe the Nutrition Surveillance Division, National Nutrition
Division Council (NNC)
18 Dr. Imelda Angeles-Agdeppa Assistant Scientist and Officer- NAMD-FNRI

in-charge
19 Ms. Mae Ann Javier Science Research Specialist I Nutrition Statistics &
Informatics Section, Food and
Nutrition Research Institute
20 Ms. Lynell Maniego Science Research Specialist II Nutrition Statistics &

Informatics Section, Food and
Nutrition Research Institute
Annex 2: eHATID Electronic Medical Record Data Sets
Annex 3: Description of PNC Nutrition and Nutrition-related Interventions in NegOr
The following are descriptions of the PNC nutrition and nutrition-related interventions conducted
in Negros Oriental.
Establishment of Food laboratories and Food Processing Centers
The Department of Science and Technology (DOST) in Negros Oriental supports the establishment
of food laboratories and food processing centers. These food labs are capable of producing
complimentary food packages which may be used in nutrition programs. In partnership with the
Food Nutrition Research Institute (FNRI), DOST was able to develop food packages composed of
rice and mongo as basic food products which may be supplemented with fruits. The DOST, in
partnership with the PCHRD, is also capable of formulating a research agenda on nutrition and
provide grants to study several concerns on nutrition.
Likewise, Silliman University has food technology laboratories where they produce food packs as
well from various agricultural products such as rice, mongo and vegetables. The University also
has a water filtration facility where water from unclean sources may be filtered to become
potable drinking water.
Immersion Program for Nutrition Students
Silliman University had an immersion program for 2nd-4th year college students, where selected
communities were adopted as social laboratories for students to learn about the practical
application of theories on nutrition. The immersion program provides for a two-way learning
process where students and the community learn from each other. Through an action-reflection
process, students learn about community life but also provide useful and practical services to the
community based on these reflections.
Second-year students are given 4 hours of community immersion with learning activities focused
on health and basic nutrition. For third-year students, immersion activities focus on the
preparation and provision of nutrition education to the community. Immersion of fourth-year
students is focused on experiencing public health activities such as the conduct of community
diagnosis, problem identification and planning of community interventions. The immersion
program provides for continuous nutrition education, conduct of nutrition interventions and
services to the selected community.
Gulayan at Palayan Alay sa Kabataan Program
The Gulayan at Palayan Alay sa Kabataan or popularly called GPAK was a program implemented
by the Provincial Agriculturist’s Office to address malnutrition in the province. The program
consisted of distributing agricultural seeds to elementary and high schools to grow and maintain a
vegetable garden on the school grounds. It also included technical assistance from PAO in growing
and maintaining the vegetable garden.
The initial selection of elementary and high schools for the GPAK program was based on the list of
wasted to severely wasted Grade 1 – 6 students and 1st – 4th year High School as baseline
information. The vegetable gardens were to be maintained by grade school and high school
students themselves, as part of the school curriculum under the Music, Arts and Physical
Education (MAPE) or the Technology and Livelihood Education (TLE) sessions. Produce from the
vegetable gardens was used for the school feeding program or sold in the market.
The seeds distributed by the PAO were initially based only on its suitability to the climate of
Negros Oriental rather than on its nutritious value. Eleven (11) vegetable seeds such as amplaya,
patola, upo, sitaw, eggplant, cucumber, pepper, kangkong, okra, tomatoes and chinese cabbages
were distributed to the schools.
The program was later extended to other elementary and high schools in the province. Annual
endline measurements were obtained to assess program accomplishments. In addition to growing
the vegetables and maintaining the garden, schools also began to apply organic fertilizers made
from whatever waste materials were found in the schools grounds. Some schools also maintained
a nursey for continued supply of seedlings.
The GPAK program earned recognition as a best practice in the Galing Pook Awards given to Local
Government Units for exemplary projects. Despite its success, PAO was concerned about new
malnourished children coming into the school each year. Sustainability of nutritious foods at home
and in the community to effectively reduce malnutrition in the province was a concern presented
by the PAO in continuing its activities.
Day Care Centers and Day Care Workers
Negros Oriental has a total of more than 1,100 Day Care Centers and 58 day care centers in
Dumaguete City. These Day Care Centers cater to 3-5 years old children, with a rated capacity of
10-25 children per year-old children. Activities at the Day Care Centers include supplemental
feeding, Operation Timbang (OPT) and monitoring of early childhood care and development
programs.
Day Care Centers are manned by Day Care Workers hired by the Local Government Units. Many of
the Day Care Workers are High School or College graduates receiving about 15,000 – 17,000 salary
per month. The Day Care Workers conduct classes at an average of 3 hours a day for each age-
group or bracket. They teach children to identify numbers, colors and the alphabet; how to hold a
pen or pencil using a play approach. They also teach life skills and values.
Supplemental feeding is part of the National Feeding Program implemented by the Department of
Social Welfare and Development (DSWD). It provides hot meals to children before the start of the
class. The feeding program runs for 120 days at 5 days per week. Food is prepared by the Day Care
Worker with 5 or more volunteer mothers. Budget for the feeding program comes from
Government Appropriations with central procurement of goods except for rice at the municipality.
Weighing of children and taking of their height is also conducted through the Operation Timbang
(OPT). This activity is assisted by the Barangay Nutrition Scholar (BNS) who weighs the child, with
measurements recorded by the Day Care Worker. Results of the OPT are submitted by the Day
Care Worker to the Municipal Social Welfare and Development Office.
Day Care Workers also monitor early childhood care and development (ECCD) using a checklist
provided by the DSWD and DOH. The checklist includes a socio-demographic profile of the child
and an assessment based on set standards from seven (7) domains of childhood care and
development. These domains include gross motor skills, fine motor skills, self-help skills, receptive
language, expressive language, cognitive development as well as social-emotional development of
the child.
Each year, the PSWDO assesses the performance of Day Care Centers and Day Care Workers.
These facilities and workers are evaluated based on standards set by the National DSWD Office for
Local Government Units. Areas evaluated include LGU capacity to assess children, quality of
partnerships with families, human resource development, program development and
management, and physical environment. According to the PSWD Key Informant, many of the local
facilities and workers do not meet the standards for various reasons. Some of the reasons
mentioned were: (a) inadequate financial support from the LGUs, (b) fast turn-over of Day Care
Workers due political changes in leadership and (c) inadequate qualifications of Day Care Workers.
Challenges experienced by the PSWDO in the implementation and monitoring of Nutrition-related

programs include: (a) delayed procurement of goods for the feeding program; (b) unstable source
of food commodities; (c) lack of incentives for Day Care Workers; and (c) lack of technical and
financial support for programs.
School-based Feeding Program
The Department of Education (DepEd) has several on-going initiatives on nutrition in the province.
The agency conducts health assessment of children in schools through its health personnel or
health unit. It also conducts a 120-day feeding program for students using a malunggay-based
menu. Deworming activities are conducted by providing tablets especially among children
belonging to the 4Ps (Pantawid Pamilyang Pilipino Program) beneficiaries. Integrated gardening in
partnership with the Provincial Agriculturist’s Office (PAO) had been integrated in the school
curricula. They also co-implement the GPAK Program by orienting parents about planting and
cooking technologies at home, and encouraging them to bring these vegetables to school for the
feeding program.
Milk Feeding Program
The Provincial Veterinary Office implemented the Gatasang Barangay and the Supplemental Fresh
Milk Feeding Programs. The purpose of these programs was to address malnutrition in the
province by ensuring the availability of milk in each barangay to feed the children. The
supplemental fresh milk feeding program was pilot tested in San Jose Municipality in coordination
with the livestock technician of the local government units, PCC and the National Dairy Authority.
The province has a milk collection and processing facility owned and managed by the Negros
Oriental Federation of Dairy Cooperatives (NOFDC). The Provincial Veterinary Office supports this
initiative by providing technical assistance to the association on dairy production processes,
distribution and marketing.
Provision of Micronutrients and other Services related to Nutrition
The Integrated Provincial Health Office of Negros Oriental coordinates and monitors health and
nutrition programs in the province such as the ante and post natal care, exclusive breastfeeding,
infant and young child feeding, operation timbang, and expanded program on immunization
among many programs. They also provide micronutrient supplementation to both mothers and
children such as iron, Vitamin A, iodine and deworming. The IPHO also distributes weighing scales
and height charts to Rural Health Units and City Health Offices for the nutrition program, for
nutrition services delivered at the communities. OPT and feeding programs are also implemented
by the Rural Health Units/Health Centers in line with the nutrition program of the Department of
Health. The IPHO monitors these feeding programs and provides subsidies to Barangay Nutrition
Scholars amounting to P500 pesos.
Seal of Good Local Governance
Although the Provincial Office of the Department of the Interior and Local Government (DILG) in
the province did not directly undertake nutrition activities, it monitored local government unit
implementation of programs and projects through the Seal of Good Local Governance program.
The Seal of Good Local Governance is a systematic assessment of LGU performance along the
areas of financial administration, disaster preparedness, social protection, peace and order,
business-friendliness and competitiveness, environmental management and tourism, culture and
arts. Nutrition indicators are included under the Social Protection component as a means to assess
compliance of the LGU to the Local Code for Children. The code allows for the institutionalization
of health and nutrition programs in the community.
The DILG actively participates in the activities of the Provincial Nutrition Council. They have a
designated permanent representative to the PNC and had taken part in the evaluation of nutrition
programs. The DILG also monitors and submits reports on the implementation of the Philippine
Plan of Action 2017 – 2022 to the National Nutrition Council.
Annex 4: Description of Nutrition and Nutrition-related Information Systems in NegOr
The following are descriptions of the nutrition and nutrition-related information systems
implemented by PNC members in Negros Occidental to support, monitor and evaluate their
programs:
E-HATID Project
The Department of Science and Technology (DOST) promoted the e-HATID system, which was an
android application generating real-time health information and aimed to serve as a platform for
communication between the local chief executive and the Rural Health Unit. The project was part
of the joint DOH-DOST partnership formed to implement the Philippine eHealth Development
Plan. A National Governance Steering Committee and Technical Working Group 45 were created to
implement the plan. As one of their projects, the Institute of Philippine Culture from Ateneo de
Manila University was contracted to develop an information system on nutrition for LGUs. The
system was piloted tested in Negros Oriental Province for use of the Local Government Unit. The
e-HATID system, however, was overtaken by the creation of the iclinicsys, an electronic
information system developed by the Department of Health for use and adoption also by the
Rural Health Units. Adoption of the e-HATID information system was not further pursued in the
province.
iclinicsys and OPT-NNC Online
As provincial lead office on health in NegOr, the IPHO monitors results of the Operation Timbang
(OPT), where weight and height of children are measured by Barangay Nutrition Scholars to
determine whether children had normal weight for their age, underweight or overweight.
Measurements of weight and height were undertaken by the Rural Health Units and submitted to
the IPHO every quarter. Based on the measurements submitted, the IPHO estimates the
percentage of children with normal weight, overweight, underweight, and severely underweight
children in the province. They also determine the malnutrition rate of each municipality
supervised. At the end of each year, the IPHO determines the over-all malnutrition rate of the
province and submits this data to the Governor, the National Nutrition Council and the DOH
Regional Office.
In addition to the OPT-NNC monitoring, the IPHO also monitors health statistics through the
iclinicsys. The iclinicsys is an electronic health information system developed by the Department of
Health for use of the Rural/City Health Units. It is based on the Field Health Service Information
System accomplished by Rural Health Units and submitted to the Department of Health to track
health prevalence.
Learner Information System (LIS) and Enhanced Basic Education Information System (EBEIS)
45
Joint DOH-DOST Department Memorandum no. 2013 -0200 entitled: “Creation of Joint DOH-DOST
National Governance Steering Committe and Technical Working Gorup on e=Health”
The Learner Information System (LIS) and Enhanced Basic Education Information System (eBEIS) is
an on-line information system managed by the Department of Education to establish accurate and
reliable registries of learners and schools in aid of planning and budgeting, allocation of resources
and setting of operational targets. Provincial DepEd staff is responsible for data collection,
consolidation, analysis and submission of reports to the regional and national offices.
In line with the implementation of the school-based feeding program, DepEd identified severely
wasted and wasted students using the OPT results. Meals are provided to students from Kinder to
Grad 6 for 120 days. Vegetable products for the feeding program are obtained from the school
garden maintained by students. Food preparation is handled by the PTA or Home economics
teachers. A narrative report is submitted to the regional office about the activity.
Seal of Good Local Governance Assessment
In line with monitoring the performance of Local Government Units, DILG undertakes the Seal of
Good Local Governance (SGLG) program to assess LGUS with remarkable local government
performance across selected core areas of peace and order, financial administration, disaster
preparedness, social protection, tourism, culture and arts. A checklist is used to measure LGU
efforts along these areas. Qualified LGUs are awarded and consistent performers recognized.
Nutrition indicators are included in the checklist under the Social Protection section in line with
LGU compliance to Local Code for Children. Results of the assessment are forwarded to the
Regional Office for consolidation.
Philippine Plan of Action Accomplishment Report
In line with the implementation of the Philippine Plan of Action for Nutrition 2017-2022, the
Provincial DILG monitors the implementation of LGUs action plans on nutrition. Accomplishments
from implementation of programs, projects or activities are reported to the National Nutrition
Council of the region. Quarterly achievements of targets and indicators in addressing malnutrition
such as reducing the number of underweight children 0-5 years old, increasing calorie intake of
households and reducing deficiencies in iron, iodine and Vitamin A are collected and forwarded to
the NNC Regional Office and then to the NNC National Office. The Provincial DILG only collects the
data but is not required to formulate an analysis on the information. Through the data collection
activities undertaken by the DILG the agency is able to maintain a data base on local officials, local
ordinances and LGU programs and projects.
Assessment of Day Care Centers and Day Care Workers
The Provincial Social Welfare and Development Office (PSWDO) has its own system of assessing
compliance of Day Care Centers and Day Care Workers to standards set by the agency on the
management of these facilities and competencies of Day Care Workers. The PSWDO uses an
assessment tool with indicators to determine the extent to which the Day Care Centers meet
standards and Day Care Workers are competent in managing the program. Work areas examined
include the ability of the facility to advance children’s growth and development, partner with
families, communities and the local government unit, human resource development, program
management and physical environment and safety. Competencies of Day Care Workers are
likewise assessed for accreditation. Results of the assessment are forwarded to the Regional
PSWDO after analysis and recommendation by the PSWD. Other agencies are invited to the
assessment.
Assessment of ECCD
In addition to the assessment of Day Care Centers and Day Care Workers, the PSWDO also
requires assessment of Early Childhood Care and Development as part of the responsibilities of
the Day Care Centers. A separate checklist is used to determine the extent of child development.
Methods of assessment include direct observation, elicitation of behaviour or interviews with
parents and care givers. Seven domains are assessed namely: gross motor domain, fine motor
domain, self-help domain, receptive language domain, expressive language domain, and socio
emotional domain. Results of the assessment are submitted to the MSWDO for analysis and
action. Reports are likewise submitted to the PSWDO for validation.
Annex 5: Description of Health and Nutrition-related Information Systems
Developed by National Agencies
The following are descriptions of nutrition and nutrition-related information systems developed
by national agencies to achieve goals in line with the e-Government Master Plan:
Under the Knowledge Management and Information Technology Service (DOH-KMITS)
The DOH-KMITS developed the iclinicsys46as an integrated clinic information system that was
primarily designed to generate required national health statistics such as those included in the
Field Health Services Information System (FHSIS) and Disease Registry Reports. It includes an
Electronic Medical Records (EMR) and health information system that supports the functions of
the Rural Health Units (RHUs), City Health Centers (CHC) and Barangay Health Stations (BHS) in
service delivery.
The iclinicsys aims to provide an automated system to effectively and efficiently monitor patient
care in primary health care facilities. The software created can run in both an online and offline
environment. It allows the health workers to track each patient’s data, diagnosis and treatment by
accessing the patient’s medical records through the system.
The system is compliant to national health data standards and includes an interoperability feature
that links data with reporting requirements of the Department of Health programs, the Philippine
Health Insurance Corporation (PHIC) and other government agencies. The iclinicsys provides
information to Philhealth’s primary care benefits. It supports the Philippine Health Information
Exchange (PHIE) system managed by the Philippine Council for Health Research Development in
line with the National eHealth Program (NeHP).
At present, the iclinicsys has been adopted in 65% of the Rural Health Units and linked with the
Philippine Health Information Exchange (PHIE) system of the Department of Science and
Technology.
Under the National Nutrition Council (NNC)
The National Nutrition Council47 is a Philippine government agency under the Department of
Health responsible for creating a policy environment for national and local nutrition planning,
implementation, monitoring and evaluation, and surveillance. It was created in 1974 through
Presidential Decree No. 285 as the highest policy–making and coordinating body on nutrition.
The Council’s Governing Board48 is chaired by the Secretary of Health with Vice-chairs from the
Department of Agriculture and Department of Interior and Local Government. Members include
the Secretaries from the Department of Budget and Management, Department of Education,
Department of Labor and Employment, Department of Science and Technology, National
46
iclinicsys https://uhmis.doh.gov.ph/iClinicSys/
47
National Nutrition Council (Philippines)
https://en.wikipedia.org/wiki/National_Nutrition_Council_(Philippines)
48
NNC Officials http://www.nnc.gov.ph/transparency/8-transparency/182-nnc-officials
Economic and Development Authority, Department of Social Welfare and Development, and the
Department of Trade and Industry.
The NNC led the formulation of the Philippine Plan of Action for Nutrition (PPAN) 2017-202249
which serves as a framework of action for nutrition improvement. It is an integral part of the
Philippine Development Plan 2017 – 2022 and the Medium Term Philippine Development Plan. It
contributes to the attainment of UN Sustainable Development Goals specifically SDG 2 which aims
to end hunger, achieve food security and improve nutrition, and promote sustainable agriculture.
The PPAN 2017-2022 is a results-based plan which aims to achieve reduction of target outcomes
in different forms of malnutrition such as wasting, stunting, micronutrient deficiencies and
overweight or obesity. It features 8 nutrition-specific programs, 11 nutrition-sensitive programs
and 3 enabling programs. Strategic thrusts include: (a) focus on the first 1000 days of life; (b)
complementation of nutrition-specific and nutrition-sensitive programs; (c) intensified
mobilization of local government units, (d) reaching geographically isolated and disadvantaged
areas (GIDAs), communities of indigenous peoples, the urban poor especially those in
resettlement areas; and (e) complementation of actions of national and local governments.
In terms of information-related systems to monitor the PPAN, the NNC had devised a guide sheet
or score sheet for the evaluation of provincial or city nutrition programs 50. This guide sheet looks
into the program efficiency and program effectiveness of LGU plans. It also notes some innovative
features in program implementation. LGU nutrition plans are evaluated based on a comparison of
targets and actual outreach of interventions in: (a) home, school, and community food
production; (b) micronutrient supplementation; (c) food fortification; (d) food assistance; (e)
nutrition education; (f) nutrition in essential maternal and child health services; (g) livelihood
assistance; and (h) program management. Program effectiveness is measured in terms of changes
in the prevalence rate of malnutrition among pre-school children and grade school children. It was
not clear from the interview, however, how national outcomes on nutrition will be evaluated. No
instruments were presented at the time of the interview.
Under the Philippine Council for Health Research and Development (PCHRD)
In line with the implementation of the Universal Health Care (Kalusugang Pangkalahatan) and
guided by the Philippine eGovernment Master Plan, the Department of Health, Department of
Science and Technology, and Philippine Health Insurance Corporation had joined to implement
the Philippine eHealth Strategic Plan (PeHSP) 2017 – 2020, which aims to develop and implement
a harmonized National eHealth Program that will align and provide interoperability mechanisms
among eHealth initiatives, programs and projects.
A key project of the National eHealth Program is the Philippine Health Information Exchange
(PHIE). The PHIE is a platform for secure electronic access and efficient exchange of health data
and/or information among health facilities, health care providers, health information
organizations and government agencies for public health interests. It is envisioned to be an
integral component of the health care delivery system available to all patients. The PHIE serves to
integrate and harmonize health data coming from different electronic medical record systems and
49
NNC Officials http://www.nnc.gov.ph/transparency/8-transparency/182-nnc-officials
50
Guidesheet/Scoresheet for Evaluation of Provincial/City Nutrition Programs
hospital information systems. It provides an infrastructure for data/information sharing or
exchange between health care providers and support to the access of patients’ records among
providers. The PHIE system is expected to improve the efficiency and reliability of communication
among health care providers, as well as improve total patient care and decision-making in public
health.
At present, the PHIE serves as the national repository of health data for both DOH and PHIC. It
provides an automated reporting system which is currently being piloted with both DOH and PHIC.
The system is not yet fully operational since the PHIE system is still to be purchased. Only about
10% of its capacity is being used. The PHIE collects data from the Electronic Medical Records
submitted by the RHUs. At present, there are 5 Electronic Medical Record systems– iclinicsys
(developed and managed by the DOH), CHITS (managed by UP Manila), Wireless Access Health
(Tarlac-based system but operating nationwide), SHINE-OS (operated by SMART) and the eHATID
application (ADMU-IPC). Although forms vary among these system, data sets and indicators are
similar.
The PHIE has information on the Primary Care Benefits of 4Ps members and government
employees. It is the primary data source of PHIC for PBC1 information of its members for use in
reimbursement purposes. The system collects data on health standards and registries but not for
all health programs and other health indicators.
Some of the challenges mentioned by the key informant referred to project implementation issues
among partner agencies, weak internet access of LGUs and unstable sources of power in some
areas of the Philippines.
In line with the eHealth Program, the DOST-PCHRD also commissioned the Ateneo de Manila
University Institute of Philippine Culture (ADMU-IPC) to develop an information system for Local
Government Units, called the eHealth TABLET for Informed Decision-making of Local Government
Units or what was popularly known as eHATID LGU. This system was funded by PCHRD and pilot-
tested in several provinces including the Province of Negros Oriental.
Following the success of the e-HATID LGU Project, the DOST-PCHRD plans to develop a similar
PHIE system for Local Government Units. This system aims to integrate all data sets of
government agencies at the Provincial level for the Local Chief Executives, using the eHATID
application. They have also commissioned the ADMU-IPC to develop this local information system.
Under the Food and Nutrition Research Institute (FNRI)
The FNRI is one of the research institutes under the Department of Science and Technology is
mandated as per Executive Order No. 128 signed on January 30, 1987, to conduct researches on
the nutritional status of the Filipinos and to identify causes and effects of malnutrition problem in
the country, as well as recommend solutions.51
It has conducted the 8th national nutrition survey last 2013 and the update on the nutrition status
of Filipinos in 2015.
51
In 2013, the FNRI conducted the electronic NNS using tablet and netbook, where the field
researchers directly encode the responses in the tablet. This digital survey minimized the time for
encoding responses/raw data in the system while doing the field research. The field supervisors
also validate the responses/raw data and directly transmit the clean and validated data to the
FNRI servers. After 6 months, official results of the survey were able to be provided to the
stakeholders. The full reports were published in 2015, about one and half year later.
In 2015, another e-survey was conducted as updating of the nutritional status. NNS is done every
five years. The next NNS is in 2018.
The NNS is a more reliable source of nutrition and related data because it is a survey using
rigorous methods, measurements and calibrated instruments as well as scientific methods. It is
coordinated with the PSA for the list of sample households and with NNC, DOH, DILG and the
LGUs, who are also its stakeholders. It fields trained field researchers who are nutritionist
dieticians or nurses with field supervisors by team. It has an office dedicated solely to validating
and maintaining the database and statisticians to analyze the data.
Annex 6: Programmatic Recommendations to Enhance NegOr’s Nutrition Interventions
To maximize the results of the scoping assessment, the consulting team hereby recommends the
following actions to enhance NegOr’s nutrition interventions:
Provincial Nutrition Program Framework
Current initiatives as contained in the Global Nutrition Report 2017 Nourishing the SDGs
provide a broad framework for addressing current nutrition concerns in the world. In
addition, the PPAN may also provide direction to setting nutrition targets for the country
through LGUs. Aligning the development of targets and strategies for the Provincial
Nutrition Program may be beneficial to the nutrition improvement efforts.
It is recommended that the proposed nutrition program for Negros Oriental Province be
guided by the goals, strategies and proposed global initiative and PPAN as a framework to
guide the development of objectives and strategies in the implementation of their local
nutrition programs as well as in setting provincial nutrition targets.
Development of Information System
Current national information systems collect different data sets for nutrition and assign
different roles to both national and regional units in the collection, analysis and utilization
of these data by their respective agencies. As a result, information systems on nutrition
has been fragmented and provided with a vertical management of the information
system. There are, however, on-going efforts to ensure an integrated system and its
interoperability are being undertaken by the PCHRD through the e-HATID Project.
It is recommended that local nutrition programs are supported by integrated information

systems so that progress of implementation may be tracked and decisions to address
nutrition concerns is based on evidences such as data, It should also be linked to
development goals of the province. Efforts should likewise be made to establish
interoperability of these systems. Current initiative of the e-HATID program to provide
information services to LGUs that aims to integrated operations of provincial agencies
aims to benefit the PNC and implementation of its programs.
In as much as prevalence of malnutrition and other heath indicators are collected and
analyzed by national agencies, access to data from these sources for use in local nutrition
planning activities should be strengthened. Information management systems at the
provincial level need to be strengthened as well to enable the PNC to monitor progress
and assess achievements, identify gaps in the implementation of their nutrition programs.
Nutrition and Nutrition-Related Interventions
Given that the nutrition program in Negros Oriental Province had various achievements
brought on by its technical capabilities, active implementation efforts and support of
member agencies, efforts should be continued, strengthened and sustained. Several
outcomes were likewise proposed by the PNC from the focus group discussion, to which
they have expressed the need to prioritize improvement of the Provincial Nutrition
Program interventions:
Strengthen LGU leadership and governance of its Nutrition Program. It is

recommended that the PNC develop a strategic plan of action for the implementation
of the Provincial Nutrition Program and get the buy-in of the Governor to support and
implement this plan. The plan should present updated strategies in line with the
current global and national nutrition efforts and should be linked with the general
development plan of the province. Roles of the PNC members are outlined and
needed resources indicated.
Develop an investment plan for the Nutrition Program. It is recommended that the
PNC develop an investment plan which outlines the details of resource needs to
reduce malnutrition in the province across a 3 – 5 year period and identifies the fund
sources available.
Build capacities of local nutrition workers to provide better nutrition services.

Enhance the knowledge, attitudes and practices of the BNS, BHWs, DCWs and RHU
staff in the management of OPT, feeding programs, ECCD and other nutrition-related
interventions. Enhance skills of local nutrition health workers in data collection,
analysis and use to track and assess the progress of nutrition interventions as well as
performance of health workers. Ensure that nutrition health workers have the
necessary IT-capabilities to manage information systems for nutrition. Full-time
technical nutrition officer and staff be designated/hired and trained to provide the
technical support and supervision to the BNS and Day Care workers in the
implementation of the local nutrition program.
3.4 Maximize the use of available food and nutrition supplements to improve the nutrition
status of children. Maximize the use of local facilities, such as the milking stations,
water filter facilities and vegetable gardens to increase availability and access of
communities to nutritious products. Establish agreements or arrangements with the
technical agencies to ensure continuous supply of food products and technical
trainings in the implementation of nutrition interventions.
3.5 Establish effective local nutrition information systems in support of the

implementation of nutrition programs in the province. Ensure that these systems
have interoperability features to facilitate access and consistency of information with
partner agencies.
3.6 Establish partnerships with academic institutions for the conduct of nutrition
researches and development to further improve approaches in the implementation of
nutrition programs. Provide venues for nutrition information sharing and use of data
for evidence-based programming.
3.7 Engage the participation of local communities (e.g. parents, barangay officials, etc.) in
the delivery of nutrition services.
Promotion of Nutrition
Given the inadequacy of knowledge and practices about nutrition among communities
served, increasing community awareness of the importance of nutrition for both mother
and child is critical to reducing malnutrition in the province.
It is recommended that nutrition education be intensified and nutrition campaigns be

conducted especially in localities with high prevalence of malnutrition. Health promotion
on nutrition specifically target children in the first 1000 days of life and vulnerable
populations. Communication plans be designed to target specific populations and
organize messages that aim to change behaviours and nutrition practices.
Program Sustainability
To sustain efforts in reducing malnutrition in the province, participation of the community

is critical. Nutrition and nutrition related interventions are important to be supported by
the community and consistent with nutrition practices at home.
It is recommended that Community Based Nutrition Programs be initiated to address

malnutrition on a broader scale in the province, build community capacities to support
nutrition interventions at basic levels. Engagement of community participation in the
implementation of these community-based nutrition programs is central to the effort.
Particular attention should therefore be made on the design of these programs and
appropriately piloted to ensure effective approaches in the management of the
community nutrition interventions.
6. Proposed Role for IPNAP
The Infant and Pediatric Nutrition Association of the Philippines (IPNAP) can play a
significant role in supporting efforts of Negros Oriental Province improve to its nutrition
status and contribute to both global and national efforts of reducing child malnutrition. Its
role would need to be multi-faceted to ensure a comprehensive approach to addressing
child malnutrition concerns.
IPNAP can organize the following Technical Assistance (TA) Packages that will assist the
LGU -- through the PNC -- in the design, implementation, monitoring and evaluation of a
comprehensive Provincial Child Nutrition Program for Negros Oriental Province:
a) TA modules that are based on a practical assessment of the strengths and weaknesses
of the Provincial Nutrition Program implementation, focusing on child nutrition. The
child nutrition program uses strategies consistent with proven best practices and
effective approaches in reducing child malnutrition. The plan aims to contribute to the
achievement of international and national targets to reduce child malnutrition.
b) TA modules that provide guidelines in the implementation and coordination of the

child nutrition programs that will effectively steer efforts to improve child nutrition in
the province. This assistance shall be supported by capacity building programs that
strengthen skills of nutrition workers in the implementation and management of more
effective methods of service delivery in child nutrition. Capability building programs
shall include the development of training modules which outline specific steps and
interventions on child nutrition based on approved standards and conduct of
community-based nutrition interventions.
c) TA modules that provide guidelines in setting up appropriate indicators for child

nutrition, track and monitor progress, as well as assess and evaluate its impact on
child health and community nutrition practices.
Through the proposed community-based child nutrition program envisaged during the
FGD, IPNAP can explore the possibility of supporting an information system for nutrition
using an expanded or enhanced version of the eHATID as the platform for integrating or
making operable the different information system at the LGU where data are generated
and useful in the nutrition program. These data include the OPT results and in
disaggregated forms, the DepEd data on malnourished children and adolescents, the
DSWD information system on the ECCD, and the profiles of 4 P families, the civil registry
on birth and death of children, and mothers, the Philhealth benefit utilization and
membership, the D ILG data on supportive policies for child protection and rights, budget
and best practices by LGUs, especially on nutrition and related programs. The information
system through e-HATID will also need to be able to analyze the data into information that
will be useful for planning and program enhancement by the LGUs and decision-makers
especially the barangay, municipal, city and provincial nutrition councils or committees.
7. Proposed Role for NegOr Provincial Nutrition Committee
Consistent with its mandate, the Negros Oriental Provincial Nutrition Committee provides
local leadership and governance in implementing and coordinating comprehensive
Provincial Nutrition Programs especially for child health.
a) Conduct joint planning for the development of a comprehensive Provincial Plan of

Action for Nutrition and prioritize target municipalities and barangay for assistance
(technical and funds). The plan should include the establishment of coordination and
monitoring mechanisms to bring together efforts of various agencies and track
progress of activities.
b) Validate the data (calibrate weighing scales, provide height boards, regular updates
and supervisions to BNS and DCWs plus incentives) in these priority sites and present
the data with analysis to the LCE for advocacy to generate both policy and funding
support.
c) Mobilize support of the provincial government for the nutrition program and other
private sector partners in the locality.
d) Maximize utilization of existing resources and programs to address malnutrition, such

as: (a) use of community-based vegetable gardens to increase nutritious food access
of the community in the home; (b) promote the Bahay -Kubo concept, so that the
vegetable gardens are not limited in the schools; (c) use milk supplies provided by the
PAO and food packs by the DOST for their feeding programs.
e) Actively participate in strengthening local information systems for effective

management of nutrition programs. Work towards establishing appropriate and
effective interoperability systems.
Annex 7: Composition of the PHANSUP Consulting Team
Team Leader : Roberto A.O. Nebrida
Research Specialists : Lourdes Risa S. Yapchiongco
Mary Juliet R. Labitigan
Administrative Coordinator : Salve R. Pasco
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INFANT AND PEDIATRIC ASSOCIATION OF THE PHILIPPINES, INC. (IPNAP)

PHILIPPINE NGO SUPPORT PROGRAM, INC. (PHANSUP)

C. Discussion and Analysis 48

D. Conclusions, Implications and Recommendations 55

2) Element#2: development and deployment of an integrated electronic nutrition

3) Element#3: piloting of community-based nutrition management project as an action

When undertaken as logically sequenced components of a medium-term development program to

b) Output 2: interoperable information management system linked with ‘official’ systems

A.2 Purpose and Objectives

1) Compile a comprehensive set of information on similar initiatives locally and globally;

A.3 Scope of Work and Deliverable

Table 1. Scope of work and deliverables.

Activity Output/ Deliverable

A.4 Methodology and Analytical Framework

Prospective System Supporters are defined in this assessment as individuals or organizations

Table 2. Respondents at national and provincial levels.

Level Respondents Respondent Type Venue of Interview

National Knowledge Management Information System Developer DOH

B. Focus Group Discussion

Provincial Provincial Nutrition Committee (PNC) System User Negros Oriental

Figure 1. Framework of analysis.

The following are the limitations of the scoping assessment:

B.1 Review of Library and Online Documents

B.1.1 Global and National Situation on Child Nutrition

Global Nutrition Situation

The Philippine Nutrition Situation

a) 21.4% prevalence of stunted children under 5 years

Regional and Provincial Nutrition Situation13

B.1.2 Approaches in Promoting Community Health and Nutrition

1) Improvement in community health and development involves the population as a whole,

Community-based Nutrition Programming

Documented experiences indicate that community-based nutrition programming is effective in

Success in community-based nutrition programs is often defined as the achievement of objectives,

Socio-political factors. Genuine community participation or involvement was identified as a key

B.1.3 Role of Information Management Systems in Nutrition Programs

B.1.4 Considerations in the Design and Development of Information Management

3) The formatting or packaging of information for decision-makers is a core function of the

B.1.5 Overview of Past, Current and Future Initiatives on Health Information

The Field Health Service Information System (FHSIS)

LGU-based Health Information Systems

a) Community Health Information Tracking System (CHITS), an extensible, modular, open

e) iclinicsys was developed by the Department of Health as an integrated clinic information

National Health Information Systems on Nutrition

B.2.1 Provincial Level Key Informants (System Users)

Nutrition and Nutrition-related Programs in Negros Oriental

Table 3 presents a general description of the nutrition or nutrition-related programs as well as

Achievements in the Implementation of Local Nutrition Programs

1) Improvement of Negros Oriental’s rank in malnutrition. Through efforts of the various

3) Proven, award-winning program on gardening (known as Gulayan at Palaisdaan Alay sa

Information Systems on Nutrition

Organization Initiatives Tools Achievements

Implementation of the information systems covered a range of data collection activities

Achievements in Information-related Activities

Experiences, Challenges and Suggestions in Nutrition and Nutrition-Related Programs

Table 5. Experiences, challenges and recommendations of key informants

Organization Experience Issues/Challenges Recommendations

Consider how nutrition

e) Nutrition interventions were implemented at normal and emergency periods. As

g) Nutrition interventions were implemented by experienced and technically competent PNC

Experiences, Challenges and Recommendations in Nutrition and Nutrition-related Information

Table 6. Experiences, challenges and recommendations of key informants in

Organization Experience Challenges Recommendations

Participated in nutrition Use of nutrition data