|Effective Communications for Nutrition in Primary Health Care (UNU, 1988, 208 pages)|
|11. An evaluation of the effect of a communication system on the knowledge of mothers and nutritional status of preschool children in rural Philippines|
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).
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.
PNP for the delivery of basic nutrition and related health services in the barangay.
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
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.
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
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:
Training of the BNS
- 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.
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
- 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.
- 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.
- 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)|
|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)
- 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.
All areas not covered in the definition of urban are considered rural.
APPENDIX 10. Data Collection Team and Equipment
APPENDIX 11. Mean Indicator Response to Supplementary Feeding for the Prevention of Protein-Energy Malnutrition (PEM)
|Type of |
|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|
|"||"||"||"||0.15 cm||1.1 mm||0.01|
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 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|
Percentage combined second- and third-degree undernutrition |
|9. Proportion of second- and third-degree
undernourished per BNS area |
Decrease 1979-1981: 0.07x 140
|59.08 children |
|10. Percentage target mothers reporting
improved diet for child |
|11. Proportion of target mothers reporting
improved diet for child per BNS area |
Increase 1979-1981: .268 x 100
|32.0 mothers |
|12. Number of BNS nationwide, 1981||10,000|
|13. Total Philippine national budget, 1981||P54.8 billion|
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)
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
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)
APPENDIX 15. List of Services Provided by Nutri-Bus
|Services||Target group reached|
|Barangay VTR showing||x||x||x||x|
|School VTR showing||x||x||x|
|Distribution of IEC materials||x||x||x|
|Referral to hospital malward/nutri-hut||x||x|
|Referral to feeding centre||x|
|Seeds and seedlings||x|
|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|