Philippine Plan of Action for Nutrition 2023-2028 PDF

ii ISSN 3028-1504 Philippine Plan of Action for Nutrition 2023-2028 Published every six years by the National Nutrition Council Nutrition Building 2332 Chino Roces Avenue Extension, Taguig City, Philippines 1630 Telephone No.: +632-8892-4271 Email address: [email protected] Editorial Team National Nutrition Council Asec. Azucena M. Dayanghirang, MD, MCH, CESO III · Rita D. Papey ·Jovita B. Raval · Ellen Ruth F. Abella · Jasmine Anne DF. Tandingan · Axell M. Alterado · Reginaldo T. Guillen · Arlene R. Reario · Strawberry F. Alberto · Marivic S. Samson · Jesel R. Bagos · Jaira Denisse Pedraja · April Jasmine May C. Ducusin · Kristine Marie N. Benavidez-Fabi · Enah Eunice R. Calanog · Rachel B. Mangao · Christine Jane B. Almira · Julia Marie S. Los Baños · Maria Camille Andrea L. Hari · Jomarie L. Tongol · Ma. Queenie Rose G. Amosco-de Jesus · Pamela Diane B. Yanga · Irish Liezl R. Fuentes · Kristian Jebsen B. Bandong United Nations Children's Fund Alice Nkoroi Rene Gerard C. Galera Jr. Maria Evelyn P. Carpio Xavier Foulquier Frederich Christian S. Tan World Food Programme Carleneth Fernandez-San Valentin Kristine Jane S. Atienza An electronic copy of this publication can be downloaded at: https://www.nnc.gov.ph. This document may be reproduced in whole or in part for non-profit purposes without prior permission, provided credit is given to the NNC. A copy of the reprinted or adapted version would be appreciated. Suggested Citation: National Nutrition Council. Philippine Plan of Action for Nutrition 2023-2028. Taguig City, Philippines, 2023. iii The PPAN 2023-2028 is dedicated to every Lolo, Lola, Tatay, Nanay, Tito, Tita, Ate, Kuya, and Bunso. Acknowledgement is given to the individuals and organizations who contributed in the development of the PPAN 2023-2028. A call to action to the stakeholders who in one way or another, will implement the Philippine Plan of Action for Nutrition 2023-2028. iv NNC GOVERNING BOARD RESOLUTION NO. 1, SERIES OF 2023 APPROVING AND ADOPTING THE PPAN 2023-2028.......................................... viii MESSAGES........................................................................................................................... xi LIST OF ACRONYMS.................................................................................................... xxix LIST OF TABLES..........................................................................................................xxxiii LIST OF FIGURES........................................................................................................ xxxiv LIST OF ANNEXES........................................................................................................ xxxv EXECUTIVE SUMMARY................................................................................................... 1 CHAPTER 1: Introduction.................................................................................................. 8 Overview of the PPAN 2023-2028.................................................................................... 8 PPAN in the Development Spectrum................................................................................ 8 The PPAN Formulation Process........................................................................................ 9 Guiding Principles........................................................................................................... 10 Risks and Assumptions.................................................................................................... 11 CHAPTER 2: Food and Nutrition Security Situation...................................................... 14 Pregnant and Lactating Women (PLW)........................................................................... 15 Children 0-23 months...................................................................................................... 16 Children 2-5 Years Old.................................................................................................... 17 School Age-Children (5-9 years)..................................................................................... 19 Adolescents (10-18 years)................................................................................................ 19 Adults (19-59 years)........................................................................................................ 20 Older Adults (60 years and above).................................................................................. 21 Causality of Malnutrition................................................................................................. 22 Effect of COVID-19 to the nutrition situation................................................................. 25 Conceptual Framework on the Determinants of Maternal and Child Nutrition.............. 26 CHAPTER 3: Gains, Challenges and Lessons.................................................................. 27 Gains................................................................................................................................ 27 Achievement of nutrition outcomes........................................................................... 27 Gains in improving the policy environment for nutrition improvement................... 29 v Administrative Issuances on Nutrition............................................................................. 30 Zero Hunger initiatives.............................................................................................. 30 NNC Governing Board Resolutions.......................................................................... 30 Nutrition specific programs............................................................................................. 31 Infant and Young Child Feeding................................................................................ 31 Integrated Management of Acute Malnutrition......................................................... 32 National Dietary Supplementation Program.............................................................. 32 Mandatory Food Fortification.................................................................................... 33 Micronutrient Supplementation................................................................................. 33 Nutrition in Emergencies........................................................................................... 33 National Nutrition Promotion Program for Behavior Change................................... 34 Overweight and Obesity Management and Prevention Program............................... 36 Nutrition-sensitive programs........................................................................................... 38 LGU Mobilization strategy.............................................................................................. 39 Challenges........................................................................................................................ 39 Lessons............................................................................................................................. 41 CHAPTER 4: Strategic Framework.................................................................................. 43 Theory of Change............................................................................................................ 45 Desired Output Results.................................................................................................... 47 PPAN Desired Vision of Change and Outcome Targets................................................. 47 PPAN Results Framework............................................................................................... 50 Nutrition-Specific Interventions................................................................................ 52 Nutrition-Sensitive Interventions............................................................................... 53 CHAPTER 5: Institutional Arrangement......................................................................... 60 Management and Operationalization of the PPAN.......................................................... 60 National level coordination.............................................................................................. 62 Regional level coordination............................................................................................. 62 Sub-national level coordination....................................................................................... 63 Multi-Sectoral coordination............................................................................................. 65 Nutrition in Emergencies................................................................................................. 65 CHAPTER 6: Monitoring and Evaluation........................................................................ 66 CHAPTER 7: Financing the PPAN 2023-2028................................................................. 67 Financial Targets by Key Outcome................................................................................. 68 Unfunded Targets............................................................................................................. 69 Guiding Principles on Financing..................................................................................... 69 Modes of Financing......................................................................................................... 70 Financial Monitoring and Oversight................................................................................ 71 vi CHAPTER 8: Implementing the PPAN 2023-2028.......................................................... 72 PPAN Priority Areas........................................................................................................ 72 Implementation Plan........................................................................................................ 74 REFERENCES..................................................................................................................... 75 ANNEXES........................................................................................................................... 80 Annex 1: Roles of Agencies in PPAN............................................................................. 80 NNC-member Agencies and their Roles and Functions in PPAN............................. 80 Other Government Agencies with Nutrition Supporting Functions....................... 85 Annex 2: Computation of Need Score to identify PPAN Priority Provinces.................. 86 Annex 3: PPAN 2023-2028 Results Framework............................................................. 90 Healthier Diets........................................................................................................... 90 Better Nutrition Practices........................................................................................... 96 Improved Access to Quality Services...................................................................... 101 Enabling Environment............................................................................................. 106 Annex 4: PPAN 2023-2028 Implementation Plan......................................................... 109 Healthier Diets......................................................................................................... 109 Better Nutrition Practices......................................................................................... 126 Improved Access to Quality Services...................................................................... 134 Enabling Environment............................................................................................. 138 vii Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL National Nutrition Council Governing Board Resolution No. 1, Series of 2023 APPROVING AND ADOPTING THE PHILIPPINE PLAN OF ACTION FOR NUTRITION 2023-2028 WHEREAS, malnutrition continues to be of alarming levels across different life stages in the Philippines as reported by the National Nutrition Surveys conducted by the Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). WHEREAS, poor nutrition has economic and social costs to the country. WHEREAS, malnutrition violates the constitutional right of Filipinos to health and proper care and nutrition of children, WHEREAS, the Universal Declaration on Human Rights has affirmed the right of every human being to a standard of living adequate for the health and well-being of himself and his family, including food. WHEREAS, the attainment of nutritional well-being is a main responsibility of individuals and families but the government and other stakeholders should help the individuals and families, especially the marginalized, to be able to provide for their own nutritional needs and being enabled to achieve adequate nutrition, by greater availability and affordability of a nutritious diet, regular access to health and nutrition services, and enjoying a physical and social environment conducive to proper nutrition. WHEREAS, the country has committed to pursue the Sustainable Development Goals (SDGs) in 2030, the United Nations (UN) Decade of Action for Nutrition 2016-2025, the World Health Assembly (WHA) targets on maternal, infant, and young child nutrition in 2025 and the Association of Southeast Asian Nations (ASEAN) Strategic Framework and Action Plan on Nutrition 2018-2030. WHEREAS, the Philippine Development Plan (PDP) 2023-2028 identifies as desired outcomes the ensuring of food security and proper nutrition, the strengthening of social protection, the boosting of health, and the modernization of agriculture and agribusiness. WHEREAS, the gains of the past PPAN 2017-2022 in the reduction of stunting and wasting among children; low birth weight; nutritionally-at-risk pregnant women; chronic energy deficiency among lactating women, adults, and older adults; and the challenges of reducing overweight and obesity need to be continued and addressed, respectively, in PPAN 2023-2028. WHEREAS, the PPAN 2023-2028 seeks to reduce all forms of malnutrition across various life stages, which continue to be a major impediment to national development. viii WHEREAS, global evidence has established that nutrition-specific and nutrition-sensitive interventions on food and diet, practices and behavior, multi-sectoral nutrition interventions and enabling environment across various life stages can be effective in reducing malnutrition and improving health outcomes. WHEREAS, each of the National Nutrition Council Governing Board (NNC GB) members have committed programs, projects and activities that will contribute to the attainment of the Plan. NOW, THEREFORE, BE IT RESOLVE AS IT IS HEREBY RESOLVED, in consideration of the foregoing, we the NNC Governing Board as the country’s highest policy-making body on nutrition do hereby approve and adopt the PPAN 2023-2028. RESOLVED FURTHER, that we commit our departments or agencies or organizations to: 1. Pursue the interventions, programs and projects herein specified and continue to identify new innovative ones in the course of plan’s implementation; 2. Ensure the availability of needed resources by and among others, including budgetary requirements in the agency budget proposal; 3. Cascade the PPAN 2023-2028 to local governments towards preparation and implementation of Local Nutrition Action Plans; 4. Ensure reporting of related physical and financial accomplishments; 5. Commit to conducting an evaluation of outcomes and impacts of PPAN 2023-2028; and 6. Advocate for nutrition to be a perspective and component of our policies, plans and programs. RESOLVED FURTHER, that the PPAN implementation will be prioritized in 34 provinces, 799 municipalities, 73 cities and 22,725 barangays, with highest to high food insecurity and malnutrition needs, and high financial support priority. RESOLVED FURTHER, for the NNC Secretariat to ensure t hat the plan is disseminated as widely as possible to enable stakeholders to align their efforts along the priority concerns. RESOLVED FURTHER, for the NNC Secretariat, in coordination with relevant agencies, to complete the Results and Resource Framework and the Implementation Plan by 31st of October 2023 and to facilitate annual program plans thereafter. RESOLVED FURTHER, for the NNC Secretariat to monitor and to ensure the full implementation of this resolution. Approved this 12th day of July 2023. TEODORO J. HERBOSA, MD Secretary of Health and Chairperson, NNC Governing Board Attested: AZUCENA M. DAYANGHIRANG, MD, MCH, CESO III Assistant Secretary and Executive Director IV Council Secretary, NNC Governing Board ix x MESSAGE I convey my utmost support to the National Nutrition Council (NNC) as you launch and disseminate the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. Our progress as a people is largely dependent on our collective nutrition, which influences many aspects of our society such as education, gender equality, and access to various opportunities. It is through proper nutrition that we are able to realize the full potential of our citizens who can then take charge of their health and nutritional choices. I fully support the NNC as it shares the PPAN 2023- 2028, which will serve as a comprehensive roadmap towards addressing malnutrition that afflicts many of our countrymen and women today. Let this important resource be the principal guide for stakeholders from the government, private sector, civil society, and other development partners to implement the appropriate interventions that will remarkably reduce all forms of malnutrition in the years to come. With everyone’s support, I am certain that we will be able to usher in a healthier future for every Filipino. Together, let us work towards a Philippines where no child suffers from malnutrition, where no family goes through a day hungry, and where every Filipino thrives with dignity and purpose. I wish you the best in your endeavors. PRESIDENT FERDINAND R. MARCOS, JR. xi MESSAGE Assalamualaikum. I extend my sincerest gratitude to the National Nutrition Council and everyone involved in the development of the Philippine Plan of Action for Nutrition 2023- 2028. The general health and development of people, families, and communities are fundamentally influenced by nutrition. The Philippine Plan of Action for Nutrition 2023–2028 offers a thorough road map to address the nutritional issues our nation is currently facing and defines tactical measures to improve the nutritional status of every Filipino. The plan highlights the necessity for coordinated efforts, effective governance, and evidence-based solutions. It is important to acknowledge that a multi-sectoral strategy or cooperation between several sectors—including agriculture, education, social welfare, and industry—is necessary to achieve good nutrition. Let us work together to address issues such as maternal and child nutrition, adolescent health, the prevention and control of non-communicable diseases, nutrition in emergencies, and sustainable food systems. Our collective efforts will be invaluable in ensuring the successful implementation and impact of the plan. I pledge my unwavering support to the National Nutrition Council in their endeavors to improve nutrition. Together, let us help Filipinos rebuild and pursue a life of good health and confidence, making them valuable assets for our nation. May this action plan inspire us to unite and work with all stakeholders to build a robust and healthy nation. Tayo po ay maging MATATAG. Tungo sa isang Bansang Makabata at Batang Makabansa. Lahat - para sa Diyos, sa bayan at sa pamilyang Pilipino. Shukran VICE PRESIDENT SARA Z. DUTERTE Secretary, Department of Education Member, NNC Governing Board xii MESSAGE Greetings to the National Nutrition Council (NNC), and congratulations on the launch of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028! Along with the inalienable rights to safe shelter and quality education, proper nutrition is a cornerstone of decent and dignified living. As such, I thank the NNC for your invaluable efforts to lead and mobilize public and private actors alike to address and alleviate malnutrition across the country, particularly malnutrition in our youth, who are at a crucial point in their physical development, and whose dietary needs must be attended to with the full force of local and national government. With the PPAN 2023-2028, we will have a useful roadmap toward a future populated by wholly empowered and healthy individuals, whose most basic needs are always taken care of, and who are therefore able to actively engage in the growth and development of their communities and of the country. Trust that I am with you all in this journey, ready to offer legislative support in the goals of the NNC, as we continue our fight against hunger and malnutrition. Maraming salamat, at mabuhay po kayo! JUAN MIGUEL F. ZUBIRI Senate President xiii MESSAGE Warm greetings to all officials and employees of the National Nutrition Council under the Department of Health! First of all, let me congratulate you as you launch the Philippine Plan of Action for Nutrition 2023- 2028. May this Plan embody all plans and programs that will help the country battle a very serious problem, especially among our children. Addressing malnutrition has never been more urgent. Several sources of data available indicate that it affects a third of Filipino children under five years, an age where 90% of brain development occurs. This is catastrophic not only for the health of our children but for the future of our country as well. Left unaddressed, we can only imagine its deleterious effects in years to come. This is why the Council’s role in mitigating or completely eliminating malnutrition in the Philippines is of crucial importance. It will take the collective effort of everyone, not only the government, to effectively address the problems brought about by malnutrition. And the Council is central to the solution. I do hope that the Philippine Plan of Action for Nutrition 2023-2028 makes strides in fighting malnutrition in the country. The doors of our offices at the House of Representatives are always open to the Council should you need assistance in legislation to supplement your efforts at curbing malnutrition. Thank you very much for inviting me to be a part of your endeavor. Mabuhay po kayong lahat. FERDINAND MARTIN G. ROMUALDEZ Speaker, House of Representatives xiv MESSAGE I am delighted to offer sincere congratulations to the people behind the Philippine Plan of Action for Nutrition (PPAN) 2023-2028 and to all the champions of nutrition. You all deserve to be recognized! PPAN 2023-2028 truly marks our participation in the global movement in encouraging collaboration to battle malnutrition, particularly stunting and wasting, overweight and obesity, and micronutrient deficiencies, and to massively step up for the health and wellness of our kababayans. The Department of Health (DOH) with the National Nutrition Council (NNC) hope that the PPAN 2023-2028 will serve as a guide for various stakeholders from the National Government Agencies (NGAs), Non-Government Organizations (NGOs), development partners, academe, private sector, and local government units in order to accomplish our common goals in operationalizing and realizing the Ambisyon Natin 2040 and reduce all forms of malnutrition, which translates into saving millions of lives in the country. In fact, in line with the National Nutrition Council’s (NNC) mandate of formulating an integrated national program on nutrition, and relative to the Universal Health Care (UHC) Act, I included in the Department’s eight-point action agenda, “Pag-iwas sa sakit.” Through this agenda item, we will improve the state of nutrition of our nation. Through a whole-of-country and whole-of-society approach, I am genuinely looking forward to seeing healthy, smiling people - mothers, children, and their families - in our communities. For all who are ceaselessly pushing nutrition forward, your efforts are much appreciated. Let us continue building a more enlightened path to health and wellness. I am confident that working hand in hand will give us tangible and numerable outcomes towards a healthy, comfortable, and secure life for every Filipino and for generations to come. Sa Healthy Pilipinas… bawat buhay mahalaga! TEODORO J. HERBOSA, MD Secretary, Department of Health Chair, NNC Governing Board xv MESSAGE Malnutrition in the country remains a challenge despite the nationwide implementation of various interventions/programs on nutrition. One of the key factors contributing to this is the limited access to affordable and nutritious food. Recognizing this, the agriculture and fisheries sector is seen as one of the major sectors that can contribute in addressing this challenge. Thus, the Department of Agriculture (DA), as the national government agency mandated for agricultural development, also takes into account the promotion of consumer health and nutrition. This is one of the shared goals of the National Agriculture and Fisheries Modernization and Industrialization Plan (NAFMIP) 2021-2030, in pursuit of a food- and nutrition-secure, and resilient Philippines. In doing so, the DA implements key strategies such as expanding the food supply by boosting local production and improving the distribution system of agriculture and fisheries commodities. Further, in collaboration with relevant stakeholders, including the National Nutrition Council (NNC), we are gearing towards ensuring accessibility to adequate, affordable, safe, and nutritious food together with quality nutrition services and practices at all times to improve the nutritional status in the country. It is an honor to work alongside the NNC, other national government agencies, LGU partners, private sector, and other key stakeholders in the formulation of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. Rest assured that we will use this Plan as one of the frameworks for action in addressing the challenges related to food and nutrition security in the country. We will continue to work with the NNC and other stakeholders to pursue the goals of ending hunger, achieving food security, and improving nutrition aligned with the country’s commitments to the 2030 Agenda for Sustainable Development and the Ambisyon Natin 2040. The Department of Agriculture supports the PPAN’s desired vision of change - Reduced all forms of malnutrition across all age groups by 2028! Mabuhay! MERCEDITA A. SOMBILLA Undersecretary for Policy, Planning, and Regulations Department of Agriculture Vice Chairperson (Authorized Representative), NNC Governing Board xvi MESSAGE Warmest greetings and congratulations to the National Nutrition Council (NNC) for spearheading the formulation of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028, which serves as the country’s overall framework in addressing concerns arising for malnutrition, particularly stunting and wasting, overweight and obesity, and micronutrient deficiencies. Malnutrition is a multifactorial problem that needs a multisectoral solution. With this in mind, the DILG has been keen on implementing and promoting social protection programs that aim to assist local government units (LGUs) in providing effective basic social services. The Department has also issued various policy guidelines in support of poverty alleviation and social development like the Karapatan at Ugnayan ng Mamamayan sa Akmang Pagkain at Nutrisyon (KUMAIN). Consultations on the Philippine Multisectoral Nutrition Project (PMNP), which aims to increase the utilization of a package composed of nutrition- specific and nutrition-sensitive interventions across various local government platforms. The DILG also launched the Halina’t Magtanim ng Prutas at Gulay (HAPAG) sa Barangay Project to promote community gardening in a bid to increase the country’s food productivity and address hunger at the local level. Truly, every Filipino, as the country’s most vital resource, deserves and, in fact, has the right to adequate food and nutrition. The DILG acknowledges that to meet this end, an effective multisectoral, multilevel, and coherent approach is needed - one that will benefit every Filipino especially those at the grassroots level. DILG commits to providing its full support and participation in operationalizing PPAN 2023-2028 to realize its vision of reducing all forms of malnutrition. The PPAN 2023-2028 reflects the government’s deep resolve to address malnutrition within the national development framework. This undertaking will improve the lot of our people across the board, especially the marginalized sectors of society. Therefore, we must continue to exert our best efforts to ensure that a well-orchestrated and coordinated strategy like this will be maximized and will contribute to the attainment of Ambisyon Natin 2040, which represents the collective long-term vision and aspirations of the Filipino people. xvii Again, my congratulations to the NNC for this comprehensive plan. May this endeavor fulfill not only our country’s solemn commitment to the global movement against hunger and malnutrition but also our commitment to the nutritional well-being of the Filipino people that we serve. Ang lahat ng ito ay para sa isang masigla at malusog na sambayanang Pilipino! Patuloy po tayong magkaisa sa pagpapatupad ng PPAN 2023-2028! ATTY. BENJAMIN C. ABALOS, JR. Secretary, Department of the Interior and Local Government Vice Chairperson, NNC Governing Board xviii MESSAGE Assalamu alaikum wa Raḥmatullahi wa Barakatuh. Congratulations to the National Nutrition Council for developing a strategic policy roadmap to ensure that Filipinos from all walks of life will have the assistance they need to be healthy and productive. The Philippine Plan of Action for Nutrition (PPAN) 2023-2028 is vital in achieving our Agenda for Prosperity. Health and nutrition go hand-in-hand with socioeconomic development as they directly affect education, livelihoods, and ways of life. Thus, we must see to it that the PPAN will be executed with the participation of all stakeholders including government agencies and local government units, as well as civil society organizations. It is also paramount to communicate the plan, the practice, and the purpose of the PPAN in a way that factors in socio-cultural backgrounds so that we are all aligned in realizing its objectives. In doing so, let us remember our commitment to inclusivity. Malnutrition may be experienced not only by adults but also by newborn babies, toddlers, adolescents, and even pregnant and lactating women. Therefore, to truly address this social predicament, we must have a practical approach directed at all groups. Let us also keep in mind our sustainability goals and seek assistance from nutrition experts, public health specialists, scientists, and workers in the development sector to discuss the most effective and viable ways to make healthy food and proper diet accessible to all Filipinos. Through the PPAN, we can be assured that we are on the right track in realizing holistic, multi-disciplinary, and multi-level nutritional improvement. Let us keep striving for a healthier nation that will ultimately lead to a more productive economy. Mabuhay! AMENAH F. PANGANDAMAN Secretary, Department of Budget and Management Member, NNC Governing Board xix MESSAGE The Department of Labor and Employment (DOLE) wishes to congratulate the members of the National Nutrition Council (NNC), its Governing Board, Technical Committee, and Secretariat, for the final form of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. The Plan indeed captures the aspirations of every Filipino for an equitable and ready access to developmental pathways for improved nutritional outcomes for all, more importantly for our children and young adolescents. A nation's talents, I believe, are its greatest asset, and investing in social safety nets and protection programs, delivered along the life cycle of individuals, will provide them with opportunities to reach their optimal capacities and skills that are needed for nation building. Reaching our nutritional outcomes and guaranteeing access to the same are deemed as a clear strategy towards this direction. PPAN 2023-2028 serves as the country's framework in mitigating all forms of malnutrition in the Philippines. The Plan has likewise adopted the whole of government and society approach in order to ensure that the institutional arrangements needed to carry out the identified nutritional interventions are efficiently and effectively done. As an action document, PPAN will guide national and local government units, non-government and civil society organizations, developmental partners, academe, and other stakeholders in a well targeted and timely manner, ensuring that individuals can access the needed resources and services at the right time and given when they need it the most. As one of the agencies identified in the PPAN 2023-2028, the DOLE hopes that our contribution in creating an enabling environment for a sound and robust economy, where industrial peace is attained and adherence to the principles of full, decent, and productive employment and employment opportunities for all are continuously promoted, will ensure that the key performance results areas, as expressed in PPAN 2023-2028, are achieved and sustained. xx Continued collaborative efforts however are needed in order to reach our shared goals and aspirations, and address possible limitations, such as resources, capacities, policies and other facilitating factors, which affects our targets. Rest assured that the DOLE, as an active partner, will continuously show support in order to attain the objectives as encapsulated in the Plan. The roll-out of PPAN 2023-2028 came at a significant time as the Philippines is nearing its 2030 targets under the Sustainable Development Goals, specifically SDG 2 on zero hunger. Hopefully, this Action Plan will become a vital instrument in improving the nutritional goals of the country thereby addressing all forms of malnutrition. The same should also be coupled with the enactment of policies that support decent job creation, and the strengthening of employment-led poverty reduction programs, likewise aligned with SDG 8 on decent work and economic growth. Ultimately, PPAN 2023-2028 is a shared commitment of all concerned actors. Let us continuously work together in order to achieve the mission of providing optimum nutrition for all age groups, with emphasis on the at-risk, vulnerable, and marginalized groups, and ensure the viability of nutrition-specific, and sensitive interventions indicated in the Plan. Mabuhay at maraming salamat. BIENVENIDO E. LAGUESMA Secretary, Department of Labor and Employment Member, NNC Governing Board xxi MESSAGE I would like to extend my deep appreciation to the National Nutrition Council, for the unwavering dedication in spearheading the formulation of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. All of us have been waiting for this moment when we are to unveil the blueprint on how we will end malnutrition among Filipinos. By we, I mean the national government, the local government units, non-government organizations, development partners, academe, business and private sector --- all of us have a stake in the Philippine Plan of Action for Nutrition. After almost 5 decades, these national plans have guided the country into achieving improvements in the food and nutrition situation of the country. We have had successes since then as we have been able to reduce the problem of underweight children, micronutrient deficiencies. However, we still face major challenges such as the slow reduction in child stunting and the increasing prevalence of overweight and obesity. For this PPAN to do well, we must go that extra mile. We do not want the Philippines to remain lagging behind other countries as they are able to drastically reduce child stunting. We do not want the Philippines to remain to be one of the biggest contributors to child stunting in the world. The PPAN tells us how we can overcome child stunting. Let us all be ambitious this time. We can no longer be complacent that Filipinos remain among the shortest people in the world. We can no longer afford to let our children suffer from brain drain because we cannot prevent them from being stunted in their first 1000 days. The PPAN is not merely policies and strategies on paper; it embodies the hopes and aspirations of our nation, the aspirations for better health, improved nutrition, and a society where no one is left behind. Our success in this endeavor hinges on our collective efforts, as every contribution, no matter how small, holds the potential to create a lasting impact. With renewed resolve and strengthened collaboration, let us embark on this journey to uplift our nation's nutrition landscape. Let us seize this opportunity to harness our strengths, pool our resources, and amplify our efforts toward achieving the goals of PPAN. Together, we can make a lasting impact and build a nation where good nutrition and optimal health are not just aspirations but realities for all. Mabuhay ang PPAN! Mabuhay ang Pilipinas! RENATO U. SOLIDUM, JR. Secretary, Department of Science and Technology Member, NNC Governing Board xxii MESSAGE The Department of Social Welfare and Development (DSWD) supports the strategies and initiatives to end hunger, improve nutrition and fight malnutrition in our country. As one of the leading government agencies in the field of food, nutrition and health, the National Nutrition Council (NNC) has published a significant document that will serve as a basis to reinforce and harmonize the policies to improve the nutritional condition of Filipinos. This is through the publication of the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. The PPAN 2023-2028 will serve as a significant guide document for local government units, national government agencies, non-government organizations and other stakeholders in the planning, implementation, monitoring and delivering responsive nutrition policies, programs, and services to improve the health and well-being of vulnerable and marginalized Filipinos. With this, the DSWD congratulates the NNC and all their partners who have contributed in the creation of the PPAN 2023-2028. May the information and strategies in this document be used by duty-bearers and other stakeholders to address the country’s food and nutrition challenges. Together, let us continue to work together for a zero hunger and healthier Philippines. REX T. GATCHALIAN Secretary, Department of Social Welfare and Development Member, NNC Governing Board xxiii MESSAGE On behalf of the Department of Trade and Industry, I extend my sincerest congratulations to the National Nutrition Council (NNC) for spearheading the implementation of the Philippine Plan of Action for Nutrition (PPAN), which establishes food and nutrition policies in the Philippines. The PPAN is a policy tool critical in providing a strategic, multi-level, and directional platform that will address all forms of rampant malnutrition in the country - one of the top priorities of the Marcos administration. Further, the PPAN outlines a strategic plan that enables improved coordination and partnership between its duty-bearers and stakeholders, particularly those working in the nutrition sector, a very important task to efficiently implement the plan. We at DTI remain committed to assisting the NNC in the efficient implementation of the plan as we all work to uplift the lives of the Filipino people, especially those situated in the nutritionally at-risk areas. We will also strictly implement policies and programs aligned with ensuring that food products are properly labeled, with proper nutritional facts to guide consumers. We look forward to our continued collaboration and partnership in the coming years as we all work to fully realize the Philippine government’s vision of attaining food security. Together, let us create a Philippines with zero hunger and poverty. Let us strive for food justice! ALFREDO E. PASCUAL Secretary, Department of Trade and Industry Member, NNC Governing Board xxiv MESSAGE The Philippines has made significant progress in addressing nutrition, particularly in reducing the prevalence of stunting and wasting among children under five. The rate of stunting has decreased from 33.4% in 2015 to 26.7% in 2021, while the rate of wasting decreased from 7.1% in 2015 to 5.5% in 2021. While these achievements from the 2017- 2022 PPAN are promising, the country still faces challenges such as supply-side shocks and food inflation, which continue to threaten the hard-earned gains in food security and nutrition. Looking ahead, the Marcos administration's development agenda emphasizes the urgent need for collective action to reduce food insecurity and end hunger by providing accessible, affordable, safe, and nutritious food for all Filipinos at all times. The Philippine Development Plan 2023-2028 recognizes the fundamental link between food security and proper nutrition. It presents transformational strategies to further improve both sectors. The PPAN 2023- 2028 provides a detailed blueprint that will serve as the compass for the National Nutrition Council (NNC), its member-agencies, local government units, and other stakeholders in addressing all forms of malnutrition, particularly among the poorest and most vulnerable groups in the country. It sets specific goals and strategies to improve nutrition across all life stages and consumer groups, employing a multi-sectoral, whole-of-government, and whole-of-society approach. Together with the NNC, the National Economic and Development Authority is committed to supporting the realization of the PPAN 2023-2028, along with other relevant initiatives to improve nutrition outcomes. Our aim is to create an enabling environment that enhances the nutritional status and well-being of all Filipinos. We invite all stakeholders to join us in turning this plan into action, with the hopeful expectation that every Filipino will achieve a matatag, maginhawa, at panatag na buhay (strongly-rooted, comfortable, and secure life) by 2040. ARSENIO M. BALISACAN, PhD Secretary, National Economic and Development Authority Member, NNC Governing Board xxv MESSAGE The PPAN 2023-2028 is the government’s new framework for multi-sector collaborative action towards food and nutrition security. This provides the impetus for the NNC in ensuring substantive investment capital for the nutritional needs of every Filipino. While its predecessor document, PPAN 2017-2022, has shown positive nutrition outcomes by achieving most of its targets, the Philippines remains to be one of the top ten countries in the world with cases of stunting, exclusive breastfeeding practices for infants under six months are wanting, and cases of overweight children are increasing. These challenges remain despite the enactment of laws such as RA 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act in the First 1000 Days); RA 10028 or the Expanded Breastfeeding Promotion Act; RA 10354 or the Responsible Parenthood and Reproductive Health Act; RA 11210 or the 105-Day Expanded Maternity Leave Law; RA 10963 or the TRAIN Law of 2019; and RA 11037 or the Masustansyang Pagkain para sa Batang Pilipino Act, among others. As such, an accelerated concerted effort through increased public and private partnership, and a stronger governance structure are urgently needed. As a legislative advocacy organization and the only Private Sector Representative of the NNC Governing Board, the Philippine Legislators’ Committee on Population and Development (PLCPD) remains committed to working with the NNC in mainstreaming nutrition and food security in human rights, and population and development legislation. Our Board of Trustees and regular members from the Senate and House of Representatives, as well as the 64 member-organizations of the Child Rights Network, will work closely with the NNC in developing new and enhancing current legal frameworks for improved nutrition outcomes for all Filipinos. PLCPD will maximize its current partnerships on child protection, social protection, comprehensive adolescent sexual and reproductive health, women empowerment, rural development, tobacco-free generation, and protection of vulnerable sectors during emergency situations in contributing to the achievement of the country’s improved nutrition outcome for all. ROMEO C. DONGETO Executive Director Philippine Legislators’ Committee for Population and Development xxvi MESSAGE On behalf of the team responsible for formulating this document, and in recognition of the valuable inputs provided by our esteemed partners and stakeholders, I am proud to share with you all the Philippine Plan of Action for Nutrition (PPAN) 2023-2028. As the Assistant Secretary and Executive Director of the National Nutrition Council (NNC), I am confident that with this plan, the Philippines can make significant strides towards reducing all forms of malnutrition across all age groups so every Filipino can enjoy a stable, comfortable, and secure life. PPAN 2023-2028 is a product of systematic review, multi-sectoral and interdisciplinary processes, and public consultations. It surfaces the immediate and underlying causes of malnutrition particularly, the mismatch between nutritional needs of Filipinos and their diet, the inappropriate behaviors and practices affecting health and nutrition, the poor quality and inadequacy of nutrition and nutrition-related services such as sanitation and social protection, and the deeper societal issues such as low purchasing power of households and the lack of financial and institutional capacity of local government units. The Plan’s Theory of Change (TOC) and Strategic Framework highlights interventions and approaches that would plausibly result in healthier diets, better nutrition practices, and improved access to quality services. The targets set forth in the plan ranging from reduction in the prevalence of undernutrition, overnutrition, and micronutrient deficiencies, to improving feeding practices among young children and increasing food security among households, signify a bold step towards ensuring the well-being and future prosperity of the Filipino population. The Plan demonstrates a holistic appreciation of the complexities surrounding nutrition and the need for collective action to overcome these and achieve lasting results. It recognizes the significance of whole-of-government and whole-of-nation approach, with the government harnessing multi-sectoral collaboration and multi-level platforms involving national government agencies, academe, business sector, civil society organizations, donors, and United Nations networks. xxvii Please accept my deepest appreciation to all our stakeholders and partners who extended their support and contribution in the development of this Plan. Your commitment to addressing malnutrition and to promoting food and nutrition security is both commendable and inspiring. The NNC Secretariat will ensure widespread dissemination of PPAN 2023-2028 and will diligently monitor its full implementation. Together, let us continue to champion better programs and interventions to achieve Nutrisyong Sapat, Para sa Lahat! AZUCENA M. DAYANGHIRANG, MD, MCH, CESO III Assistant Secretary and Executive Director IV Council Secretary, NNC Governing Board Scaling Up Nutrition (SUN) Coordinator for Philippines xxviii 4Ps Pantawid Pamilyang Pilipino Program AIDS Acquired Immunodeficiency Syndrome AIP Annual Investment Programs AMIA Adaptation and Mitigation Initiatives in Agriculture ANC Antenatal Care ASEAN Association of Southeast Asian Nations BARMM Bangsamoro Autonomous Region in Muslim Mindanao BEDP Basic Education Development Plan BHW Barangay Health Worker BNS Barangay Nutrition Scholar BIDANI Barangay Integrated Development Approach for Nutrition Improvement BMI Body Mass Index BSND Bachelor of Science in Nutrition and Dietetics CHD Center for Health Development CDC Child Development Center CED Chronic Energy Deficiency CPD Commission on Population and Development CRVA Climate Resiliency, and Vulnerability Assessment CSOs Civil Society Organizations CCT Conditional Cash Transfer COVID Coronavirus Disease CVDs Cardiovascular Diseases DA Department of Agriculture DAR Department of Agrarian Reform DBM Department of Budget and Management DepEd Department of Education DILG Department of the Interior and Local Government DOH Department of Health DOLE Department of Labor and Employment DOST Department of Science and Technology DSP Dietary Supplementation Program DSWD Department of Social Welfare and Development DTI Department of Trade and Industry xxix DRRM-H-NiE Disaster Risk Reduction and Management for Health-Nutrition in Emergencies EBF Exclusive Breastfeeding ECCD Early Childhood Care and Development ENNS Expanded National Nutrition Survey EO Executive Order F1KD First 1000 Days FAO Food and Agriculture Organization FCA Farmers and Fisherfolk Cooperative or Association FDA Food and Drug Administration FDS Family Development Sessions FHSIS Field Health Services Information System FMR farm-to-market road FNRI Food and Nutrition Research Institute FOPL Front-of-pack nutrition labelling GB Governing Board GDP Gross Domestic Product GIDA Geographically Isolated and Disadvantaged Area HAPAG Halina't Magtanim ng Prutas at Gulay HDPRC Human Development and Poverty Reduction Cluster HIV Human Immunodeficiency Virus ICN International Conference on Nutrition IDD Iodine Deficiency Disorders IFA Iron-folic acid IFR Iron- fortified rice IMCI Integrated Management of Childhood Illnesses IP Investment Planning IPC Integrated Food Security Phase Classification IRR Implementing Rules and Regulations IYCF Infant and Young Child Feeding IATF-ZH Inter-Agency Task Force on Zero Hunger IATWG Interagency Technical Working Group LBW Low Birth Weight LCE Local Chief Executive LGU Local Government Unit LNAP Local Nutrition Action Plan LNC Local Nutrition Committee / Cluster LNEWS-FNS Local Nutrition Early Warning System for and Nutrition Security MAD Minimum Acceptable Diet MDD Minimum Diet Diversity xxx MELLPI Monitoring and Evaluation of Local Level Plan Implementation M&E Monitoring and Evaluation N4G Nutrition for Growth NAFMIP National Agriculture and Fisheries Modernization and Industrialization Plan NAR Nutritionally-at-risk NBM National Budget Memorandum NCDs Non-communicable Diseases NCSC National Commission on Senior Citizens NDHS National Demographic and Health Survey NDSP National Dietary Supplementation Program NEDA-SDC National Economic and Development Authority-Social Development Committee NFP National Food Policy NGA National Government Agencies NOH National Objectives for Health NGO Non-Government Organization NiE Nutrition in Emergencies NNC National Nutrition Council NNIS National Nutrition Information System NNPPBC National Nutrition Promotion Program for Behavior Change NM Nutrition Month NSOA Nutrition School-on-Air NYC National Youth Commission MBFHI Mother-Baby Friendly Hospital Initiative MHPSS Mental Health and Psychosocial Support Services OPT Operation Timbang PCB Program Convergence Budgeting PKG Pilipinas Kontra Gutom PD Presidential Decree PDP Philippine Development Plan PEIRIDDDEC Prevention, Early Identification, Referral, Intervention of Delays, Disorders, and Disabilities in Early Childhood PES Parent Effectiveness Service PHA Philippine Health Agenda PHC Primary Health Care PIMAM Philippine Integrated Management of Acute Malnutrition PLW Pregnant and Lactating Women PNPM Philippine Nutrient Profile Model from PPAs Programs, Projects, and Activities PPAN Philippine Plan of Action for Nutrition xxxi PRiSM Philippine Rice Information System RA Republic Act RCM Rice Crop Manager RF Results Framework RNAS Rapid Nutrition Assessment Survey RNC Regional Nutrition Committee / Cluster RNPC Regional Nutrition Program Coordinator RPAN Regional Plan of Action for Nutrition SAM Severe Acute Malnutrition SBCC Social and Behavior Change Communication SBFP School-Based Feeding Program SDC Social Development Committee SNP Supervised Neighborhood Play SNPDC Supervised Neighborhood Playgroups and Daycare Centers SDGs Sustainable Development Goals SK Sangguniang Kabataan SLP Sustainable Livelihood Program SP Social Protection SSNPs Social Safety Net Programs SUN Scaling-Up Nutrition Movement TKDSP Tutok Kainan Dietary Supplementation Program TOC Theory of Change UHC Universal Health Care UIC Urinary Iodine Concentration ULAP Union of Local Authorities of the Philippines UN United Nations UP University of the Philippines UPLB University of the Philippines- Los Baños UNICEF United Nations Children's Fund VAD Vitamin A Deficiency WASH Water, Sanitation, and Hygiene WB World Bank WFP World Food Programme WHA World Health Assembly WHO World Health Organization WRA Women of Reproductive Age UP University of the Philippines UNFSS United Nations Food Systems Summit UNICEF United Nations Children's Fund VAD Vitamin A Deficiency xxxii Table Page 1 Outcome Result Areas 5 2 PPAN Priority Provinces 7 3 Achievement of PPAN Targets 27 4 Outcome Result Areas and Statements 47 5 Output Results Statements under Healthier Diets 48 6 Output Results Statements under Better Nutrition Practices 48 7 Output Results Statements under Improved Access to Quality 49 Services 8 Output Results Statements under Enabling Environment 50 9 PPAN 2023-2028 Outcome Targets 54 10 Financial targets by life stage, 2023 – 2028 68 11 Financial targets by key outcome, 2023 – 2028 68 12 Top 27 provinces with the highest Need Score or those with the 73 largest population of stunted children and subsistence-poor 13 Top 16 provinces with high priority for financial support 74 xxxiii Figure Page 1 Trends in Malnutrition among Pregnant and Lactating Women 14 2 Trends in Malnutrition among Children 0-23 months 16 3 Trends in Malnutrition among Children 0-5 years old 17 4 Trends in Malnutrition among School-age Children 5-9 years old 18 5 Trends in Malnutrition among Adolescents 20 6 Trends in Malnutrition among Adults and Older Persons 21 7 Conceptual Framework of Malnutrition 22 8 Conceptual Framework on the Determinants of Maternal and 26 Child Nutrition 9 Strategic Framework for PPAN 2023-2028 43 10 Theory of Change for the PPAN 2023-2028 46 11 PPAN Structure for Coordination 61 12 PPAN Structure for Implementation 64 xxxiv Annex Page 1 Roles of Agencies in PPAN 81 2 Computation of Need Score as basis for identifying PPAN Priority 87 Provinces 3 PPAN 2023-2028 Results Framework 91 Healthier Diets 91 Better Nutrition Practices 97 Improved Access to Quality Services 102 Enabling Environment 107 4 PPAN 2023-2028 Implementation Plan 109 Healthier Diets 109 Better Nutrition Practices 126 Improved Access to Quality Services 134 Enabling Environment 138 xxxv The Philippine Plan of Action for Nutrition (PPAN) is a policy and plan document formulated under the leadership of the National Nutrition Council (NNC) to address the nutrition situation of the country. PPAN is a six-year strategic and directional plan to guide stakeholders towards achieving target nutrition outcomes. PPAN 2023-2028 is the 11th of the series documents formulated and released by the NNC since 1974. This is aligned with the AmBisyon Natin 2040 and the Philippine Development Plan (PDP) 2023-2028, as well as with other relevant international and national plans and commitments. Summary of Food and Nutrition Situation Filipinos suffer from the so-called triple burden of malnutrition where undernutrition, overnutrition, and micronutrient deficiencies affect a significant proportion of the population. Undernutrition in the form of stunting, wasting, and being underweight affects children under-five, preschool age children, school-age children, and adolescents. Many pregnant women, mainly adolescents, are likewise considered as nutritionally at-risk of giving low birth weight babies, while adults and older persons suffer from chronic energy deficiency (CED). At the same time, overnutrition in the form of overweight and obesity is increasing across all population groups. Micronutrient deficiencies in vitamin A, iron, and iodine are still present in vulnerable groups. Considerable improvements in the last decades in reducing child undernutrition and micronutrient deficiencies have been noted but the pace is slow compared to other countries. Along with malnutrition, food insecurity affects 33.4 % of households or 3 in every 10 households have moderate or severe food insecurity. Theory of Change (TOC) The development of the PPAN 2023-2028 is a participatory and collaborative process through a series of workshops using theory of change approach and consultation activities spearheaded by the NNC. A PPAN Planning Ad Hoc Group was organized composed of representatives from key government agencies and experts. The Country Offices of the United Nations Children’s Fund (UNICEF) and the World Food Programme (WFP) extended technical and funding assistance in the development process. The TOC is grounded on the situation analysis of nutrition in the country and the causality analysis of the factors that drive malnutrition. The TOC presents a logical and realistic 1 multi-year vision and pathway of how each of the outcome results will contribute to achieving the desired vision of change over the next six years. Life Stage Approach The life stage approach recognizes that nutritional needs and risks vary at different stages of life. It recognizes the interrelated vulnerabilities in nutrition and that addressing these disparities across all the life stage will have mutually reinforcing benefits. For instance, good nutrition in the early years will have positive effects in later life. The PPAN is intended to contribute to the nutrition of Filipinos at each life stage. While the first 1000 days continue to remain a focus, interventions to address malnutrition among adolescents and older persons are included. Guiding Principles The PPAN 2023-2028 is guided by the following principles that are crucial to determine the best ways to achieve the intended results of the plan: 1. Food is a fundamental human right and nutrition is a basic child’s right 2. Equity and social justice 3. Intra- and Inter-sectoral collaboration 4. Community participation 5. Evidence-based approach 6. Sustainability Outcome Targets PPAN 2023-2028 aims to reduce, with the aim of eventually eliminating, all forms of malnutrition across all life stages through strategies such as healthier diets, better nutrition practices, improved access to quality nutrition services, and enabling mechanisms. These are: Pregnant and Lactating Women 1. Reduce the prevalence of nutritionally at-risk pregnant women by 3.5% per year, from 16.4 % (2021-2022) to 13.2% in 2028. 2. Decrease the prevalence of Vitamin A deficiency (VAD) among pregnant women by 0.27 per year, from 2.8% in 2019 to 0.53% in 2028. 3. Decrease the prevalence of VAD among lactating women by 0.19 per year, from 2.8% in 2019 to 0.38% in 2028. 4. Increase the median urinary iodine concentration (UIC) among pregnant women, from 122 μg/l (2018-2019) to 150-249 µg/l (adequate iodine nutrition) by 2023-2028. 5. Increase the median UIC among lactating women, from 99 μg/l (2018-2019) to 100- 199 µg/l (adequate iodine nutrition) by 2023-2028. 2 6. Reduce the prevalence of anemia among pregnant women, from 23.0 % (2018- 2019) by 3.2 reduction per year, based on past trend and to achieve a mild public health problem by 2025 and continued reduction until 2028. 7. Reduce the prevalence of anemia among women of reproductive age (WRA) by 50% in 2025 World Health Assembly (WHA) target, from the 2013 level (12.5%). Children Under-five 1. Reduce the prevalence (%) of low birth weight (LBW) infants by 30% from the 2017 levels of 14.5% to 10.2% in 2025, based on WHA targets, and continued reduction to 8.6% until 2028. 2. Increase the percentage of exclusively breastfed (EBF) infants at 6 months from 32.1% (2021-2022) to 50% by 2028. 3. Increase the prevalence of children 6-23 months old with Minimum Acceptable Diet (MAD) from 13.3% (2021-2022) to at least 25% by 2028. 4. Increase the prevalence of children 6-23 months old with Minimum Diet Diversity (MDD), from 13.8% (2021-2022) to at least 50% by 2028. 5. Decrease the prevalence of VAD children 6 months to 5 years old, from 15.5 % (2018- 2019) to

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