A 2004 WHO assessment on infant and young child feeding (IYCF) in the Philippines found the country was performing poorly on IYCF health indicators, and thus spurred the development of a IYCF National Plan of Action in 2005 and subsequent IYCF Program. The six objectives and five key strategies of the IYCF Plan had corresponding action points, a responsible agency/group, and an allocated budget. Despite the multi-sectorial representation and multi-layer action, it was not funded adequately and lacked monitoring and evaluation systems, data collection and management, and strong coordination within and outside government agencies. The lesson that can be learned from the Philippine’s first attempt at providing a national budget for breastfeeding activities is the importance of coordination, enforcement and evaluation, and proper financing.
Description & Context
A 2004 WHO assessment on infant and young child feeding (IYCF) in the Philippines found the country was performing poorly on IYCF health indicators, and this spurred the development of an IYCF National Plan of Action in 2005 and subsequent IYCF Program (1). The IYCF Plan contained six objectives and five key strategies to achieve them (1). Each of these strategies had corresponding action points, the responsible agency/group, and an allocated budget (1).
While excellent as a stand-alone program, the IYCF Program has been seemingly absorbed by the Department of Health’s National Nutrition Council, whose Philippine Plan of Action for Nutrition 2017-2022 includes the intermediate outcome target of increasing exclusive breastfeeding rates (2). The country has experienced problems with providing a budget line specifically for breastfeeding– the 2015 WBTi report cites that while the National IYCF Plan of Action existed, it was not funded adequately (3). Another indicator of the obstacles the Philippines faced in implementing its IYCF Plan was the involvement of different actors whose programs overlapped, but were not coordinated with, the IYCF Plan of Action.
Annex 1 from the IYCF Strategic Plan of Action for 2011-2016 contains the budget with specific monetary amounts appropriated to the different action points for the five strategies every year, as well as the unit/agency responsible for the action(1):
- Strategy 1 – Partnerships with NGOs and GOs in the coordination and implementation of the IYCF program.
- Strategy 2 – Integration of key IYCF action points in Maternal, Newborn, and Child Health Nutrition (MNCHN) Plan of Action.
- Strategy 3 – Harnessing the executive arm of the government to implement and enforce IYCF related legislations and regulations.
- Strategy 4 – Intensified focused activities to create an environment supportive to IYCF practices.
- Strategy 5 – Engaging the Private Sector and Intermediate Organizations to raise funds for the scaling up and support of the IYCF program.
Please refer to reference 1 for further detail and budgetary information.
Evidence of Implementation Strategy
The 2011-2016 IYCF Strategic Plan of Action claimed that previous objectives of increasing the IYCF budget were
obtained, increasing the budget from 1 million Philippine pesos to 20 million, a nearly 2,000% increase (1). It also cites additional funds secured from the United Nation’s Joint Programme in the Philippines to achieve Millennium
Development Goals and improve the IYCF status of children 0-24 months (1). Despite the reported increases and locations in the budget, the 2015 WBTi cites that while the National IYCF Policy and action plan existed, it was not funded adequately and points to budget constraints (3).
The Philippines has slightly improved its IYCF outcomes without adequate funding, however, the USD $3.5 million UN Joint Programme on “Ensuring Food Security and Nutrition for Children 0-24 Months in the Philippines” may have also contributed (5). The Joint Programme reports increasing the proportion of mothers who exclusively breastfeed by 8% and increasing the percent that initiated breastfeeding within one hour of birth by 12% in the program areas (4). The Joint Programme recognized the need to use existing structures, recommending that in the future, UN agency staff be integrated into government agencies such as the Philippines National Nutrition Council (NNC) to work more efficiently and effectively (4).
Cost and Cost-Effectiveness
The total budget of the Philippine Strategic Plan of Action for IYCF 317.8 million Php (1). Due to a lack of monitoring and evaluation, it is unclear what parts of the Plan of Action were financed in reality. The WBTi report claims it was not adequately funded (3). This lack of finance and evaluation speaks to the critical issue of ensuring funding and a monitoring system before implementation to ensure an efficient, active, cost-effective program that will affect breastfeeding rates.
The UN Joint Programme on “Ensuring Food Security and Nutrition for Children 0-24 Months in the Philippines” report showing an increase in breastfeeding rates demonstrates the positive effect of a well-planned, adequately financed program (4).
The Philippines Plan of Action for Nutrition 2017-2022 that absorbed IYCF goals states it has a budget estimate for the whole 6 years, as well as a monitoring and evaluation framework (2). The Department of Health in the Philippines funds the National Nutrition Council that is responsible for this Plan of Action (2). The Department of Health gave the National Nutrition Council a budget of 0.63 billion Php in 2017 (6).
Perceptions and Experiences of Interested People
The IYCF Strategic Plan of Action for 2011-2016 itself cites major constraints and challenges such as the intra-sectorial and inter-sectorial coordination and management structure, and the need for advocacy, funding, and scaling-up (1) and the WBTi report highlights the positive aspects of the plan (multi-sectorial representation and multi-layer action) but is very clear about the need for proper monitoring and evaluation, adequate funding a better coordination(3).
Benefits and Potential Damages and Risks
- There is a risk that while there may be budget lines for breastfeeding protection, promotion, and support activities, these will not be adequately funded and fall behind on achieving their objectives.
- Developing a plan with ambitious outcomes and budgetary expenses can lead to a disappointment in outcomes and further lack of funding; countries must set realistic, obtainable goals with appropriate budgets.
Scaling Up Considerations
- Developing a sustainable, renewable, long-term funding system is essential to scaling up breastfeeding.
- IYCF/breastfeeding strategic plans need realistic, obtainable goals with appropriate budgets.
- Coordination with other government organizations and non-governmental organizations is a key factor described by Philippine IYCF Strategic Plan of Action (1). The plan stipulated the membership of the national Technical Working Group (TWG)- groups such as the National Center for Disease Prevention and Control, the Council for
Health and Development, National Nutrition Council, International Labor Organization, and UNICEF (1). To increase coordination further, the TWG was tasked with organizing IYCF committees comprised of various non-governmental and governmental stakeholders (1). Finally, more systematic and programmed contracting outside of the Department of Health, with the relevant organizations and consultants, was another step towards coordination and implementation (1). Effective coordination is key to reduce overlap or conflicting programs.
Barriers to Implement
- The largest barrier is obtaining adequate and sustained funding for the budget proposed. Governments that do not allocate sufficient funding to breastfeeding are a barrier, as well as the lack of any non-governmental organization that would fund such projects.
- Coordination must be clearly stipulated in the plan of action, as well as funding sources.
- The participation of many different actors, including international actors, in program delivery can be a hindrance instead of a benefit; for instance, the United Nation’s Joint Programme on “Ensuring Food Security and Nutrition for Children 0-24 Months in the Philippines” ran from 2009-2013 and included its own budget, goals on breastfeeding, and actions to achieve them. This can lead to uncoordinated, inefficient efforts.
1. Republic of Philippines, Department of Health. (2011). Philippine IYCF Strategic Plan of Action 2011-2106. Retrieved from https://extranet.who.int/nutrition/gina/sites/default/files/PHL%202011%20IYCF%20%20Strategic%20Plan.pdf
2. Republic of the Philippines, National Nutrition Council. (2016). Philippine Plan of Action for Nutrition 2017-2022 Executive Summary. Retrieved from http://nnc.gov.ph/downloads/category/118-ppan
3. World Breastfeeding Trends Initiative; IBFAN (2015). WBTi Assessment Report: Philippines. Retrieved from http://www.worldbreastfeedingtrends.org/GenerateReports/report/WBTi-Philippine-2015.pdf
4. UNICEF, UN: MDG Achievement Fund. (2013). Final Evaluation of the Joint Programme: “Ensuring Food Security and Nutrition for Children 0-24 Months Old in the Philippines.” Retrieved from https://www.unicef.org/evaldatabase/files/Philippines_2013-001_Final_report__MDGF_2030__22072013.pdf
5. UNICEF, UN: MDG Achievement Fund. (2008). Philippines: Ensuring Food Security and Nutrition for Children 0-24 Months Old in the Philippines. Retrieved from http://www.mdgfund.org/node/178
6. Republic of the Philippines, Department of Health. (2018). Budget Folio Fiscal Year 2018. Retrieved from http://www.doh.gov.ph/sites/default/files/publications/FY%202018%20Budget%20Folio.pdf