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close this bookEffective Communications for Nutrition in Primary Health Care (UNU, 1988, 208 pages)
close this folder11. An evaluation of the effect of a communication system on the knowledge of mothers and nutritional status of preschool children in rural Philippines
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View the documentAPPENDIX 7. Philippine Nutrition Program Implementing Guidelines on the Barangay Nutrition Scholars Project

APPENDIX 7. Philippine Nutrition Program Implementing Guidelines on the Barangay Nutrition Scholars Project

Introduction

The extent of the malnutrition problem in the country is such that greater involvement and participation of people at the grass-roots level are urgently needed. While the health and nutrition programme is comprehensive in that it is organized at the national, regional, provincial and municipal levels, its implementation at the barangay level is far from being effective because of the lack of manpower to deliver the health and nutrition services. The manpower resources are not enough to cope with the increasing number of people who have to be reached by health and nutrition intervention schemes in the more than 40,000 barangays of the country. Hence, the Barangay Nutrition Scholars Project was conceptualized.

The Barangay Nutrition Scholars Project is a strategy for providing each barangay with a trained community worker to deliver basic nutrition and related health services. This strategy calls for active community participation in designing and implementing an action plan for the barangay through the Barangay Nutrition Scholar (BNS).

Objectives

General
To develop a system or facility for the delivery of basic nutrition and related health services in the barangay through the use of the BNS as a support to the Philippine Nutrition Program.

Specific

  • To establish an administrative and supervisory machinery built into the existing structure of the

PNP for the delivery of basic nutrition and related health services in the barangay.

  • To develop trainers and supervisors for the BNS.
  • To develop competencies of the BNS in the following areas: (a) planning and organizing; (b) identifying and locating targets; (c) providing basic services; and (d) reporting and monitoring.

Organizational Linkages of the BNS Project

Figure A shows the co-ordinative relationship of those involved and the flow of administrative and technical supervision of the overall provincial/municipal/city nutrition programme in general and the BNS project in particular.

Added to the PNP structure at the local level is the district nutrition programme co-ordinator (DNPC)/city nutrition programme co-ordinator (CNPC), who will be hired by the governor/city mayor to assist the PAO/CAO in the overall co-ordination of the provincial/city nutrition programme, as well as being fully responsible for the BNS in his areas of assignment.

A DNPC/CNPC will have under his supervision 30 to 50 BNS. The DNPC/CNPC ratio will depend on the BNS location distribution, the geographical terrain of the province, and funds made available by the provincial/city government.

Mechanics for Project Implementation

Social Preparation

For effective project implementation, an orientation of local administrators will be undertaken. The orientation shall include rationale of the BNS Project and its potential contribution to the attainment of the objectives of the PNP, objectives and the mechanics of the project, monitoring system and the flow of supervision, the responsibility of all those involved and the cost of the project.



Fig. A.

Recruitment of DNPC/CNPC

The governor/city mayor shall appoint the DNPC/CNPC upon the recommendation of the PAO/CAO and RTA.

Qualifications of DNPC/CNPC

  1. Preferably a nutritionist/home economist, nurse, social worker, community development worker with at least one year's experience in community work.
  2. Must have the ability to communicate effectively, preferably in the dialect.
  3. Must be willing to travel to follow up, supervise, and evaluate the BNS activities.
  4. Must be a bona fide resident of the province.
  5. Preferably between 23 and 45 years old.
  6. Must have a pleasing personality.

Recruitment of BNS

Organization of Screening Committee
The screening committee shall be organized by the CAO/MAO at both barangay and municipal/ city levels. The MAO/CAO shall inform the barangay captain and head teacher, who will become members of the barangay screening committee. The barangay screening committee shall be composed of the barangay captain as chairman, the head teacher or teacher co-ordinator, and the president of any of the community organizations such as the PTA, RIC, or Anak-Bukid (4-H Club) as members. The barangay captain submits to the MAO/CAO the list of qualified applicants endorsed by a majority of the screening committee. The municipal/city screening committee composed of the MAO/CAO and two other members of the MNC/CNC shall convene to choose the best qualified from among the applicants, using a prescribed NNC Form. The MAO/CAO endorses the final recommendees to the mayor for approval.

Qualifications of BNS
The screening and recruitment of the BNS shall be guided by the following qualifications:

  1. Bona fide resident of the barangay for at least four years and can speak the dialect.
  2. Must possess leadership potential as evidenced by past experiences such as membership/ leadership in community organizations.
  3. Must be willing to undergo one month's training.
  4. Willing to serve the barangay, part-time or full-time for at least one year.
  5. At least primary-school graduate but preferably has reached high-school level.
  6. Physically and mentally fit.
  7. At least 18 years old but not more than 60.

Training of the BNS

  1. The objectives in training the BNS shall be:
  • In general, to train and develop the BNS to support the barangay nutrition programme in the delivery of basic nutrition and related health services to target families.
  • Specifically, to enable the BNS at the end of training to:
  • initiate/assist in the organization/revitalization of the barangay nutrition committee (BNC).
  • provide basic information on the seven-point programme.
  • develop skills and desirable attitudes necessary for the delivery of basic nutrition and health.
  • record/monitor basic services rendered to families in the barangay.
  1. The selection of the training site shall be the responsibility of the DNPC/CNPC upon the approval of the PAO/CAO. The training site should be a municipality which is centrally located and accessible to the majority of the BNS.
  2. Fifteen to twenty BNS shall be trained per training session using a perscribed BNS course syllabus.
  3. The training of the BNS shall the conducted for 30 days giving emphasis on experiential learning. The first 10 days shall be devoted to lectures, discussions, and workshops.
  4. The stipend for the IO days' training will be provided by NNC. However, more than two absences during the first 10 days of training automatically disqualifies the BNS from continuing training, but she will be given the stipend for the days she has attended.
  5. After the 10 days' training, the BNS, under the supervision of the DNPC/CNPC, goes back to her barangay for a 20-day practicum.

Delivery of Services by the BNS

After successful completion of the practicum, the BNS shall work in their respective barangays for a period of at least one year. A memorandum of agreement shall be signed by the scholar and the mayor, stipulating among other things that the BNS shall serve for at least one year with corresponding benefits and incentives.

Basic Tasks of the BNS

1. Organization. community suney/resurvey, and planning

  • Assist the barangay captain/organizelreactivate the barangay nutrition committee and the barangay network.
  • Assist the BNC in training purok and unit leaders to assist the BNS.
  • Prepare a one-year work plan (based on the seven-point BNS programme and the community survey), within the framework of the Barangay Nutrition Action Plan.

2. Identifying and locating targets

  • Weigh all 0- to 83-month-old children at least once a year.
  • Carry out follow-up reweighing of identified third-degree cases and of 0- to 18-month pre-schoolers monthly.

3. Providing basic services

  1. Nutrition and related health
  • Provide basic nutrition and health information to mothers of underweight children.
  • Refer sick and underweight children to health centres, clinics or hospitals.
  • Refer eligible targets to feeding programmes giving priority to third-degree.
  • Distribute and/or sell food commodities to targets.
  • Distribute available vitamin/mineral preparation.
  • Conduct or assist in conducting systematic nutrition and health education classes to mothers, especially the pregnant and nursing.
  1. Environmental sanitation
  • Promote the construction and proper and continued use of sanitary toilets, giving priority to households with pre-school children.
  • Campaign for the eradication of breeding places for insects and rodents that are carriers of diseases.
  • Refer household water sources of doubtful quality to the RHU.
  1. Food production
  • Distribute available seeds and seedlings, particularly to target families.
  • Advise families of possible resources for food production.
  • Recommend which food crops to produce for home consumption.

APPENDIX 8. Criteria for Selection of Sample Villages, 1979 and 1981

 

Socio-economic status C and D (lower SES as classified in most recent census)
Population size 600-1,200
Primary source of livelihood Rice farming and fishing
Distance from Poblacion (municipal capital) 6 km or more
Distance from other sample villages Separated by at least one village
Recent feeding programmes None within three months of survey
OPT results (community weighing) Average for Leyte or worse prevalence of malnutrition
Recent nutrition education programmes from other agenices None
Health facilities No facilities in the village or of easy access
Health facilities No unusual programmes during previous two years.

APPENDIX 9. Classification of Urban and Rural (Philippine Population Census)

Urban

  1. In their entirety, all cities and municipalities having a population density of at least 1,000 persons per square kilometre.
  2. Poblaciones or central districts of municipalities and cities which have a population density of at least 500 persons per square kilometre.
  3. Poblaciones or central districts (not included in I and 2), regardless of the population size, which have the following:
  1. Street pattern, i.e. network of streets, in either parallel or right-angle orientation;
  2. At least six establishments (commercial, manufacturing, recreational, and/or personal services); and
  3. At least three of the following:
  • a town hall, church, or chapel with religious services at least once a month;
  • a public plaza, park, or cemetery;
  • a market-place where building or trading activities are carried on at least once a week;
  • a public building like a school, hospital, child-care or health centre, or library.
  1. Barrios having at least 1,000 inhabitants which meet the conditions set forth in 3 above, and where the occupation of the inhabitants is predominantly non-farming/fishing.

Rural

All areas not covered in the definition of urban are considered rural.

 

APPENDIX 10. Data Collection Team and Equipment

Team

Checker

  • enrols mothers and children;
  • makes sure all forms are complete;
  • helps manage crowd.

Measurer

  • weighs children and "surrogate mothers";
  • records weights and position of sliders on weight balances;
  • measures and records length or height of child.

Assistant measurer

  • helps control and calm children;
  • helps hold knees straight for length or height measurement.

Interviewer

  • asks mothers questions exactly as written on questionnaire;
  • encourages mothers to give complete and accurate answers.

Equipment

Weighing scales

  • Healthometer clinical scales.

Height board

  • locally made;
  • same for height and length.

 

APPENDIX 11. Mean Indicator Response to Supplementary Feeding for the Prevention of Protein-Energy Malnutrition (PEM)

Type of
analysis
Indicator Age
(months)
Duration
of suppl.
(months)
Percentage
suppl.
diet
Initial
deficit relative
to standard
Response
to suppl.
Pooled Responsiveness
SD=1/2 (resp/SD)2
Suppl. v.control Attained:
Weight 36 36 17% cal. 36% Pro. 4.5 kg (Denver) 0.9 kg 1.3 kg 0.24
Height " " "   2.3 cm 3.9 cm 0.17
Arm circum. " "     0.35 cm 0.9 cm 0.08
Triceps
skinfold
" " " " 0.15 cm 1.1 mm 0.01
Subscapular
skinfold
" " " " 0 1.1 mm 0

Source: R. Martorell,. R.E. Klein, and H. Delgado "lmproved Nutrition and Its Effects on Anthropometric Indicators of Nutritional Status. Nutrition Reports International, 21(2): 219-230 (1980).



APPENDIX 12. Nutri-Bus Evaluation Coverage by Condition, August 1978 to March 1981

 

APPENDIX 13. Nutri-Bus Programme Cost Estimates Worksheet

Values used in formulae:
1. Annual cost per bus P140,171a
2. BNS areas per bus 90
3. Population per BNS area 1,000
4. Estimated target group of 14% of
children (12-66 months) populationb
5. Target group (12-66 months) per BNS area 140 pre-schoolers
(14% x 1000= 140)
6. Target-group mothers per BNS area 100 mothersc
7. Target-group mothers ever attending VTR per BNS area 66 mothersc
8. Percentage combined second- and third-degree undernutrition
  • 1979 Rural Leyte
  • 1981 Rural Leyte

Decrease 1979-1981

42.2C
35 2c
7.0%
9. Proportion of second- and third-degree undernourished per BNS area
  • 1979:0.422 x 140
  • 1981:0.352 x 140

Decrease 1979-1981: 0.07x 140

59.08 children
49.28 children
9.80 children
10. Percentage target mothers reporting improved diet for child
  • 1979 Rural Leyte comparison
  • 1981 Rural Leyte

Increase 1979-1981

32,0c
58.8c
26.8%
11. Proportion of target mothers reporting improved diet for child per BNS area
  • 1979: .32 x 100
  • 1981: .588 x 100

Increase 1979-1981: .268 x 100

32.0 mothers
58.8 mothers
26.8 mothers
12. Number of BNS nationwide, 1981 10,000
13. Total Philippine national budget, 1981 P54.8 billion

 

Cost estimates

1. Annual cost per bus per BNS area

Annual cost per bus / No. of BNS areas per bus = P140,171/90 = P1,557 (= US$188.00)

2. Annual cost per target-group child in catchment area

Annual cost per BNS area/No. of target-group childran in BNS area = P1,557/140 = P11.12 (= US$1.34)

3. Annual cost per target-group mother in catchment area

Annual cost per bus per BNS area / No. of target-group mothers in BNS area = P1,557/100 = P15.57 (= US $1.88)

4. Annual cost per target-group child whose mother attended VTR

Annual cost per bus per BNS area/No. of children whose mothers attended VTR per BNS area = P1,557/66 (140/10)
= P16.85

(= US$2.03)

5. Annual cost per target-group mother ever attending VTR

Annual cost per bus per BNS area / No. of target-group mothers attending VTR per BNS area = P1,557 / 66 = P23.59
(= US$2.84)

6. Cost per target-group child whose mother's report of foods given to child changed from in adequate to complete

2 x annual cost per bus per BNS area / No. of target children whose mothers report reflected diet change(d)
= 2(PI,557) / .268(140) = P3,114 / 37.52 = P83 over 2 years (or P41.50 per year) (= US$10 over 2 years or US$5 per year)

7. Cost per target mother where report of foods given to child is changed from inadequate to complete

2 x annual cost per bus per BNS area / No. of target mothers where report reflects change(d) = 2(PI,557) / .268(100)
= P3,114 / 26.8 = P116 over 2 years (or P58 per year) (= US$14 over 2 years or US$7 per year)

  1. Total operating expenses including management and field personnel. training and communication materials development. Equipment and vehicle depreciated over 5 years Actual average figure for 1981.
  2. Estimate taken from 1980 National Census and Statistics Organization.
  3. Estimated from Leyte data, 1981.
  4. Over a two-year period.



Appendix 14. Area coverage, nutri - bus project

 

APPENDIX 15. List of Services Provided by Nutri-Bus

Services Target group reached
  BNS Mothers Pre-school
children
School-
children
Teachers CNC
PNC, MNC
Communication
Barangay VTR showing x x x x    
School VTR showing x     x x  
Community video x x        
Radio plugs x x x x x  
Distribution of IEC materials x x x      
Nutrition counselling   x x      
Health protection
Ped-O-Jet immunization     x x    
Dietary counselling   x x      
Referral to hospital malward/nutri-hut   x x      
Food assistance
Nutri-Pak     x x    
Referral to feeding centre     x      
Food production
Seeds and seedlings   x        
Management support
Systematic super vision of BNS x         x
Quarterly BNS reinforcement training x         x
Monthly individual training of BNS (during long call) x         x
Monitoring and referral of field problems x x       x
Impact evaluations x x x     x