Saturday, September 29, 2007

Nutrition in the Philippines: The Past for Its Template, Red for Its Color (A Kasarinlan Review)

Cecilia Florencio. Nutrition in the Philippines: The Past for Its Template, Red for Its Color. Quezon City: University of the Philippines Press, 2004. 179 pp.

First published in Kasarinlan: Philippine Journal of Third World Studies 19, 1 (2004): 233-238.

Nutrition in the Philippines: The Past for Its Template, Red for Its Color is the latest contribution to the voluminous literature written on the nutritional status of the Filipino. The book is the output of a pioneering initiative commissioned by the National Nutrition Council (NNC) to critically examine the scientific bases of the Medium-Term Philippine Plan of Action for Nutrition (MTPPAN), which is the sixth medium-term plan on nutrition since the proclamation of the Nutrition Act of the Philippines in 1974 and the first to be subjected to a critical and external review. The review process aims to examine the accuracy and consistency of national data in terms of providing the appropriate policy directions and interventions set in the MTPPAN, the budgetary allocations vis-à-vis the actual expenditure for every program, and, the institutional capacity of the NNC as the lead agency in implementing, monitoring and evaluating the program components.

The book is divided into five chapters. After setting forth the objective of the study, which is to provide a comprehensive scientifically-based assessment of the MTPPAN, the author lays down the questions that probe into the inherent characteristics of the plan. The Philippine Plan of Action for 1993-1998, the predecessor of the MTPPAN, is used as the springboard for evaluation and is discussed thoroughly in the second chapter followed by an in-depth scrutiny of the main elements of the MTPPAN focusing on its framework and guiding principles. More than merely describing the program components of the plan document, the meticulous review of the impact of the programs and the various mechanisms to carry out strategies is anchored on a sociocultural context and past endeavors to give the proper perspective upon which appropriate intervention to eventually eradicate malnutrition can be drawn. Definition of terms such as undernutrition, micronutrient deficiency, and overnutrition that would otherwise fall under the general term “malnutrition” is presented to establish the relevance of the strategies identified as a response to the poor state of nutrition in the country.

As the title suggests, previous undertakings seeking possible solutions to the malnutrition challenge in the country, whether in paper or through experience, provide the corresponding milieu that enables the crafting of a nutrition plan addressing the perennial malnutrition problem in the country. This adheres to the conviction that as much as the past can impart lessons for sound policymaking, importance given by both government and the public to the implementation of policies, plans and programs are requisites to achieve successful intervention.

The author posits that the nutrition problem in the country has not been arrested despite the rosy picture that national statistics paint. Instead, malnutrition evolved into a multitiered challenge “where the layers, although of different thickness and onset, are not unrelated to one another” (129). The author characterizes the nutrition status in the country as having “a thick, expanding layer of undernutrition in both children and adults” at its base and “over it also a thick, expanding layer of micronutrient deficiency” across all age groups in the population. A third layer of overweight and obesity that is beginning to form in certain segments of the population has also set in that exacerbate the incessant problem of malnutrition. These problems are traced to the “inequities and inadequacies in food, health, and care” (129). The author’s assessment of the gravity of the problem across ages also puts emphasis on the geographic dispersion of the problem. According to the author, the spatial distribution of the nutrition problem would have provided a clearer picture of its spread across the different provinces in the country. Furthermore, this enables strategic planning on the part of the NNC to equitably allocate resources to areas where appropriate programs should have to be implemented in accordance with provincial nutritional requirements. Using a localized analysis of the extent of the problem would give substance to the MTPPAN’s rhetoric of being a “needs-driven” plan.

While national statistics provide a picture of the current state of nutrition in the country its relevance in plan formulation relies on how planners interpret them and how these are enunciated in nutrition policies and agenda. The author cautions that misinterpretation of figures endangers simplifying the nutritional problem of the Filipinos, thus coming up with oversimplified and incongruous strategies. This is especially true when official statistics culled from national surveys do not match prevailing conditions or when figures are taken at face value. National data were used as success indicators in evaluating the PPAN 1993 to 1998 but does not truly represent the variation in terms of target beneficiaries reached across programs and among target groups. The author supports this assertion by illustrating the fluctuating performance indicators of each program from 1993 to 1998. Contrary to NNC’s claim that the targets for the PPAN have been met, the author pointed out the inconsistency of applying the same targets for the MTPPAN.

Aside from looking into the PPAN 1993-1998 to gauge the bases of the MTPPAN 1999-2004, supplementary national level plans, statutes and international commitments are also examined to establish the coherence of the MTPPAN. The Medium-Term Philippine Development Plan (MTPDP) 2001-2004 provided the overall development agenda of the country. Health and nutrition-related planning documents such as the Directional Plan for Vitamin A Deficiency and Control Program 1989-1993, Directional Plan for the Philippine Population Management Program 2001-2004, National Objectives for Health 1999-2004, and the National Diabetes Prevention Control Plan presented the strategies for specific dietetic concerns, which the MTPPAN is supposed to capture as the most comprehensive nutrition framework of the country. Attention is also afforded to the Agriculture and Fisheries Modernization Act (AFMA) as well as the Philippine commitments to General Agreement on Tariffs and Trade (GATT) to ascertain its implication on the direction of food security in the country.

The measure of success of a national plan can be approximated by the level of implementation that takes place at the local level. Drawing lessons from the village level performance and the difficulty in aligning national level plans with local plans is manifested in the dismal performance of formulating local nutritional plans. The author attributes this to the dependence of local implementers on their national counterparts in terms of formulating a local plan that reflects the needs of their constituents. The lack of meaningful exchange between the two aggravates the poor institutional mechanism of the nutrition program. The apparent absence of local government units (LGUs) as participants in the national plan formulation does not correspond with the role expected of LGUs as local implementers of national programs and policies. The lack of inputs from LGUs may be ascribed to the poor appreciation of local executives of the importance of nutrition in local development as seen in several comprehensive development plans (CDP) even of first class municipalities where nutrition plans are mere enumeration of projects formulated by national government agencies such as providing vaccination and vitamins and minerals supplementation program. This compounds underlying factors that the author identified such as the mismatch between projection of budgetary requirements and the target number of beneficiaries, “underreported” actual expenditures and “overreported” service delivery. These are but reflections of the lack of clear policies and guidelines, fragmentary implementation, and poor monitoring and evaluation, as the author pointed out.

Aside from the lack of coordination between national and local level implementers, national level “nutrition manpower” is also beset with inadequate capacity for data analysis and interpretation, which is an important aspect in the planning process. Distorted data analysis and interpretation have consequences in the identification of targets and objectives. Budgetary requirement, albeit passing through political intramural in Congress during budget deliberations, may not be presented accurately and this has ramifications on the implementation of programs and projects. In response to the challenge faced by the “nutrition manpower,” the author proposes that importance should be given to people involved in the planning, policy-making and implementation of the nutrition program. In the same way that attention and budgetary allocations are afforded to programs to curb malnutrition in the country, importance should also be given to human resources development “to strengthen the nutrition manpower” (88).

The state-centered and militaristic concept of security has broadened to include social, economic and cultural facets of the individual. Constructs such as food security is yet to be introduced in the nebulous discourse of human security wherein food becomes the focal point of national development. Moreover, international treatises such as the International Covenant on Social, Economic and Cultural Rights and the Convention on the Rights of the Child explicitly articulates the individual’s right to food for one to achieve “the highest attainable standard of living” (Briones, Cajiuat and Ramos 1997). In particular, food security does not only mean advancing self-sufficiency in food production but more importantly providing an environment where nutritionally adequate food is physically and economically accessible to the population (Briones, Cajiuat and Ramos 1997). As a party to these agreements, the Philippine government has committed itself to providing for the basic needs of its citizens to eradicate poverty by obviating hunger and significantly reducing the prevalence of malnutrition. The State’s recognition of nutrition as fundamental in social reform and economic development has afforded it a status of being a national priority.

Commendation is due to the author’s effort to tie up the MTPPAN with the various plan documents which affirms its comprehensiveness as the general framework to combat the nutrition problem in the country. The attempt to consult other supplementary national level plans underscores the need for horizontal alignment of various plans related to the nutrition status of Filipinos with the MTPPAN as the principal document.

The book has the benefit of having a very objective and straightforward assessment given the author’s experience as a former member of the National Nutrition Council (NNC), the highest policy-making body on nutrition in the country. The author has the advantage of having the knowledge of the inner workings of the executive body, as well as the nuances of implementing its policies. Her position as a respected scientist in the field of nutrition gives her due authority to provide an incisive and comprehensive analysis of the Philippine nutrition program and its corresponding policies. Her advocacy of the scientific and practical field of nutrition, which center on food as a basic human right has also given the study a more holistic appreciation of one aspect of human security hinged on the nutritional well-being of the individual. More importantly, as the author emphasized plans such as the MTPPAN should be reflective of the social and cultural context. Thus, the book is a valuable input in charting the future of nutrition policy in the country. Policymakers, researchers and students of nutrition can very well gain insights from the book as to the importance of recognizing that nutritional well-being of a people is anchored on the individual’s basic right to food and is crucial in bringing about social reform and economic development.

More than gaining public acceptance and recognition, the book’s influence would be measured in terms of a change in the perspective of national and local governments in viewing nutrition as a concern second only to economic development. The yearnings of a nation, or at least of its leaders, are articulated in national plans such as the MTPPAN. Turning this yearning into a reality necessitates the involvement not only of government but of also individuals seeking to instigate changes in the overall condition of a nation.

Lastly, the author’s assertion that the basic framework in formulating our national level plans should be the right of the every individual to food. The contribution of the book as a practical guide to policy makers can be summed up in the words of the author that “…the nutritional well-being of a people is inextricably linked with the country’s overall socioeconomic development and progress toward a more equitable distribution of its resources” (129).
Zuraida Mae D. Cabilo, University Research Associate, Third World Studies Center.


Briones, Angelina, Jocelyn Cajiuat and Charmaine Ramos. 1997. Food security perspectives: Focus on Asia and the Philippines. Paper presented at the United Nations and the Global Environment in the 21st Century: From Common Challenges to Shared Responsibilities, 14-15 November 1997, United Nations, New York City.,%20A%20PAPER.pdf

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