2.
06
Groups 3 & 4
NATIONAL OBJECTIVES FOR HEALTH 2011-2016 OF MCH
PROGRAM IN RELATION TO MDG 4 AND 5
MDG 4: REDUCE CHILD MORTALITY
 TARGET: Reduce by 2/3, between 1990 and 2015, the
under-five mortality rate
 Child mortality indicators are the most sensitive markers of the
general health care status of a country.
 Number of infant and under-five deaths continued to decrease
from 2006 to 2011
 In 2006
o Infant deaths: 24 per 1,000 live births
o Under-five deaths: 32 per 1,000 live births
 In 2011
o Infant deaths: 22 per 1,000 live births
o Under-five deaths: 30 per 1,000 live births
 Pneumonia - leading cause of death in children below 5 years
old in both male and female
 See appendix for assessment of MDG 4 and leading causes
of mortality in children below 5 years old
HEALTH SERVICES INVOLVING MDG 4
 Breastfeeding
o During the first six months
o Conveys significant immunological, and nutritional benefits
on infants
o 2011 Family Health Survey (FHS)
 Almost 92% of children age 6-35 months old had been
breastfed at some time
 27% were exclusively breastfed.
o Higher percentage of poor children (34%) than non-poor
children (24%) were exclusively breastfed
o CAR - highest exclusively breastfed
o Region 4A - lowest to be exclusively breastfed
 Mandatory Infants and Children Health Immunization
Act of 2011
o Republic Act No. 10152
o Provides a comprehensive, mandatory and sustainable
immunization program for vaccine‐preventable diseases for
all infants and children
o Mandatory basic immunizations for all infants and children
cover the following vaccine‐preventable diseases
 Tuberculosis
 Diphtheria, tetanus and pertussis
 Poliomyelitis
 Measles
 Mumps
 Rubella or German measles
 Hepatitis‐ B
 H. Influenza type B (HIB)
o Given free at government hospitals or health centers to
infants and children up to five years of age
o A child is considered fully immunized if he or she had BCG,
measles, and three doses each of DPT, polio and Hepatitis‐B
vaccines before the first birthday
o ARMM - least to receive all vaccinations
NATIONAL OBJECTIVE FOR 2011-2016
Reduced Child Mortality
OVERALL GOAL
Reduction of under-five mortality rate by two-thirds
STRATEGIC OBJECTIVES
 See appendix
STRATEGIES FOR 2011-2016
 Promote universal access to the standard child survival
package of interventions. Priority will be given to areas with
high prevalence of under-five mortality rate using the CHTs.
 Routine vaccination of all infants ages 0-11 months adopting
the Reaching Every Barangay strategy.
 Supplemental immunization activity either as small scale or
large scale immunization.
 Enhance the capacity and coordination of the service delivery
networks as channels of child survival interventions.
 Create opportunities for communities to overcome barriers to
utilization of child survival (CS) services.
 Build the LGU’s resolve to adopt and implement the CS
Strategy.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
Maternal and Child Health Program
02 September 2015
 Harmonize efforts of DOH, allied agencies and partners in
supporting local delivery of CS services.
MDG 5: IMPROVE MATERNAL HEALTH
 TARGET: Reduce by 3/4, between 1990 and 2015, the
maternal mortality rate
 Maternal mortality
o Death of a woman while pregnant or within 42 days after
pregnancy termination
o Considered as a strong indicator for health care status in a
country since it arises from risks attributed to pregnancy and
childbirth as well as from poor quality of health care services
 MMR
o 1990: 209 per 100,000 live births
o 1998: 172 per 100,000 live births
o 2008: 162 per 100,000 live births in 2006
o 2011: 221 per 100,000 live births
 Contraceptive prevalence rate (CPR)
o Among currently married women: almost 50% (from 1998
to 2011)
o From 2006 to 2011, decreased from 50.6 percent to 48.9
percent. For the same period, the prevalence rate for modern
methods was roughly constant, while the traditional methods
decreased by 2.8 percentage points
 Causes of increase in maternal deaths
o Delay in taking critical actions
o Delay in seeking care
o Delay in making referrals
o Delay in providing appropriate medical management
o Other factors
 Unplanned, mistimed and unwanted pregnancies
Poor detection and management of high-risk pregnancies
Poor access to health facilities due to geographic distance
and cost of transportation
Lack of staff competent in handling obstetrical
emergencies
 Hypertension & postpartum hemorrhage
o Leading causes of maternal mortality
o Significant portion of pregnant women do not have access to
prenatal care and professional births attendants, which
increase the occurrence of pregnancy-related complications
 73% of Filipino mothers do not want additional children or want
to delay pregnancy
o However the mean number of children born to a Filipino
woman upon reaching 40-49 years is 4, with an average
fertility rate of about 3.3 in 2008
o The high fertility rate can be attributed to the low
contraceptive prevalence rate among Filipino women of
reproductive age and among married women,
o 35-39 years age group: highest percentage of
contraceptive use
o 15-19 years age group: lowest percentage of
contraceptive use
 See appendix for percentage of distribution of main
causes of maternal mortality, and health-related
practices affecting maternal health, and health-related
practices affecting maternal health
NATIONAL OBJECTIVE FOR 2011-2016
Improved Maternal Health
OVERALL GOAL
Improve maternal health and ensure the survival, health
and well-being of mothers and their unborn
STRATEGIC OBJECTIVES
 See appendix
STRATEGIES FOR 2011-2016
 Provide information on FP-MCH through the CHTs and other
organized local efforts.
 Ensure availability of reproductive health and other pre-
pregnancy services including adolescent health and control of
sexually-transmitted infections and HIV prevention services
through local public health authorities.
 Increase competencies of health providers in providing
comprehensive reproductive health and maternal and child
health services.
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 MATERNAL AND CHILD HEALTH PROGRAM
 Promote facility-based births attended by skilled health
professionals catering to the specific needs of the mother and
the newborn (Essential Newborn Care).
 Immediate postpartum and postnatal care by skilled health
professionals to include immediate and thorough drying, skin-
to-skin contact, properly-timed cord clamping, sustained
contact for initiation of breastfeeding within the first hour.
 Presence of local capacities for securing reliable, updated and
complete information about the use of health services on
maternal and child health.
CHILD SURVIVAL
 It has been estimated that 3000 children under 5 years of age
die every day from common preventable and treatable
conditions including diarrhea, pneumonia, and perinatal events
o Many of these deaths are associated with undernutrition
o Vaccine preventable diseases and injuries further contribute
to this high number of childhood death
 Most childhood deaths occur in low-income countries or poor
communities in middle-income countries where many deaths
are unrecorded.
 Countries account for more than 75% of all deaths
among children under 5
o Cambodia
o China
o The Lao People’s Democratic Republic,
o Papua New Guinea
o Philippines
o Vietnam
RATIONALE FOR ACCELERATED AND SUSTAINED ACTION
FOR CHILD SURVIVAL
STAGNATING MORTALITY REDUCTION
 There has been slow reduction in child mortality
 The infant and under-5 mortality rates show a deceleration in
improvement, with an actual worsening in some countries
 A worsening in the under-5 mortality rate has occurred in
Cambodia since 1994
 Kiribati, Papua New Guinea and the Philippines have shown
little change in the last 10 years.
PERSISTENCE OF THE MAJOR CAUSES OF CHILDHOOD
MORTALITY
 Recent child and neonatal health data from the Region on
causes of death in 0-4 year old children show a yearly average
of approximately 1.02 million deaths over 2000-2003.
 Neonatal events are estimated to account for 32% of the
deaths, and the proportion tends to increase in areas where
the total under-5 mortality decreases.
 Acute lower respiratory infections are still the single most
important cause of death among children under 5 years old,
with
 Diarrhea a close second cause
 Measles remains a cause of 2.4 % of childhood deaths.
 While malaria does not account for a high total percentage of
child deaths in the Region, it is a cause of high child mortality
in some countries
 Undernutrition is an underlying cause in around 50% of
deaths
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
CONTINUED DISPARITY
 Disparities are not only geographical but are also found across
socio-economic strata
INSUFFICIENT FUNDING FOR CHILD SURVIVAL
 An estimated $34 per capita is required for basic health
services including an essential package for child survival
 Many countries and areas do not allocate enough general
government resources to health
 The allocation for tax revenue to health is insufficient and
mechanisms such as insurance for collecting more resources
are not well developed
 Most of the under-5 high-mortality countries and areas spend
less than 5% of their gross domestic product on health, and
the per capita health spending is lower than recommended by
the Commission on Macroeconomics and Health
 Per capita government expenditure on health at average
exchange rate (US$) in 2002
LACK OF COHERENCE AND VISIBILITY
 Progress towards national coverage of a full package of life-
saving interventions has been slow due to:
o Lack of focus on the major causes of mortality
o Failure to invest sufficiently in proven interventions
o Lack of human resources needed to implement them
GOAL
To reduce inequities in child survival and achieve national
targets for MDG 4 by accelerating and sustaining actions
to reduce childhood mortality
OBJECTIVES
 To improve access to and utilization of the essential package
for child survival particularly in areas of greatest need; and
 To provide an enabling environment for child survival where
political will, financial and human resources match the burden
of disease.
ESSENTIAL PACKAGE FOR CHILD SURVIVAL (7
STRATEGIES TO ENHANCE CHILD SURVIVAL)
1. Skilled attendance during pregnancy, delivery and the
immediate postpartum
2. Care of the newborn
3. Breastfeeding and complementary feeding
4. Micronutrient supplementation
5. Immunization of children and mothers
6. Integrated management of sick children
7. Use of insecticide–treated bednets
1. SKILLED ATTENDANCE DURING PREGNANCY,
DELIVERY AND THE IMMEDIATE POSTPARTUM
 Child survival interventions provided through skilled
attendance during pregnancy
o Antenatal care with a hemoglobin estimate for maternal
anemia
o Urine protein and blood pressure monitoring for prevention
and management of pre-eclampsia and eclampsia
o Prevention and treatment of malaria
o Counseling for breastfeeding
o Preparation of a birth plan
o Detection of complications
o Early referral of complications
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 MATERNAL AND CHILD HEALTH PROGRAM
 At delivery and in the immediate postpartum period it is
necessary to have a skilled attendant who can
o Ensure a clean delivery
o Use a partogram and delivery kit,
o Recognize complications
o Refer, if necessary
2. CARE OF THE NEWBORN
 Interventions that should be available as part of national
newborn care guidelines
o Clean cord care
o Newborn resuscitation
o Newborn temperature management
o Initiation of breastfeeding within one hour of delivery
o Weighing the baby to assess for low birth-weight
o Kangaroo mother care for low birth-weight babies
o Case management of neonatal pneumonia and sepsis
 Postnatal care also needs to be ensured
3. BREASTFEEDING AND COMPLEMENTARY FEEDING
 Exclusive breastfeeding up to 6 months of age
 Continued breastfeeding up to 2 years of age or beyond
 Adequate and safe complementary feeding from 6 months
onwards
4. MICRONUTRIENT SUPPLEMENTATION
 Vitamin A
o Most important micronutrient supplementation for the
reduction of child mortality is
o Given every six months for children aged 6-59 months.
 Micronutrient supplementation of the mother
o Iron
o Folic acid
o Vitamin A
 Improved diets including fortification and supplementation of
food are necessary to achieve appropriate micronutrient levels
for children and mother
5. IMMUNIZATION OF CHILDREN AND MOTHERS
 Expanded Program on Immunization (EPI)
o Measles
o Tetanus
o Diphtheria
o Pertussis
o Polio
o BCG
o Hepatitis B
 To ensure protection among newborns against tetanus
o Mother should have received two doses of tetanus toxoid
vaccine during the recent pregnancy, or at least three doses
of tetanus toxoid in the past
 Vitamin A and deworming may also be delivered with
immunization
 Use of insecticide-treated bed nets should be promoted during
immunization sessions.
6. INTEGRATED MANAGEMENT OF SICK CHILDREN
 Management of pneumonia, diarrhea and malaria requires an
integrated approach.
 Assessing the whole child during a consultation will allow the
identification and treatment of all major conditions
 Pneumonia in children requires treatment with antibiotics
 Standard case management of diarrhea
o Oral rehydration therapy with low-osmolarity oral
rehydration salts (ORS) solution along with zinc
o Antibiotics are indicated for dysentery only
 Falciparum malaria is treated with artemisinin-based
combination therapies due to high multidrug resistance
o Due to the high cost of this treatment, it is important that
there is a blood-sample-based diagnosis with microscopy or
rapid diagnostic tests
 A continuum of care must be emphasized where case
management occurs in the community, at first-level health
facilities and at referral hospitals
 Different combinations of interventions will be available at each
delivery point
 Referrals to hospitals are necessary for children with severe
pneumonia, diarrhea and malaria as well as with other severe
conditions.
7. USE OF INSECTICIDE–TREATED BEDNETS
 In malarious areas, insecticide-treated bednets should be
available as a preventive intervention for malaria
 For vulnerable populations living in remote areas, long-lasting
insecticide-treated nets have an advantage over insecticide
dipping of conventional nets
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
ESTIMATED COST OF MAIN COMMODITIES FOR CHILD
SURVIVAL
MAIN COMMODITIES FOR CHILD SURVIVAL ESTIMATED
COST
Breastmilk Free
Vitamin A supplements required in P4.50
childhood
Immunizations of a child against seven P675.00-
major childhood diseases P765.00
Three-day course of oral antibiotics for P9.00
pneumonia
Long-lasting impregnated bednet to P135.00-P270
prevent malaria
10 packets of ORS to prevent P22.50
dehydration in children with diarrhea
Ten-day treatment with zinc P9.00
STRATEGIC APPROACHES FOR CHILD SURVIVAL
1. Improving leadership and governance
2. Consolidating partnerships
3. Improving efficiency and quality of service delivery
4. Engaging and empowering families and communities
5. Ensuring health care financing support for child
survival
1. IMPROVING LEADERSHIP AND GOVERNANCE
 Policy-makers in different government sectors must provide
strong and consistent leadership
 Accelerating child survival efforts will require leadership from
influential political figures at the highest possible level
 To ensure wide support and that children’s rights to health and
health care are addressed, highly visible and well-respected
champions will be needed across different sectors of society
2. CONSOLIDATING PARTNERSHIPS
 Efforts of various existing child-health related programs should
be synchronized to maximize impact
 All activities should build upon what the country has already
initiated in child health with a focus on overcoming difficulties
 Roles and responsibilities should be defined and collaboration
among all stakeholders strengthened to ensure resource
pooling and to avoid duplication of efforts
3. IMPROVING EFFICIENCY AND QUALITY OF SERVICE
DELIVERY
 The principles of primary health care form the foundation for
implementing the essential package for child survival, while the
specific approaches taken to achieve accelerated and sustained
action towards MDG 4 will depend on the capacities of health
systems
 All available delivery points for child survival interventions
should be exploited at various levels
 Include commodity retailers, pharmacies, drug sellers,
community health workers and outreach services
A. Delivering essential interventions at the community
level
 Where health facilities are scarce or poorly utilized,
community-based and outreach services should be promoted
to deliver interventions selected according to the prevailing
diseases
 This might require adjustments to health system policies such
as adopting a list of non-prescription drugs that can be
delivered in the community
 This may also require community health workers who are
adequately trained and formally authorized to carry out specific
tasks
 Outreach is most efficient if delivery of several interventions is
integrated and takes advantage of existing services, for
example of immunization
 Outreach services have considerable health system
implications including human resource planning, training and
incentives as well as logistics.
SERVICE DELIVERY AT THE HEALTH FACILITY LEVEL
 Facility-based service delivery, both preventive and curative at
the primary and referral levels, is at the core of most health
systems
 Interventions to be delivered for child survival must be clearly
defined, along with quality standards that can be monitored
and supported by adequate supplies and equipment
 Human resources need to be appropriately trained, distributed,
remunerated, supervised and authorized to deliver the full
essential package for child survival
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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
 Appropriate referral mechanisms that remove or reduce  Proportions of children 0-59
financial and other barriers to referral and hospital care are also months of age who had diarrhea in
critical to saving lives the past 2 weeks and were treated
 Involvement of the communities in health service planning and Integrated with ORT
provision strengthens provider responsiveness, particularly management of sick  Proportion of children 0-59
towards the poor and marginalized children months of age who had suspected
 It can improve the functioning of facilities and the quality of pneumonia in the past 2 weeks
care leading to increased demand and utilization of services. and were taken to an appropriate
health care provider
4. ENGAGING AND EMPOWERING FAMILIES AND  Proportion of children 0-59
COMMUNITIES Use of insecticide-
months of age who slept under an
 The potential of family and community practices to improve treated bed nets (in
insecticide-treated net the
child survival has been well demonstrated. malarious areas)
previous night.
 Most of the care of childhood illness occurs in the home; to
improve this care families may need to change their behaviors  Countries and areas of the Region should measure baseline
 This can be accomplished by repeatedly providing information, values for core indicators and then repeat measurements on a
education and communication to families through different yearly basis
channels including mass media, community and religious  Monitoring system should build on existing and planned
leaders, and health workers national monitoring tools
 Improving health worker skills in counseling and working with  Coordination and collaboration with programs with well-
peer-educators and community groups is essential developed monitoring systems, such as EPI, would assist this
 Empowering families, particularly women, facilitates decision- approach
making in relation to care of their children  Monitoring activities should be included in program
 One of the most critical decisions is when to take a sick child implementation plans with at least 5% of total budget for child
for health care survival allocated for this purpose.
 Families need to be taught to recognize the danger signs that  It is important to measure resource flows to child survival
indicate that immediate consultation with a health worker is activities and the impact of health care financing mechanisms
needed  The amount and proportion of government health spending on
 Sustainable change in family practices will be more likely when child health should be monitored annually
communities are actively involved in the planning,  The cost to the health system and to families of the key
implementation and monitoring of health promotion and health interventions should be monitored to ensure that they remain
care activities affordable to those who need them
 The analysis of monitoring results should include both health
5. ENSURING HEALTH CARE FINANCING SUPPORT FOR indicators and financing indicators
CHILD SURVIVAL
 Health care financing mechanisms that aim to reduce financial EVALUATION
barriers to health care support the right of every child to health  Periodic evaluations, every 5 years or more frequently, of the
and health care status and impact of child health interventions on mortality,
 It is important that child survival interventions funded by undernutrition and equity should be conducted.
different financing mechanisms should increase the utilization  Requires large-scale population based surveys that have the
of the essential package capacity to measure the MDG and other indicators, including
 The objectives of equity and pro-poor financing should guide under-5, infant and neonatal mortality rates, underweight and
the design of the social protection schemes selected stunting, in addition to the ten core indicators and other
 Policy-makers should aim at including children among the standard indicators routinely included in these surveys
direct beneficiaries in these schemes  Surveys should be complemented by program reviews that
 Key child survival interventions should be included in the identify best practices, as well as constraints and ways to
essential package of health services guaranteed to the overcome them
population  When possible the surveys and reviews should be performed in
 One should also aim that the essential package of child survival collaboration with independent third-party institutions
interventions should be free of any charges at the point of use
THE WAY FORWARD: ORGANIZE AND MOBILIZE
MONITORING AND EVALUATION OF CHILD SURVIVAL
ACTIVITIES
MONITORING IMPLEMENTATION
 Regular monitoring of the coverage of child survival
interventions is important so that implementers and decision-
makers can measure progress and identify problems to be
addressed

TEN CORE INDICATORS FOR CHILD SURVIVAL

COMPONENTS OF
ESSENTIAL CORE INDICATORS
PACKAGE ONE COORDINATION MECHANISM
Skilled attendance  Stronger leadership for child survival is needed among
during pregnancy,  Proportion of births assisted by governments, collaborating partners, academics, NGOs and
delivery and the skilled health personnel civil society organizations
immediate postpartum  Strong child survival advocates must be developed and
 Proportion of infants less than 12 promoted to place child survival firmly on the political,
Care of the newborn months of age with breastfeeding economic and health development agenda
initiated within one hour of birth  A national body, led at the highest possible political level,
 Proportion of infants less than 6 should be established to coordinate planning for child survival
months of age exclusively actions at country level
Breastfeeding and o This body should include active participation from all relevant
breastfed
complementary sectors and stakeholders
 Proportion of infants 6-9 months
feeding
of age receiving breastmilk and
complementary food ONE NATIONAL PLAN
 Proportion of children 6-59  Countries should ensure that child survival is included in
Micronutrient national plans of action for children or they should develop a
months old who have received
supplementation national strategic plan specifically for child survival
vitamin A in the past 6 months
 Proportion of one-year-old  National plans should be developed with multi-stakeholder
children immunized against participation.
measles o These should show clearly where child health fits into the
Immunization of  Proportion of one-year-old overall health agenda, and where the health agenda fits into
children and mothers children protected against the development framework of the country, including
neonatal tetanus through national socioeconomic development plans and poverty
immunization of their mothers reduction strategy

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 MATERNAL AND CHILD HEALTH PROGRAM
ONE MONITORING AND EVALUATION PROCESS
 It is critical for monitoring and evaluation to be met through
one single process to which all stakeholders adhere
 This is essential to avoid duplication of effort, ensure
comparability and use of standard indicators, and enable the
government to assume its role of oversight of child survival
activities and progress.
MOBILIZE FOR ADVOCACY AND COMMUNICATION
 Emphasis must be placed on increasing awareness for child
survival within the greater community, including village
leaders, parents, teachers, the media and private sector
 Respected national figures and prominent stars of sports and
entertainment may be engaged as champions for child survival
and to give children a voice
 All available channels for raising the profile of child health
should be used through the development and dissemination of
advocacy materials
MOBILIZE FINANCIAL RESOURCES TO ACCELERATE AND
SUSTAIN PROGRESS
 To achieve MDG 4 in the Region massively increased
investments in child health will be required through increased
government spending and external assistance
 To achieve and sustain adequate and stable financing for child
health, there needs to be stronger political commitment to
increased government resource allocation
 Estimates of resource requirements should be made based on
credible costing
 While this strategy does not promote the creation of a
separately financed child health system, it does advocate for
financing that is adequate to ensure that child health outcomes
are improved, sustained and equitably delivered
MATERNAL, NEONATAL AND CHILD HEALTH AND
NUTRITION STRATEGY (MNCHN)
 Despite efforts and improvements in the general health status
indicators in the country, decline rates of maternal and
neonatal mortality have slowed in the past decade
o Country’s commitments to achieving the Millennium
Development Goals of decreasing maternal mortality ratio
(MMR) and infant mortality rate (IMR) may not be achieved.
 With pregnancy and childbirth still posing risks to Filipino
mothers and newborns, this must be remedied as quickly as
possible with targeted and tailor-made interventions to further
the reduction of the aforementioned indicators.
 Four risks are critical in the amplification of the increasing risk
for maternal and neonatal deaths:
o Risk of having a mistimed, unplanned, unwanted and
unsupported pregnancy;
o Having become pregnant exposes the mother and fetus to
the risk of not securing adequate care during the course of
pregnancy;
o Risk of delivering without being attended to by skilled birth
attendants (i.e. skilled midwives, nurses and physicians) and
not having access to emergency obstetric and neonatal care
services
o Risk of not securing proper postpartum and postnatal care
for the mother and neonate, respectively.
 Survival of the newborn is inevitably linked to the health of
the mother as evidenced by the high risk of newborn and
infant death whose mothers die in childbirth due to various
complications.
o The highest risk of death for both the newborn and the
mother occur within the first 7 days of birth for the
newborn and within 42 days of birth for the mother.
o This emphasizes that the importance of postpartum and
postnatal period follow-ups is at par with the importance of
prenatal and childbirth care.
 The slow decline of maternal and neonatal mortality despite
focused efforts on Maternal and Child Health in the past may
stem from gaps in the health service delivery which challenges
the system.
 These gaps result to poor access and utilization of services—
leading to the slow decline of maternal and neonatal mortality.
 The aforementioned gaps are as follows:
o Emergency obstetrics and newborn care services are
available only in secondary and tertiary level health facilities
such as big district hospitals, provincial hospitals and medical
centers, facilities that are not geographically accessible to
majority of women
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
o Past policy on maternal car accommodated TBA training and
home deliveries assisted by TBAs
o Failure to link TBAs to the formal health system
o Failure of the health system to address women’s issues that
result to their deciding to give birth at home rather than in
hospitals or health centers
o Poor access to family planning commodities.
 To address the aforementioned problems, the implementation
of an integrated maternal, neonatal, and child health and
nutrition strategy (MNCHN) aims to achieve the twin goals of
maternal mortality reduction and neonatal mortality
reduction.
 The MNCHN strategy calls for coordinated actions with the end
goal of improving women and children’s health and
consequently effecting a rapid reduction in the maternal,
newborn and child mortalities towards attaining MDGs 4 and 5
within the set time frame.
 The DOH now commits to work hand-in-hand with the LGUs in
upgrading the health facilities to EmONC (Emergency Obstetric
and Newborn Care) standard, which is a major initiative of
MNCHN.
GENERAL PRINCIPLES OF THE MNCHN
 As a bridge to significantly lower the risk of mortality secondary
to pregnancy and childbirth, the following intermediate
results shall stem from reforms, improvements and changes
in the local health systems:
o Every pregnancy is wanted, planned and supported;
o Every pregnancy is adequately managed throughout its
course;
o Every delivery is facility-based and managed by skilled birth
attendants; and
o Every mother-and-newborn pair secures proper postpartum
and postnatal care with smooth transitions to the women’s
health care package for the mother and child survival
package for the newborn.
 The above four intermediate results shall be achieved by the
following:
o Health service delivery
 Addresses the direct causes of mortality during childbirth
by managing deliveries either by a basic emergency
obstetric and newborn care (BEmONC) or a comprehensive
emergency obstetric and newborn care (CEmONC) facility.
 In addition, public health services that reduce risks for
mortality and improvement of the well-being of women,
mothers and children are to be made available.
o Health regulation
 Enforcement of regulatory measures and guidelines
related to the establishment and operations of health
facilities
 Health staff capacity building via competency-based
standards linked with suitable performance-based
incentive mechanisms.
o Health financing
 Combined financing strategies using instruments made
available through DOH and LGU budgets, PhilHealth
payments and other funding sources.
 The aforementioned sources shall finance the acquisition
of additional capacities and maximize utilization of services
in areas where maternal and neonatal mortality is most
severe.
o Governance for health
 Secure commitment of stakeholders and exact
accountability for results
 Mechanisms shall incorporate broad-based participation,
non-partisan leadership and sustained popular support—
thus assuring continued local effort regardless of diversity
in political, economic and sociocultural settings
GOALS AND OBJECTIVES
GOAL
 Rapidly reduce maternal and neonatal mortality through local
implementation of an integrated MNCHN strategy.
OBJECTIVES
 Develop, adopt, promote, implement and evaluate an
integrated MNCHN strategy for the rapid reduction of maternal
and neonatal mortality;
 Engage all province-wide or city-wide health systems to adopt
and implement the integrated MNCHN strategy;
Page 5 of 32
 MATERNAL AND CHILD HEALTH PROGRAM
 Provide targeted support to province-wide or city-wide health
systems and specific population groups where the maternal
and neonatal mortality problem is most severe; and
 Achieve national MNCHN program targets for the following key
indicators:
o 80% modern contraceptive prevalence rate (CPR) by 2015
(baseline, 2006 FPS, NSO: 35.9%).
o 100% of pregnant women with at least 4 antenatal visits by
2015 (baseline, 2003 NDHS: 70%).
o 90% facility-based deliveries by 2015 (baseline, 2003 NDHS:
39%).
o 50% of infants 4-5 months old are exclusively breastfed by
2010 (baseline, 2003 NDHS: 16%).
o 100% of newborns are screened for metabolic disorders by
2015
o 80% postpartum and postnatal visits done within the first
week of delivery by 2015(baseline, 2003 NDHS: 51%).
o 100% fully immunized children by 2015 (baseline, 2003
NDHS: 70%).
OUTCOME
 Implementation of the MNCHN strategy shall lead the country
to its most desired outcome: no woman dies giving birth; no
newborn dies at birth.
KEY STRATEGIES IN RESPONSE TO THE MNCHN
SITUATION IN THE PHILIPPINES
 The key strategies employed are the following:
o Ensuring universal access to and utilization of an MNCHN
Core Package of services and interventions directed not only
to individual women of reproductive age and newborns at
different stages of the life cycle, but also to the community.
o Establishment of a Service Delivery Network at all levels of
care to provide the package of services and interventions.
This network shall include private hospitals and clinics.
o Organize use of instruments for health systems development
to bring all localities to create and sustain their service
delivery networks, which are crucial for the provision of
health services to all
o Rapid build-up of institutional capacities of DOH and
PhilHealth, being the lead national agencies that will provide
support to local planning and development through
appropriate standards, capacity build-up of implementers
and financing mechanisms.
 With this, it is important to note that one of the desired
outcomes of the integrated MNCHN strategy is to prioritize
the areas with higher risk from adverse maternal and
neonatal outcomes and GIDAs (geographically isolated and
disadvantaged areas) by making these least progressive and
most vulnerable areas move more rapidly and catch-up with
the rest of the localities in the country.
 Poor MNCHN performance in the aforementioned areas can be
measured in terms of service coverage indicators such as:
contraceptive prevalence rate, prenatal care, skilled-birth
attendant/skilled health professional deliveries and facility-
based deliveries, early initiation of breastfeeding, fully
immunized children, and those areas that have large
populations with poor and less education mothers.
MNCHN KEY INTERVENTIONS
 Key interventions tailored to the various stages of the life cycle
from pre-pregnancy, antepartum, intrapartum, postpartum,
neonatal and post neonatal period may be used to address the
risks to maternal and newborn health.
 Effective implementation of these interventions is expected to
reduce burden of maternal and neonatal deaths, especially
those in the underserved.
 Strategy to rapidly reduce maternal and neonatal mortality in
the context of Formula One (F1) for Health adopts a model
which demands sustainable delivery of an integrated
package of MNCHN services in strategically located health
facilities adequately equipped to allow provision of
appropriate emergency obstetric and newborn case.
 Its foci are areas that have the greatest impact on reproductive
health which are:
o Provision of Family Planning and other pre-pregnancy
services including adolescent health and control of sexually
transmitted infections and HIV prevention services.
o Access to comprehensive antenatal care services.
o Facility-based births attended by skilled health professionals.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
o Immediate postpartum and postnatal care by skilled health
professionals to include initiation of breastfeeding and
immunization among others.
MNCHN STRATEGIC PLAN 2013 TO 2017
VISION
 Every woman, child and their families utilize quality health
services in a continuum of care.
MISSION
 To lead, harmonize, and converge all efforts in delivery of
maternal, newborn, child health and nutrition (MNCHN)
package of services to ensure equitable, accessible, efficient
health services to communities through dynamic partnership
and shared advocacy, responsibility and accountability.
GOAL
 Rapidly reduce maternal and neonatal mortality through local
implementation of a MNCHN strategy
OBJECTIVES
 To reduce maternal mortality ratio from 162/100,000 live
births to 52/100,000 live births
 To reduce neonatal mortality rate from 17/1,000 live births to
14/1,000 live births
SPECIFIC OBJECTIVES
 Increase contraceptive prevalence rate from 50.7% to 63%
 Reduce unmet need from 19% to 16%
 Increase percentage of pregnant women having at least four
antenatal care visits from 78% to 80%
 Increase facility-based delivery from 55% to 85%
 Increase skilled birth attendance from 72% to 85%
 Increase percentage of newborns initiated to breastfeeding
within one hour of life from 53.5% to 90%
 Increase percentage of exclusively breastfed infants for the
first 6 months of life from 48% to 70%
 Increase percentage of fully immunized children from 82% to
95%
STRATEGIES
 Scale up, promote, implement, and evaluate the delivery of
comprehensive MNCHN service package in a continuum of care
through strengthened local health systems. National
government will provide support to local health systems that is
guided by the six pillars of UHC strategy.
 Enhance capacity to provide targeted support to province-wide
or city-wide health systems and disadvantaged population
groups where access to MNCHN services is limited and where
mortalities are likely to occur or are most severe
 Engage the, advocate to, and mobilize resources of all
province-wide or city-wide health systems to adopt, implement
and steward the integrated MNCHN strategy
STRATEGY TO REDUCE MATERNAL AND CHILD
UNDERNUTRITION (UNICEF)
 Adopted by DOH
 From the East Asia & Pacific Regional Office of UNICEF entitled
“Strategy to Reduce Maternal and Child Undernutrition”
 The strategies strive to reduce maternal and child
undernutrition—consequently reducing maternal mortality rate
and infant mortality rate. The strategy includes the following:
STRATEGY 1: TARGET ADOLESCENT GIRLS, PRE-
PREGNANT WOMEN AND PREGNANT WOMEN WITH
INTERVENTIONS TO IMPROVE MATERNAL AND CHILD
NUTRITION
 Emphasizes the importance of maternal nutrition and well-
being in contributing to the survival, growth and development
of young children and ultimately—to their adult stature.
 Targets adolescent girls and pre-pregnant women to ensure
optimal health and nutrition prior to pregnancy—thus
ensuring optimal fetal growth and development and pregnancy
outcome.
 Reaching out to adolescent and pre-pregnant women will help
impart to them the importance of pregnancy and women need
to be healthy and prepared for it.
 Adolescent girls should also be counseled regarding pregnancy
during the younger years wherein they themselves have yet to
complete their own growth as this may result to
undernourished offspring.
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 MATERNAL AND CHILD HEALTH PROGRAM
STRATEGY 2: INCREASE THE NUTRITION CONTENT OF
PREVENTATIVE AND CURATIVE HEALTH CARE AND
IMPROVE THE ACCESS OF ADOLESCENT GIRLS, PRE-
PREGNANT WOMEN AND PREGNANT WOMEN TO THESE
AND CONTRACEPTION SERVICES
 The following services will contribute to the fulfillment of the
above strategy:
o Micronutrient supplements: iron folate or multi
micronutrients
o Nutrition counselling and education that emphasizes the
importance of protein foods, micronutrient-rich foods, animal
foods, etc., especially in pre-pregnancy and during early
pregnancy (with greater emphasis on the caloric quantity of
foods in later pregnancy)
o Monitoring of pre-pregnancy weight (aim is to achieve at
least 40kg50) and weight gain during pregnancy (aim is to
achieve a total weight gain of at least 6kg during the
pregnancy amongst the population to be reached)
o Identification, prevention and treatment of diseases and
infections such as anaemia, hookworm infestation, malaria,
tuberculosis, HIV and STDs
o Tetanus toxoid vaccination
o Contraception services to enable women to plan their
pregnancies, delay the age of first birth, lower fertility,
improve birth spacing and prevent unwanted pregnancies.
o Health education to encourage better caring practices of the
pregnant woman such as improved hygiene practices,
reduction of workload, ANC visits and access to quality food.
 Nutrition is an intrinsic part of the existing preventive and
curative care services and these can be provided via extended
basic health or antenatal care services with strong linkages to
communities.
o This therefore increases the access, demand and utilization
of these services—contributing to its attainment.
STRATEGY 3: DEVELOP COMMUNITY-BASED PROCESSES
AIMED AT EMPOWERING ADOLESCENT GIRLS, PRE-
PREGNANT WOMEN AND PREGNANT WOMEN.
 This emphasizes the importance of a management or
development structure that enables the community to
assess and analyze their own problems and in turn identify
actions to address them.
 The communities need to recognize the special needs of
adolescent girls and reproductive-age women for optimal
health and nutrition and to facilitate behavioral change to
increase their access to care and to participate in decision
making.
STRATEGY 4: INCREASE COVERAGE OF EFFECTIVE CHILD
NUTRITION INTERVENTIONS
 This strategy recognizes the importance of infant and child
nutritional interventions to ensure full and normal growth of
the child.
 The Bellagio group has recently confirmed the importance of
key nutrition interventions in reducing child mortality.
o The group found evidence that the following significantly
reduced under-five mortality:
 Exclusive breastfeeding
 Appropriate complementary feeding
 Zinc supplementation
 Vitamin A supplementation
F. MNCHNN SERVICE DELIVERY
 Refers to the network of facilities and providers within a
province and (chartered) city health system offering
integrated MNCHN services in a coordinated manner,
including the supporting financing communication, and
transportation systems.
o Includes the BEmONC-CEmONC network (a network of
facilities providing emergency obstetric and newborn care)
and matches the inter-local health zone (ILHZ) arrangement.
 The failure and incapability of antenatal protocols in accurately
predicting the onset of complications during childbirth lead to
a paradigm shift in the maternal and newborn care packages
from focusing on identifying pregnant women at risk of
complications to considering all pregnant women at risk of
complications.
o The adjustment and modification in the approach seeks to
encourage women to give birth in conveniently located
health facilities that are suitably equipped to render basic
emergency obstetric and newborn care (BEmONC).
o Complicated pregnancies and pregnancies needing caesarian
sections and blood transfusions are referred to higher level
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
facilities rendering comprehensive emergency obstetric
and newborn care (CEmONC).
 The new strategy also seeks to manage the new MNCHN
service delivery which involves shifting from centrally
controlled national programs operating separately and
governed independently at various levels of the health system,
to an LGU-governed health system that delivers the integrated
maternal newborn child health and nutrition service package.
MNCHN CORE SERVICE PACKAGE
 Health services which are preventive and curative in
nature.
 These are recognized and proven to lower the risk and respond
to the direct causes of maternal and neonatal deaths.
 It is catered to the needs of women and children for health
improvement.
 The service packages offered for the women extend over the
period before pregnancy to post childbirth including
essential newborn care during the first week of life.
 It also consists of services covering essential health care
of the newborn after the first week to adolescent stage.
 Availability and easy accessibility to these service packages
must be guaranteed to the target population.
 The following standards of care must be delivered in all facilities
within the MNCHCN service delivery network to assure the
safety of mothers and newborns:
1. Micronutrient supplementation (Iron folate 60 mg
PRE-PREGNANCY PACKAGE OF
tablets 1 tablet daily)
2. Tetanus toxoid immunization following the
recommended schedule
3. Fertility awareness, birth spacing, and family
planning counselling
SERVICES
− IEC and FP counseling with focus on modern
methods and fertility awareness and observing
the principles of informed choice, birth spacing,
responsible parenthood and respect for life
− Contraceptive provision as appropriate
4. Nutrition and healthy lifestyle
5. Provision of oral health services
6. Counselling and services on STI/HIV/AIDS
7. Management of lifestyle-related diseases like
diabetes, CVD, etc.
1. Provision of eight essential antenatal care
services
− Monitoring of height and weight
− Blood pressure determination and monitoring
− Screening and blood testing including
pregnancy test, urinalysis, complete blood
count, blood typing, and STI screening
− Micronutrient supplementation
− Malaria prophylaxis where appropriate
− Tetanus toxoid
− Birth planning
2. Counselling on the use of modern FP methods
especially lactation amenorrhea (LAM) and
COMPLETE PRE-NATAL PACKAGE
contraceptives
3. Counselling on healthy lifestyle with focus on
smoking cessation, healthy diet and nutrition,
regular exercise, STIC control HIV prevention and
oral health
4. Prevention and management of bleeding in early
pregnancy
5. Early detection and management of danger signs
and complications of pregnancy
6. Assessment of fetal growth and well being
7. Prevention and management of other conditions
as indicated
− Hypertension
− Anemia
− Diabetes
− Tuberculosis
− Malaria
− Schistosomiasis
− STI/HIV/AIDS
8. Provision of other support services
− Antenatal registration through active tracking
by the WHTs
− Birth planning
− Home visits and follow-up
− Safe blood supply
− Transportation and communication support
services
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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
1. Monitoring vital signs and the progress of labor  These facilities operate 24 hours with obstetrician-
DURING DELIVERY using the partograph gynecologists, surgeons, pediatricians, nurses, midwives,
2. Identification of early signs and symptoms and and medical technologists among others
COMPLETE CARE

administration of appropriate management of

prolonged labor, hypertension, abnormal
presentation, bleeding
3. The 3 C’s of childbirth (continuity, choice, and
control)
4. No episiotomy and no fundal pressure
5. Active management of the third stage of labor
6. Essential Newborn Care Package
Postpartum service care package
1. Physical examination (BP monitoring, pelvic
exam)
IMMEDIATE POSTPARTUM AND NEONATAL PACKAGE
MNCHN SERVICE DELIVERY NETWORK
 The MNCHN Service Delivery Network is a network of facilities
and providers within the province-wide or city-wide health
system that offers the MNCHN core package of services in an
integrated and coordinated manner. No single facility or unit
can adequately provide the entire MNCHN Core Package of
Services thus it is important for health service providers are
organized and coordinated in delivering MNCHN services to
meet the varying needs of the populations and ensuring the
continuum of care. There are three levels of care in the MNCHN
service delivery network: the community level providers, the

2. Postpartum check-up including identification of BEmONC-capable network of facilities and providers and the
early signs and symptoms of postpartum CEmONC-capable facility or network of facilities and these will
complications like hemorrhage, infection, and be discussed below:
hypertension
3. Micronutrient supplementation, including iron and 1. DETERMINE THE PRESENCE OF COMMUNITY LEVEL
folate PROVIDERS
4. Provision of FP services and contraception  Service delivery involving public health services initially
including surgical procedures where appropriate: takes place at the household or the community level.
bilateral tubal ligation (BTL), no-scalpel  This includes: outpatient clinical services such as family
vasectomy (NSV), and management of planning, prenatal, post-partum and newborn care and
complications resulting from contraception nutrition.
5. Counselling on:  It also comprises of sharing of information to empower clients
− Nutrition and assisting in the setting up of support systems (e.g.
− Exclusive breastfeeding up to six months transport and communication systems).
− Essential neonatal care  The core package of services of MNCHN must be made
available through a network of BHS, RHUs, private clinics and
Immediate neonatal care package (required Community Health Teams (CHT) organized in each barangay
within 24 hours after birth) or purok of the locality.
1. Cord care  CHTs are essential and necessary in every priority communities
2. Vitamin K injection and each member can manage at most 20 households.
3. Eye prophylaxis  The community-level MNCHN providers as part of the overall
4. Delayed bathing until 6 hours of life MNCHN service delivery network are comprised of the
5. BCG and first dose of Hepatitis B immunization following:
6. Newborn screening
7. Birth registration A. AT THE BARANGAY LEVEL
8. Counselling on postpartum/postnatal check-up,  A community health team led by the midwife or any barangay
home care, and immunization official identified that carries out the task of providing
1. Low birth weight newborns information and basic health services to households.
MATERNAL AND

2. Premature newborns  The team may be composed of the following: barangay health
EMERGENCY

3. Sick newborns workers, traditional birth attendants, barangay nutrition

NEWBORN

PACKAGE
SERVICE

− Sepsis workers and other volunteers from organizations or non-

− Fetal alcohol syndrome government organizations.
− Asphyxia  The community health teams provide preventive, promotive
− Severe birth trauma and clinical MNCHN services to community members
− Severe jaundice o They are critical in the improvement of service utilization by
− Others families.
o Other functions include health risk assessment, assistance in
 COMMUNITY LEVEL SERVICE PROVIDER developing health plans for families, informing families of
o These facilities are upgraded or enhanced Barangay Health available services and where to access them, giving
Stations (BHS), Rural Health Units (RHU), District and appropriate health messages and discussing financing
Community Hospitals. options.
 BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE  The CHT will use the family health diary as a medium in
(BEmONC) PROVIDER FACILITIES informing and educating the community as well as monitoring
o Include the district hospitals and Rural Health Units (RHU) the utilization of services by mothers and children.
with skilled health professionals (SHP). o The diary consists of three parts: the mother’s record, child’s
o The services offered by these facilities must include the record and key health messages.
following:  The barangay health stations, which is manned by the midwife
 Parenteral administration of loading dose of anti- serving as the CHT leader, shall provide the following
convulsant services:
 Initial dose of antibiotics o Prenatal care
 Oxytocin during the third stage of labor, o Post-partum care
 Assisted delivery during imminent breech presentation o Vaccination and immunization
 Mmanual removal of placenta o Child care
 Removal of retained placental products o Family planning
 Administration of loading dose of corticosteroids for o Micronutrient supplementation
threatened pre-mature delivery  In areas where the priority population is located, the nearby
 Newborn resuscitation with oxygen support barangay health station should be the designated birthing
 Essential newborn care. center.
 COMPREHENSIVE EMERGENCY OBSTETRIC AND  Community leaders should also be given regular feedback on
NEWBORN CARE (CEmONC) PROVIDER FACILITIES the implementation of health services by CHTs to ensure access
o End referral facilities which are usually the provincial of families to the following resources: transportation and
hospitals. communication, outreach services, health information
o It provides the same functions as BEmONC with the following campaigns among others.
additional services:  The barangay officials should be involved in securing funding
 Operative deliveries (Caesarian section) for CHT-related activities.
 Blood transfusion services
 Advanced life support management for low birth weight B. THE DOCTOR
 Premature and newborn like sepsis  Functions as the head of health facilities (i.e. clinics, BHS,
 Asphyxia or RHU) together with a team consisting of nurses, medical
 Severe birth trauma technologists, midwives, sanitary officers, and other type of
 Severe jaundice, etc. health staff.

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 MATERNAL AND CHILD HEALTH PROGRAM
 The health providers also provide medical outreach services
in areas that do not have access to health care.
 The specific major functions of CHT are listed below.
 Obtain the basic information on each family member
for the identification of persons who are most in
need of health care via Form 1 provided in the CHT
PROFILING
Guidebook from the Department of Health (DOH).
 Pregnancy tracking and postpartum tracking reports
must be attached to the combined family profile.
 It is important in the entry of Target Client List (TCL)
for updating and to ensure that all pregnant women
and new mothers are recorded and reported
accordingly.
 The families included must be oriented on the
available sources of information that they can get
ORIENT
and how they can directly benefit. Family health
guide and family health diary are utilized.
 Health risk assessment of each member of the
families is guided using the CHT Manual and Health
ASSESS
Diary.
 Specific assessment that must be done mist include
prenatal care, postpartum care, newborn, infant,
and child health, family planning, and chronic cough
management.
 Key health messages and helpful tips for the families
that will enable them to make decisions about their
health as well as accessing services in the health
facilities from the professional health personnel
must be provided using the family health diary
 The messages that must be included are the
following:
o Development of the baby in mother’s womb and
reminders to the expectant woman
o Things to prepare for birth of the baby including
the formulation of Birth and Emergency Plan
o Routine baby care
INFORM
o Newborn screening
o Common problems when breastfeeding
o Feeding recommendations especially to children
with diarrhea
o Vitamin A supplementation and deworming
o Child developmental milestone
o Early childhood screening tool
o Oral health care of pregnant women and children
and tooth eruption schedule
o Practical tips to ensure child’s safety
o Rights of a child
 Indigenous women must also be ensured to have
access to appropriate MNCHN core package of
services in their own languages while protecting
their cultural integrity.
 The CHTs shall assist the families in planning health
goals and using health services.
PLAN
 The CHT member will aid the families in selecting
health service providers in the health facilities and
transport options using the family health guide and
family health diary.
 Regular monitoring of all families shall be done to
ensure that all members who have identified needs
MONITOR
have accessed appropriate health services.
 This is specific for pregnant women in acquiring pre-
natal case, new mothers for post-partum care and
newborns for vaccination, newborn screening and
breastfeeding.
 The CHT shall periodically accomplish and submit
monthly summary forms including pregnancy and
REPORT
post-partum tracking.
 This is essential in monitoring the overall health
status of the community and the subsequent
decision making for the improvement of
implementation of health programs.
2. DESIGNATE BASIC EMERGENCY OBSTETRICS AND
NEWBORN CARE (BEMONC) – CAPABLE NETWORK OF
FACILITIES AND PROVIDERS
 This network can be based in hospitals, RHUs, BHS, lying-in
clinics or birthing homes.
o Aside from skilled health professionals, emergency transport
and communication facilities also comprise the facilities,
which operate on a 24-hour basis.
o Blood transfusion services such as blood collection and
screening, among others, are offered by hospital-based
BEmONC.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
 BEmONC-capable facilities may be stand-alone units, such as
RHUs, or comprised of networks of facilities.
 A midwife under the supervision of the rural health physician,
or with arrangements with a doctor or hospital trained in
managing maternal and newborn emergencies, can operate a
BEmONC facility.
 BEmONC aims to treat and manage the complications of
pregnancy such as:
o Hemorrhage
o Severe infection
o Hypertension
o Complications of abortions (such as septic abortion and
dystocia)
 In line with this, BEmONC-capable facilities have six signal
functions, as follows:
Parenteral administration of oxytocin in the third stage of
labor
o Parenteral administration of loading dose of anti-convulsants
o Parenteral administration of initial dose of antibiotics
o Performance of assisted deliveries (imminent breech
delivery)
o Removal of retained products of conception
o Manual removal of retained placenta.
 Under the MNCHN Strategy, BEmONCS serve several purposes:
o Provide maternal services including management of specific
emergencies
o Provide emergency newborn services
o Act as bridge facilities that allow immediate clinical
interventions and stabilization of maternal and newborn
emergency cases for referral
o Provide screening/diagnostic services for mothers and
newborns
o Provide population based maternal and child health services
to priority populations.
 With regard to the provision of maternal services, BEmONCs
serve to manage specific emergencies that do not require
CEmONC referral, such as:
o Ative management of the third stage of labor
o Use of anticonvulsants
o Use of initial dose of antibiotics in prolonged labor and
premature rupture of membranes
o Use of magnesium sulfate for the prevention and
management of eclampsia
o Aassisted breech vaginal delivery
o Management of retained placenta and uterine atony
o Administration of antenatal steroids in preterm labor.
 Newborn services provided for by the BEmONCs include:
o Nwborn resuscitation
o Treatment of neonatal sepsis and infections
o Oxygen support
o Blood transfusion services.
 The following steps are done by the MNCHN Team in the
designation of BEmONC:
o First, priority areas for the establishment or designation of
BEmONCs are identified
 BEmONCs are designated based on an area’s access to
CEmONC services.
o The second step is the identification and selection
facilities to provide BEmONC services.
 This entails listing of all the hospitals identified in
designating a CEmONC as well possible BEmONC facilities
to constitute the pool for potential BEmONC-capable
facilities; confirming of the distances of each health facility
from the identified population groups; categorization of
these health facilities according to type of BEmONC; and
completion of their characteristics and features, including
addresses, licensing and accreditation status, ownership,
modes of transportation, and client volume.
o Third is the assessment of the suitability of potential
health facilities as BEmONC providers.
 Suitability is assessed in terms of using core BEmONC
capacities as basis
o Fourth is the designation of a health facility as BEmONC
provider.
 BEmONCs are designated among those considered as
BEmONC capable.
 If there is a public owned BEmONC facility with blood
services, the facility is designated; in the absence of
services, a private facility with the services is designated.
 If the public owned facility can provide BEmONC services
through a network arrangement, the facility is designated;
however, if this is not fulfilled by the public facility, and in
the presence of a private facility that can satisfy the
condition, the private facility is designated.
Page 9 of 32
 MATERNAL AND CHILD HEALTH PROGRAM
3. DESIGNATE THE CEMONC-CAPABLE FACILITY OR
NETWORK OF FACILITIES
 End-referral facilities able to manage complicated deliveries
and newborn emergencies.
 Private or public secondary or tertiary level hospitals may be
designated as CEmONCs.
 They are ideally less than 2 hours away from the priority
population or from the referring facilities.
 The CEmONC must be capable of managing maternal
emergencies, such as caesarean sections, and must also be
capable of handling basic and emergency newborn care
and providing blood transfusion and storage services; to deliver
these services, they must also have a set of sophisticated
equipment, special infrastructure and highly skilled health
staff.
 CEmONCs must be strategically located to ensure wide
accessibility to clients, substantial caseloads to maintain skill
proficiency and adequate financing for operational viability, and
finally, they must have the responsibility to serve its target
population, provide quality care and reduce financing barriers
to access.
 CEmONCs, should, at the very least, be capable of performing:
o Six signal of obstetric functions
o Provide caesarean delivery services
o Blood banking and transfusing services
o Other highly specialized obstetric interventions
 It should also be capable of providing newborn emergency
interventions, such as:
o Newborn resuscitation
o Treatment of neonatal sepsis/infection
o Oxygen support for neonates
o Management of low birth weight or preterm newborn
 CEmONCs may also serve as high volume providers for IUD and
VSC services, such as tubal ligations and vasectomies.
MONITORING THE IMPLEMENTATION OF MNCHN
 The Department of Health makes use of a monitoring and
evaluation system to assess the progress and status of the
MNCHN Strategy.
 There are several indicators to be monitored to assess different
outcomes, and they are as follows.
 Maternal Mortality Ratio
HEALTH
 Neonatal Mortality Rate
OUTCOME
 Infant Mortality Rate,
INDICATORS
 Under Five Mortality Rate
 Contraceptive Prevalence Rate
SERVICE  Antenatal Care
COVERAGE  Facility-Based Deliveries
INDICATORS  Early Initiation of Breastfeeding
 Fully Immunized Children
 The target health indicators will be determined by the National
Center for Disease Prevention and Control (NCDPC) using the
latest National Objectives for Health.
 Progress of individual regions and provinces shall then be
compared to national targets.
 Maternal Death Reviews (MDR) should be conducted per
province as a means by which healthcare providers and
managers can find solutions and resources to address maternal
deaths.
 To monitor the progress in implementation of the MNCHN, the
following process indicators are used:
o Number of Community Health Teams organized, trained and
deployed
o Number of CEmONCs designated, capacitated, made
functional and accredite
o Number of BEmONCs- designated, capacitated, made
functional and accredited
o Number of Facilities for Safe Blood Supply
designated/established
o Number of Transportation and Communication Systems
established
HOME-BASED MOTHER’S RECORD (HBMR)
 Maternal, neonatal and perinatal mortality rates are
unacceptably high in developing countries.
o Most deaths during the vulnerable periods associated with
pregnancy and childbirth occur because of failure to
recognize the seriousness of problems and to make
use of available services in good time, together with poor
health infrastructures.
o In addition, many deaths occur in at risk cases, in which one
or more of the conditions and characteristics considered to
be risk factors are present.
o Fortunately, most risk factors can be dealt with, provided
that they are diagnosed and managed in time.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
 In many developing countries, health-care institutions are
inadequate and not easily accessible.
 However, timely identification and referral of cases at risk by
primary health care services may allow the full utilization of
limited resources available in institutions by those most in
need.
 Another approach is to encourage the active involvement of the
individuals and their families, the community and the health
care provider with the aim of helping people to understand how
to look after their own health.
 The home-based maternal record, is one of the numerous
developments that encourage people to participate in
caring for themselves and improving their chances of
survival and the quality of their lives. T
o This home-based maternal record takes the form of a card
that is kept at home by mothers themselves and on which
information about their pregnancies, the birth of their
children, and health problems between pregnancies can be
recorded.
1. CONTENT OF HOME-BASED MOTHER’S RECORD
 The home-based mother’s record was designed to include
information on pregnancy, childbirth, and the postpartum and
interpregnancy period. There are four parts of the record
PANEL 1
 The first part is for basic information about the woman’s
obstetrical history and present health problems; this will show
if she has any risk factors.
 The Barangay Health Worker (BHW) should be able to fill up
most of this panel.
 General information gathered in this panel include the
patient’s name, address, age, height, Family Serial
Number/Individual Treatment Record, blood type and date of
tetanus toxoid.
 The obstetrical history includes the history of previous
pregnancies, previous caesarian section, abortion and/or
miscarriages, stillbirths, and postpartum hemorrhage.
 Present health problems documented include
tuberculosis/cough for more than 2 weeks, heart disease,
diabetes, bronchial asthma and goiter.
 The risk factors for pregnant women included in the HBMR are
as follows:
o Age less than 18 or greater than 35
o Being less than 145cm (4’9”) tall
o Having four or more babies
o Having had one or more of the following:
 Previous caesarean section
 3 consecutive miscarriages or a stillborn baby
 Postpartum hemorrhage
o Having one or more of the following medical conditions:
 Tuberculosis
 Heart disease
 Diabetes
 Bronchial asthma
 Goiter
PANEL 2
 This contains information about the present pregnancy.
 This is to be filled up by the midwife, the nurse, or the doctor
who examines the woman.
 The record can be used for three (3) consecutive pregnancies.
o At the top of the panel, a space is provided for recording
information on the date or month of the last menstrual
period (LMP) and expected date of confinement or
delivery (EDC/EDD).
 The next section is for recording the following:
o AOG in months
o Date of the visit
o Vaginal bleeding
o Urinary tract infection
o Eeight in kilograms
o Blood pressure
o Temperature
o Pallor
o Findings of abdominal examination (fundal height,
presentation, fetal heartbeat)
o Edema
o Vaginal infection and laboratory test results (e.g.
hemoglobin, urine, VDRL).
 Below this, space is provided for details of the action taken
during prenatal care with regard to:
o Administration of iron/folate and chloroquine tablets for
malaria prophylaxis
o Intention to breast-feed by the mother
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 MATERNAL AND CHILD HEALTH PROGRAM
o Advice regarding the 4 danger signs (any type of vaginal
bleeding; headache, dizziness, blurred vision; puffiness of
the face and hands; and pallor or anemia)
o Dental check-up
o Emergency plans and place of delivery, risks and date of next
visit.
 Then follows a section for essential data on labour and
delivery, in which the duration of labor, presentation, type of
delivery, and excess vaginal bleeding after delivery can be
recorded.
 At the bottom of each panel is a section recording the date and
place of delivery, the type of health worker who assisted the
delivery, the sex of the baby, the number of babies in multiple
births, cry at birth, birth weight, breathing difficulty, success of
breastfeeding and the health status of the baby up to one
month of age.
PANEL 3
 This contains a space for information about referrals.
 It is where findings of community health workers, nurses or
physicians are entered.
 Each time a woman is referred for a risk condition, the date of
referral, problems identified and action taken are recorded.
 A record should also be made of the advice given, so that
continuity of care can be maintained.
 This section also provides a useful link between the mother,
the community health worker and the referral center.
PANEL 4
 This panel contains information about the mother after delivery
as well as advice on follow up visits for family planning.
 Information is used for recording events over a period of 8-10
years during the time when the woman is not pregnant.
 The community health worker or the mother can use this panel
to record information regarding menstruation, breast-feeding
and family planning methods adopted during the reference
period.
 The presence of pallor, extreme thinness, malaria and other
health problems can also be recorded.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
2. FUNCTION OF THE HOME-BASED MOTHER’S RECORD
EARLY IDENTIFICATION OF RISKS
 The home-based mother’s record is designed to provide a
simple way of screening for the presence of risk factors.
 It serves to alert primary health care workers, such as
traditional birth attendants and community health workers, so
that high-risk cases can be referred early and the appropriate
measures taken quickly to prevent further complications.
 With help from health workers and voluntary groups, mothers
and family members can learn to use home-based maternal
records themselves to detect the presence of risk factors.
 Surveillance for the identification of risk factors helps to
establish contact with women and newborn infants during their
most susceptible period.
 At the same time, it also provides an excellent opportunity for
health education, for promoting self-care, and for planning and
instituting appropriate measures to control major public health
problems.
SELF-DIAGNOSIS AND SELF-CARE
 Among literate women, HBMR are better understood and used
if filled in by record-holders themselves.
 In a control trial in UK, it has been shown that women liked
keeping their own records and significantly felt more in control
of their antenatal care and found that records made it easier to
talk to their health care workers.
 In developing countries, where the literacy rate among women
is very low, literate family members other than the record-
holders, can, after some instructions, fill in the records, explain
the risk signs of mothers and thus help in the process of self-
diagnosis and self-care.
 After necessary explanations, illiterate mothers participating in
the WHO collaborative study were able to recognize risk
conditions.
 In the Philippines, illiterate mothers who had a Home based
maternal record since their previous delivery could recall the
risk factors that they had experienced in that pregnancy and
describe the action that they had taken themselves
PREVENTIVE AND PROMOTIONAL HEALTH CARE
 Home-based mother’s record provides printed information to
help in health promotion and prevention of risk.
o For example, they can be used by community health workers
and traditional birth attendants in conjunction with health
and nutrition education to provide reminders about diet
during pregnancy and the postpartum period, intake of
locally scheduled doses of iron and folic acid tablets, malaria
prophylaxis and management, and vitamin A intake.
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 MATERNAL AND CHILD HEALTH PROGRAM
 The section of the record concerned with interpregnancy
periods can play an important role in educating mothers about
contraception and proper spacing of children, and in promoting
breast-feeding.
 When menstrual history is monitored regularly, pregnancies
are identified very early and the necessary care can be
initiated.
 The record can also incorporate information on monitoring for
cervical cancer (Pap smear), rhesus blood group incompatibility
(blood group assessment), screening tests for sexually
transmitted diseases and acquired immunodeficiency
syndrome (AIDS), and on rubella and hepatitis immunizations.
 Information on newborn infants concerning, for example, birth
weight and immunization against tuberculosis, diphtheria,
pertussis, tetanus and poliomyelitis, can also be incorporated
which prompts improved immunization coverage and identifies
low-birth-weight babies who may need special care at home or
referral to hospital.
CONTINUITY OF CARE
 It is just as important for women to preserve their health
between pregnancies as during pregnancy and childbirth: poor
nutritional status, anemia, infections, heavy physical work and
other stresses and strains in the inter-pregnancy period can
adversely affect subsequent pregnancy, labor and postpartum
events, possibly leading to low birth weight or the death of the
mother or baby.
 Home-based maternal records can then make an important
contribution to continuity of care throughout a woman’s
reproductive life, as it can be used for monitoring during both
pregnancy and inter-pregnancy periods for up to 8-10 years,
and this can be extended, if appropriate, by adding further
pregnancy panels and increasing the space allowed for inter-
pregnancy periods.
 Monitoring of menstrual history also helps in early identification
of pregnancy and in guiding family planning
REFERRALS AND APPROPRIATE UTILIZATION OF HEALTH
SERVICES
 Early detection of risk using home-based mother’s record helps
to channel those women most in need to referral facilities, while
those not at risk are managed in the community, thus
promoting better utilization of health services.
 The WHO collaborative study showed that the use of home-
based maternal records prompted referrals of ‘at-risk’ women
and newborn babies.
 Women found the record a useful “passport” to referral centers
in ensuring prompt service; they said that with the card,
‘someone knows and takes better care of us at the health
center’.
FAMILY PLANNING
 One of the important functions of HBMR is to provide
information on the menstrual status and parity of women.
 This helps community health workers and nurse-midwives to
educate and motivate couples on the use of suitable family
planning methods, and can also be used in detecting and
providing guidance to couples with primary or secondary
sterility.
COLLECTION OF HEALTH INFORMATION
 Reporting systems in current use do not always provide reliable
data and there is often lack of information at the most basic--
but most important—level of health care.
 In developing countries, more than half the women give birth
at home.
o Many cannot reach or contact a health worker and therefore
have no records.
 The forms used in community-based health information
systems should be simple and easy to fill in and contain
relevant data on factors likely to influence the health of
pregnant women and outcome of pregnancy.
 The format would be such that information can be easily
abstracted for reporting purposes and is available both in the
home and health center.
 Linking information from HBMRs with existing health
information systems can serve a number of purposes including
program planning, management, monitoring, surveillance, and
evaluation and assessment of health status.
VITAL Births; maternal, perinatal, and neonatal
EVENTS deaths; age of death; pregnancy rates, etc.
“AT RISK” Proportion in the population, prevalence of
CASES “at-risk” conditions, referral, outcome
HEALTH Surgical deliveries, anemia prophylaxis,
COVERAGE tetanus toxoid and vitamin A coverage
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
Low birth weight, nutritional status, family
SPECIFIC planning (eligible couples, spacing methods,
PROGRAMS infertility)
COMMUNITY INVOLVEMENT
 The potential for family and community members to improve
the health and nutritional status of women and newborn babies
through self-monitoring and self-care has remained largely
unrecognized
 Once the community understands how to recognize the risks of
morbidity and mortality, it can cooperate in managing and
controlling risk conditions
 It can also tackle social and economic risks by such means as
providing transport for a woman’s referral visit, arranging to
send an attendant with the woman, and reducing health care
costs through self-care.
3. POTENTIAL BENEFITS OF HOME-BASED RECORDS
 Because HMBR are simple and can be kept at home, they have
a number of potential benefits as an aid to health care for
mothers and family members, as well as for health-care
providers and programme managers
 However, mother and other family members will need help
from health workers or voluntary groups, particularly if they
are illiterate, to gain maximum benefit from the records
POTENTIAL BENEFITS TO WOMEN AND FAMILY MEMBERS
 Encouraging continuity of care during pregnancy, labour and
post-partum and inter-pregnancy periods
 Promoting self-detection of risks and initiation of timely action
 Increasing awareness of health problems and availability of
health-care facilities
 Prompting timely visits to referral centers
 Serving as passports to care at health centers
 Fostering confidence in primary health workers and referral
centers
 Encouraging family and community participation in health care
 Providing a readily accessible record within the family
 Encouraging family planning, breast-feeding, immunizations
and improved nutritional status
 Saving time and money
POTENTIAL BENEFITS TO PHYSICIANS AND NURSE-
MIDWIVES
 Prompt referral of at risk women for actions to reduce
complications and maternal and fetal/infant deaths
 Preventing overcrowding at referral centers
 Providing information on previous pregnancies, immunizations
and family planning
 Improving monitoring of the progress and outcome of labor
 Providing important health data
 Improving relationships with women
 Helping to strengthen links among health workers
 Reducing the need for maintenance and storage of records in
referral centers
 Helping to standardize the services provided to pregnant
women and newborn infants
POTENTIAL BENEFITS TO TRADITIONAL BIRTH
ATTENDANTS AND COMMUNITY HEALTH WORKERS
 Improving of detection of high risk cases
 Enhancing credibility and increasing confidence in the care
provided
 Helping to build and maintain a good relationship with women
and their families
 Improving the coverage with tetanus toxoid vaccine and, in
malaria and endemic areas, the detection, treatment and
prophylaxis of malaria
 Promoting family planning and breast-feeding
 Promoting growth monitoring through links and child growth
records
 Records information on migration of women and on specific
local problems such as goiter, vitamin A deficiency, cancer of
the cervix and AIDS
POTENTIAL BENEFITS TO PROGRAM MANAGERS
 Helping in the introduction of a simplified at-risk approach in
health care delivery systems
 Strengthening the referral system
 Improving the coverage of vulnerable groups (mother and
children)
 Contributing to the achievement of health targets in family
planning, breast-feeding, immunization, cervical smear
testing, etc.
 Helping to involve communities and their resources in health
care
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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
 Providing data to help estimate current and future 3. Respiratory distress of
requirements, streamline logistic support for clinics and health 2,526 1.4 11.2
newborn
centers and compile national health statistics 4. Congenital malformation of
 Improving the accountability to the community of health 1,572 0.9 7.0
the heart
personnel
5. Disorders related to short
NATIONAL POLICY ON gestation and low birth weight, 1,487 0.8 6.6
INFANT AND YOUNG CHILD FEEDING (IYCF) not elsewhere classified
STATISTICS AND TRENDS 6. Congenital pneumonia 1,095 0.6 4.9
MATERNAL MORTALITY RATE (MMR) 7. Neonatal aspiration
1,079 0.6 4.8
 MMR in the Philippines syndrome
o 1990: 209/100,000 livebirths 8. Intrauterine hypoxia and
o 1998: 172/100,000 livebirths, () 950 0.5 4.2
birth asphyxia
o 2006 162/100,000 livebirths, ()
9. Other congenital
o 2011: 221/100,000 livebirths, () 941 0.5 4.2
o Recent reports by WHO, UNICEF, The World Bank and the malformations
UN Population Division: 120/ 100,000 livebirths, () 10. Diarrhea and
 Despite decrease in MMR, health officials predict that the 2015 gastroenteritis of presumed
Millennium Development Goal of 52 per 100,000 live 900 0.5
infectious
births will not be met. Origin

PROFILE/ RATIONALE OF THE HEALTH PROGRAM

 WHO and UNICEF issued a global strategy for IYCF in 2002.
o AIM: to reverse the disturbing trends in infant and young
child feeding practices.
 In 2004, WHO assessment protocol was used to assess infant
and young child feeding practices. However, the rating was
poor to fair.
o 4/10: initiated to breastfeeding an hour after birth
o 3/10 infants < 6 mos: exclusively breastfed
o 13 months: median duration of breastfeeding
o 57.9 percent: children 6-9 months who received
complementary foods while continuing to breastfed;
resulted to a rating of poor using the complementary
feeding indicator.
o <2 months: age when complementary foods were
introduced (too early)

Figure. Maternal Mortality by Main Cause, from the 2010

 The 1st National IYCF Plan of Action was formulated to
Philippine Health Statistics
address these problems on infant and young child feeding
practices.
 Causes of maternal deaths are hemorrhage, sepsis, obstructed
o Aim: To improve the nutritional status and health of
labor, hypertensive disorders in pregnancy, and complications
children especially the under-three and consequently
of unsafe abortion  most are preventable with proper
reduce infant and under-five mortality.
diagnosis and intervention.
o Specific Objectives
 The maternal mortality ratio in the Philippines is listed as
 To improve, protect and promote infant and young
the MDG least likely to be achieved by 2015.
child feeding practices
 The country has an adjusted maternal mortality ratio of
 To increase political commitment at all levels
160/100,000 live births against a goal of 55-60 deaths/
 To provide a supportive environment
100,000 live births.
 To ensure its sustainability.
 Highest MMR: Region 11 (1.08/1,000 live births)
o The main efforts were directed towards creating a
supportive environment for appropriate IYCF practices
o Administrative Order (AO) 2005-0014: National
UNDER-FIVE, INFANT, AND NEONATAL MORTALITY Policies on IYCF  intended to guide health workers and
 Targets for infant and under-five mortality rates remain to be other concerned parties in ensuring the protection,
achievable by 2015. promotion and support of exclusive breastfeeding and
 Number of infant deaths: adequate and appropriate complementary feeding with
o 2006: 24/1,000 live births continued breastfeeding.
o 2011: 22/1,000 live births, ()
 Number of under-five deaths
o 2006: 32/1,000 live births
o 2011: 30/1,000 live births, ()
 Under-5 Mortality rate (U5MR): 30  the probability of
dying between birth and exactly five years of age, expressed
per 1,000 live births; the Philippines rank 75th worldwide
 Highest infant mortality: NCR (19.88/1,000 live births)  with
significant discrepancy compared to the other regions

Table. Top Ten Leading Causes of Infant Mortality, from the

2010 Philippine Health Statistics
INFANT MORTALITY: TEN (10) LEADING CAUSES
NUMBER AND RATE per 1000 live births AND
PERCENTAGE DISTRIBUTION
Philippines, 2010
Cause Number Rate Percent
1. Bacterial sepsis of newborn 3,608 2.0 16.1
2. Pneumonia 2,628 1.5 11.7

Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS Page 13 of 32

 MATERNAL AND CHILD HEALTH PROGRAM
GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS
GOAL
Reduction of child mortality and morbidity through optimal
feeding of infants and young children
MAIN OBJECTIVE
To ensure and accelerate the promotion, protection and
support of good IYCF practice
OUTCOMES
 By 2016:
o 90% of newborns are initiated to breastfeeding within
one hour after birth
o 70% of infants are exclusively breastfeed for the first
6 months of life
o 95% of infants are given timely adequate and safe
complementary food starting at 6 months of age
TARGETS
 By 2016:
o 50% of hospitals providing maternity and child health
services are certified MBFHI;
o 60% of municipalities/cities have at least one functional
IYCF support group;
o 50% of workplaces have lactation units and/or
implementing nursing/lactation breaks;
o 100% of reported alleged Milk Code violations are acted
upon and sanctions are implemented as appropriate
o 100% of elementary, high school, and tertiary schools
are using the updated IYCF curricula including the
inclusion of IYCF into the prescribed textbooks and
teaching materials
o 100% of IYCF related emergency/disaster response
and evacuation are compliant to the IFE guidelines
TARGET BENEFICIARIES
 Infants (0-11 months)
 Young children (12 to 36 months years old or 1 to 3 years
old)
POLICY GUIDELINES
BREASTFEEDING PRACTICES
1. Early initiation of breastfeeding
 Breastfeeding is unequalled in providing nutrition to
infants; and is an integral part of the reproductive process,
giving health benefits to the mother as well
 It stimulates full milk production and bonding between
infant and child
 All medical personnel are to support breastfeeding
 The health care delivery system shall ensure that all
newborns are initiated into breastfeeding within an hour
after delivery
2. Exclusive breastfeeding for the first 6 months
 To ensure optimum growth and development
 No other means of sustenance shall be used, except for
vitamins and medicine drops
 Unrestricted breastfeeding results in ample milk
production
 Experts conclude that there are no observable deficits in
growth for infants exclusively breastfed for 6 months or
more
 Reduction of morbidity due to GI infections and mothers
remain w/ amenorrhea for 6 months postpartum
3. Extended breastfeeding up to two years and beyond
 Continued breastfeeding as frequent and on demand for
up to 2 years and beyond
COMPLEMENTARY FEEDING PRACTICES
1. Appropriate complementary feeding: infants shall be given
appropriate complementary foods at age 6 months in order to
meet their evolving nutritional requirements
 Timely: provided when need for nutrition is exceeded by
what can be provided
 Adequate: provide enough to meet needs of the child
 Safe: hygienically stored and prepared, fed with clean
hands and utensils
 Properly fed: given consistent with a child’s signal of
appetite and satiety
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
2. Ensure access to appropriate complementary foods:
Feeding interventions shall be provided to ensure access to
foods that adequately meet energy and nutrient needs with the
use of home and community based technologies to enhance
nutrient density, bio-availability and micronutrient content.
3. Use of locally available and culturally acceptable food
 Provision of sound and culturally-specific nutrition
counselling and recommendations on indigenous
foodstuffs
 The agricultural sector shall play an important role in
ensuring affordable and available foodstuffs
4. Low-cost complementary foods/ industrially processed
foods
 Prepared with locally available ingredients using small-
scale production technologies
 Industrially processed complementary foods is also an
option who have the means to buy them and knowledge of
their preparation
 Processed foods shall meet the applicable standards
recommended by the Codex Alimentarius Commission and
the Codex Code of Hygiene Practice for Foods for Infants
and children
MICRONUTRIENT SUPPLEMENTATION
1. Universal vitamin A supplementation
 Infants and children 6-71 months of age
 Vitamin A given to children at risk, those with measles,
persistent diarrhea, sever pneumonia and malnutrition
 Post-partum women shall be given vitamin A capsules
within one month after delivery to increase vitamin A in
her breast milk
 Children during emergencies shall be a priority for
vitamin A supplementation
2. Iron supplements
 Pregnant and lactating women and low birth weight
babies, and children 6-11 months of age
 Anemic and underweight children 1-5 yrs. old shall also
receive iron supplements
3. Iodine supplementation
 Women of reproductive age, school age children and adult
males when urinary iodine excretion is less than 50µg/L in
more than 20% of the population
UNIVERSAL SALT IODIZATION (USI)
 Families shall be encouraged and educated to use iodized salt
in food preparation for older infants and younger children
FOOD FORTIFICATION
 Food fortification of staple foods will help ensure older infants
and young children receive adequate amounts of
micronutrients.
 The DOH shall encourage manufacturers to fortify processed
foods based on BFAD standards.
EXERCISING OTHER FEEDING OPTIONS
 Most mothers can and should breastfeed, just as most infants
can and should be breastfed.
 For those few health situations where infants cannot, or should
not, be breastfed, the choice of the best alternative depends
on individual circumstances
o Expressed breast milk from an infant’s own mother
o Breast milk from a healthy wet-nurse
o Human-milk bank
o Breast-milk substitute fed with a cup safer method than
a feeding bottle and teat
 Only under exceptional circumstances can a mother’s milk be
considered unsuitable for her infant. There are three metabolic
disorders that may interfere with breastfeeding:
1. Galactosemia
 Infants suffering from this disease cannot be fed
either breastmilk or other infant or milk formula since
lactose must be eliminated from the diet of these
infants.
 Specially formulated milk-based, but lactose-free
preparations or soya-based formula are required.
2. Phenylketonuria
 Infants suffering from phenylketonuria may be
breastfed while their phenylalanine blood levels are
monitored.
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 MATERNAL AND CHILD HEALTH PROGRAM
 Breast milk should be supplemented with or replaced
by a special low-phenylalanine formula if
concentrations reach dangerous levels.
3. Maple Syrup Urine Disease
 As in the case of phenylketonuria, breast milk can be
combined with special synthetic formulas low in the
non-tolerated amino acids.
 For infants who do not receive breast milk, feeding with a
suitable breast-milk substitute shall be demonstrated only by
health workers, or other community workers if necessary,
and only to the mothers and other family members who
need to use it; and the information given shall include
adequate instructions for appropriate preparation and the
health hazards of inappropriate preparation and use.
o Infant formula
o Other specially prepared formula that conform with
applicable Codex Alimentarius standards
o Home-prepared formula with micronutrient supplements
 Infants who are not breastfed, for whatever reason, shall
receive special attention from the health and social welfare
system since they constitute a risk group.
FEEDING IN EXCEPTIONALLY DIFFICULT
CIRCUMSTANCES
1. As a general rule, the following is the range of feeding options
for infants and young children in certain circumstances and
during times of crisis:
 Breastfeeding is the first and best feeding option for
infants
 Expressed breastmilk, fed by cup
 Breastfeeding from healthy wet nurse
 Human milk from milk bank, fed by cup
 Infant formula (preferably generically labelled), fed by cup
2. Families in difficult situations including but not limited to natural
or human-induced calamities, shall require special attention and
practical support to be able to feed their children adequately.
 Wherever possible, mothers and babies shall remain
together and be provided the support they need to
exercise the most appropriate feeding option under the
circumstances.
3. Health workers shall ensure the protection, promotion and
support on breastfeeding and timely, safe, and appropriate
complementary feeding.
 In exceptional cases, when a small number of infants have
to be fed on breast-milk substitutes and milk supplements,
ensure that substitutes/supplements, such as infant
formula is safe, suitable and prepared in accordance with
applicable Codex Alimentarius standards, or a home-
prepared formula with micronutrient supplements.
4. Artificial feeding is difficult in these situations because the basic
needs for artificial feeding such as clean water, fuel and utensils
are scarce. Transport and adequate storage conditions of
breastmilk substitutes cause additional problems. To minimize
the risks of artificial feeding and avoid commercial exploitation
of crises, the following procedures are recommended:
 Donations of breast-milk substitutes, feeding bottles, teats
and commercial baby foods should be limited, if not
refused.
 If needed, breastmilk substitutes should never be part of
a general distribution. Distribution should only be to
infants with a clear need, and for as long as the infant need
them (until a maximum of 1 year or until breastfeeding is
re-established).
 Bottles and teats should never be distributed, and their
use should be discouraged. Cup feeding should be
encouraged instead.
 Information on adequate preparation and the hazards of
inappropriate preparation of breast-milk substitutes or
milk supplements should be given.
 Uncontrolled distribution of infant formula or milk
supplements during difficult situations can lead to early
and unnecessary cessation of breastfeeding. More detailed
guidelines shall be developed in collaboration with the
national disaster coordinating body and health teams and
provided to local government units and others concerned.
5. Infants and young children who are malnourished are most often
found in environments where improving the quality and quantity
of food intake is particularly problematic.
 To prevent a recurrence and to overcome the effects of
chronic malnutrition, these children need extra attention
both during the early rehabilitation phase and over the
longer term.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
 Nutritionally adequate and safe complementary foods may
be particularly difficult to obtain and dietary supplements
may be required for these children.
 Continued frequent breastfeeding and, when necessary,
relaxation are important preventive steps since
malnutrition often has its origin in inadequate or disrupted
breastfeeding.
6. The proportion of infants with low birth weight is about 13%.
 Most are born at or near term and can breastfeed within
the first hour after birth.
 Breast milk is particularly important for preterm infants
and the small proportion of term infants with very low birth
weight; they are at increased risk of infection, long-term
ill health and death.
7. Feeding options for HIV positive mothers
 Despite that HIV infection is reported to be slow and low
in the Philippines, there is a need to address concern on
the absolute risk, of HIV transmission through breast
feeding for more than 1 year, which is globally between
10-20%.
 On the other hand, there is a need to balance the concern
of HIV transmission through breastfeeding with the
increased risk of morbidity and mortality when infants are
not breastfed.
 All HIV infected mothers shall receive counseling, which
includes provision of general information about meeting
their own nutritional requirements and about the risks and
benefits of various feeding options, and specific guidance
in selecting the option most likely to be suitable for their
situation.
 Feeding options for HIV positive mothers include exclusive
breastfeeding, wet-nursing, expressing and heating
treated breastmilk, and breastmilk from banks,
commercial infant formula and home modified animal milk.
 Mothers shall be supported in their feeding options.
8. Children living in special circumstances also require extra
attention
 orphans and children in foster care
 children born to adolescent mothers
 mothers suffering from physical or mental disabilities
 drug- or alcohol dependence
 mothers who are imprisoned or part of disadvantaged or
otherwise marginalized populations
SUPPORT SYSTEM
1. Mothers, fathers and other caregivers shall have access to
objective, consistent and complete information about
appropriate feeding practices, free from commercial
influence.
 Includes recommended period of early initiation, exclusive
and continued breastfeeding; the timing of the
introduction of complementary foods; what types of food
to give; the quantity, frequency; and how to feed these
foods safely.
 Where fathers are concerned, research shows that breast-
feeding is enhanced by the support and companionship
they provide as family providers and caregivers.
2. Mothers shall have access to skilled support to help them
initiate and sustain appropriate feeding practices, and to prevent
difficulties and overcome them when they occur.
3. Infant and Young Child Feeding “specialist” to respond to
common problems of mothers to initiate and sustain
exclusive and continued breastfeeding practices, and other
feeding difficulties, shall be accessible to mothers.
 The most common reasons for never breast feeding and
those who stop breastfeeding include:
o Insufficient milk
o Breast and nipple problem
o Weaning age
o Child refusal
4. Community-based networks offering mother-to-mother
support, and training breastfeeding counselors working
within, or closely with, the health care system, also have an
important role to play in this regard.
5. A communication and marketing plan shall be developed to
generate high political support at all levels including
communities and families.
6. The Mother Baby Friendly Hospital Initiatives (MBFHI)
shall be reviewed, accelerated and sustained. Efforts shall focus
on the sustenance of certified MBF hospitals in the country
to comply with the 10 steps to Successful Breastfeeding.
7. The Rooming In and Breastfeeding Act (R.A. 7600) shall
be strictly enforced in all the hospitals of the country to ensure
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 MATERNAL AND CHILD HEALTH PROGRAM
the fulfillment of the right of mothers to breastfeed and right of
children to be breastfed.
8. All health facilities, public or private, in the health care system
in the Philippines shall provide a supportive environment to
Infant and Young Feeding practices through compliance to
the Philippine Code of Marketing of Breast-milk
Substitutes  shall not display any breastmilk substitute or
any poster or sampling of such
9. Hospitals shall support and provide an enabling environment for
mothers to ensure continued breastfeeding and adequate
complementary feeding to their hospitalized sick
children.
10. Continuing training programs for promoting, protecting,
support and improving Infant and Young feeding shall be
institutionalized for pre-service and in-service health providers.
11. Work places shall provide an enabling environment for
breastfeeding mothers who return to work. This can
include:
 Breastfeeding rooms
 Refrigerators for storage of breastmilk
 Crèches
 Breaks for breastfeeding or expressing milk
12. Mothers shall also be able to continue breastfeeding and
caring for their children after they return to paid
employment. These shall be available:
 Maternity leave
 Day-care facilities
 Paid breastfeeding breaks
13. The Department of Health as the lead agency shall ensure
the fulfilment of the rights of children to the highest attainable
standard of health care and nutrition
14. Consistent with the accepted principles for avoiding conflict of
interest, the Department shall not forge partnerships with
manufacturers and distributors of infant formula, milk
supplements, complementary foods, feeding bottles and teats
and other related products.
ADVANTAGES OF BREASTFEEDING
Benefits for Children
 The benefits of breastfeeding begin from the first moments
after childbirth and last for many years after breastfeeding
ends.
 Compared with formula-fed children, those who are breastfed
are healthier and have fewer symptoms and shorter illnesses
when they do get sick.
 Breastfed children:
 Score higher on cognitive and IQ tests at school age,
and also on tests of visual acuity
 Have a lower incidence of sudden infant death
syndrome (SIDS)
 Less likely to suffer from infectious illnesses and their
symptoms (e.g., diarrhea, ear infections, respiratory tract
infections, meningitis)
 Have a lower risk of Crohn’s Dse & ulcerative colitis
 Suffer less often from some forms of cancer (e.g.,
Hodgkin’s disease, childhood leukemia)
 Have a lower risk of juvenile onset diabetes, if they
have a family history of the disease and are breastfed
exclusively for at least 4 months
 Significantly protected against asthma and eczema,
if at risk for allergic disorders and exclusively breastfed for
at least 4 months
 May have a lower risk of obesity in childhood and in
adolescence
 Have fewer cavities, less likely to require braces
 Breastfeeding provides benefits not just for full-term infants
but also for premature and low birth weight infants. Compared
with premature infants who receive human milk, those who
receive formula have future IQs that are 8–15 points lower.
 For premature infants, human milk:
 Significantly shortens length of hospital stay
 Reduces hospital costs
 Hastens brainstem maturation
 Reduces the risk of life-threatening disease of the
gastrointestinal system and other infectious diseases
Benefits for Mothers
1. Less likely to develop ovarian and pre-menopausal
breast cancers. The more months a woman has spent
breastfeeding, the greater the beneficial effect.
2. Reduces osteoporosis.
3. Quicker recovery after childbirth, with reduced risk of
postpartum bleeding
4. More likely to return to their pre-pregnancy weight
5. Reduces the risk for long-term obesity.
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
6. Reduces the risk of anemia by delaying the return of the
menstrual cycle for 20 to30 weeks.
7. Prevents pregnancy (exclusive breastfeeding for the first
6 months postpartum, in the absence of menses, is 98
percent effective)
8. More confident and less anxious
9. Contributes to feelings of attachment between a mother
and her child.
STRATEGIES IN THE PROMOTION OF BREASTFEEDING
 GOAL: The overall goal of the program is the reduction of child
mortality and morbidity through optimal feeding of infants and
young children
 INTERVENTION FOCUS
 Health Facility(all levels )
 Family, Community & Public Place Workplace (Formal and
Informal)
 School (Different Levels)
 Industry (Monitoring & Compliance)
(Please see appendix for the summary of strategies)
STRATEGIES  ACTION POINTS  INTERVENTIONS 
GOAL!!!
IMPLEMENTING MECHANISMS OF STRATEGIES
A. Management
 At the national level, the over-all management of the IYCF shall
be the responsibility of a Management Committee of the
Department of Health:
o National Center for Disease Prevention and Control
(NCDPC)
o National Center for Health Facility Development (NCHFD)
o Bureau of Food and Drugs (BFAD)
o Bureau of Health Facility Services (BHFS)
o National Center for Health Promotion (NCHP)
o Bureau of Local Health Development (BLHD)
o Dr. Jose Fabella Memorial Medical Center (also designated
IYCF National Training Institution)
 The NCDPC staff shall act as the Secretariat and convenor of
the Committee.
 National IYCF Coordinators or focal persons from
concerned offices shall be designated for the major
components of the program:
o Mother and Baby Friendly Hospital Initiatives: NCHFD
o Enforcement of E.O. 51 (Milk Code) & R.A. 7600: BFAD
o Public Health Initiatives: NCDPC
B. Supervision, Monitoring, Evaluation
 Periodic monitoring and evaluation of the progress of the
implementation of the IYCF Strategy shall be established,
institutionalized and integrated with other MCH reviews.
 Monitoring of the different indicators shall be integrated into the
DOH Monitoring Coaching Team and the regular hospital
assessment system.
 National as well as regional monitoring teams shall be
strengthened to ensure strict compliance to the laws in support
of IYCF.
 Incentive and award system shall be planned to sustain efforts
on promoting, protecting and improving infant and young child
feeding.
 The National Nutrition Council gives regular awards for
local government units.
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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
 Models of good practice shall be documented and disseminated
to stakeholders including local government units.  LGU Ordinances & Guidelines
 Advocacy with LGU Stakeholders
C. Research & Development o PowerPoint presentations and
 Continuing clinical and population-based research and hand-outs for LCEs and TSEK Peer
STEP 1:
investigation of behavioral concerns are essential ingredients Counselors for use of CHDs
FORMAL LGU
for improving feeding practices. o Visual promotional materials to be
SUPPORT
 Crucial areas include: used by Mayors/ LGUs
o Improving access to breastfeeding support, o Sample press stories, radio scripts
o Programmatic approaches and community-based for Mayors/LGUs to promote local
interventions for improving breastfeeding and initiatives on keeping mother and
complementary feeding practices, baby safe and healthy
o Improving maternal nutritional status and pregnancy  Training of Peer Counselors (PCs):
outcome, o A Training Institution , ARUGAAN,
o Interventions for preventing mother-to-child transmission was hired to conduct the Peer
of HIV in relation to infant feeding. Counselor’s Training- training
design is done and trainer’s
BREASTFEEDING TSEK reference manual being finalized
STEP 2:
after the pilot run in 3 cities
TRAINING OF
o PC trainings conducted in Quezon
PEER
City, Marikina, Pasig, Taguig,
COUNSELORS
Caloocan, Navotas, Parañaque,
Pasay, Mandaluyong, Makati - a
total of about 1,800 PCs trained
o Mentoring done in Quezon City,
Marikina, Pasig, Taguig, Caloocan,
Navotas, Parañaque

 House to House Visits

 TSEK: (Tama, Sapat, at EKsklusibo)” STEP 3:  Practicum w/ Mentors
 The primary target: new and expectant mothers in urban MENTORING  Regular monthly meetings w/ midwives
areas DONE AT THE to process (share and learn)
 Encourages mothers to exclusively breastfeed their BARANGAY experiences in actual counseling
babies from birth up to 6 months
 Aims:
o Establish a supportive community
o Promote public consciousness on the health benefits of
breastfeeding
 Lower risk of diarrhea, pneumonia, and chronic illnesses
 Specific strategies:
o Appropriate home care and timely treatment of STEP 4:
complications for newborns MONITORING
o Integrated management of childhood illness for all children WITH TSEKLIST
under five years old CARD
o Expanded program on immunization
o Infant and young child feeding
 THE MDG-F JOINT PROGRAM
o The Breastfeeding TSEK campaign is a component of the
Joint Program by the UN Country Team to help the
Philippines achieve MDG # 1 and 4
 Supported by the Spanish Government
 Advocacy Kits & Materials
 It is called the MDG-F 2030: Ensuring Food Security and STEP 5:
 Joint issuance with DSWD, Dep Ed,
Nutrition for Children 0-24 months in the Philippine MOBILIZING
DILG, Civil Service
LGU
 MOAs with NGOs, civic and professional
PARTNERSHIPS
societies and groups

 Enact LGU policy allocating resources

for Breastfeeding TSEK
 Build breastfeeding facilities
 Expand and motivate the TSEK Peer
Counsellors
 Strengthen mothers education
 Build capacity of health facilities & LGU
health professionals for safe & quality
Essential Intrapartum and Newborn
Care or “Unang Yakap”
STEP 6:
SUSTAIN
BREASTFEEDING
TSEK

BREASTFEEDING TSEK IN LGUs

 Key Action Steps
1. Update LGU Ordinances & Health Policies
2. Train LGU Health Staff & TSEK Peer Counsellors
3. Develop the Breastfeeding TSEK Plan & incorporate into
LGU Health Plan
4. Mobilize TSEK Counsellors and build strong community
support STATUS OF THE PROGRAM
5. Mobilize private sector support: private health sector, *See Appendix
academe, business,
6. Monitor, Innovate & Sustain Breastfeeding TSEK

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
ROOMING-IN ACT
REPUBLIC ACT 7600: “THE ROOMING-IN AND BREAST- d. Formula feeding - the feeding of a newborn with infant
FEEDING ACT OF 1992” formula usually by bottle feeding (aka artificial feeding)
 ROOMING-IN
e. Human Milk Bank – is a service established for the
o The practice of placing the newborn in the same room as
purpose of collecting, screening, processing, storing,
the mother right after delivery up to discharge to facilitate
and distributing donated human milk to meet the
mother-infant bonding and initiate breastfeeding
specific medical needs of individuals for whom milk is
o The infant may either share the mother’s bed or be placed
prescribed
in a rib beside the mother
f. Incentives – The expenses incurred by a private health
o Act of 1992
and non-health institution, establishment or institution,
 To encourage, protect and support the practice of
in complying with the provisions of the Act, shall be
breastfeeding by creating an environment where basic
deductible expenses for income tax purposes up to twice
physical, emotional, and psychological needs of mothers
the actual amount incurred: provided, that the
and infants are fulfilled through the practice of rooming-
deduction shall apply for the taxable period when
in and breastfeeding
the expenses were incurred: provided, further, that all
 REPUBLIC ACT 7600
health and non-health facility, establishments and
o Mandated all private and government health institutions to
institutions shall comply with the provisions of
practice rooming-in and breastfeeding under the provision
The Act within six (6) months after its approval
written in chapter I section 4
o Section 5 of the same chapter indicated that in
g. Lactation stations – private, clean, sanitary, and well-
 NORMAL SPONTANEOUS DELIVERIES: Well infants
ventilated rooms or areas in the workplace or public
regardless of age of gestation as well as infants with
places where nursing mothers can wash up,
low birth weights but who can suck shall be put to
breastfeed or express their milk comfortably and
the breast of the mother immediately after birth and
store this afterward (aka breastfeeding
forthwith roomed-in within thirty (30) minutes
room/area/station)
 CAESAREAN DELIVERIES (SECTION 6): Mandated
rooming – in and breastfeeding of infants within 3 – 4
h. Milk Storage Facility – any private, clean, sanitary and
hours after birth
well-ventilated area or space in a health institution
 NEWBORNS DELIVERED OUTSIDE THE HEALTH
designated for the purpose of collecting and storing
INSTITUTIONS: Have met the general conditions stated
milk among mothers separated from their own babies
in Section 5 of this Act shall also be roomed-in and
due to medical reasons
breastfed immediately (Section 7)
o EXEMPTIONS to the provisions of Section 5, 6, and 7 are
i. Networking – the process of linking up diverse
given to infants whose conditions do not permit
individuals or groups bringing about their mutual
rooming-in and breastfeeding as determined by the
agreement to share one another’s resources and
attending physician, and infants whose mothers are
competencies as a way of serving mutual interests
either:
a. Seriously ill
j. Nursing employee - any female worker, regardless of
b. Taking medications contraindicated to
employment status, who is breastfeeding her infant
breastfeeding
and/or young child
c. Violent psychotics
d. Whose conditions do not permit breastfeeding and
k. Philippine Health Promotion Program through
rooming-in as determined by the physician
Healthy Places (PHPP) – a national multi-sectoral
o In section 9 of RA 7600, the right of the mother to
health promotion strategy which aims to communicate
breastfeed is indicated
health messages and build health supportive
o Bottle feeding shall be allowed only after the mother has
environment through advocacy, networking and
been informed by the attending health personnel of the
community action as per Administrative Order No. 341:
advantages of breastfeeding and the proper techniques of
Implementing PHPP through Healthy Places
infant formula feeding and the mother has opted in writing
to adopt infant formula feeding for her infant
l. Rooming-in - the practice of placing the newborn in the
o In 2009, a new law was passed amending RA 7600
same room as the mother right after delivery up to
 REPUBLIC ACT No. 10028 otherwise known as the
discharge to facilitate mother-infant bonding and to
"Expanded Breastfeeding Promotion Act of 2009"
initiate breastfeeding; the infant may either share the
mother's bed or be placed in a crib beside the mother
REPUBLIC ACT No. 10028: "Expanded Breastfeeding
Promotion Act of 2009" m. Seriously ill mothers - are those who are: with severe
 Promote breastfeeding not only in health institutions but as infections; in shock, in severe cardiac or respiratory
well as to all non-health establishments that not covered in distress; or dying; or those with other conditions that
RA 7600 may be determined by the attending physician as
 All entities to which this is applicable are mandated to build serious
lactation stations
 The state shall protect working women by providing safe n. Wet-nursing - the feeding of a newborn from another
and healthful working conditions, taking into account their mother's breast when his/her own mother cannot
maternal functions, and such facilities and opportunities that breastfeed
will enhance their welfare and enable them to realize their
full potential in the service of the nation o. Young child - a child from the age of twelve (12)
 In RA 10028, 6 sections were removed and amended: months and one (1) day up to thirty-six (36)
a. Section IV. Applicability months
b. Section V. Normal Spontaneous Deliveries
c. Section VI. Deliveries by Caesarian  Other terms include advocacy, bottle feeding, breastfeeding,
d. Section VII. Deliveries outside Health Institutions breastmilk, breastmilk substrate, expressing milk, formula
e. Section VIII. Exemptions feeding, health institutions, health personnel, health
f. Section IX. Right of the Mother to Breastfeed. promotion, health workers, health workplace, infant, infant
 To be better understand the new law, important terms taken formula, low birth weight infant, milk donor, mother’s milk,
from section 3 of the law must be defined: non-health facilities, private sector organizations, public
a. Age of gestation - the length of time the fetus is inside sector, public place, workplace, and workplace policy
the mother's womb

b. Donor milk - the human milk from a non-biological

mother BREASTFEEDING IN THE WORKPLACE AND PUBLIC
PLACES
c. Expressed breastmilk - the human milk which has  "Expanded Breastfeeding Promotion Act of 2009" is
been extracted from the breast by hand or by breast composed of five chapters
pump; It can be fed to an infant using a dropper, a  Chapter III
nasogastric tube, a cup and spoon, or a bottle

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 MATERNAL AND CHILD HEALTH PROGRAM
o Mandated all health and non-health facilities,
establishments or institutions to establish lactation
stations
o The lactation stations shall be adequately provided with
the necessary equipment and facilities, such as:
 Lavatory for handwashing, unless there is an easily-
accessible lavatory nearby
 Refrigeration or appropriate cooling facilities for storing
expressed breastmilk
 Electrical outlets for breast pumps
 A small table
 Comfortable seats
o The lactation station shall not be located in the toilet
 Section 12
o Stated provisions on lactation periods in which nursing
employees shall granted break intervals in addition to the
regular time-off for meals to breastfeed or express milk
o These intervals, which shall include the time it takes an
employee to get to and from the workplace lactation
station, shall be counted as compensable hours worked
 Any health and non-health facility, establishment or
institution satisfying the requirements relative to a proper
lactation station may apply with their respective Local
Government Unit for a 'working mother-baby friendly'
certification
 CHDs may coordinate with the Establishments that
have lactation station, or which comply with the Act, shall
be considered eligible for purposes of availing the
incentives
 The expenses incurred by a private health and non-health
facility, establishment or institution, in complying with the
provisions of the Act and this IRR, shall be deductible
expenses for income tax purposes up to twice the
actual amount incurred, subject to the following conditions:
the deduction shall apply for the taxable period when the
expenses were incurred, that all establishments shall comply
with the provisions of this IRR within 6 months after its
approval; and that they shall secure a "Working Mother-
Baby-Friendly Certificate" from the DOH to be filed with
the BIR, before they can avail of the incentive
MILK STORAGE AND MILK BANKING IN HEALTH
INSTITUTIONS
 Section 10
o All health institutions practicing rooming-in and
breastfeeding are encouraged to set up milk banks for
storage of breastmilk donated by mothers and which have
undergone pasteurization
o The stored breastmilk will primarily be given to children in
the neonatal intensive care unit whose own mothers
are seriously ill
 A human milk bank should only be used as a temporary
solution when the mother and baby are separated
 Milk Banks may be source of breastmilk for infants that
are victims during an emergency and/or a disaster
 The importance of breastfeeding should at all opportunities
be emphasized to all mothers through counselling
 Human milk banks should be registered, licensed and
monitored by the DoH
 Human milk banks should follow the guidelines set by the
Department of Health defining the proper donor screening,
collection, storage, transport, processing and distribution of
human milk
 Donation of human milk must be made on a voluntary
basis
 Donors must pass the screening procedures set forth by
the Department of Health and Human milk donors may come
from, but not limited to the following: Lying-in
clinics/maternity clinics, Health Centers, Community Support
Group, Government agencies and Private enterprises with
lactation stations and Private individuals
"INFORMATION, EDUCATION AND RE-EDUCATION DRIVE
 Section 13 of the Act authorized the Department of Health
with the assistance of other government agencies,
professional and nongovernmental organizations shall
conduct continuing information, education, reeducation, and
training programs for physicians, nurses, midwives,
nutritionist-dietitians, community health workers and
traditional birth attendants (TBAs) and other health worker
on current and updated lactation management
 The law also has provisions on information dissemination
and educational programs for pregnant women and
women of reproductive age
 Mothers or pregnant women are taught and trained of
lactation management and infant care during the
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
2.05
prenatal, perinatal and postnatal consultations and/or
confinements
 DOH mandated to develop and provide breastfeeding
programs for working mothers whose employees are
encouraged to avail of it as part of their human resource
development programs
 To encourage and promote breastfeeding, the
Department of Education, the Commission on higher
Education and the Technical Education, and the Technical
Education and Skills Development Authority shall integrate
in the relevant subjects in the elementary, high school and
college levels, especially in the medical and education, the
importance, benefits, methods or techniques of
breastfeeding, and change of societal attitudes towards
breastfeeding
 To raise awareness on the importance of and to further
promote breastfeeding, the month of August in each and
every year throughout the Philippines has been declared as
"Breastfeeding Awareness Month"
MILK CODE
EXECUTIVE ORDER NO. 51
"National Code of Marketing of Breastmilk Substitutes,
Breastmilk Supplement and Other Related Products"
 AKA Milk Code, a law that governs the safety and
adequacy of nutrition for infants through the promotion
of breastfeeding and the regulation of promotion,
distribution, selling, advertising, product public relations,
and information services of artificial milk formulas and
other covered products
 Issued by President Corazon Aquino on October 28, 1986
through the legislative powers granted to the president
under the Freedom Constitution
 AIM OF THE CODE
o To contribute to the provision of safe and adequate
nutrition for infants by the protection and promotion of
breast feeding and by ensuring the proper use of
breastmilk substitutes and breastmilk supplements when
these are necessary, on the basis of adequate information
and through appropriate marketing and distribution
 SCOPE OF THE CODE
o The Code applies to the marketing, and practices related
thereto, of the following products: breastmilk substitutes,
including infant formula; other milk products, foods and
beverages, including bottle-fed complementary foods,
when marketed or otherwise represented to be suitable,
with or without modification, for use as a partial or total
replacement of breastmilk; feeding bottles and teats. It
also applies to their quality and availability, and to
information concerning their use
 POLICIES
o Exclusive breastfeeding for infants from 0 to 6
months should be implemented
o In addition to breastfeeding, appropriate and safe
complementary feeding of infants should start from
6 months onwards
o Breastfeeding is still appropriate for children up to 2
years of age and beyond
o Other related products such as teats, feeding bottles, and
artificial feeding paraphernalia are prohibited in health
facilities
Rules on donations
 Donation of products and materials defined and covered by
the Milk Code shall be strictly prohibited
 Other donations which are given in kind or in cash by milk
companies, their agents, and their representatives, must be
coursed through the Inter-Agency Committee (IAC) for
approval
Prohibitions/Violations
 Advertising, promotion, and other marketing materials that
are not approved by the IAC
 Giving of samples and supplies of covered products to any
member of the general public, hospitals, health facilities,
personnel within the healthcare system, and members of
their families
 Point-of-sale advertising, giving of samples, or any
promotion devices to induce sales directly to consumers at
the retail level (ex. special displays, discount coupons,
premiums, rebates, special rates, bonus and tie-in sales,
loss-leaders, prizes or gifts)
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 MATERNAL AND CHILD HEALTH PROGRAM
 Gifts, articles or utensils [that may promote the use of breast
milk substitutes or bottle feeding] given to pregnant women,
mother of infants, the general public and all mothers
 Direct or indirect promotion of covered products to pregnant
women or mothers of infants
 Gifts of any sort with or without company name, logo, or
brand name, given by milk companies, manufacturers,
distributors, and representatives of products covered by the
Code, to any member of the general public, hospitals, and
other health facilities, including their personnel and members
of their families
 Promotion of infant formula or other products covered by the
Milk Code in the healthcare system
 Undermining of breastfeeding (e.g. outright prescribing of
infant formula without medical or other legitimate reasons)
 Display of products covered by the Milk Code or placards and
posters concerning such products in a healthcare facility
 Using of "professional service" representatives, "mother craft
nurses", or similar personnel provided or paid for by
manufacturer or distributors of products covered by the Milk
Code in the healthcare system
 Assistance, logistics, or training, financial or material
incentives, or gifts of any sort from milk companies to health
workers
 Information that implies or creates a belief that bottle
feeding is equivalent or superior to breastfeeding
 Accepting financial or material incentives or gifts of any sort,
from milk companies, by a health worker
 Providing samples of infant formula or other covered
products, or of equipment and utensils for their preparation
or use to health workers
ADMINISTRATIVE ORDER NO. 2006 – 0012
“Revised Implementing Rules and Regulations of
Executive Order No. 51 otherwise known as the “Milk
Code”
Rule I. Enabling Provisions
 The Revised Rules and Regulations ensure safe and adequate
nutrition for infants and young children by promotion,
protection and support of breastfeeding. These encompass
the proper use of breastmilk substitutes/supplements when
medically indicated and necessary, on the bases of enough
information and appropriate marketing and distribution
 These also apply to the marketing and quality of the products
that are suitable as partial or total replacement of breastmilk
(breastmilk substitutes, including infant formula; other milk
products, foods and beverages, including bottle-fed
complementary foods)
 Guiding principles state that exclusive breastfeeding must be
for infants from 0 to 6 months and that there is no
substitute for breastmilk
 At 6 months, right and safe complementary feeding
must be started in addition to breastfeeding
 And that breastfeeding is still appropriate for 2 years old
and beyond
 It is also stated that infant or milk formula may be hazardous
to a child’s development, that breastmilk substitute
products are prohibited in health facilities, that
government shall continuously supply campaign strategies
on the advantages of breastmilk
Rule II. Definition Of Terms
 The following are the terms deemed more pertinent in
reading the succeeding sections of the code:
a. "Breastmilk substitute" means any food being marketed
or otherwise represented as partial or total
replacement of breastmilk whether or not suitable for
that purpose
b. "Committee" shall refer to the Inter-Agency Committee
created under E.O. No. 51, s. 1986 composed of the
Secretary of Health, as Chairman, and the Secretary of
Trade and Industry, the Secretary of Justice, and the
Secretary of Social Welfare and Development, as
members
c. "Complementary" means any food, except milk
substitutes, whether manufactured or locally prepared,
suitable as a complement to breastmilk to satisfy the
nutritional requirements of the infant
d. "Exclusive breastfeeding" means giving only
breastmilk without water, liquids, teas, herbal
preparations, or other food and fluid intake for the first
six months of life;
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e. "Infant" shall refer to a person within the age bracket of
0-12 months
f. "Infant Formula" means one of the breastmilk
substitutes formulated industrially in accordance with
applicable Codex Alimentarius standards;
g. "Latching on" means that with the assistance of the
health worker and immediately after its delivery, the
infant is placed to the breast of the mother in order
to initiate suckling
h. "Natural and indigenous food" means locally grown or
produced foods which are neither artificial nor
processed
i. "Products within the scope of this Code" shall pertain to
breastmilk substitutes and infant formula,
including bottle-fed complementary foods, as well as
teats and other commodities which intend to replace or
substitute, in whole or in part, breastmilk and
breastfeeding
j. "Young Child" means a person from the age of more
than twelve (12) months up to the age of three (3)
years (36 months)
Rule III. Information and Education
 The DoH shall take measures to promote, protect,
support and monitor IYCF practices (infant and young
child feeding) which include:
a. Proper latching-on immediately after birth
b. Initiation of breastfeeding within the first 30 minutes
c. Exclusive breastfeeding from 0-6 month
d. Right complementary feeding from 6 months onwards
and continuous breastfeeding up to 2 years and beyond
 These can be achieved by providing women support in
the family, community and the workplace and by
consistently updating information and training health
workers and general public on infant and young child
nutrition
 It is the responsibility of the State to inform the general
public on the hazards of the breastmilk substitutes and
other products covered by the Code
 When medically indicated or when necessary, the use
of substitutes is proper if based on complete and updated
information
 The complete and updated information is collaboration with
the national agencies, LGUs, NGOs and civil societies. They
plan, provide, regulate information; formulate
communication plans and create technical working groups.
 The information include:
a. Benefits and superiority of breastfeeding
b. Maternal nutrition, and the preparation for and
maintenance of breastfeeding
c. The negative effect on breastfeeding of introducing
partial bottle-feeding
d. Difficulty of reversing the decision not to breastfeed
e. The proper use of infant formula when needed
 The promotion, protection and support of breastfeeding and
the proper implementation of the Milk Code shall be an
integral part of all information, education, and
communication plans and training activities of the DOH, as
well as that of the DEPED, DSWD, LGU's and other such
concerned agencies/individuals
Rule IV. Research
 The DOH shall ensure that research conducted for public
policy purposes, relating to infant and young child feeding
should, at all times, be free from any commercial
influence/bias
 Such research and its findings shall be subjected to
independent peer review
 Assistance for research and clinical trials given by
manufacturers/distributors are allowed only upon approval
by an ethics committee led by DOH
 Recipients of research rewards shall not use themselves,
their organizations or their subjects to be used for
promotional activity
 For transparency purposes, a disclosure and/or disclaimer
of the sponsoring company should be done by the company
itself, health worker, researcher involved through verbal
declaration during the public presentation of the research
and in print upon publication
Rule V. Advertising, Promotion, Marketing and
Sponsorships
 The Inter-Agency Committee (IAC) shall review all
advertising, promotion or other marketing materials
for products within the scope of this Code
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 MATERNAL AND CHILD HEALTH PROGRAM
 All approved advertisement and/or promotional materials for
breastmilk substitutes must bear the messages both in
English and in Filipino
 The DOH, based on the latest scientific information and
products may modify the messages, provided that wide
dissemination of the message to all concerned is ensured
 Promotion of products within the scope of this Code
must be objective and should not make the product appear
to be as good or equal to breastmilk or breastfeeding in the
advertising concept
 It must not in any case undermine breastmilk or
breastfeeding
 The "total effect" should not (in)directly suggest that
buying their product would produce better individuals, or
resulting in greater love, intelligence, ability, harmony or in
any manner bring better health to the baby or other such
exaggerated and unsubstantiated claim
 No advertising, promotion or other marketing materials
for products within the scope of this Code shall be printed,
published, distributed, exhibited, and broadcasted or
in any manner released to the public without the prior
written consent and approval of the Committee
 The following shall not be included in promotional materials:
a. Texts/pictures/information which tend to undermine the
benefits of breastfeeding
b. Pictures of babies/children with their mothers/ siblings/
yayas in any advertisements for infant formula
c. The term “humanized”/”maternalized”/”close to
mother’s milk”
Rule VI. Prohibited Acts
 All health and nutrition claims for products within the scope
of the Code arc absolutely prohibited
 No financial or material things to promote products
within the scope of this Code shall be offered or given by
milk companies nor accepted by health workers and/or
members of their unities
 Manufacturers, distributors and marketing firms are
prohibited from donating or giving samples and supplies
to any member of the general public, to hospitals, and other
health facilities
 They cannot also use the health workers and health
care system in distribution and promotion of products
within the scope of the Code, are not allowed to be
involved in breastfeeding promotion and shall avoid the
use of these venues to market their brands or company
names
Rule VII. Containers/Labels
 Containers and labels shall be designed to provide
necessary information on appropriate use of the
products within the scope of the Code in such a way as not
to undermine, or equate it to, breastfeeding
 Each message cannot be readily separated therefrom,
relative the following points:
a. The words or phrase "Important Notice" or "Government
Warning" or their equivalent
b. A statement of the superiority of breastfeeding
c. A statement that there is no substitute for breastmilk
d. A statement that the product shall be used only on the
advice of a health worker as to the need for its use and
the proper methods of use
e. Instructions for appropriate preparation, and a warning
against the health hazards of inappropriate preparation,
and
f. The health hazards of (the use) unnecessary or improper
use of infant formula and other related products
including information that powdered infant formula may
contain pathogenic microorganisms and must be
prepared and used appropriately
 Food products within the scope of this Code, which do not
meet all the requirements of an infant formula but which can
be modified to do so, shall carry on the label, a warning that
the unmodified product should not be the sole source of
nourishment of an infant
 The labels of food products within the scope of this Code, in
addition to the preceding requirements, shall conform to
the rules and regulations of the BFAD
Rule VIII. Quality and Standard
 The quality of products is an essential element for the
protection of the health of infants and young children and
therefore shall be of highly recognized standard. Food
products within the scope of this Code shall meet applicable
standards recommended by the Codex Alimentarius
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Commission and also the Codex Code of Hygienic Practice for
Foods for Infants and Children
 To prevent quality deterioration, adulteration or
contamination of food products within the scope of this Code,
distribution outlets, shall not be allowed to open cans and
boxes for the purpose of retailing them by the cup, bag or in
any other form
Rule IX. Health Workers and the Health Care System
 It is the primary responsibility of the health workers to
promote, protect and support breastfeeding and
appropriate infant and young child feeding
 Part of this responsibility is to continuously update their
knowledge and skills on breastfeeding
 No assistance, support, logistics or training from milk
companies shall be permitted
Rule X. Monitoring and Implementation
 The DOH shall be primarily responsible for the monitoring,
implementation and enforcement of the Milk Code and these
Implementing Rules and Regulations
 The department shall adopt appropriate monitoring
guidelines for the national, regional and provincial
levels
 It shall likewise provide regular training on monitoring
compliance and enforcement on violations of the Milk
Code for all persons engaged in or volunteering to help in the
monitor and implementation of the Code
 The monitoring team shall monitor compliance as well as
problems encountered in the implementation of the Milk
Code, reviews/acts/verifies on reports of violations of the
Code, monitors labels of products within the scope of the
Code, recommends sanctions and submit regular reports
 The Department of Health shall convene and chair the Inter
- Agency Committee (lAC) with BFAD acting as its
Member/Secretariat
 BFAD shall investigate and verify reports of violations;
when appropriate apply administrative sanctions against the
violators; and/or file criminal complaints against persons and
entities found to have violated, singly or repeatedly, the
provisions of the Code or these implementing rules and
regulations
 Problems/violations arising at the regional/provincial levels
shall be filed, investigated and resolved at these levels
 The regional/provincial level shall notify BFAD of any
action taken relative to the aforesaid problems/violations.
Violations that require prosecution or imposition of
administrative sanction as stated in these rules shall be
elevated to the BFAD for appropriate action
 Immediately upon receipt of the report of violation, the
investigating officer shall conduct an ex parte examination of
the evidence presented
 If a prima facie case is established, a Cease and Desist Order
(COO) shall be issued by the BFAD Director or the DOH
Regional Director, as the case may be
 Non-compliance with the COO shall be ground for the
imposition of administrative sanctions
 The Department of Justice (DOJ) shall cause the criminal
prosecution of the violators of this Code
Rule XII. Administrative Sanctions
 This part was voided by the court to answer the petitions as
mentioned above sanctions of the original Milk Code were
instead used
 Any license, permit or authority issued by any
government agency to any health worker, distributor,
manufacturer, or marketing firm or personnel for the practice
of their profession or occupation, or for the pursuit of their
business, may, upon recommendation of the Ministry of
Health, be suspended or revoked in the event of repeated
violations of this Code, or of the rules and regulations issued
pursuant to this Code
 All fees collected, charges imposed and administrative
fines that have accrued as a consequence of the
implementation of these Rules shall be for the account and
income of the BFAD
 In accordance with the Administrative Code and pertinent
Civil Service rules and regulations, erring government
employees found to be liable, and depending on the gravity
of said violation, shall be imposed the appropriate penalty by
the disciplining authority
Rule XIII. Crime Penalties
 Any person who violates the provisions of this Code or these
rules and regulations shall, upon conviction, be punished by
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 MATERNAL AND CHILD HEALTH PROGRAM
a penalty of 2 months to 1 year imprisonment or a fine
of not < P1,000.00 nor > P30,000.00 or both
 Should the offense be committed by a juridical person,
the Chairman of the Board of Directors, the president,
general manager, or the partners and/or the persons directly
responsible therefore, shall be penalized
MOTHER-BABY FRIENDLY HOSPITAL INITIATIVE (MBFHI)
INTRODUCTION
 Part of the National Policy on Infant and Young Child Feeding
 WHO and UNICEF launched this program in 1990 in response
to the Innocenti Declaration which aims to promote,
protect and support breastfeeding
o This declaration also aims to provide health facilities with
a framework for addressing practices which have a
negative impact on breastfeeding
 WHO statistics estimate that 19% of l <5 year old deaths in
the Philippines can be traced to inappropriate feeding
practices including formula feeding
 In the first 2 months of life, an infant who is not breastfed
is up to 25x more likely to die from diarrhea and 4x
more likely to die from pneumonia as compared to a child
who is exclusively breastfed
 According to a study conducted by a Demographic Health
Survey comparing 56 countries, the Philippines has the
lowest ever breastfed rate in the past 10 years
 MBFHI, the name for the Philippine version of the initiative,
was launched by the DOH in 1992 in line with the Rooming-
in and Breastfeeding Act of 1992 (RA 7600)
o In this law, all private and government private hospitals
offering maternity and newborn care may be accredited as
Mother-Baby Friendly if they implement the 10 Steps to
Successful Breastfeeding adopted from UNICEF/WHO
criteria of BFI
 MBFHI aims to facilitate and protect breastfeeding in
private and public hospitals and help mothers and their
newborns to start breastfeeding soon after birth
o Faces obstacles such as poor compliance in the ten
steps to successful breastfeeding
o It is thus important for previously certified hospitals to be
reassessed and to continue capacity building of
health workers
 In order for health facilities to be accredited, the following
should be demonstrated:
a. At least 75% should be exclusively breastfeeding
among mothers at discharge
b. Adheres to the International Code of Marketing
Breast milk Substitutes
c. Successful implementation of the 10 Steps to
Successful Breastfeeding
LAWS RELATED TO THE MBFHI
1. Executive Order No. 51 dated 20 October 1986, otherwise
known as “National Code of Marketing of Breastmilk
Substitutes, Breastmilk Supplements and Related
Products”
 Intensification of the dissemination of information on
breastfeeding and proper nutrition and the regulation of
advertising, marketing, distribution of Breastmilk
substitutes and other related products including bottles
and teats and prohibiting the use of health facilities and
health workers in the promotion and marketing of the
products covered by the Code
2. Under Article 24 of the 1989, the United Nations Convention
on the Rights of the Child emphasized the social
responsibility of the member States to protect children and
to provide them with the appropriate support and
services, emphasizing their right to the highest
attainable level of health care services and guarantees
the provision of and access to adequate nutrition for all
infants and young children
3. Republic Act 7600 otherwise known as the “Rooming- In
and Breastfeeding Act” of 1992 provides that rooming-
in shall be observed within 30 minutes after birth
 NSD: breastfeeding should be done within one hour
after birth
 (C/S) deliveries: 3- 4 hours after birth, to ensure
support for early, exclusive and continuous
breastfeeding
4. The Philippine and Infant and Young Child Feeding
(IYCF) policy as adopted from the WHO and UNICEF “2002
Global Strategy on Infant and Young Child Feeding” calls for
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2.05
a renewed and accelerated action towards the promotion of
appropriate infant and young child feeding practices
5. PHIC Circular No. 26 s. 2005 had included the Mother- Baby
Friendly Hospital Initiative as part of its accreditation
for all hospitals in order to encourage, support and promote
breastfeeding in the primary, secondary and tertiary levels
of the hospital facilities recognizing that breastfeeding is
essential for the health and well- being of the infant
and the mother
6. Administrative Order No. 2005- 0023 of the Department of
Health identified Formula One for Health as the
implementing mechanism for health sector reforms,
thereby ensuring better health outcomes, a more responsible
public health system, and a more equitable health care
financing for Filipinos
 This involves critical reform initiatives which focus on
F1 Health Priority Programs/ Projects/ Activities (PPA’s)
for the National Investment Plan for Health, where the
Breastfeeding Program is one of the priorities for Public
Health Program Development
OBJECTIVES
1. Transform all health institutions with maternity and
newborn services in both the government and the private
sector and other health facilities into facilities that fully
protect, promote and support rooming- in,
breastfeeding and mother- baby friendly practices
2. Build the critical capacity and commitment of health
care staff in protecting, promoting and providing support for
appropriate infant and young child feeding practices
3. Establish linkage with the primary health care facilities and
community support groups to sustain the practice and
ensure an enabling environment for optimal feeding
practices
COVERAGE AND SCOPE
 These guidelines shall, apply to all government, private and
other health facilities nationwide providing maternity and
newborn care services regardless of their current MBFHI
certification/ accreditation status
DEFINITION OF TERMS
1. Breastmilk Substitute – means any food being marketed
or otherwise represented as a partial or total replacement for
Breastmilk, whether or not suitable for that purpose
2. Complementary food – means any food, whether
manufactured or locally prepared, suitable as a complement
to Breastmilk or to infant formula, when either becomes
insufficient to satisfy the nutritional requirements of the
infant. Such food is also commonly called “weaning food” or
“Breastmilk supplement”
3. Exclusive breastfeeding - providing Breastmilk as the sole
source of nutrition for infants
4. Health workers – any person working in the health care
system, whether profession or non- professional, including
voluntary and unpaid workers, in public or private practice
5. Infant – a child within zero (0) to eleven (11) months
and 29 days of age
6. Infant formula – the Breastmilk substitute formulated
industrially in accordance with applicable Codex
Alimentarius standards, to satisfy normal nutritional
requirements of infants up to six (6) months of age, and
adopted to their physiologic characteristics
7. Lactation management – the general care of a mother-
infant nursing couple during the mother’s prenatal,
immediate post- partum and post- natal periods
o It deals with educating and providing knowledge and
information to pregnant and lactating mothers on the
advantages of breastfeeding, the physiology of lactation,
the establishment and maintenance of lactation, the
proper care of the breasts and nipples, and such other
matters that would contribute to successful breastfeeding
8. Low birth weight infant – a newborn weighing less than
two thousand five hundred (2,500) grams at birth
9. Rooming- in – the practice of placing the newborn in the
same room as the mother right after delivery up to discharge
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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
to facilitate mother- infant bonding and to initiate
breastfeeding. The infant may either share the mother’s bed 12. Maintain records for self- assessment, reporting and
or be placed in a crib beside the mother monitoring purposes

10. Skilled birth attendant – refers to professional health 13. The hospital as a workplace must have in its hospital
worker such as doctor, nurse, midwife with the training or policy the following:
educational background to perform safe and clean deliveries a. Milk Code enforcement
b. Breastfeeding breaks
IMPLEMENTING GUIDELINES c. Two additional breaks to allow mothers to express
 For health facilities to be considered Mother-Baby Friendly, Breastmilk
a set of criteria based on guidelines provided by the d. Breastmilk storage facilities
UNICEF/ WHO have been developed and adopted locally e. There shall be a refrigerator exclusively for the
for the purpose of setting the standards which shall be the storage of expressed Breastmilk from the mother
basis for the requirement among other to be institutionalized f. Breastfeeding room or a safe designated area in the
through licensing, accreditation and other regulatory hospital
mechanisms in the pursuit of quality maternity and g. This is a physical facility where mothers can express
newborn care service delivery in the hospital facilities Breastmilk and where a refrigerator is located,
exclusively used for the storage of Breastmilk. A
A. Steps to a Mother- Friendly/ handwashing facility must be accessible
Safe Motherhood Initiative h. Support group
i. Other hospital personnel ready or available to assist
 Requires Steps to be followed by the health facilities
and counsel the mother to be successful in
according to the UNICEF/WHO Global Criteria
breastfeeding or peer counselor from among the
1. The hospital facility shall incorporate mother-
successful breastfeeding mothers
friendly labor and birthing practices in the health
facilities’ policies or standard operating procedures,
 Working mothers need a supportive environment and as
including:
such, are given due consideration by their employers in
a. Clean birthing technique
adjusting work schedules of breastfeeding mothers
b. Delayed cord clamping (3 minutes)
 They are also encouraged to continue breastfeeding
c. Placenta removal and disposal
through provision of enabling conditions such as paid
d. Collaboration / consultation with other maternity
maternity leave, part- time work arrangements, on- site
services, including maintaining communication with
crèches, day care facilities or facilities for expressing and
all caregivers when referral or transfer is necessary.
storing Breastmilk and paid breastfeeding breaks
e. Linking the mother and the baby to appropriate
 Mothers should still be able to continue breastfeeding and
community resources, including pre- natal and
care for their infants after they return to paid
post- natal discharge follow- up and breastfeeding
employment
support.
2. Train staff responsible on maternity services on
B. Ten Steps to Successful Breastfeeding
essential and emergency obstetric and newborn care
 To become a Baby- Friendly Institution, the following are the
3. Educate the staff in non- drug methods of pain relief recommended steps to be followed by the health facilities
that can provide options in minimizing the use of according to the UNICEF/ WHO Global Criteria:
analgesics or anesthetic drugs
STEPS INDICATOR
4. Motivate and refer pregnant women for STD/ HIV/ 1. Development of a Implementation of a
AIDS screening and voluntary counseling and treatment written breastfeeding current breastfeeding
policy that is routinely protocol that has been
5. Provide the best available care, including quality communicated to all the communicated to all staff
antenatal, delivery, postpartum and newborn care with health care staff during orientation or during
timely referral department level meetings
2. Training of all health Schedule of staff that will
6. Birthing mother may be offered access to a birth care staff in skills attend in- service training
companion of her choice who can provide emotional and necessary to implement that teach the skills
physical support during labor the policy on necessary to implement the
breastfeeding within breastfeeding protocol
7. Birthing mothers may be allowed the freedom to the first six months
walk, move about and assume the positions of her upon entry into the
choice during labor and birth as a feasible option that hospital
shall not be limited to the lithotomy position
3. Providing information Written, non- commercial
8. Women may be allowed to drink during labor, upon to all pregnant women pre- natal information on
the discretion of the attending physician about the benefits and breastfeeding schedule of
management of parents referred to
9. The performance of obstetrical procedures shall be breastfeeding in the OPD breastfeeding classes/
rationalized to minimize or avoid unnecessary during pre- natal and in childbirth education classes
procedures and instrumentation that may inhibit the wards during the
breastfeeding postpartum period
o A baby born by Caesarian Section is less likely to
have early skin to skin contact and more likely to 4. Assisting mothers to Infant is placed on the
have nursery care increasing the risk of cross initiate breastfeeding mother’s chest to promote
infection as well as restricting breastfeeding within one hour after pre- feeding sequence of
o The option to perform invasive procedures such birth for normal behavior that leads to proper
as rupture of membranes, episiotomies, acceleration spontaneous deliveries latching and sucking
or induction of labor, instrumental deliveries or and within 3- 4 hours
caesarian section specifically required for a after birth for C/S
complication shall be governed by implementing deliveries
guidelines to be set by the National Management 5. Training mothers how to A breast pump should be
Committee based on the Global criteria on mother breastfeed and maintain available for expressing milk
friendly care lactation, even if they and milk is expressed at least
should be separated from eight times in 24 hours
10. Encourage all mothers and families with sick premature their infants.
newborns or infants with congenital problems, to touch, Provision for milk banking in
cuddle, breastfeed, and care for their babies to the the hospital facility for the
extent compatible with their condition collection and storage of
expressed breast milk
11. Encourage postpartum mothers to have at least two
postpartum visits

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
6. Giving newborn infant No sterile water, glucose Lactation Management Training Center (Dr. Jose Fabella
no food or drink other water or milk formula in the Memorial Hospital) and other designated Regional Lactation
than breast milk, unless clinical wards Management Training Centers shall be responsible in the
medically indicated and conduct of Lactation Management Courses for local
educating mothers on government unit and private health facilities
the importance of
exclusive breastfeeding E. Roles and Responsibilities
unless other food/drink  The National Management Committee shall provide the over-
are medically indicated all management of the IYCF program duly supported by its
7. Practicing rooming-in All babies are roomed-in and National Technical Working Group (NTWG)
allows mothers and only pathologic babies are  The members of the TWG shall provide technical assistance
infants to remain placed in a nursery (NICU) and conduct performance audit to ensure quality assurance
together 24 hours a day. on program implementation
8. Encourage Mothers are taught  The CHD Coordinators / Assessors Team shall provide the
breastfeeding on demand behavioral feeding cues for technical assistance, conduct assessment / reassessment,
them to feed their infant on conduct monitoring, facilitate the accreditation process and
cue for 8-12 times each 24 build the critical capacity of both the government and private
hours health facilities in their respective regions in the
9. Giving no artificial No artificial nipples or implementation of MBFHI
teats or pacifiers (also pacifiers or any feeding  The Dr. Jose Fabella Memorial Hospital shall continue to
called dummies or paraphernalia in the wards serve as the designated National Lactation Management
soother (also called Center for all government and private health facilities
dummies or soothers) to providing newborn maternity care services within the NCR
breastfeeding infants
10. Fostering the Organized peer ASSESSMENT AND ACCREDITATION PROCESS
establishment of breastfeeding support  Accreditation shall be conferred to the health facility which
breastfeeding support groups supervised by a has sustained compliance to the MBFHI steps to successful
groups and referring lactation consultant/ staff breastfeeding and has integrated mother-friendly steps in its
mothers to them upon nurse MBFHI program implementation
discharge from the  Upon accreditation, it shall fully implement and sustain the
hospital. Documented regular ten steps to successful breastfeeding. The creation of a
monitoring and coaching functional Breastfeeding Committee in the health facility,
activities with the roster of with recording and reporting mechanisms, may facilitate
breastfeeding support groups MBFHI program implementation and promote its
recognized as peer sustainability
counselors within their
catchment area to further UPDATES
strengthen/sustain the 10th
 In a monitoring study by Labbok (2012), it was reported that
step
the percentage of hospitals accredited by the DOH has
*UNICEF’S VERSION (See Appendix _)
increased from 58% in 1997-1998 to 79% in 2003-2004
 This rate however has not changed with the latest report in
C. Responsibilities of the Hospital Staff
2009-2010 that shows 1,427/1,798 (79%)
Relative to EO 51
hospitals/maternities have been accredited by the DOH
 The Health Worker’s Responsibilities under the Milk Code:
GARANTISADONG PAMBATA PROGRAM
1. Protect, promote, and support breastfeeding with the
capacity to explain the following:  The Aquino Health Agenda mandated in Administrative Order
a. The benefits and superiority of breastfeeding 36 Series 2010 the achievement of universal health care
b. Proper maternal nutrition in preparation for/ for all Filipinos by way of a special program called the
maintenance of breastfeeding Garantisadong Pambata (GP)
c. The risk of partial or non-breastfeeding, such as but not  GARANTISADONG PAMBATA
limited to the following: o Comprehensive integrated package of service and
i. The health hazards of inappropriate foods or feeding communication on health, nutrition and environment for
methods children for everyday living at various places like in home,
ii. The health hazards of unnecessary or improper use school, health facilities and communities by government,
of infant formula and other breastmilk substitutes non-government organizations, private sectors and civic
iii. The financial and social implications in the use of organizations
breastmilk substitutes o Aims to support the Millenium Developmental Goal
(MDG) 1 and 4, eradication of extreme poverty and
2. Refuse any gifts/samples, offered by manufacturers or reduction of child mortality, respectively
distributors as well as the representatives of the milk
companies

3. Never pass any samples or gifts to pregnant women, AIM OF THIS Target children ages 0 up to 5 years
mothers of infants and young children and members of their PROGRAM old
families that will undermine breastfeeding
OVERALL  Achieve better health outcomes
4. Refrain from accepting or availing of any contribution made GOAL OF  Sustained health financing
by the representatives if the milk industry for fellowships, THIS  Responsive health system
study tours, research grants, attendance to professional PROGRAM By ensuring that all Filipinos especially the
conferences or the like, intended for the health workers or disadvantaged group (lowest 2 income
the management staff of the health facility quintiles) have equitable access to
affordable health care
5. Be aware that any form of support/logistics and other SPECIFIC  Contribute to the reduction of infant and
incentives for health professionals and administrators OBJECTIVES child morbidity and mortality towards
working for infant and young child health should in no way OF THIS the attainment of MDG 1 and 4
create conflict of interest PROGRAM  Ensure that all Filipino children,
especially the disadvantaged group
6. Ensure that the health facility is not used for the display, (Geographically Isolated and
dissemination and distribution of products within the scope Disadvantaged Areas), have equitable
of the Code access to affordable health, nutrition
and environment care
D. Capacity Building  Geographically Isolated and Disadvantaged Areas
 The trainers who have satisfactorily undergone the (GIDA)
prescribed 40 hours standard training with the National

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
o Refer to communities with marginalized population
physically and socio-economically separated from the
mainstream society and characterized by:
a. Physical factors, isolation due to distance, weather
conditions and difficulties in transportation
b. Socio-economic factors, high poverty incidence,
vulnerable sector and communities in or recovering
from situations of crisis or armed conflict

DOH-GARANTISADONG PAMBATA CORE MESSAGE

1. MAGPASUSO (BREAST-FEEDING)
 In accordance with the Expanded Breastfeeding
Promotion Act, the GP program promotes exclusive
breast-feeding for the first 6 months of life and breast-
feeding with complimentary feeding for 6 months to 2
year-olds
 The use and ingestion of products with SANGKAP PINOY
seal is also advised
 Sangkap Pinoy seal is found in food products rich in
Vitamin A, Iron and Iodine to address the
micronutrient malnutrition in the country

2. MAGPABAKUNA (IMMUNIZATION)
 The program recommends the infant to have complete
immunization by 1 year old
 MMR vaccine is also recommended to be given in
children 1 year to 1 year and 3 months of age

3. MAGBITAMINA A (VITAMIN A)
 Vitamin A administration is recommended every 6
months for children 6 months old to 5 year-olds

4. MAGPURGA (DE-WORMING)
 Deworming is recommended every 6 months for
children 1-12 years of age

5. GUMAMIT NG PALIKURAN (USE OF TOILET

FACILITIES)

6. MAGSIPILYO (BRUSHING OF TEETH)

 The program recommends brushing of teeth at least
twice a day especially before bed time

7. MAGHUGAS NG KAMAY (PROPER HAND-WASHING)

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 2.06
Maternal and Child Health Program

Groups 3 & 4 02 September 2015

APPENDIX
NATIONAL OBJECTIVES OF MCH PROGRAM IN RELATION TO MDG 4 AND 5
2013 ASSESSMENT OF MILLENNIUM DEVELOPMENT GOAL 4

LEADING CAUSES OF MORTALITY IN CHILDREN BELOW FIVE YEARS OLD

STRATEGIC OBJECTIVES FOR NOH 2011-2016 FOR MDG 4

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
2011 ASSESSMENT OF MILLENNIUM DEVELOPMENT GOAL 5

PERCENTAGE DISTRIBUTION OF MAIN CAUSES OF MATERNAL MORTALITY, 2000 & 2005

PERCENTAGE DISTRIBUTION OF MAIN CAUSES OF MATERNAL MORTALITY, 2010

HEALTH-RELATED PRACTICES AFFECTING MATERNAL HEALTH, 1998, 2003 & 2008

HEALTH-RELATED PRACTICES AFFECTING MATERNAL HEALTH (NDHS, 2013 - PRELIMINARY RESULTS)

INDICATORS 2013
% of pregnant women with at least 4 prenatal
84.3%
visits
% of births attended by professional, health
72.8%
providers

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
STRATEGIC OBJECTIVES FOR NOH 2011-2016 FOR MDG 5

Appendix: Summary of the Strategies, Action Points, and Activities in the Promotion of Breastfeeding
STRATEGIES ACTION POINTS ACTIVITIES
A. Strengthen the TWG (technical working group) to allow it to
effectively coordinate the GOs and NGOs working for the
IYCF Program
1. PARTNERSHIPS WITH B. Organize functional Intervention Setting Committees (ad-
Action point 1:
NGOS AND GOS IN THE hoccommittee)
Formalize partnerships with GOs and
COORDINATION AND
NGOs working on IYCF program C. Return the MBFHI responsibility from NCHFD to NCDPC
IMPLEMENTATION OF
coordination and implementation D. Augment human resource complement of NCDPC- FHO, IYCF
THE IYCF PROGRAM
program
E. Programmed contracting out of activities to organizations
outside of DOH
A. Institutionalize the collection of Program Information Report
Action point 2.1:
(PIR) Data and generate annual performance report.
Institutionalize the IYCF monitoring
2. INTEGRATION OF KEY B. Maximize the use of the unified monitoring tool
and tracking system for national,
IYCF ACTION POINTS C. Collaborate with the National Epidemiology Center (NEC)
regional and LGU levels
IN THE MNCHN PLAN and Information Management Service (IMS) regarding IYCF
OF ACTION data
/STRATEGY Action point 2.2: A. Designate the IYCF Focal Person as a regular member
Participation of the IYCF of the team working for the development and implementation of
Focal person in MNCHN planning and the MNCHN Strategy
monitoring activities
Action Point 3.1 A. Devise and implement a consultation mechanism to bring
Consultation mechanism with the together the IAC, DOJ and other relevant GOs for IYCF related
Industry Advisory Council (IAC) and legislations and regulations
3. HARNESSING THE
DOJ for the enforcement of the Milk
EXECUTIVE ARM OF
Code and with other relevant GOs for
GOVERNMENT TO
other IYCF related legislations and
IMPLEMENT AND
regulations.
ENFORCE THE IYCF
RELATED A. Institutionalize enforcement of MBFHI compliance in the
LEGISLATIONS AND regulatory function of the DOH
REGULATIONS (EO 51, B. Review and improve the processing of reports on violations
Action Point 3.2:
RA 7200 AND RA on the Milk Code
Support Civil Society in the
10028) C. Invite the Professional Regulatory Board as a resource
implementation and enforcement of
agency of the IAC
IYCF related laws and regulations
D. Augment human resource of FDA as secretariat of the IAC
E. Engage professional societies to come-up with measures for
self monitoring and regulation
A. Set up Models of MBFHI and MNCHN implementation in key
strategic hospitals and referral networks
Action Point 4.1: Modeling the MBF B. Establish protocols/standards on how to set-up and maintain
system in the key intervention MBF workplaces and integrated in the standards for healthy
settings in selected regions workplace
C. Enhance the primary, secondary and tertiary education
curricula on IYCF
D. Develop policy on IYCF in emergencies and
guidelines on the management of malnutrition, and IYCF in
4. INTENSIFIED special medical conditions for the community
FOCUSED ACTIVITIES Action Point 4.2: A. Review and update the existing awarding system
TO CREATE AN Creation of a Regional and National B. Establish a recognition system for health facilities complying
ENVIRONMENT incentive and awarding systems for with EO51, RA10028 and the MBFHI National Policy
SUPPORTIVE TO IYCF the most outstanding IYCF
PRACTICES champions in the different sectors of
society.
A. Carry out an inventory of best practices on IYCF . Identify best
IYCF practices by allowing every province in the country to
Action Point 4.3 identify exemplary or creative activities on IYCF that boosted
Allocate/Raise /Seek resources for program services/performance. Validate the reports through
IYCF Research activities that CHDs and select the best practices for documentation and
document best practices in the publication.
Philippines B. Allocate resources and conduct IYCF related researches
focusing on the documentation and measure of impact of noble
experiences and interventions

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
5. ENGAGING THE A. Set-up the fund raising mechanism
PRIVATE SECTOR AND Action Point 5.1
INTERNATIONAL Setting up of a fund raising PILLAR 1: Capacity Building
ORGANIZATIONS TO mechanism for IYCF with PILLAR 2: Supportive Supervision
RAISE FUNDING FOR the participation of PILLAR 3: Communication Plan
THE SCALING UP AND International Organizations and the
SUPPORT OF THE IYCF Private Sector
PROGRAM
Appendix _. Status of the Program
TARGETS SET IN 2005-2010 STATUS OF ACHIEVEMENT REMARKS
OBJECTIVE 1: TO IMPROVE, PROTECT AND PROMOTE APPROPRIATE INFANT AND YOUNG CHILD FEEDING PRACTICES
CHILD FEEDING PRACTICES
- 70% of newborns initiated to
53.5% (NDHS 08) 40.7%(NDHS 1998)
breastfeeding within 30 minutes
- 80% of 0-6 months infants are exclusively
34% (NDHS 2008) 33.5%(NDHS 2003)
breastfed
- 50% of infants are exclusively breastfed for 6
22.2% (NDHS 2008) 16.1%(NDHS 2003)
months
- median duration of breastfeeding is 18 months 15.1months (NDHS 2008) 13 months (NDHS 1998)
- 90% of 6- <10 months infants are given timely,
58% (NDHS 2008) 57.9%(NDHS 2003)
adequate and safe complementary foods
76% (NDHS 2003)
NDHS 2008 and 2003 data
- 95% of children 6 months to
75.9% (NDHS 2008) refers to those that received
59 months received Vitamin A
vitamin A in the past 6
months from the interview
37% of children age 6-59 months
received iron supplements in the seven
days before the survey 72.8% of 6-59 months
- 70% of low birth weight babies and iron deficient 6
(NDHS 2008) received iron drops /
months to less than 5 years received complete dose of
syrup (not specified if
iron supplements
78.3% of children 6-59 months complete dose, MCHS 2002)
consumed foods rich in iron in the past
24 hours from the time of the survey
- 80% of pregnant women have at least 4
77.8% (NDHS 2008) 67.5% (MCHS 2002)
prenatal visits
- 80% of pregnant women received complete dose of 82% (not specified if
82.4% (NDHS 2008)
iron supplements complete dose, MCHS 2002)
44.6% (NDHS 2003) NDHS
2003 and 2008 data
- 80% of lactating women received vitamin A capsule 45.6% (NDHS 2008) represents the % of women
that received Vitamin A dose
during post-partum

41.9% (NDHS 2008) 38%, household using

iodized salt and
- 80% of household using iodized salt
81.1% household positive for iodine in 56.4% household positive for
salt (NDHS 2008) iodine in salt (NNS 2003)

OBJECTIVE 2: TO INCREASE POLITICAL COMMITMENT

AT DIFFERENT LEVELS OF GOVERNMENT, INTERNATIONAL ORGANIZATIONS, NON- GOVERNMENT ORGANIZATIONS,
PRIVATE SECTOR, PROFESSIONAL GROUPS , CIVIL SOCIETY, COMMUNITIES AND FAMILIES
IYCF Policy approved May 25, 2005
- Approved and widely disseminated National Infant
and disseminated to all Regions and
and Young Child Feeding Policy
LGUs.
- Approved multi-sectoral National IYCF Plan of Action 2005-2010
IYCF Plan of Action approved.
AO 2007-0017: Guidelines on the
Acceptance and Processing of Local
- IYCF policy enhancement for emerging issues and Foreign Donations During
Emergency and Disaster Situations
was signed May 28, 2007.
New groups were active in supporting Active organizations include
- Increase number of organizations actively involved activities on IFE mostly during the Latch, La Leche League, Save
in IYCF post-Ondoy interventions and in the Children, Plan
relation to breastfeeding support. International and Arugaan.
From 1 million pesos in 2005 to 20
Additional funds for IYCF
million pesos in 2010.
were secured since April
2007, the start of the AHMP
with intensive IYCF training.
- Increase budget for IYCF Additional funds were secured by the
Joint program on MDG-F, wherein UN
September 2009, signing of
Agencies (Unicef, FAO, ILO
the JP for Ensuring Food
and WHO) with NNC and DOH, started
Security and Nutrition for
implementing key IYCF interventions.

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
Children 0-24 months in the
Philippines, funded by the
Government of Spain
through the MDG
Achievement Fund.
OBJECTIVE 3: PROVIDE SUPPORTIVE ENVIRONMENT THAT WILL ENABLE PARENTS, MOTHER, CAREGIVERS, FAMILIES
AND COMMUNITIES TO IMPLEMENT OPTIMAL FEEDING PRACTICES FOR INFANTS AND YOUNG CHILD
PROGRAMME MANAGEMENT
National TWG active and 11/12
Regions confirmed having established
a TWG. Data as of Dec 2009.
Although the national TWG is
- Functional IYCF Program authority and responsibility Considered active, the
flow at the national, regional and LGU level At the LGU level 7/80 provinces, collaboration between
9/120 cities and 175/1425 agencies can be considered
municipalities have passed a deficient.
resolution/ordinance in support of
IYCF.
- Existing local committees functioning as IYCF
No available data
committees
INSTITUTIONAL SUPPORT
AO 2007-0026: Revitalization of the
MBFHI in Health Facilities with
Maternity Services was signed and Within 2 years after the
endorsed on July 10, 2007. issuance of COC, 0/47
- 1,426 currently certified MBF hospitals sustained 10 hospitals applied for
steps accreditation to become MBF
PhilHealth Circular No. 26 S-2005: based on the new standards
Requirement for Accredited Hospitals and requirements.
to be “Mother- Baby Friendly” was
issued on October 11, 2005.
Only 47/1487 have received a COC
- 300 additional hospitals/lying-in certified as MBF
since 2007
- 100% of hospitals rooming–in their newborns No available data
RA 10028: Expanded Breastfeeding
- All offices of government agencies who are members RA 10028 set the standards
Promotion Act of 2009 was enacted on
of the IYCF IAC will be MBF to becoming MBF.
March 16, 2010.
6/16 Regions reported that there are
- At least one model workplace per province/city
at least 88 breastfeeding friendly
certified as MBF
workplaces.
- At least one model IYCF resource center 1 province
No resource center established
and 1 city in each region
10/16 Regions reported that there are
- At least 3 IYCF model barangay/
at least 2159 breastfeeding support
municipality per province and city
groups at the barangay level.
RA 10028 encourages other
Milk bank is functional in 3 Medical Medical
- Functional milk bank in all medical centers
Centers: PGH, DJFMH and PCMC Centers to set up their own
milk bank.
IMPROVING SYSTEMS
- 100% of national, regional and LGU health facilities
Based on monitoring visits and reports
have integrated IEC on IYCF into regular MCH services No available data on private
from CHDs, public health facilities have
with clearly stated protocols on how to provide key health facilities.
ensured the integration.
IYCF
Only 4/13 Regions reported some sort
of Milk Code monitoring activities.

- Functional and effective Milk Code

At the FDA, from 2007 to 2009, there
Monitoring system
were 67 reports of violations and only
3/13 Regions reported filing a
complaint for the alleged violations.
Draft tool developed and used in two
- Institutionalize facility IYCF MIS
key instances. No institutionalization
system in place by end of 2009
yet.
28,063/34,298 staff were trained on NCDPC and NNC combined
-Improving skills of health manpower
IYCF Counseling. report
- Available national / regional IYCF 16/17 Regions reported conduct of
trainers training on IYCF.
- Active IYCF Speakers’ Bureau No available data
- Available IYCF counselors in 50% 28,063/34,298 staff were trained on NCDPC and NNC combined
of health facilities IYCF Counseling. report.
DOH focused on capacitating health
- At least 10 Filipino health professionals
workers on Counseling and Lactation With the support of NNC.
internationally accredited as breastfeeding counselors
Management.

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
by the International Board of Lactation Consultants
Examiners
9/13 Regions reported having trained
a total of 1485 hospital based health
- A lactation specialist is available in tertiary hospitals workers on Lactation Management No denominator available.
with the support of DJFMH,
NCDPC,CHDs and NNC.
In June 2010 a workshop on
integration/updating of good IYCF
- Improved curricula for IYCF of medical / nursing The process of integration is
practice into the medical, nursing,
/ midwifery schools on-going.
midwifery and nutrition curricula was
conducted.
RA 10028 was enacted on
RA 10028: Expanded Breastfeeding
March 16,
- Inclusion of breastfeeding in elementary education Promotion Act of 2009 mandates the
2010. The IRR is yet to be
integration.
signed.
As of Dec 2009.
10/16 Regions reported that there are
at least 2,159 barangay level BF
- Community level support systems and services RA 10028 will help boost the
support groups and more than 40 BF
number of breastfeeding
friendly public places.
friendly public places.
- 100% of target communities with functional
community level monitoring system of IYCF practices No available data
and changes
10/16 Regions reported that there are
- At least 50% of city and poblacion municipalities with
at least 2,159 BF support groups at the
adequate number of trained IYCF peer counselors
barangay level.
10/16 Regions reported that there are
- At least one functional BF / IYCF support group in at least 2,159 BF support groups at the
poblacions and selected communities barangay level.

OBJECTIVE 4: ENSURE SUSTAINABILITY OF INTERVENTIONS TO IMPROVE, PROTECT AND PROMOTE INFANT AND YOUNG
CHILD FEEDING
- Functional self-assessment health
facility tools for IYCF in certified MBFH and main Tool Drafted. Not yet institutionalized.
health centers
- Annual progress reports of status of implementation
1st IYCF PIR: 2007
of Milk Code, Rooming In and Breastfeeding Act,
ASIN Law, Food Fortification and ECCD Law / IYCF
2nd IYCF PIR: 2009
Policy
Key result of integration was
- IYCF integrated into Philippine Plan of Action for IYCF integrated in PPAN 2005-
the intensive training on IYCF
Nutrition and annual planning and health monitoring 2010. PIR was conducted last quarter
Counseling in AHMP target
systems at all levels of 2010.
areas.
Regular Presentations are offered by
- Periodic feedback of IYCF status during annual
DOH on IYCF status (2005:
conventions of health professionals/Leagues of
1st presentation during National
Provinces/ Cities/Municipalities and Barangays
Convention Liga Ng Barangay)
APPENDIX _. UNICEF VERSION OF THE CRITERIA
1. HAVE A WRITTEN BREASTFEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTH CARE STAFF.
 WHO implemented a written policy in all areas of the breastfeeding facilities so that in situations of differences in opinions and
staff changes, the policies would still be effective? The written policy should contain appropriate policies on all practices
concerning breastfeeding agreed between relevant authorities and all staff and patients should be made aware of the policies.
This should also be available so that all staff that takes care of mothers and babies can refer to it. This should be visibly
posted in all areas of the health care facility (in languages understood by most patients and staff) which serve mothers,
infants and children. Together with this written policy, an institutional ban on acceptance of free or low cost supplies of
breast-milk substitutes, bottles, and teats and its distribution to mothers should be made effective.
2. TRAIN ALL HEALTH CARE STAFF IN SKILLS NECESSARY TO IMPLEMENT THIS POLICY.
 All health care staff who has any contact with mothers, infants and children must receive instructions on the implementation
of the breastfeeding policy. Breastfeeding and lactation management training (at least 18 hours in total with a minimum of 3
hours of supervised clinical experience) should be given to various types of staff including new employees. This training is
required for all the health care staff because this is necessary to increase their knowledge, skills, and attitudes to maximize
and improve breastfeeding promotion. The knowledge they acquired may later on be passed on to mothers.
3. INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS AND MANAGEMENT OF BREASTFEEDING.
 If the hospital has an affiliated antenatal clinic or antenatal ward breastfeeding counseling should be given to most pregnant
women through those services. The counselling should include the importance of exclusive breastfeeding for the first 4-6
months, the benefits of breastfeeding, and basic breastfeeding management.
4. HELP MOTHERS INITIATE BREASTFEEDING WITHIN A HALF-HOUR OF BIRTH.
 Mothers in the maternity ward who have had normal vaginal deliveries should confirm that within a half-hour of birth they
were given their babies to hold with skin contact, for at least 30 minutes, and offered help by a staff member to initiate
breastfeeding, while mothers who have had caesarean deliveries should confirm that within a half-hour of being able to
respond, they were given their babies to hold with skin contact. Early initiation of breastfeeding increases the duration of
breastfeeding in the future. It allows skin-to-skin contact for warmth and colonization of baby with maternal organisms.
Lastly, this provides colostrum as the baby’s first immunization, and takes advantage of the first hour of alertness.
5. SHOW MOTHERS HOW TO BREASTFEED, AND HOW TO MAINTAIN LACTATION EVEN IF THEY SHOULD BE
SEPARATED FROM THEIR INFANTS.
 Nursing staff should offer further assistance with breastfeeding within six hours of delivery and mothers should be taught how
to express their milk, as well as positioning and attachment techniques for manual milk expression.

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 MATERNAL AND CHILD HEALTH PROGRAM 2.05
6. GIVE NEWBORN INFANTS NO FOOD OR DRINK OTHER THAN BREAST MILK UNLESS MEDICALLY INDICATED.
 The following are the global criteria for this step:
a. Hospital data indicate that at least 75% of the full-term babies delivered in the last year have been exclusively breastfed
or exclusively fed expressed breast milk from birth to discharge, or, if not, that there were documented medical reasons
or fully informed choices.
b. Review of all clinical protocols or standards related to breastfeeding and infant feeding used by the maternity services
indicates that they are in line with BFHI standards and current evidence-based guidelines.
c. No materials that recommend feeding breast milk substitutes, scheduled feeds or other inappropriate practices are
distributed to mothers.
d. The hospital has an adequate facility/space and the necessary equipment for giving demonstrations of how to prepare
formula and other feeding options away from breastfeeding mothers.
e. Observations in the postpartum wards/rooms and any well baby observation areas show that at least 80% of the babies
are being fed only breastmilk or there are acceptable medical reasons or informed choices for receiving something else.
f. At least 80% of the randomly selected clinical staff members can describe two types of information that should be
discussed with mothers who indicate they are considering feeding breast milk substitutes.
g. At least 80% of the randomly selected mothers report that their babies had received only breast milk or, if they had
received anything else, it was either for acceptable medical reasons, described by the staff, or as a result of fully
informed choices. At least 80 % of the randomly selected mothers who have decided not to breastfeed report that the
staff discussed with them the various feeding options and helped them to decide what were suitable in their situations.
h. At least 80% of the randomly selected mothers with babies in special care who have decided not to breastfeed report
that staff has talked with them about risks and benefits of various feeding options.
7. PRACTICE ROOMING IN - ALLOW MOTHERS AND INFANTS TO REMAIN TOGETHER - 24 HOURS A DAY.
 The following are the global criteria for this step:
a. Observations in the postpartum wards and any well-baby observation areas and discussions with mothers and staff
confirm that at least 80% of the mothers and babies are rooming-in or, if not, have justifiable reasons for not being
together.
b. At least 80% of the randomly selected mothers report that their babies have stayed with them in their rooms/beds since
they were born, or, if not, there were justifiable reasons.
8. ENCOURAGE BREASTFEEDING ON DEMAND.
 The following are the global criteria for this step:
a. At least 80% mothers should report that they have been told how to recognize when their babies are hungry and can
describe at least two feeding cues.
b. At least 80% mothers should report that they have been advised to feed their babies as often and for as long as the
babies want or something similar.
9. GIVE NO ARTIFICIAL TEATS OR PACIFIERS (ALSO CALLED DUMMIES OR SOOTHERS) TO BREASTFEEDING
INFANTS.
 The following are the global criteria for this step:
a. Observations in the postpartum wards or rooms and any well baby observation areas should indicate that at least 80% of
the breastfeeding babies observed are not using bottles or teats or, if they are, their mothers have been informed of the
risks.
b. At least 80% of the randomly selected breastfeeding mothers should report that, to the best of their knowledge, their
infants have not been fed using bottles with artificial teats (nipples).
c. At least 80% of the randomly selected mothers report that, to the best of their knowledge, their infants have not sucked
on pacifiers
10. FOSTER THE ESTABLISHMENT OF BREASTFEEDING SUPPORT GROUPS AND REFER MOTHERS TO THEM ON
DISCHARGE FROM THE HOSPITAL OR CLINIC.
 The following are the global criteria for this step:
a. Head director of maternity services should report mothers are given information on where they can get support if they
need help with feeding their babies after returning home, and the head/director can also mention at least one source of
information.
b. Head director of maternity services should report that the facility fosters the establishment of and/or coordinates with
mother support groups and other community services that provide breastfeeding/infant feeding support to mothers, and
this same staff member can describe at least one way this is done.
c. Head director of maternity services should report that the staff encourages mothers and their babies to be seen soon
after discharge (preferably 2-4 days after birth and again the second week) at the facility or in the community by a
skilled breastfeeding support person who can assess feeding and give any support needed and can describe an
appropriate referral system and adequate timing for the visits.
d. A review of documents should indicate that printed information is distributed to mothers before discharge, if appropriate,
on how and where mothers can find help on feeding their infants after returning home and includes information on at
least one type of help available.
e. Out of the randomly selected mothers at least 80% should report that they have been given information on how to get
help from the facility or how to contact support groups, peer counsellors or other community health services if they have
questions about feeding their babies after return home and can describe at least one type of help that is available.

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