How Do Barangay Nutrition

Committees Contribute to Better

Nutrition?
Philippines
 In the Philippines, nutrition-related health issues persist.
According to most recent data, stunting

25%
remains a major challenge in the Philippines.

% children
under 5 38 of women of reproductive age
34 34
32
30
have anemia

That means 6.2 million Filipina

women have a critical
micronutrient deficiency (2011)
1998 2003 2008 2011 2013

Anemia also persists as a major issue for

children in the Philippines.

only
27%
% children 43.3
under 5
36.7 35 34.9
34.7

of infants are exclusively

breastfed for 6 months
(2011)

1993 1998 2003 2008 2011

Source: World Bank Databank: Global Nutrition Report

We know evidence-based, cost-effective interventions
can improve nutrition outcomes.
It is estimated that the following 10 evidence-based, nutrition-specific interventions, if
scaled to 90 percent coverage, could reduce stunting by 20 percent and severe wasting
by 60 percent.

• Management of severe acute • Periconceptual folic acid

malnutrition supplementation or fortification
• Preventive zinc supplementation • Maternal balanced energy protein
• Promotion of breastfeeding supplementation
• Appropriate complementary feeding • Maternal multiple micronutrient
• Management of moderate acute supplementation
malnutrition • Vitamin A supplementation
• Maternal calcium supplementation

Source: Bhutta et al. 2013.

Studies have demonstrated the
effectiveness of community health
workers in achieving demonstrable health
benefits directly related to the Millennium
Development Goals (MDGs), including
reducing child malnutrition and both
child and maternal mortality.
- Perry and Zulliger (2012)
Community health workers play a critical role in
providing these proven, evidence-based, cost-effective
interventions.

By making basic primary care available at the community level,

CHWs make it possible for women and children to receive the
services they need for better health outcomes.

Frequently based in the communities where they are from,

community health workers (CHWs) have direct access to the
community and can link with other nutrition-related community-based
service providers. They can provide clients with a range of services
such as medical care, information, counseling, and referral.

However, CHWs are often expected to carry out a wide range of

interventions with limited time, resources, and remuneration. They
need appropriate academic curricula, training programs, and support
systems – including systems for monitoring, supporting, and
mentoring. Countries like the Philippines must take this into
consideration as they scale up and expand the services provided by
CHWs.
Information on the services that community health
workers provide and the systems that support them in
doing their work is often hard to find.

To begin to fill this void, the two USAID-funded projects -

Advancing Partners and Communities (APC) and Strengthening
Partnerships , Results, and Innovations in Nutrition Globally
(SPRING) - collaborated to conduct a desk review of existing policies
and documents related to community health systems.

Due to the diversity and magnitude of community health programs in

a given country, we collected information based on individual country
policies/strategies that comprise the key areas of a community health
system and not the realities of program implementation. Due to
funding and timing, we focused on national public sector programs,
and only when possible, captured community-based private sector
health programs operating at scale.
These are our findings:
This is what community health
workers can do in the
Philippines, according to
government policy.
See the Data Notes at the end for more on how data were collected and analyzed.
Community health service delivery in the
Philippines is guided by multiple policies.
Relevant Government Policies Last
Reviewed Updated
Health in the Hands of the People 2003

Creation of the National Primary Health Care Not Available

Committee

Policy on Primary Health Care for Community 1996

Health Development

Community Organizing Policy Guidelines Not Available

Regional Guidelines on the Utilization of Not Available

Regional Primary Health Care Funds as
Approved in the GAA

Partnership for Community Health Not Available

Development (PCHD) Field Guide
 The Philippines has four distinct cadres* of
community health workers, three of which provide
nutrition services.
1. Barangay Health Workers (BHW) are frontline health
workers who provide basic health education and selected primary 216,941 in country
health care services (e.g., maternal and child health, first aid, Coverage ratio not available
environmental health) and link clients to health facilities.
2. Barangay Nutrition Scholars (BNS) provide nutrition
education, conduct nutrition-related activities like child growth
monitoring and micronutrient supplementation, link clients to
health facilities, manage feeding programs, and collaborate with
local organizations to promote gardening and livestock-raising. 19,527 in country
1 BNS:1 barangay
3. Community Health Teams (CHT) comprise BHWs, BNSs,
Barangay Supply Point Officer (BSPO), midwives, and other health
workers. Members target poorer families to enroll them in the
national health insurance program, improve their access to health
facilities, and provide them with critical health and social services, 223,399 in country
such as nutrition counseling, antenatal care, and family planning. 1 CHT: 100 targeted households;
Ratio may be adjusted depending on
household density

* In addition to these three cadres, BSPOs provide selected family planning services in
some areas.
Community health workers in the Philippines provide
services in multiple health service delivery areas.
Services Services not
Family planning provided by provided by
CHWs CHWs
Maternal and child health

Integrated community case management

HIV/AIDS

Nutrition
How is training
Malaria managed for CHW cadres?
Tuberculosis We were unable to find any
national training curriculum for
Immunization CHWs.

Water and sanitation

Note: Some ANMs may be able to conduct HIV testing and

counseling, but it is not a core job function of the CHW cadres.
Community health workers
in the Philippines support
improved nutrition outcomes
throughout the continuum of
care.
How we present our findings on nutrition services
provided by community health workers.
Services, listed in tables, are categorized as nutrition assessment,
counseling, or support actions.

Assessment The tables presented for each stage of life across

the continuum of care include specific nutrition-
Activity / action to be taken Cadres of CHWs related services queried as part of the Community
who conduct this
task Health Systems Catalog Assessment.

For each stage of life, we indicate if the service is

provided by community health workers and which
cadres have the responsibility to provide that
Counseling service.

Community health workers who provide services

are identified by cadre:
Support BHW-Barangay Health Workers
BNS-Barangay Nutrition Scholars
CHT-Community Health Teams
Services provided Service not provided by
by CHWs CHWs or not clearly
specified in policy
For adolescents
Counseling
Provide information/education/counseling (IEC) on
iron/folate for women who are not pregnant and BHW
adolescent girls

Support
Provide/administer iron/folate for women who are not
--
pregnant and adolescent girls
For pregnant women
Assessment
Monitor weight gain during pregnancy --

Measure mid-upper arm circumference (MUAC)

--
screening for pregnant women
Give information on hemoglobin testing for women
--
who are pregnant
Test blood for hemoglobin levels --

Counseling
Provide IEC on nutrition/dietary practices during
BHW / BNS
pregnancy
Provide IEC on iron/folate BHW / BNS /
CHT
Provide IEC on insecticide-treated net use --

Support
Provide/administer insecticide-treated nets BHW*

Provide/administer iron/folate --

*In areas where malaria is endemic, BHWs may be

trained to administer ITNs, though it is not a primary duty
or included in the 2015 BHW Reference Manual.
For breastfeeding women
Assessment
Monitor nutritional status of women who are
--
breastfeeding (e.g., using MUAC)

Counseling
Provide IEC on correct positioning and attachment of
BHW
the newborn during breastfeeding
Provide IEC on managing breastfeeding problems
(breast health, perceptions of insufficient breast milk, CHT
etc.)
Provide IEC on nutrition/dietary practices during
BHW / BNS
lactation
For newborns
Assessment

Weigh newborns BHW / BNS

Counseling
Provide IEC on skin-to-skin contact between baby and
BHW / CHT
mother/caregiver
Provide IEC on breastfeeding within
BHW / CHT
1 hour of birth
For children
Assessment Counseling
Scales to measure weight of children up to 2 BHW / Provide IEC on Vitamin A for children 6– BHW / BNS
years of age BNS 59 months of age

Use length boards to measure length of BHW / Provide IEC on general micronutrient BHW / BNS /
children up to 2 years of age BNS supplementation CHT

Measure MUAC of children -- Provide IEC on de-worming medication BHW / BNS /

CHT
Screen children for bilateral edema --
Provide IEC on complementary feeding BHW / BNS /
practices and continued breastfeeding (6– CHT
23 months of age)

Support Provide IEC on exclusive breastfeeding BHW / BNS /

(first 6 months of age) CHT
Provide/administer Vitamin A BHW /
supplementation for children 6–59 months of BNS / Provide IEC on introduction of soft, semi- BHW / BNS /
age CHT solid foods at 6 months of age CHT

Provide/administer micronutrient BHW / Provide IEC on continuing breastfeeding BHW / CHT

supplementation BNS for children less than 6 months of age who
have diarrhea
Provide/administer deworming medication BHW /
BNS Provide IEC on increasing fluids and --
continuing solid feeding for children over 6
Treating moderate acute malnutrition for -- months of age with diarrhea
children under 2 years of age
Treat severe acute malnutrition with ready-to- --
use therapeutic foods (RUTF) or ready-to-use
supplementary foods (RUSF)
For all stages of life
Counseling
Provide IEC on handwashing with soap BHW

Provide IEC on community-level total sanitation BHW / BNS

Provide IEC on household point-of-use water treatment BHW / BNS

Our key takeaways
In the Philippines, three cadres of community health
workers provide 25 of the recommended 38 nutrition
services discussed in this assessment.
Adolescents Services provided
by CHWs
Pregnant women
Service not
Breastfeeding women provided by
CHWs or not
clearly specified
Newborns in policy

Children

All stages of life

How to use this information

You can use the data we have presented here to:

Identify which nutrition-related services CHWs can

provide, according to policies;
Prioritize and/or reassign responsibilities to avoid
overburdening CHWs;
Build a stronger foundation of policies, tools, and
systems for CHWs to conduct their work;
Plan additional support to CHWs;
Design and conduct other in-depth assessments of
community nutrition programs;
Inform program implementers to strengthen community
health interventions.