ACCELERATED HUNGER-MITIGATION PROGRAM(AHMP) Program Implementation Review of the Promote Good Nutrition Component (PGN) in the National Capital Region April 6-8, 2010 Lagos Del Sol Resort, Cavinti, Laguna 1 Introduction The Promote Good Nutrition (PGN) is a component of the Accelerated Hunger-Mitigation Program (AHMP). It includes the conduct of trainings on Infant and Young Child Feeding (IYCF) and Pabasa sa Nutrisyon (PSN) for community-based implementers as well as distribution of IEC materials promoting good nutrition particularly, the Nutritional Guidelines for Filipinos (NGF). The PGN is being implemented to contribute to hunger-mitigation through improved food and nutrition knowledge, attitude and practices of families in AHMP areas. Specifically, the PGN aims to 1) increase the number of 0-6 month old infants who are exclusively breastfed; 2) increase the number of infants 6-11 months old receiving calorie and nutrient-dense complementary food; 3) increase the number of households with improved diets in terms of quality and quantity; and 4) increase the number of households involved in food production activities. In 2007, the NNC-NCR Regional Office provided funds to all the cities and municipality in Metro Manila for the conduct of trainings on Infant and Young Child Feeding and Pabasa sa Nutrisyon for community-based implementers covering 50% of barangays in the region. The NNC-NCR also provided IEC materials promoting good nutrition particularly, the NGF. This year, NNC-NCR will provide funds to cover the remaining 50% of the barangays once the training materials are available. Prior to the expansion to the remaining 50% of the total barangays, a Program Implementation Review (PIR) was conducted to assess how the program was implemented by the LGUs after trainings were conducted and IEC materials were distributed. Objectives The three-day workshop aimed to: 1. determine accomplishments of the program vis-à-vis targets, program gaps and recommendations for improving the program to ensure sustainability; 2. share and identify good practices, facilitating and deterring factors; 3. identify strategies and follow-through actions for the expansion of the program to other barangays; 4. review the concept of breastfeeding support groups and to clarify other concepts in relation to PGN implementation; and 5. reinforce IYCF counseling and practical skills learned from the training and identify common problems faced by participants in applying IYCF counseling. 2 RNPC Mila V. Federizo Mandaluyong City Day 1: Opening Program The PIR held on April 6-8, 2010 at Lagos del Sol Resort in Cavinti, Laguna was attended by selected IYCF-trained doctors, nurses, midwives, nutritionists, barangay nutrition scholars and volunteer mothers from the 16 cities and municipalities in the region. Unfortunately, there were no participants from Manila. The program was moderated by NOIII Emerenciana D. Lagadia and NOII Arlene A. Famoso. The invocation was led by Ms. Teresa Abando, Nutritionist of Caloocan City. In her prayer, she thanked God for the safe arrival of the participants to the venue and she asked for the guidance of the Almighty Father so that the participants will learn new knowledge that they can share with their community. After the prayer, Ms. Edna Cipriano, Nutritionist of Navotas City, led the singing of the National Anthem. RNPC Milagros Elisa V. Federizo gave the welcome message. She thanked everyone for attending the PIR even if the venue is far from Metro Manila. She expressed hope that the participant will enjoy the view of nature and the company of each other. She said that the activities of the PIR will enable the participants to review the program as implemented in their respective LGUs and assess what activities have been done, what were done well, what were not done as planned, what could have been done better and what still should be done. She expressed optimism that the objectives of the PIR will be achieved and that the activity will be a good opportunity to enhance the camaraderie among the participants and establish a good working relationship among them even after the PIR . The participants from the LGUs and facilitators were introduced by NO II Arlene Famoso. Without photo is Mr. Anthony Benabese of San Juan City who came in later in the evening. Mandaluyong: 1. Ms. Marivel Pornea 2. Ms. Madgeline Soria 3. Ms. Amy Ruby Balmaceda 4. Ms. Marie Tess Belo 5. Dr. Shari Sabalvaro (Facilitator) Navotas City Navotas: 1. Ms. Remedios Suaco 2. Ms. Edna Cipriano 3 Muntinlupa City Marikina City Muntinlupa: 1. Mr. Francis Tagle 2. Ms. Rhonda Rabino Marikina: 1. Ms. Eileen Guevara 2. Ms. Rizalita Torrenueva Valenzuela City Valenzuela: 1. Ms. Elizabeth Provido 2. Ms. Winona Villanueva Quezon City Quezon City: 1. Ms. Minerva Victoria Perlada 2. Ms. Judith Peralta Caloocan 1. Ms. Maria Teresa Abando 2. Ms. Virginia Dagucon 3. Ms. Adela Villanueva Taguig 1. Ms. Julie Bernabe 2. Ms. Emma Espina 3. Ms. Sylvia Maliton Caloocan City Taguig City 4 Malabon City Municipality of Pateros Malabon 1. Dr. Ma. Rossana Miciano 2. Dr. Purita Javier Pateros 1. Ms. Joyce Parco 2. Ms. Emerina Asuncion Pasig 1. Dr. Nilda del Rosario 2. Ms. Marissa Almario Parañaque 1. Ms. Enrica Vallono 2. Ms. Girlie Mercado Pasig City Parañaque City Las Piñas City Las Piñas 1. Ms. Bernadette Mendez 2. Ms. Eileen Rimando Pasay City Pasay 1. Ms. Josephine Galang 2. Ms. Elizabeth Angat Makati 1. Ms. Adora Carandang 2. Ms. Angeles Campo 3. Ms. Elvira Quinon 4. Ms. Sonia Zabala 5. Ms. Femilina Tuazon 6. Ms. Marlet Despues (Facilitator) 7. Ms. Alma Gammad (Facilitator) Makati City 5 NOIII Emerenciana D. Lagadia NOIII Lagadia explained the mechanics and objectives of the PIR. Expected outputs of the PIR were as follows: 1. Recommendations for sustaining the program 2. Good Practices 3. Plan for follow-through activities for expansion The PIR has four workshops on the following: 1. Assessment of accomplishments vis-à-vis targets 2. Identifying good practices and facilitating and deterring factors and recommendations 3. Assessment of IYCF competencies 4. Sustaining and expanding PGN and Re-entry plan She expected the participants to be friendly, open, candid and able to share their ideas. Overview of AHMP-PGN and Plans for Expansion in P1 areas Ms. Milagros Elisa V. Federizo Regional Nutrition Program Coordinator, National Nutrition Council - NCR RNPC Federizo gave a brief overview of AHMP-PGN and plans for expansion in P1 areas. The PGN consisted of three components: 1) conduct of social marketing activities; 2) promotion of IYCF and the increased consumption of vegetables and other nutritious foods; and 3) nutrition education in schools. The PGN component aims to improve the nutrition knowledge, attitudes and practices of families in the AHMP areas including all cities and municipality of the National Capital Region being a Priority One area. Specifically, the program aims to increase the number of infants 0-6 months who are exclusively breastfed; reduce the number of infants receiving food and drink other than breast milk and increase the number of infants 6-12 months old who are given calorie and nutrient-dense complementary foods. 6 The promotion of good nutrition is anchored on two key messages: 1. for primary targets, especially mothers and caregivers to practice proper infant and young child feeding, and 2. for the general population, which includes children and other members of the family, to put into practice the Nutritional Guidelines for Filipinos To achieve the desired impact, the nutrition education component involves the following: 1. Community-based promotion of the IYCF for local implementers and hospital practitioners A. Training on IYCF and Pabasa sa Nutrisyon Along community-based promotion of IYCF and NGF, one of the major activities includes the training on IYCF and Pabasa sa Nutrisyon strategy. Several sub-activities are being conducted under this activity which includes the training of trainers and community-based training on IYCF and PSN, nutrition counseling of pregnant and lactating women, and conduct of nutrition education classes or Pabasa sa Nutrisyon. 7 The Training of Trainers on IYCF and PSN was held last 10 April 2007 and attended by 33 participants composed of technical staff from NNC central office and regional offices and nutrition workers from Lanao del Norte, Surigao del Norte, and Agusan del Sur. The participants later composed the pool of national trainers who were deployed to conduct the trainings for municipal and city IYCF trainers/implementers, who, in turn conducted the barangay-based trainings. Among the topics covered during the training were breastfeeding, complementary feeding, and NGF. The trainings for hospital-based implementers or clinicians were held in September 2007 onwards. All trained implementers from the municipal, city and barangays levels are expected to counsel mothers on IYCF, particularly those in their catchment areas and conduct nutrition education classes using Pabasa sa Nutrisyon as strategy. Barangay-based IYCF implementers are expected to continuously identify pregnant and lactating women, visit these women regularly, and counsel them on infant and young child feeding. They are expected to intensify the promotion of exclusive breastfeeding from 0-6 months and proper complementary feeding from 6 months onwards while continuing breastfeeding. They need to help and guide pregnant women to prepare themselves for exclusive breastfeeding from birth up to six months by explaining the proper techniques of breastfeeding, its importance and advantages; the dangers of bottle-feeding; and by helping them prepare their bodies physically for breastfeeding. Counseling of mothers with 6-month old infants will focus on complementary feeding such as what foods to give, in what quantities, and under what conditions (e.g. give complementary food after a breastfeed not before, ensure that all the paraphernalia to be used, including water, are clean and sanitized, etc.) Nutrition education classes highlight topics on breastfeeding, complementary feeding and the NGF. 8 B. Multi-Media Campaign on NGF a. Printing of educational materials b. Airing of nutrition plugs/spots on breastfeeding an NGF Airing of nutrition plugs in key radio and television stations were done and continuously being done at the national and local levels. These plugs highlight the importance of fruits and vegetables, eggs, NGF and breastfeeding. Copies of the radio and TV plugs were distributed to radio and TV stations nationwide for free airing. c. Nutrition School on the Air (NSOA) d. Drama series on nutrition and hunger e. Nutrition segment f. Guestings in various radio and TV programs to discuss nutrition and AHMP g. Conduct of special events as highlights of Nutrition month celebration and sectoral celebration 2. School-based promotion of the NGF School-based promotion of the NGF is being done as part of AHMP. Due to limited funds, only 50% of public elementary schools in the region were targeted in 2007. Each school received a set of posters on the Daily Nutritional Guide for Filipinos, exhibit material on Pagkaing Sapat at Abot Kaya and NGF tarpaulin billboard. To ensure the utilization of the materials, NNC also coordinated with the DepED-Health and Nutrition Center and the Bureau of Elementary Education for the development of a module that will guide teachers on the use of the materials. The teaching module is targeted to be used this coming school year. The NNC is also coordinating with DepED for the issuance of the necessary memorandum circular to ensure that these materials are used by the teachers. 3. Multimedia campaign 4. Conduct of advocacy meetings 9 The following are the actions requested from the LGUs: 1. Breastfeeding promotion a. Organize and sustain community breastfeeding support groups b. Revive the Mother-Baby Friendly Hospital Initiative 2. Nutrition Education Classes 3. Capability Building a. Identify training participants and support their attendance i.e. travelling expenses b. Cover additional barangays as local counterpart c. Implement post-training actions e.g. conduct of nutrition education classes and counselling for pregnant/lactating women 4. Support materials a. CNAO or alternate(s) to receive, acknowledge and ensure security of ALL materials b. Distribute these to appropriate recipients properly documented c. Maintain master list of materials received and recipients 5. IEC materials a. Tarpaulins Hang in strategic place and ensure its security Put in frame to make it permanent and prevent loss b. Posters Ensure posting in health centers; if space is filled up, post in barangay outpost Encourage utilization of posters during nutrition education classes 6. Program management a. Designate a full-time focal person to oversee hunger-mitigation program b. Nutrition committee to monitor and evaluate AHMP implementation c. Submit monthly status reports to NNC for inclusion in report to Cabinet 7. Support materials for schools a. School superintendent or alternate/s to receive, acknowledge and ensure security of ALL materials b. Distribute to schools covered by FSP or schools with high prevalence of malnutrition c. Ensure that each school to receive complete set of materials Changes made to PGN in 2009 1. Training on IYCF/PSN now called Promote Good Nutrition Training a. To incorporate the other components including topics on MTPPAN, NGF, Vegetable Syllabus b. Changes in the design of the training Pabasa sa Nutrisyon, Egg and Vegetable first before IYCF sessions IYCF to include topic on Lactation Amenorrhea Method (LAM) 2. Training for barangay implementers a. Increased budget to P500/day for five days to allow live-in training 10 b. To use the IYCF Flipchart (being developed) for the training as well as in orienting BF support groups 3. Some minor changes in the Pabasa sa Nutrisyon kit a. Added 2 play cards for rice b. Increased size of play cards and bag Comments/issues raised and agreements: 1. Cities of Pasig, Marikina and Muntinlupa shared that their posters and tarpaulins were washed-out by typhoon Ondoy. They want to request that these materials be replaced by NNC, if possible. 2. NPC Federizo informed the group of the following: NNC-CO will be giving additional IEC materials to LGUs to cover the remaining 50% of the barangays. LGUs whose materials were destroyed/washed out by typhoon Ondoy can send letter informing NNC about this and request for the PGN materials destroyed in the typhoon be replaced. She assured the concerned LGUs that if there are still available IEC materials, they will be given priority in the allocation and distribution. NNC-NCR will also find out from NNC-CO if they can increase the allocation of materials to the areas affected by Typhoon Ondoy. Fund (partial) for the PGN training of the remaining barangays in NCR has already been downloaded to NNC-NCR RO. Training funds will be provided to the LGUs once the training materials are available so that the barangay-based trainings can commence. PGN trainings are expected to start on August or even earlier, after election. NPC Federizo requested those in-charge of the PGN at the local level to ensure that the IEC materials to be given to them for the remaining 50% of barangays be well secured and to prepare acknowledgement receipt and masterlist of recipients. Regional Situation on Infant and Young Child Feeding Practices Ms. Myrna Lapuz Nutritionist-Dietitian III, Center for Health Development-Metro Manila Ms. Lapuz presented the regional situation on IYCF. From 1993 to 2008, the proportion of children ever breastfed or has been breastfeed at some point in time after birth in the Philippines did not increase as shown in the table. Based on the 2003 National Demographic and Health Survey (NDHS), only 20.0% of infants in NCR were exclusively breastfed, 29.0% were not breastfed. Year % 1993 87.0 1998 88.0 2003 87.0 2008 87.7 11 In 2008, 80.7% of children were ever breastfed in NCR, which is lower than the national prevalence of 87.7%. Infant and Young Child Feeding (IYCF) Practices of 6-23 months From the same survey, 99.1% of children were either given breastmilk or milk products. This figure is higher than the national level of 95.0 %. On the other hand, only 76.2% of children were given foods from the recommended number of food groups. She also mentioned that 12 LGUs in NCR have already established their respective IYCF technical working group. Only Pateros, Makati and Taguig have passed resolutions/ordinances supporting IYCF while Makati, Quezon City and Pateros have barangays resolutions supporting IYCF. Regional Accomplishments on AHMP-PGN Ms. Emerenciana D. Lagadia Nutrition Officer III, NNC-NCR NOIII Lagadia presented the Regional Accomplishment on AHMP-PGN. Below is the status of Training on IYCF and Pabasa sa Nutrisyon: City/ Municipality No of batches of brgy trainings conducted No. of brgys covered No. of implementers trained Caloocan 12 94 376 Malabon 2 11 44 Navotas 1 7 28 Valenzuela 2 16 64 Quezon City 8 71 284 (98.2%) Marikina 1 8 32 Pasig 2 15 60 Pateros 1 5 20 Taguig 1 9 36 Manila 62 448 1,792 Makati 2 17 68 Mandaluyong 2 13 52 San Juan 2 11 44 Pasay 10 100 400 Parańaque 1 8 32 Las Pińas 1 10 40 Muntinlupa 1 5 20 TOTAL 111 (100%) 848 (100%) 3,392 (99.85%) NCR PHIL % Ever Breastfed 80.7 87.7 % Started Breastfeeding within 1 hr. of birth 49.1 53.5 % started Breastfeeding with in 1 day of birth 82.3 82 % Received Pre-lacteal feeds 52 54.5 12 There were 3,392 implementers trained on IYCF and Pabasa sa Nutrisyon in the 111 batches of trainings conducted in 848 barangays in NCR. In 2007, each LGU received: 1. Tarpaulin-Billboards a. 1 NGF for every barangay hall or health center b. 3 for every public market (1 each of NGF, Ang Itlog and Kumain ng Gulay) 2. Posters (1 set per Barangay or Health Center) a. Milk Code b. Breastfeeding c. Egg d. Nutritional Guidelines for Filipinos e. Vegetables f. Eat a Variety of Foods Every Day Multi-media campaign participated were: 1. Airing of radio & TV plugs Part of the multi-media campaign on PGN and IYCF were the TV and Radio Guestings wherein RNPC Federizo and NOIII Lagadia were two of the resource persons. 13 2. Nutrition-School-on-air module There were 1,083 graduates from from the cities of Malabon, Navotas, Las Piñas, Quezon City, Taguig, Pasig and Muntinlupa. A total of 669 copies of the Veggie recipe book and 3,392 copies of the “Let’s learn more about veggie” syllabus were distributed to all LGUs in Metro Manila. Special Events: Gulayan Contest (school and community-based levels) was conducted by 10 out of 17 LGUs wherein P20,000 was provided to each LGU that conducted the contest for their cash prizes. Buntis Congress was held at SM Megamall AHMP Media Forum Caravan was held in Mandaluyong City Gawad Pagkain Search was held in September 2009 and awarding was held in October wherein Taguig City won the Best AHMP LGU Implementer in 2008 Award. Advocacy meetings with LNCs AHMP was always included in the agenda during the meetings of Regional Nutrition Committee, Regional Management Group, C/DNPCs and BNS Federation Field Monitoring Visits Conducted in different LGUs to monitor the status of implementation of AHMP projects and activities at the local level Accomplishments on the School-based PGN Ms. Arlene A. Famoso Nutrition Officer II, NNC-NCR DepEd-NCR failed to send a representative to the PIR to present the PGN accomplishments in the public elementary schools in the region. Hence, Ms. Famoso presented the status report on their behalf. In 2007, NNC-CO distributed tarpaulin-billboard, posters on the Daily Food Guide for school children and NGF, as well as exhibit materials on Pagkaing Tama sa Abot Kayang Halaga. Only 50% of schools in LGUs were given PGN materials. In 2009, NNC distributed again IEC materials to public elementary schools in Metro Manila: one (1) set of NGF tarpaulin which was later posted at the DepED-NCR office, copies of Syllabus on “Let’s Talk about Veggies” and Learning Modules on integrating Nutrition Education in the elementary curriculum for use of public elementary school teachers. 14 Status of distribution of AHMP-PGN materials in Public Elementary Schools Division Office No. of Schools Tarpaulin- Billboard Posters on daily Nutri- Guide Exhibit on “Pagkain Abot Kaya” City of Manila 37 37 222 37 Quezon City No Report 49 No report No report Pasay City No Report 10 No report No report Caloocan City 29 30 180 30 Mandaluyong 8 8 48 8 Marikina 9 9 54 9 Makati 14 14 84 14 Pasig & San Juan 36 18 108 18 Parañaque 21 11 66 11 Las Piñas 30 10 60 10 Valenzuela 37 19 114 19 Malabon/Navotas 22 22 132 22 Taguig/Pateros 29 15 90 15 Muntinlupa 17 9 54 9 Actions requested from DepED-NCR: 1. Identify target schools provided with IEC materials (Schools Division Office of Taguig, Pateros, Pasig and San Juan have not yet submitted the list of schools given IEC); 2. Ensure installation of the tarpaulin-billboard and utilization of IEC materials; and 3. Conduct an orientation on the use of the learning modules and other IEC materials. Actions requested from the local Anti-Hunger Task Force and nutrition committees: 1. Monitor if the tarpaulin-billboard and posters provided are still posted in the schools; 2. Get feedback from the DepEd member of the local AHTF or C/MNC on the utilization of the PGN materials in the schools. 15 Workshop 1: Assessment of Accomplishments vis-à-vis targets Ms. Soccoro Alma F. Gammad Chief, Nutrition Office, Makati City Ms.Gammad facilitated the first workshop. She explained the mechanics as follows: Each LGU to review the level of PGN implementation in their area prior to the PIR. Each LGU will refer to the PGN framework and determine targets vs. implementation gaps; other accomplishments outside of the framework that contributed to the achievement of PGN objectives. Each LGU should have accomplished and submitted the matrix for the workshop. Based on the matrix, LGUs fill up the blank summary of accomplishments using color-coded metacards with this legend: Blue - above target Green - within target Red - below target 16 Output of workshop 1 This workshop was participated in by all LGUs in NCR except San Juan (participant came in late in the evening of Day 1) and Manila (failed to send participants). Hereunder are the results of workshop: A. Program Outputs Indicators within targets are the following (Green): 1. Training for 50% of barangay with 4 participants per barangay conducted 2. All training materials were distributed to the barangay training participants 3. All IEC materials provided were distributed to the barangays 4. Targets for multi-media campaign (TV, radio and print) reached 5. Adequacy of support generated for the program to implement the program (e.g. allocation of budget, staff) 6. Local ordinance or resolution adopted. Majority of the cities and municipality have already passed local ordinance or resolution. 7. Adequate number of municipal and barangay implementers trained 8. At least 3 BF support groups established per city/municipality 9. At least 50% of pregnant women and mothers with children below 2 years of age provided with counseling on IYCF 10. At least 10% of mothers with children below 2 years old graduated/attended Pabasa sa Nutrisyon classes 11. At least 10% of mothers with children below 2 years old attended classes using egg and vegetable syllabi Indicators that are below target and need to be improved (Red): 1. At least 50% of families with home food production activities 2. At least 10% of mothers with children below 2 years old graduated/attended Pabasa sa Nutrisyon classes 3. At least 50% of pregnant women and mothers with children below 2 years of age provided with counseling on IYCF 17 Indicators which are above target (Blue): 1. At least 3 BF support groups established per city/municipality 2. At least 10% of mothers with children below 2 years old attended classes using egg and vegetable syllabi B. Program outcome Based on the consolidated LGU accomplishments, majority of the LGUs have increased percentage of 0-6 month old infants who are exclusively breastfed. Based on their perception, there was an increased consumption of vegetables and eggs. However, this was based only on their perception and need to be validated. LGUs also do not have data on the percent of children 6 -24 months old with appropriate complementary feeding. All LGUs reported a decreasing number of underweight preschool children which they consider as an indicator that their efforts in promoting IYCF are paying-off and that their interventions and strategies are working toward nutrition improvement of children. NPC Federizo acknowledged and congratulated the LGUs who are well on-track in their accomplishments and challenged them to sustain their accomplishments. She ended the workshop by encouraging the LGUs to: a. review the indicators which are below target (Red metacards) and identify specific measures to improve accomplishment particularly with regards to the coverage of PSN classes and IYCF counseling; b. organized community breastfeeding support groups should be sustained and made functional through follow-through activities such as meetings, supervision and mentoring; recognizing the contributions being done by the peer counselors in the promotion of IYCF in the barangays (i.e. giving incentives); c. trained peer counselors/BFSGs should be mobilized in order to increase number of PSN graduates and pregnant and lactating women counseled on IYCF; d. In terms of food production, FAITH Gardening technique or container gardening can be done to increase number of families engaged in vegetable gardening. Since there are data gaps on complementary feeding and vegetable consumption, NPC Federizo encouraged the LGUs to undertake local studies or surveys to generate these information which are important for monitoring and evaluation as well as program planning. Day 2 Before proceeding to the workshop proper, Ms. Marlet Despues of Makati City led the opening prayer and a recapitulation of the previous day’s discussion was given by Ms. Arlene Famoso. 18 Workshop 2: Identifying good practices, facilitating, deterring factors and recommendation Ms. Myrna Lapuz Nutritionist-Dietitian III, CHD-MM Ms. Lapuz facilitated Workshop 2. The participants were divided into five groups. Each group was given specific questions to answer. They were asked to identify the facilitating and deterring factors that affected program implementation and identify concrete recommendations to improve program implementation. The participants busy working on their workshop outputs. 19 Each group posted their outputs on the wall for gallery viewing. Participants shared their comments and suggestions on the outputs of the different groups during the plenary. The group outputs are as follows: Workshop Outputs by Group Group 1: Distribution and use of IEC materials Before the distribution of the IEC materials, training for health center staff on the use of the materials was conducted. IEC materials are used during the pre-clinics lectures, mothers’ classes and community assemblies. They also hanged the tarpaulin-billboards in strategic places to be seen by as many people in the area as possible. The IEC materials were very useful to the community as these help increase the knowledge of families on good nutrition practices and the types/kinds of vegetable, their nutritive value and functions in the body. The IECMs also serve as reference materials for barangay implementers in the conduct of nutrition education sessions. The IEC materials are easy to understand since they are written in simple language and the PSN kit features enjoyable games that even children can enjoy while learning. Problems encountered in the use of IEC materials are: some of hanged tarpaulins (NGF) were stolen some of the featured dishes in the veggie recipe book are impractical, tedious and time consuming to prepare for the mothers. Suggestions to improve distribution and use of IEC materials: 1. Use T-shirts as IEC material instead of tarpaulin-billboards which are usually stolen; t-shirts have wide coverage since many people tend to read the prints on the T-shirt. 2. LGUs must allot budget for the reproduction and purchase of IEC materials in order to augment what NNC has provided. 3. One NGF message per tarpaulin is effective instead of putting all messages in one tarpaulin. Group 2: Training for barangay implementers Modifications made during the trainings at the barangay level are as follows: • The original schedule of five (5) whole days training was changed into ten (10) half days to give the mothers time to do their household chores. • Filipino or Tagalog was used in the discussions for better understanding of the topics by the participants. • Discussions on HIV-AIDS and Replacement Feeding were not included to avoid confusion among the participants. 20 Participants trained at the city and municipal level served as trainers and facilitators during barangay trainings. They also conduct and monitor the follow-through activities of the barangay implementers. The city/municipal trainers and the barangay implementers were able to apply what they have learned in the IYCF and PSN training by organizing community assembly, conducting PSN sessions, doing one-on-one counseling for mothers and conducting meeting with the breastfeeding support groups. Comments/ issues raised and agreements: 1. Ms. Lapuz shared that the cities of Makati and Caloocan were given fund by CHD-MM for the conduct of follow-through activities, e.g. meetings of BFSGs 2. Ms. Thess Abando of Caloocan shared that they do the mentoring and follow-up training through regular quarterly meeting, monitoring the accomplishment through monthly reports on number of mothers counseled, initiated to breastfeeding, etc. 3. Ms. Lagadia explained that follow-up is different from the follow- through activities which they have shared. 4. NPC Federizo clarified the difference between follow-up training and follow-through activities. Follow-up training is conducted by IYCF trainers among local trainers and implementers to assess their competencies using a checklist/tool and following a prescribed procedure as discussed in the follow-up training manual given during the IYCF ToT. She also informed the participants that NNC-NCR has a budget for follow-up training this year. This is also the reason why Ms. Lagadia pointed out that what Caloocan shared are follow-through activities and not follow-up training. LGUs to be visited in the follow-up training will still be identified. Group 3: Organization of BF support groups and conduct of counselling for pregnant and lactating women Most of the LGUs have already established at least three (3) breastfeeding support groups in their locality. Activities that were done include advocacy meetings, teambuilding, IYCF training, recruitment of mother leaders and networking with the NGOs. They were able to maintain it by having regular follow-up meetings, updates and provision of tokens/incentives like t-shirts, umbrellas and tote bags. The BFSG members have their respective catchment area. Their primary activities include counseling of pregnant women and lactating mothers. Monitoring form is used when doing home visits. BFSG members consolidate their accomplishments and submit it to the nutrition office during their meetings. The NDs who 21 serve as the supervisors of the BFSG members also provide mentoring during their meetings. The BFSGs contribute significantly in improving the community’s awareness on the importance of IYCF practices. They provide support in educating mothers on breastfeeding and giving appropriate complementary foods. Success stories shared by Quezon City and Muntinlupa: 1. Quezon City After the typhoon Ondoy, in one of the evacuation areas, a lot of mothers were seen not breastfeeding their babies. One of these mothers was encouraged by a peer counselor to re- lactate. The mother was able to breastfeed her baby after being counseled and shown proper technique of breastfeeding. 2. Muntinlupa Ms. Rhonda Rabino shared that after her IYCF training, one fellow ND asked her about the re-lactation. Because the knowledge is very fresh to her, she was able to share it to her fellow ND and that ND was able to successfully relactate and breastfed her baby until 2 years old. 3. Pasig After the typhoon Ondoy, they were able to put up breastfeeding station in the evacuation centers. Because of this, a lot of mothers were encouraged to breastfeed their babies. Comments, issues raised and agreements: 1. The participants have good practices and success stories to share. However, most of them lack the knowledge/skills in documenting these. 2. Ms. Almario and the group requested NNC-NCR for a training on documentation so that they can enhance their skills in documenting their best practices and success stories. 3. NPC Federizo informed the group that they have already included that in their WFP for 2010 and will seek the approval of and funding from NNC-CO for this training. Group 4: Implementation of the Pabasa sa Nutrisyon and use of Egg and Vegetable Syllabi When they conduct sessions on PSN, Egg and vegetable promotion, they made sure that they were able to meet their targets and plans or schedules were followed. They were also able to submit the reports needed. The sessions on PSN including the use of egg and vegetable syllabi improved the food and nutrition practices of the target families. It also motivated them put up vegetable gardens and engage in other food production activities. The mothers were able to practice what they have learned during cooking demonstrations. These activities resulted to positive change in the nutritional status of the children. 22 The good practice shared by the group is the 24/7 info assistance that they provide through SMS. Mothers can send text messages to them regarding breastfeeding problems and concerns and these inquiries will be answered by the trained IYCF personnel. Group 5: Program management The nutritionists, nurses, midwives, BNSs, BHWs and IYCF coordinator supervise the conduct of: (a) barangay-based IYCF trainings, (b) pabasa sa nutrisyon sessions, and (c) organization of breastfeeding support groups. They also conduct regular meetings and field monitoring visits. In Makati, a matrix developed by the Nutrition Office is used to record and report accomplishments. The monitoring form or “ledger” is used to collect indicators like: personal information of mother and child, problems encountered and recommendations given by the IYCF-trained health personnel and peer counselors. Review of Community Support on IYCF Dr. Shari Ludivina L. Sabalvaro IYCF Coordinator, Mandaluyong City Dr. Sabalvaro gave a brief review of the community support on IYCF. The objectives of the session are as follows: 1. Describe a mother-baby friendly community 2. Enumerate key actions to promote and protect infant and young child feeding in the community 3. State the importance of community support groups for promoting infant and young child nutrition 4. List the steps in organizing community support groups The National Plan of Action on IYCFis anchored on the Global Strategy for Infant and Young Child Feeding, which aims to contribute to improving the nutritional status and health of children and reduce infant and young child mortality and morbidity. The policies are further translated into the National Plan of Action on IYCF for 2005-2010. A technical working group identified key strategies in implementing the IYCF policy. The plan was anchored on the Global Strategy on IYCF developed by the World Health Organization and UNICEF. 23 The plan of action aimed to contribute to nutrition improvement and reduction of infant and child morbidity and mortality, which will contribute to the achievement of the UN Millennium Development Goals. Four main objectives of the plan are: 1. promote IYCF practices; 2. increase political commitment at different levels of government, international organizations, NGOs, private sector and civil society; 3. provide a supportive environment to enable families and communities to implement optimal IYCF practices; and 4. ensure sustainability of interventions along IYCF. Four key strategies are: 1. Development of policies and standards 2. Improvement of systems for effective IYCF 3. Mobilize stakeholders to IYCF and 4. Involve families and communities to promote and adopt IYCF. These strategies will focus on transforming various settings as mother-child-friendly. The six (6) settings include: 1. Health facility including hospitals 2. Workplace 3. Schools 4. Public places 5. Families and communities and 6. Industry Key actions are recommended to transform each setting into mother-child-friendly for IYCF. Particularly for health facilities, the major strategy is the Mother-Baby Friendly Hospital Initiative along with the implementation of related laws such as the Rooming-In and Breastfeeding Act and the Milk Code. To implement the plan the following can be done: 1. Present the concept to the: a. Barangay City Council to obtain the necessary support b. Health Center staff and other health facilities based in the barangay c. schools, work places and other public places in your barangay d. existing groups and organizations /partners related with the protection, promotion and advocacy of children’s rights 2. The group then will develop a Plan of Action that will: a. Clearly define goals and objectives b. Define target audiences c. Link with current activities/programs in your barangay d. Identify counseling channels e. Discuss structure and resources needed f. Analyze training and IEC needs g. Define supervision, monitoring and evaluation 24 h. Design timeline i. Identify needs in terms of funds 3. Identify how each one of them can help in setting up the model community (role identification) a. Training b. Technical Assistance c. IEC Materials d. Supervision and Monitoring e. Others f. 4. Organize Community Assembly to: inform the community about the program to identify pregnant women and mothers with infant and children up to 2 years old 5. Select BF counselors from each purok/sitio with the following qualifications: a. basic literacy level b. a woman with successful breastfeeding experience c. has a similar background to the women to be counseled d. has experience in community work e. lives in the community f. is respected by the community g. can allocate and commit time h. is motivated to help other mothers 6. Train / Orient the selected peer counselors to facilitate support groups Workshop 3: Assessment of IYCF counseling competencies and common problem Workshop 3 was divided into 3 parts: Part 1: Individual written exercises For those who were trained on IYCF, activity was done to reinforce knowledge and skills learned during the training. Each participant answered written exercises. Part 2: Self assessment of competencies • Each trained participant was given a list of competencies, then they assessed themselves by competency for both knowledge and skill by putting a check against the competency that they are confident they possess; they mark an X for those they were not confident about • They were given 15 minutes to do the self-assessment. Training of peer counselors 25 Part 3: Discussion of skills practiced and problems encountered • Participants were asked to reflect on their competencies and determine which of these are being practiced, the problems that they have encountered or competencies that they find difficult to practice. They wrote these on meta cards and posted them on the manila paper. The participants were divided into 4 groups. Group members and facilitators for each group are shown below: Group 1 Facilitators: Josie & Mila Group 2 Facilitators: Doc Shari & Arlene Group 3 Facilitators: Marlet & Myrna Group 4 Facilitators: Alma & Meren Peng Francis Sylvia Eileen R. Sonia Judith Beth P. Dette Matet Doc Purita Ruby Tess Remy Dang Sally Angeles Enrica Marivel Marissa Doc Rossana Doc Nilda Eileen G. Anthony Girlie Marivic Madgelin Virgie Emma Julie Emerina Joyce Adora Jojie Beth A. Nona Edna Elvira Adela Processing of workshop 3 The following is a summary of competencies that participants are not able to practice with confidence: • Assess a breastfeed. • Help a mother to attach her baby to the breast. • Explain to a mother about the optimal pattern of breastfeeding. • Help a mother to cup feed her baby. • Plot and interpret a growth chart. • Support exclusive breastfeeding for the first six months of life • Help mother to sustain breastfeeding up to 2 years of age or beyond • Help a mother with not enough milk • Help a mother with a baby who cries frequently • Help a mother whose baby is refusing to breastfeed • Help a mother who has flat or inverted nipples • Help a mother with engorged breasts • Help a mother with sore or cracked nipples • Help a mother with a non-breastfed child over six months of age who is not growing well • Counsel a pregnant woman about breastfeeding. • Teach a mother the 10 key messages for complementary feeding. • Take a feeding history for an infant or young child 0 – 24 mos. 26 While the competencies that they were not able to practice or have difficulty practicing are: • Use Confidence and Support skills to counsel a mother. • Teach a mother the 10 key messages for complementary feeding. • Take a feeding history for an infant or young child 0 – 24 mos. • Help a mother with mastitis. • Help a mother to breastfeed a LBW or sick baby. • Counsel an HIV woman antenatally about feeding choices. • Support an HIV mother in her feeding choice. • Follow – up the infant of HIV mother 0 - 6 months who is receiving replacement milk. • Help an HIV mother to cease BF early and make a safe transition to replacement feeds. • Help mothers whose babies are over 6 mos. of age to give complementary feeds. • Help a mother with a BF child > 6 mos. who is not growing well. • Help a mother with a non-breastfeed child > 6 mos. who is not growing well. • Use listening and learning skills to counsel a mother. Facilitators answered their queries and concerns regarding the competencies which they found difficult to practice. Participants also shared good experiences in practicing the different competencies as they promote IYCF in the community that they serve. Workshop 4: Sustaining and Expanding PGN and Re-entry Planning A. Sustaining and Expanding PGN Ms. Lagadia facilitated this workshop. After explaining the mechanics, the participants were divided into four groups. Each group was given a general question to answer: ”What strategies and actions could be done at the barangay, municipal, city, regional and national levels to ensure sustainability of the PGN?” The participants’ answers to the question per category are as follows: 1. Getting political support Big-Bang advocacy and invite a high ranking official Send letter requesting for support “Padrino” system Present a situationer (Facts and Figures) 2. Availability of trained personnel and volunteers Continuous recruitment of volunteers by existing trained personnel/barangay official Assurance of volunteers’ commitment by providing incentives 3. Improving management of the program Develop booklet/pamphlet guidelines/flyer/operational guidelines on how to set up or start the program Organize/re-organize/strengthen the TWG on PGN Lobby for the passage of ordinances/resolutions in support of PGN, particularly the provision of budget for PGN Appoint focal person who has been trained on IYCF Develop monitoring tool for BFSG 27 4. Generating Resources Inclusion of PGN in the City Investment Plan and Barangay Development Plan Tap NGOs for support Conduct of fund raising activities e.g. Bingo, cake raffle etc. Solicit political support Presentation of program/project proposal Utilization of GAD funds B. Re-entry planning Each LGU worked on their re-entry plan. They have identified follow-through actions based on the results of the workshops. Due to the limited time, four (4) LGUs coming from the four (4) districts in NCR were randomly chosen through draw-lots to present their respective re-entry plan. These were cities of Mandaluyong, Caloocan, Pasig and Las Piñas. All the presenters gave a detailed presentation on their re-entry plan. They were able to give details on the activities that they will do after the PIR. Highlights of the group presentations are as follows: Mandaluyong Ms. Marie Tess Belo was asked to share their strategies on how they were able to get the support of barangay captains. She shared the following: Most of their barangay captains to date are “achievers”, they want to achieve something in very short time Their Congressman has an attitude/power to mobilize the barangay captains They also give recognition to barangay captains who are very supportive to the nutrition program in the barangay. Recognition rites are done during the Nutrition Month Celebration. Their CNAO, being the wife of the mayor, is very dynamic and influential in a sense that she can mobilize the barangay officials with ease. Caloocan Ms. Thess Abando presented their re-entry plan. Among their activities they are committed to do after the PIR are: 1. Feedbacking 2. Conduct follow-through activities among breast feeding support group 3. Conduct training of Egg and Vegetable syllabi among mothers of underweight preschool children. 4. For their PGN trainings, the following activities will be done: Recruitment of participants Submission of participants recruited Identification of/coordination for possible venue Solicit commitment/ availability of trainers/ facilitators Delineation of tasks and assigned topics among the trainers/facilitators Coordination with NNC-NCR for the training fund and materials Get training fund, materials from NNC-NCR 28 Preparation of training materials, syllabus, venue, etc. Actual training Pasig Dr. Nilda delos Reyes shared the following activities that they plan to do: 1. Feedback the proceedings of the training to their Local Chief Executive 2. Lobby for the passage of resolution on IYCF 3. Conduct advocacy orientation among barangay captains 4. Train Mother Leaders of Bgy. Maybunga, NDs, HC staff of Maybunga HC on IYCF for BF support group. 5. Conduct training on PGN for the 50% of the barangays. 6. As part of their routine activities, conduct PSN sessions, Egg and Veggie Syllabi and BF counseling 7. On the 4 th quarter of 2010, they target to set up a breast feeding station in City Hall and Bahay Kalinga. 8. Every quarter they will conduct monitoring and follow-through activities to make sure that the skills of the BFSG trained in IYCF are enhanced and also to identify problems and thresh out problems. 9. Every time they conduct activities on PGN, she will make sure that these are documented and more importantly, all the good practices along IYCF 10. Regularly submit accomplishment and reports. Las Piñas Ms. Bernadette Mendez shared that Las Piñas City has no IYCF task force and support group yet. They will start on scratch and commit to undertake the following activities: 1. Feedback the proceedings to their supervisor 2. Propose for the creation of TWG on IYCF (or taskforce) 3. Lobby for the passage of Barangay Ordinances supportive to PGN on the 2 nd quarter of the year. 4. Lobby among the Councilor for Health and Social services the passage of a city resolution on IYCF. 5. On the 3 rd quarter of the year, IYCF trainings will be conducted in the remaining 10 barangays. 6. Quarterly meeting will be done to monitor the program. 29 Reactions and Impressions from Participants Dr. Rose Miciano (health center physician) of Malabon, in her response, said that this PIR is very useful and they can now better promote IYCF to the community with the support of the breastfeeding support group. She said that she is happy that she was able to share ideas during the activities and also was able to learn a lot from what was shared by the other participants. Ms. Emerina Asuncion (midwife) of Pateros, said that she is now very inspired in promoting IYCF in their health center and in the barangays as well as influencing other midwives doing private practice. She thanked the facilitators for the opportunity of being one of the participants in the PIR. Ms. Sylvia Maliton (BNS) of Taguig City, said that she is very lucky to have been chosen to become one of the participants. She gained new knowledge during the workshops which she can share to her co-BNSs. Ms. Elvira Quinon (mother leader) of Makati City thanked everyone for the new knowledge she have learned from the PIR. Ms. Enrica Vallono (ND) of Parañaque said that in spite of their busy schedule in Parañaque because of HATAW activity, she is fortunate to attend the PIR. She thanked the participants and the facilitators. Ms. Marissa Almario (ND) of Pasig shared that last year was not a good year for her. She was gone for a while because of some personal matters but this PIR served as a good comeback for her. She was so excited and enthusiastic about the PIR. However, she was quite disappointed on the venue because she did not expect that the venue was very far. She mentioned that the participants will appreciate if lunch on the first day was served. 30 In response to the feedback of Ms. Almario, NOIII Lagadia explained that the PIR was supposed to be a leave-out activity as per guidelines provided by NNC-CO. But because of the request of the LGUs during the CDNPC meeting last 5 February to have the PIR in an out-of-town venue, NNC- NCR tried to accommodate their request and made arrangements to make it an out of town activity. She shared that Tagaytay was also considered as a venue. Unfortunately, most of the hotels are fully booked and that the quotations received from the hotels were quite high and did not meet the COA guidelines. Lagos del Sol Resort was also mentioned during the C/DNPC meeting as a possible venue but since there was no negative comment, and the quotation they submitted was “COA-ble”, it was chosen as the venue of the PIR. Map going to the venue as well as information how to get there was sent through fax to all LGUs as an attachment to the letter sent to the LCEs. It was also clearly stated in the letter to the LCE that the transportation to and from the venue will be shouldered by the sending LGU as counterpart. Participants were also informed through sms and phone call that lunch will not be provided since the activity will start at 2pm and the budget allocated for the PIR cannot anymore cover the expenses for lunch on the first day. Many participants also said that inspite of the resort being far and the hassle experienced by some in going there, Lagos del Sol Resort has positive points such as good service and nice view. An added bonus was the opportunity to see ABS-CBN actors/TV personalities who were there for a shoot for a TV program. Many were excited to witness and see how a TV shoot is being done. Pledge of Commitment The participants were divided into five (5) groups. They were instructed to express their commitment by drawing their right hand with their name. “We commit to support the PGN program for the health of the whole family in our communities. We will continue to advocate the IYCF policy and the activities of the PGN.” “.. AHMP is like a tree that grows and gives life and shade to protect us from heat. We commit to ensure that the AHMP will continue to grow like a tree to protect the infant and young children through PGN…” 31 ”We commit ourselves in expanding and sustaining the breastfeeding support group, creating a strong PGN TWG and continue spreading the virus of IYCF.. and NO to milk formula!!!” With the song, “Sa Ugoy ng Duyan” as background music, the group vows to… “.. maintain our commitment in promoting IYCF deep inside our hearts and we promise that as long as we live we will continue to support the IYCF. We will continuously guide the BNS in advocating IYCF in their barangays, sustain IYCF and organize breastfeeding support group and spread the IYCF in the world”… “…We commit to continue to provide assistance to BFSG in promoting PGN, continue the mission and vision of IYCF in the community, contribute in the realization of AHMP objective by promoting good nutrition and continue to be breastfeeding advocates by counseling mothers..” 32 Awarding of certificates The certificate of appreciation was awarded to the facilitators for sharing their time and expertise in the AHMP PIR of the PGN in NCR. Certificates of the participants were placed randomly on their tables prior to the awarding of certificates. Each participant has the certificate belonging to another participant. Their task is to find the intended recipient of the certificate and hand it over to him or her after giving a short message. The giving of certificates turned out to be an enjoyable one and gave the participants an opportunity to give a message to their co-participant. Awarding of certificates to the facilitators Participants exchanging their Certificates 33 Synthesis and Closing Message Before giving her closing message RNPC Mila Federizo synthesized the proceedings of the PIR. She reviewed the objectives of the program and check with the participants if these were achieved or not. She pointed out that the PIR was able to successfully deliver the expected outputs of the activity and enable the participants to look back and assess their performance in the past years since the implementation of PGN in 2007. What is more important is that the participants were able to identify the next steps to take in order to realize the objectives of the PGN component of AHMP. She expressed optimism that based on the pledge of commitment shared by the participants, the PGN implementation in NCR will be a success and eventually will contribute significantly in improving the lives of families, particularly women and children, through better nutrition. She firmly believes that with the strong network of PGN advocates and implementers, the desired outcomes of AHMP and PGN in particular, will be realized. She acknowledged and thanked the attendance and active participation of the PIR participants and the expertise and assistance provided by the facilitators. She wished everyone a safe trip as they return to their families and loved ones.