In 2019 ENN, continuing its case studies series on Multisectoral programming at the Subnational level, plans to study two more countries -Philippines and Zimbabwe, within the final year of the TAN project. With this in mind, in July, accompanied by the Global Knowledge Management Coordinator, Natalie Sessions, I visited the Philippines’ capital Manila for a scoping visit. In this week we intended to understand the history of nutrition plans and programmes in the country, the burden of malnutrition and district level variance, the structure of implementation hierarchy for nutrition programming and how this fits in with the existing governance structure in the country, the different multisectoral nutrition programmes in place and the factors that have supported nutrition improvement in the country.

Philippines is an archipelago with a population of 108,12 million and owing to its geographical location, faces regular climatic events such as typhoons and hurricanes. It is a middle income country with a per capita income of 2970 USD. Undernutrition is a serious problem with 30.3 % of children U5 being stunted with very slow progress being made within the last 15 years. Wasting has shown a consistent upward trend with a wasting prevalence in children U5 hovering between 6 and 8% in the past 15 years. Recent surveys show very poor dietary diversity scores with less than 20% of children in the 6-23 months age group consuming a minimal acceptable diet and only 1 in 4 infants aged 5 months being exclusively breastfed. The country which is rapidly urbanising like the rest of South and South East Asia is also facing rising rates of overweight and obesity in school children and adults.

This less than encouraging situation is despite a long history of Nutrition Plans and Policies by successive governments in the country from as early as the 1970s. As a result of high level of wasting in the country, the National Nutrition Council set up in 1974 was under the Ministry of Agriculture and was able to implement a country wide programme setting up nutrition centres, rural improvement clubs and recruiting and training Agricultural workers - this programme led to sharp decreases in wasting and once this was taken care of, the programme came to an end in 1986, followed by changing focus of successive governments. The focus shifted from nutrition to hunger mitigation and the NNC was unable to capitalise on the devolution process in the country which allowed the Local Governing Units (LGUs) to prioritise development needs based on their own context. However, with the country not reaching major targets in the two six year (2005-2010 and 2011-2016) Philippine Plans of Action for Nutrition and the food and nutrition security goals of the Millennium Development Goals (MDGs) there was a renewed focus brought to the alarming status of malnutrition in the country which resulted in the formulation of the Philippine Plan of Action for Nutrition (PPAN) 2017-2022 which is an integral part of the Philippine Development Plan 2017-2022.

With this brief account of the 30 year history in relation to nutrition, let me present some stand out points from the visit which left us convinced that this country will offer a different perspective on multisectoral nutrition programmes from the other countries already studied.

• The focus on local level activities-A lot of work has been done in the past 2 years with Regional Plans of Action for Nutrition (RPAN) being developed and further Local Nutrition Action Plans being developed at the level of the Municipalities and the cities, as part of the Philippines Plan of Action for Nutrition (PPAN) 2017- 2022. These local plans form the basis for annual planning and budgeting exercises - officials also mention the computerised monitoring system called the at the level of the Barangays. This tool has also been used to rank and award the LGUs for good performance through the MELLPI (Monitoring of Local Level Plan Implementation) - a very detailed and complex system of awards is in place - we heard disparate voices on this system of recognition- we look forward to understanding it better and seeing for ourselves on the ground during the field work for the case study.

• The key sectors included in the PPAN are Agriculture, Agrarian reform, Health, Education, Social Welfare and Development and Interior & Local Governance. Despite this the work so far still appears very focussed on Nutrition specific actions with coordination and collaboration across sectors yet to actually take off. We however heard of a very interesting project being currently scaled up which is a collaboration between health and education- which includes school gardens; nutritious meal planning and nutrition information sessions. In our experience, in other countries, the Education sector was a tough one to convince of the importance of becoming nutrition sensitive. The main reason emerging was that the age groups were different - a stunting reduction initiative looks at 0-2 years which is far from school/ preschool age. This project after a proof of concept phase is now being rolled out across the 36 provinces prioritised by PPAN - survey results have shown impact with decreasing trend in undernutrition in school age children in the piloted areas. This is a project which we look forward to seeing on ground in the case study areas. In addition to the PPAN 2017-22, the 1000 days programme aimed at stunting reduction, the Early Childhood Care Development programme and the Conditional Cash transfer programme for pregnant and lactating women from indigent families are also at scale.

• Philippines joined the Scaling Up Nutrition (SUN) Movement in 2014 being the 51st country to join the movement. In response to what has been the value add of joining the Movement, we heard some interesting answers - "we have always had a multisectoral approach to nutrition even if we did not know the word for it or use the global jargon; when we realised that we have what the SUN movement expects from its members we decided to be a part of it - it has helped us by ensuring that we stay focussed and more tangibly brought in technical assistance to take our plans forward." Evidence of the Technical Assistance support from Nutrition International is prominent - in addition to the Regional Plans of Action a key product has been a Compendium of Actions on Nutrition which documents the successful experiences of 11 LGUs. We participated for a day in the 3 day Joint Annual Assessment Workshop of the country - and truly were impressed by how seriously the exercise was taken by all participants, with a healthy dose of criticism and disagreement before reaching a consensus. This was surely more than a ‘ticking the box’ exercise.

In my role as the KM specialist, I will be going back in August to conduct the field work for this case study in two locations which have processes in place pointing to successful impacts over time. One of the sites will be urban, keeping in mind the opportunity that a rapidly urbanising country offers with what seems to be a fairly well organised health and other governance systems in place. As we choose the sites, we will be guided by the rich conversations with stakeholders across the board this week and in particular, the priorities of the National Nutrition Council.

A country hitherto known to me only for the Magsaysay Prize - many of its recipients being Indians (one of them my favourite musician), I was glad to meet the people and understand more about this country and look forward to going back again soon for the field work. Watch this space.