26 January 2016

What can the Philippines do to accelerate nutiriton improvement?

The Philippine launch of the GNR, brilliantly organized by the Government of the Philippines and UNICEF, was timely (slides here).  The country is coming to the end of its current economic development plan as well as its nutrition strategy and new plans are being developed for the 2017-2022 period.  The GNR data, messaging and calls to action were all cited by the National Economic Development Agency (NEDA) and the National Nutrition Council (NNC) in the Ministry of Health, as useful inputs into the process of developing the new plans.  In addition the Philippines is a relative newcomer to SUN (it is the 51st member) and is just setting up its networks, so GNR messages and data were also able to be fed into the development of their workplans. 

GNR as an input to Philippine Plan of Action for Nutrition
The nutrition situation in the Philippines is mixed.  The latest survey shows stunting rates have declined at a rate rapid enough to put the country on course to meet the global WHA goals—but only if that rate of decline is maintained for the next 10 years.  Under 5 overweight is below the WHA 7% threshold, but it is increasing, and so the GNR assigns an “on course, at risk” assessment.  All other WHA indicators are off course, including adult overweight, obesity and diabetes. 

Health Undersecretary of State Gako, reading you know what
There is some optimism, though.  There is a new Early Childhood Care and Development programme which has been allocated about $6 million by the government. The ongoing conditional cash transfer programme is seen as a promising avenue for scaling up nutrition BCC.  NEDA, the economic planning unit, understands the role of nutrition as a maker and marker of broader development processes.  Finally, the commitment and experience of the amazing NNC leadership, staff and broader set of stakeholders (including the Undersecretary of Health, Dr. Gako) is clear to see.

However there are some big challenges:

*Decentralisation of government has given mayors a lot of power.  Responsibility for nutrition has also been decentralized as part of the bundle.  In theory this could be a good thing for nutrition action if people organized themselves into effective local lobby groups to hold mayors to account.  But that requires recognition of the problem, organization, capacity and data.  None of these things seemed in abundance from talking to the participants at the day-long meeting

*The Philippines is a disaster prone country—conflict, and natural disasters—and with climate change the latter are becoming less predictable.  This makes it challenging to get out of emergency mode and plan longer term. 

*Only 2% of the government’s budget is allocated to nutrition—from across all sectors according to estimates from the country’s own SUN members.  The average for 30 SUN countries is 4%.

These challenges could be turned into opportunities.  For example:

*There is a Presidential campaign coming up in May and it would be great to try to get each of the 6 candidates to sign up to a nutrition pledge card (as was done in Peru about 10 years ago).  One of the pledges could be to make a commitment at the Rio Nutrition for Growth event in August this year.  This would be something for civil society to organize around.   

*A nutrition scorecard at the municipality level (the mayor’s patch) could be generated by constructing a malnutrition map using small area techniques and the recent national nutrition survey and the latest census data. This could be published by Mayor.  It would help raise consciousness on the issue and may help civil society members to engage with local government units on the issue.

*The nutrition community could seek to make common cause with the disaster risk community—how can nutrition interventions become more disaster prepared?

*Work hard to make nutrition sensitivity work in the conditional cash transfer (CCT) programme. To the bureaucratic leaders of the CCT, stress the legacy aspects of the impacts of their CCT.  Income transfers can lift a household out of poverty, but the gains can be quickly lost. The impacts of income transfers that can only be received if a pregnant woman gets antenatal care and a mother receives advice on complementary feeding, for example, are much harder to undo. In addition, train the CCT staff on how to liaise with the nutrition frontline staff.

*Train media to become more nutrition-savvy.  The Philippines has a vibrant media.  The members of the media that showed up at our press briefing were a bit shocked by the numbers of malnourished kids (nearly 4 million in the country) and the fact that their country had stunting rates higher than Kenya and Ghana and only just below the much poorer Cambodia.  The SUN movement would do well to engage the media not as outlets for their own messages, but as real partners who can shape opinion about norms. 

Among many great comments from the floor, one stood out for me because it gave me pause for thought on the politics of data.  One participant said that the “on course” assessment of the country on stunting might make it harder for her to make the case for funding for nutrition. I replied that the rates are still very high and that people like to invest in things that seem to be working, but still, we need to be careful of unintended consequences of our actions. 

I have a soft spot for the Philippines-it is where I did my fieldwork for my PhD 30 years ago (in Bukidnon Province, Mindanao) and so it was great to be back again.  I just hope we don’t have to wait 30 years to get stunting rates below 10%.  With all the advantages the country has it could get there in half the time.

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