REPORT ON THE CURRENT STATE OF

EARLY CHILDHOOD CARE AND DEVELOPMENT IN

THE PHILIPPINES

1 MAY 2019
FINAL DRAFT
NOT FOR WIDER CIRCULATION
TABLE OF CONTENTS

LIST OF ABBREVIATIONS 3

SECTION 1 – INTRODUCTION 6

SECTION 2: YOUNG CHILDREN’S OUTCOMES AND ECCD PROGRAMS 7

2.1 INTRODUCTION 7
2.2 HEALTH OUTCOMES AND ENABLING EFFORTS 7
2.3 NUTRITION OUTCOMES AND ENABLING EFFORTS 22
2.4 DEVELOPMENTAL OUTCOMES FOR YOUNG CHILDREN AND ENABLING EFFORTS 30
2.5 SECURITY AND SAFETY OF YOUNG CHILDREN AND ENABLING EFFORTS 41
2.6 PATTERNS AND SOURCES OF DISPARITIES - SYNTHESIS 48

SECTION 3 - INSTITUTIONS 53
3.1 KEY NATIONAL-LEVEL AGENCIES FOR EARLY CHILDHOOD PROGRAMS 53
3.2 NATIONAL-LEVEL COORDINATION MECHANISMS 60
3.3 LOCAL GOVERNMENT UNITS 72
3.4 ECCD SERVICE PROVIDERS 80
3.5 FINANCING FOR ECCD 81
3.6 LEGISLATIVE FRAMEWORK 83

SECTION 4 – SYNTHESIS ON CRITICAL GAPS AND KEY OPPORTUNITIES 88

4.1 CHALLENGING OUTCOME AREAS 88
4.2 CRITICAL GAPS AND KEY OPPORTUNITIES IN ENABLING EFFORTS 88
4.3 CRITICAL GAPS AND KEY OPPORTUNITIES IN DATA COLLECTION AND USE 93
4.4 CRITICAL GAPS AND KEY OPPORTUNITIES IN INSTITUTIONAL FRAMEWORK 96
4.5 CRITICAL GAPS AND KEY OPPORTUNITIES IN LEGISLATIVE FRAMEWORK 99

BIBLIOGRAPHY 101

2
LIST OF ABBREVIATIONS

Acronym Meaning
4Ps Pantawid Pamilyang Pilipino Program
APIS Annual Poverty Indicators Survey
ARMM Autonomous Region in Muslim Mindanao
BEST Basic Education Sector Transformation Program
BHW Barangay Health Worker
BNS Barangay Nutrition Scholars
C/MSWDOs City/Municipal Social Welfare and Development Officers
CALABARZON Cavite, Laguna, Batangas, Rizal, and Lucena
CDC Child Development Center
CDT Child Development Teachers
CDW Child Development Worker
CHERG Child Health Epidemiology Reference Group
CHR Commission on Human Rights
COA Commission on Audit
CVS Compliance Verification System
CWC Council for the Welfare of Children
DA Department of Agriculture
DBM Department of Budget and Management
DCCs Day Care Centers
DCW/Ts Day Care Workers/Teachers
DepEd Department of Education
DFA Department of Foreign Affairs
DFAT Department of Foreign Affairs and Trade (Australia)
DHS Demographic and Health Survey (USAID)
DILG Department of the Interior and Local Government
DOH Department of Health
DOJ Department of Justice
DOLE Department of Labor and Employment
DOST Department of Science and Technology
DPWH Department of Public Works and Highways
DSWD Department of Social Welfare and Development
DOTC Department of Transportation and Communication
DTI Department of Trade and Industry
ECCD Early Childhood Care and Development

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ECCD IP ECCD Intervention Package
ECCDC ECCD Council
ECEP Early Childhood Education Program
ECTEP Early Childhood Teachers Education Program
ED Executive Director
EDPID Early Detection, Prevention, and Intervention of Disability
EPI Expanded Program on Immunization
ERPAT Empowerment and Reaffirmation of Paternal Abilities
EYA Early Years Act
F1K First 1000 Days Initiative
FLEMMS Functional Literacy, Education and Mass Media Survey
FSP Family Support Program
GAA General Appropriations Act
GAD Gender and Development
GB Governing Board
ICT Information and Communications Technology
IMCI Integrated Management of Childhood Illness
IRA Internal Revenue Allotment
JWC Juvenile Justice and Welfare Council
LCPC Local Council for the Protection of Children
LFS Labor Force Survey
LGU Local Government Unit
LMIEP Leading and Managing an Integrated ECCD Program
MCP Maternity Care Package
MIMAROPA Mindoro, Marinduque, Romblon and Palawan.
MOOE Maintenance and Other Operating Expenses
NCDA National Council on Disability Affairs
NCDC National Child Development Centers
NCIP National Commission on Indigenous Peoples
NCP Newborn Care Package
NCR National Capital Region
NEDA National Economic and Development Authority
NELC National Early Learning Curriculum
NETIS NCDC Enrollment Tracking and Information System
NNC National Nutrition Council
NNS National Nutrition Survey
NPAC National Plan of Action for Children
NYC National Youth Commission

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OOSCI Out-of-school Children Initiative
OPT Operation Timbang Plus
PAGCOR Philippine Amusement and Gaming Corporation
PDP Philippines Development Plan
PES Parent Effectiveness Service
PIA Philippine Information Agency
PPAN Philippine Plan of Action for Nutrition
PSA Philippine Statistics Authority
SDG Sustainable Development Goal
SEF Special Education Fund
SNP Supervised Neighborhood Playgroups
South Cotabato, Cotabato Province, Sultan Kudarat, Sarangani and General
SOCCSKARGEN
Santos City
TESDA Technical Education and Skills Development Authority
TWG Technical Working Group
UIS UNESCO Institute for Statistics
ULAP Union of Local Authorities of the Philippines
WASH Water, Sanitation and Hygiene
WB World Bank
WHO World Health Organization

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SECTION 1 – INTRODUCTION
This report presents a general picture of the current state of early childhood care and
development (ECCD) in the Philippines. To this end, the report examines early
childhood outcomes, reviews ongoing ECCD programs, describes the institutional
framework of ECCD efforts, and highlights critical gaps and key opportunities for ECCD
efforts. The report is the output of research involving desk reviews, interviews and group
discussions.

The primary objective of the report is to guide key stakeholders working on ECCD in
identifying the main pillars of a national strategic plan that will facilitate reaching
organizational, national and global targets set for the wellbeing of young children in the
Philippines. In this regard, Section 4 on critical gaps and key opportunities is particularly
relevant and primarily recommended for policymakers reviewing this report.

Early childhood is arguably the most critical period in a person’s life. It is a critical period
both for the protection of right to life and right to development and as an enabler for the
realization of other rights. Given its effects on long-term wellbeing, programs targeting
early childhood period are deemed as highly valuable. Ensuring good nutrition in early
years is found to have sizable positive impact on life-long morbidity. A recent study in
the Philippines estimates the overall return on investments to address undernutrition to
be as high as 1 to 12 (UNICEF, DOH & NNC 2017). Good quality early learning
programs are also found to have sizable positive impact on cognitive skills with positive
implications for learning at school, labor market outcomes, health, and crime prevention
(Lancet 2017). A recent study in the United States has found high-quality,
comprehensive, early childhood education programs targeting disadvantaged families
from birth-to-five to have a life-cycle benefit-cost ratio of 6.3 (Garcia et.al., 2017).
Similarly, good quality early learning investments are found to have positive impact on
socioemotional skills that then translate into improved learning outcomes in education
and labor market outcomes (Puerta, Valerio & Bernal, 2016).

Early childhood programs have been found to be particularly effective when they are
designed and implemented in a holistic and integrated manner. Programs that bring
together different aspects of a young child’s wellbeing, such as health, nutrition, early
learning, safety and security, have been found to have a particularly positive impact not
only in other countries (Lancet 2017) but also in Philippines itself (King et.al., 2006).

Yet the importance of the early childhood period and the positive impact of integrated,
holistic early childhood programs have come to be recognized globally only more
recently. In contrast, efforts targeting young children have been underway in the
Philippines for over 40 years with a further intensification of these efforts in recent
years. Thus, this report is as much a celebration of these achievements as it is a
guidepost for future efforts. The wealth of experiences in ECCD and the widely shared
commitment to young children puts Philippines in an ideal position to become an
example for the rest of the world in improving the wellbeing of young children.

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SECTION 2: YOUNG CHILDREN’S OUTCOMES AND ECCD PROGRAMS
2.1 INTRODUCTION
Individual wellbeing of young children and the general wellbeing of their families are
inextricably intertwined. Deterioration in one is likely to bring about a deterioration in the
other just like an improvement in one is likely to bring about an improvement in the
other. Accordingly, the rest of this section discusses not only the recent trends and the
current state of young children but also inspects various aspects of the family
environment that shape young children’s wellbeing.

This link between the wellbeing of young children and their families is particularly
pertinent to fully appreciate the importance of supporting families in providing
responsive care for their young children. Responsive care by families and caregivers
has the power to protect young children from the worst effects of adversity and promote
their physical, emotional, and cognitive development (WHO, UNICEF & World Bank,
2018). Thus, the effective early childhood care and development policies and programs
starts with identifying the diverse needs of families and caregivers in providing nurturing
care for their young children and supporting them in fulfilling these needs by developing
and implementing enabling policies and programs (WHO, UNICEF & World Bank,
2018).

The rest of this section presents a snapshot of the key dimensions of a young child’s
wellbeing, i.e. good health, adequate nutrition, opportunities for early learning,
responsive caregiving, security and safety, and the main efforts for creating the enabling
environments to support families and caregivers in providing nurturing care to their
young children.

Such enabling efforts include services, programs, laws and policies that: (i) strengthen
caregivers’ capabilities in providing nurturing care, (ii) empower communities in
supporting families, (iii) make supportive services available and accessible, (iv) enable
families and caregivers to provide nurturing care with family-friendly labor policies,
universal health care policies, and equitable social welfare policies. These efforts
include universal efforts that benefit all families and children, targeted efforts that
benefit those young children whose caregivers may not be able to provide nurturing
care due to poverty, displacement, undernutrition, and tailored efforts that benefit
those young children who have additional needs due to being orphaned, being born to
violent homes, having low birth weight, being severe malnourished, or having disabilities
or developmental difficulties by providing them with additional services.

2.2 HEALTH OUTCOMES AND ENABLING EFFORTS

The good health of a young child is dependent on several factors ranging from the
availability of improved sanitation facilities and having reliable access to safe drinking
water to having reliable access to primary healthcare services and not being exposed to
household and environmental dangers. These factors shape the health of young
children from conception onwards and together determine a child’s survival, morbidity
and physical development outcomes.

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Yet the element that binds all these factors together is responsive caregiving. Young
children’s healthy development is possible when the primary caregivers monitor their
physical and emotional condition, have hygiene practices to minimize infections, use
promotive and preventive health services, and seek care and appropriate treatment for
their illnesses. Thus, fundamental to the good health of young children is the good
health and well-being of primary caregivers. An undernourished teenage mother is not
only less likely to give birth to a healthy infant, but she is also less able to be responsive
to the needs of her child. Thus, an analysis on the health outcomes of young children
must take into account the health and wellbeing of their caregivers.

Health: Prenatal Period to 23 months

Healthy Pregnancies: Poor maternal health during pregnancy increases the risk of low
birth weight or preterm birth, which increases the risk of developmental difficulties, infant
mortality and morbidity rates. Inadequate maternal nutrition (discussed in the next
section), exposure to environmental pollutants and toxic chemicals, exposure to
physical violence during pregnancy, and use of tobacco, alcohol and substances during
pregnancy all pose threats to healthy pregnancies.

Smoking cigarettes or tobacco during pregnancy, for instance, is associated with low
birth weight. On average, one out of five women (21%) who smoke cigarettes during
pregnancy gave birth to low weight newborns compared to one out of seven women
(14%) who did not smoke (PSA NDHS 2017). 5% of all women age 15-49 and 2.3% of
pregnant women smoke a tobacco product (PSA NDHS 2017). Exposure to cigarette
smoke inside the house during pregnancy also constitutes a risk factor. In 28% of
households someone smokes inside the house on a daily basis (PSA NDHS 2017).

Consuming alcohol during pregnancy may also contribute to the risk of miscarriage and
stillbirth, and fetal alcohol spectrum disorders. Overall, 0.3% of women report drinking
alcohol on a daily basis and 26% drink alcohol on some days (PSA NDHS 2017).
Among pregnant women, 0.1% report drinking alcohol on a daily basis and 16.8% report
drinking alcohol on some days (PSA NDHS 2017). Women living in urban areas
(30.1%) and women living in the wealthiest households (29.7%) are more likely to report
consuming alcohol on some days (PSA NDHS 2017).

Figures on exposure to environmental pollutants and toxic chemicals, and figures on

substance use during pregnancy could not be found.

Exposure to physical violence during pregnancy is another factor that increases the risk
of preterm birth and perinatal and maternal mortality. On average, about one out of 33
women (2.9%) between the ages of 15 and 49 who have ever been pregnant reported
experiencing physical violence during pregnancy. Women living in the poorest
households were more likely to have experienced physical violence during pregnancy
(3.9%) as well as women who have never been married (5.7%) and women who are
divorced, separated or widowed (6.4%) (PSA NDHS 2017).

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Childbearing among teenagers is another factor that increases the risk of low birth
weight and preterm birth as well as of neonatal and maternal mortality. Teenage
mothers are more likely to need additional support in their efforts to provide nurturing
care to their infants and young children. Thus, the increasing trends in the prevalence of
childbearing among teenagers in the Philippines is particularly alarming. Among 15-19
year-old women, 9% have begun childbearing with 7% having had a live birth and 2%
pregnant with their first child (PSA NDHS 2017). The percentage of 15-19 year-old
women who have begun childbearing was 7% in 1993 and about 10 % in 2008 and
2013 (PSA NDHS 2017). Teenage childbearing is most common in Davao (17.9%),
Northern Mindanao (14.7%) and SOCCKSARGEN (14.5%) (PSA NDHS 2017). A higher
percentage of 15-19 years old teenagers living in the poorest households have begun
childbearing (14.8%) compared to their peers in the wealthiest households (3.2%) (PSA
NDHS 2017). Despite being at higher risk for neonatal and maternal mortality, teenage
mothers are less likely to receive regular antenatal care visits (79.6% versus 88% of 20-
34 year-old women) (PSA NDHS 2017), which might be attributed to less access to
information and social stigma as well as higher incidence of poverty among teenage
mothers (Rivera, 2015)).

Birth interval also emerges as a relevant factor for healthy pregnancies with intervals of
less than 24 months increasing the risk of preterm birth, low birth weight, neonatal and
maternal mortality. One in four non-first births (24.5 %) occurs sooner than this
recommended interval (PSA NDHS 2017) with notable income-based, education-based
and regional disparities. For instance, this figure goes up to: (i) 31.9 % for women who
have no education (compared to 20.6 % for women who have college education); (ii)
30.3 % for women who live in the poorest households (compared to 15.8 % for women
who live in the wealthiest households); (iii) 32.5 % for women who live in Zamboanga
Peninsula (IX) and 36.3 % for women who live in ARMM (compared to 19.1 % for
women who live in Cagayan Valley and 19.3 % for women who live CALABARZON).

Antenatal care coverage constitutes a critical factor for supporting healthy pregnancies
particularly for those that are at higher risk of preterm birth, low birth weight, stillbirth,
neonatal and maternal mortality. Under a series of maternal health programs initiated by
the Department of Health with National Safe Motherhood Program as the most recent
one, there has been a steady positive trend in the coverage of early and regular
antenatal care over the last two decades. In 2017, 71% of women received antenatal
care during their first trimester, which is critical for the effectiveness of risk management
and preventive interventions, compared to 43% of women in 1993. Similarly, in 2017
87% of women stated that they received antenatal care 4 or more times from a skilled
provider during their most recent pregnancy compared to only 55% of women in 1993
and 70% of women in 2003. Over the same period, change in the percentage of women
receiving at least one antenatal care from a skilled provider has been relatively limited
(from 85% in 1993 to 94% in 2017), underscoring the particular improvement in the
frequency of antenatal care provided to pregnant women (PSA NDHS 2017). This
improvement in the coverage of regular antenatal care has been accompanied by an
improvement in some indicators related to the quality of care whereby a higher
percentage of women are having their blood pressure measured (98.6% in 2017

9
compared to 90% in 2003) and urine sample taken (78.1% in 2017 compared to 47% in
2003) (PSA NDHS 2017).

Despite the overall positive trends in the coverage of antenatal care, education-based,
income-based and cross-regional disparities remain. Among women with no education,
who arguably would benefit the most from antenatal care, one out of four (24.3%) do not
receive any antenatal care (PSA NDHS 2017). Among those who receive antenatal
care, only three out of four receive care from a skilled provider (PSA NDHS 2017).
Among women who live in the poorest households, one out of 12 (7.9%) do not receive
any antenatal care compared to one out of 100 (0.9%) among women who live in the
wealthiest households. The region with the lowest antenatal care coverage is ARMM
where one out of six women (16.9%) do not receive antenatal care and of those who
receive antenatal care only two out of three receive it from a skilled provider. ARMM is
followed by Western Visayas (6.9%) and Zamboanga (4.4%) (PSA NDHS 2017).

Similarly, despite positive trends in the quality of antenatal care, education-based,

income-based and cross-regional disparities remain. Among women who received
antenatal care, those who have college education are twice as likely to have their urine
sample taken as those who have no education, which could be partially driven by the
differences in the socio-economic status of these groups (88.8% versus 42.9%) (PSA
NDHS 2017). Among women who received antenatal care, those who live in the
wealthiest households are twice as likely to have their blood sample taken as those who
live in the poorest households (91.5% versus 51.4%) (PSA NDHS 2017). Cross-regional
differences are also stark with women in ARMM and Zamboanga Peninsula receiving
particularly low quality of antenatal care. For instance, only 16.2% of women in ARMM
and 22.5% of women in Zamboanga who receive antenatal care have their blood
sample taken, compared to the national average of 71.9% (PSA NDHS 2017).

When we turn to outcome variables of healthy pregnancies, i.e. prevalence of low birth
weight, prevalence of pre-term birth as well as maternal mortality and neonatal
mortality, the figures reveal various disparities.

Figures on low birth weight reveal some cross-regional disparities with one out of five
children in Zamboanga (20.8%) and Davao (19.7%) being reported as having low birth
weight compared to less than one out of ten children in Cordillera (8.7%) and NCR
(9.4%). Children born to the poorest households were more likely to have low birth
weight (16.4%) than children born to the wealthiest households (12.5%) (PSA NDHS
2017). These figures are particularly disconcerting given that children with a low birth
weight born to the poorest households are also less likely to receive the appropriate
intensive support needed to prevent mortality, stunting and delays in cognitive
development. It is also worth noting that even in the wealthiest households, one out of
eight newborns have low birth weight. 1

1
It must be noted that these figures are likely to under-estimate the prevalence of low birth
weight given that only 84% of the births had a reported birth weight and the unreported birth
weights are more likely to be of children living in more vulnerable households and thus have
higher prevalence of low birth weight. For instance, only 70.1% of children born to the poorest

10
Figures on pre-term birth are particularly susceptible to measurement error given
imprecision in mothers’ estimation of gestational age. About 1 out of 40 births (2.6%)
occurred at or before 8 months across the Philippines (PSA NDHS 2017). Women living
in wealthiest households were more likely to have pre-term births (3.9%) compared to
women living in poorer households (PSA NDHS 2017). Women living in urban areas
were more likely to have pre-term births (3.0%) compared to women living in rural areas
(PSA NDHS 2017). Very young women (<20) and older women (35-49) were more likely
to have pre-term births (3.3% and 3.5% respectively). The drivers of these disparities
are unclear at this point. Across the regions, the ratio of pre-term births range from 0.8%
in Caraga to 3.7% in Western Visayas (PSA NDHS 2017).

Figure 2.1: Maternal Mortality Ratio2

Figure 2.2: Infant and Neonatal Mortality Rate 3

households had a reported birth weight compared to 91.9% of children born to the wealthiest
households. (PSA NDHS 2017)
2
Panelo et.al. (2017), pg. 66.
3
Panelo et.al. (2017), pg.67.

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Healthy Deliveries: The fact that the prevalence of maternal and neonatal deaths have
not declined in the Philippines over the last 25 years (25 Year Report) is particularly
disconcerting. It must be noted that maternal mortality and neonatal mortality rates are
linked to not only adversities in pregnancy but also quality of maternal health services,
of postpartum care and of neonatal care.

Over the last 25 years, the percentage of births delivered in a health facility increased
from 28% in 1993 to 77.7% in 2017 (PSA NDHS 2017). While this improvement is
impressive, the figure did not meet the target of 85% set under the Philippine
Development Plan of 2011-2016. Furthermore, despite an overall improvement, sizable
urban-rural, income- and education-based and cross-regional disparities remain.
 Pregnant women living in urban areas delivered in a health facility at higher rates
than pregnant women in rural areas (84.8% versus 72.2%), which could be
attributed primarily to spatial differences in the degree of development of public
health institutions (Quintos 2017) especially given that one out of three (36.1%)
women living in rural areas who did not deliver in a health facility cited distance
and lack of transportation as the main reason (PSA NDHS 2017).
 While 96.9% of women living in the wealthiest households delivered in a health
facility, only 58.4% of women living in the poorest households did so. Among
women with no education, who are likely to be the poorest of the poor, only
26.4% delivered in a health facility. The strong relation between poverty and not
delivering in a health facility is further supported by the fact that one out of four
women who did not deliver at a health facility (25.2%) cited high costs as the
main reason (PSA NDHS 2017).
 In terms of cross-regional disparities, ARMM emerges as an outlier with about 1
out of 4 women (28.4%) delivering in a health facility. Among the remaining
regions, the percentage ranged from 63.5% in SOCCSKSARGEN to 91.9% in
NCR (PSA NDHS 2017). Most of the regions that had lower than the national
average rate are located in Mindanao, which could be attributed to the lower

12
 access to health facilities in Mindanao compared to the rest of the country
(Quintos 2017).
 It is particularly alarming that only 1 out of 4 women (23.3%) who had no
antenatal care visits delivered in a health facility (PSA NDHS 2017), suggesting a
double-exclusion from necessary services that increases the risk of maternal and
infant mortality.

Over the same period, the percentage of births delivered by a skilled provider such as a
doctor, midwife or nurse has increased from 53% in 1993 to 84.4% in 2017 (PSA NDHS
2017). Similar to trends and patterns in deliveries in health facilities, despite an overall
improvement over the last 25 years, urban-rural, income- and education-based
disparities and cross-regional disparities persist (PSA NDHS 2017):
 A higher percentage of pregnant women living in urban areas received
assistance from a skilled provider during delivery compared to those living in
rural areas (91.6 % versus 78.7%).
 Only two out of three women (64.5%) living in the poorest households received
assistance from a skilled provider during delivery, compared to 98.7% of women
living in the wealthiest households.
 ARMM emerges as an outlier again with only one out of three women (33.6%)
receiving assistance from a skilled provider during delivery; two out of three
women in ARMM (65.6%) received assistance from a traditional birth
attendant/hilot. Among the remaining regions, the percentage of births delivered
by a skilled provider ranged from 68.6% in MIMAROPA to 98% in Ilocos.
 Women who did not receive any ante-natal care received assistance from a
skilled provider at much lower rates (31.6%).

Perinatal mortality, that is stillbirths (pregnancy losses occurring after 7 months of

gestation) and early neonatal deaths (deaths of live births within the first 7 days after
birth), is a useful indicator in understanding factors contributing to and disparities in
healthy pregnancies and healthy deliveries. Advanced maternal age and very short
pregnancy intervals are both associated with higher risk of perinatal mortality (PSA
NDHS 2017). The relationship between household income and perinatal mortality rates
is less clear (PSA NDHS 2017).

While perinatal mortality rates in urban versus rural areas are similar (19 stillbirths and
neonatal deaths per 1000 pregnancies of 7 or more months’ durations), observable
cross-regional disparities exist. The regions with the highest perinatal mortality rates are
Western Visayas (31), Bicol (30) and Ilocos (30) while the regions with the lowest rates
are Cordillera (4), NCR (12) and SOCCSKSARGEN (14) (PSA NDHS 2017).
Additionally, the proportion of stillbirths and early neonatal deaths in total perinatal
deaths varies across the regions, which suggests differences in risk factors and
bottlenecks in services for ensuring healthy pregnancies and healthy deliveries. While
nationwide early neonatal deaths make up the majority of perinatal deaths, in some
regions, such as NCR, perinatal mortality rates are lower than other regions and early
neonatal deaths constitute only a small proportion of perinatal deaths, suggesting higher
levels of access to quality delivery and early neonatal care services.

13
Despite an overall increase in the percentage of births delivered in a health facility and
births attended by skilled health professions combined with a decrease in income-based
inequalities in these rates (Panelo et.al., 2017), avoidable maternal and neonatal deaths
continue to occur at rates higher than countries with comparable developmental status
[provide comparative figure]. This stagnation in maternal and neonatal mortality rates
has been linked to problems in the quality of care and in equitable coverage of services
(Dayrit et.al., 2018; pg 228). Under the Department of Health’s Newborn Care Program
efforts have been intensified since 2009 to improve the quality of services to decrease
neonatal mortality rates. The program’s objectives include the implementation of
essential newborn care in all health facilities and care for newborns with low birth weight
at hospitals with neonatal intensive care capacity and kangaroo mother care units.

GOOD POLICIES FOR ENABLING GOOD HEALTH OF YOUNG CHILDREN:

Universal health coverage that ensures that everyone gets good quality health services they need without
suffering financial hardship is a critical enabling policy for good health of all young children. It is especially
critical that all young children, regardless of their parents insurance status, have access to preventive and
promotive services as well as treatment, rehabilitation and palliative care (Nurturing Care Framework)

The increasing coverage of PhilHealth for Maternity Care Package (MCP) in recent years for prenatal
care, delivery and newborn care, and the Universal Health Care Act of 2019 constitutes positive
developments in this regard. MCP includes health services during antenatal period, normal delivery and
post-partum period, including visits within 72 hours and one week after delivery. Similarly, the policy for
availing Newborn Care Package (NCP), which includes Newborn Screening Test, Newborn Hearing Test
and provisions of essential newborn care (including weighing, eye prophylaxis, Vitamin K administration,
first dosage of hepatitis B and BCG vaccines), to all newborns delivered in accredited facilities regardless
of their mother’s PhilHealth coverage, is a positive development in this regard.

However, the fact that mothers who have high-risk conditions (including teen pregnancies, late
pregnancies, multiple births, history of miscarriages and stillbirth, history of serious medical conditions)
and births beyond the first four childbirths are not covered by MCP is an area that raises concern for
ensuring mothers and infants who are at higher risk for complications and death are able to receive the
appropriate care they need. Another area that is concerning is the limited tailoring of services covered
under MCP and NCP for mothers and infants who are identified to be at higher risk for preterm birth,
maternal mortality and infant mortality. Currently, medical interventions to prevent preterm delivery and
essential interventions for preterm and small newborns are covered under PhilHealth’s Z Benefit
Package. Further tailoring could entail increasing the coverage for more frequent antenatal visits,
extending the period of post-natal and post-partum visits beyond one week after delivery for higher-risk
mothers and newborns.

Another positive policy in this regard is PhilHealth’s Z Benefit Package for catastrophic illnesses that
includes children who have certain birth defects, children with mobility impairment, children with hearing
impairment, children with visual disabilities, and children with developmental disabilities. The services
covered under this benefit package include assessment and planning by a medical specialist and other
appropriate health professionals as well as rehabilitation therapy and assistive devices. However, efforts
are still underway to expand the provision of these services by contracting targeted tertiary-level
government facilities. The package presents a significant opportunity for improving early detection and
intervention for children with disabilities and developmental delays.

14
Postpartum care and neonatal care are not only essential components of preventable
maternal and neonatal deaths; they are also the foundational blocks for mothers and
infants’ good health. Quality of postnatal care for the newborn is particularly critical for
infants who have low birth weight, infants who were born preterm, infants born with a
birth defect. Similarly, quality of postpartum care for the mothers is particularly critical
for those who had a preterm delivery, who had a complicated delivery, and who are at
higher risk of postpartum depression. We know that young children’s good health
require caregivers monitoring their physical and emotional condition, giving appropriate
responses to their children’s needs, protecting them from dangers, and seeking care
and treatment for sicknesses (WHO, UNICEF & World Bank, 2018). These actions
depend on caregivers’ physical and mental well-being; and in most cases, the primary
caregiver for infants are the mothers. So when mothers who are anemic or experiencing
postpartum depression do not receive good quality postpartum care, they will be less
able to engage in responsive caregiving for their infants (WHO, UNICEF & World Bank,
2018).

Trends in early childhood mortality rates particularly highlight the importance of

postnatal care during the first month after birth. (Figure 8.1 in PSA NDHS 2017) During
the last 25 years, under-five mortality rate, that is the probability of dying between birth
and the fifth birthday, has been steadily declining from 54 deaths per 1000 live births in
1993 to 40 deaths in 2003 and 27 deaths in 2017. Infant mortality, that is the probability
of dying between birth and the first birthday, also declined during the same period but at
a slower speed with 34 deaths per 1000 live births in 1993 to 29 deaths in 2003 and 21
deaths in 2017. Much of this slower decline has been due to the limited progress in
preventing neonatal mortality, that is the probability of dying within the first month after
birth. In 1993, about half of under-one and about a third of under-five deaths occurred
during the first month after birth. By 2017, two-thirds of under-one and about half of
under-five deaths occurred during the first month. This trend in neonatal mortality is
particularly disconcerting given that the neonatal mortality rate held steady since 2013
(with 13 deaths per 1000 live births in 2013 versus 14 deaths per 1000 live births in
2017) (PSA NDHS 2017)

Looking closer at neonatal mortality rates in 2017, income-based disparities stand out
with 18 deaths per 1000 live births for infants born to the poorest households compared
to 8 deaths per 1000 live births for infants born to the wealthiest households. Paralleling
income-based disparities is cross-regional disparities with 33 neonatal deaths per 1000
live births in Western Visayas and 22 neonatal deaths per 1000 live births in Bicol, the
two regions with the highest rates, compared to 6 neonatal deaths in Central Luzon and
NCR, the two regions with the lowest rates.

These trends in neonatal mortality rates are linked to challenges faced in ensuring that
all new mothers and newborns, but especially those who are at higher risk for mortality,
have access to quality postpartum and neonatal care. Estimates based on 2017 NDHS
reveal that only 3 out of 4 (72.7%) of women have skin-to-skin contact immediately after
birth; 6.9% of women who had vaginal delivery at a health facility leave the facility in
less than 24 hours and 3.4% do so in less than 6 hours; 13.9% of women do not receive

15
a postpartum check during the first 2 days after birth and 9.2% do not receive any
postnatal check. These figures are particularly disconcerting given income- and
education-based and cross-regional disparities. 60.2% of women with no education and
20.7% of women who had Grade 1-6 education do not receive any postpartum check.
19.8% of women who live in the poorest households do not receive any postpartum
check. The percentage of women who do not receive any postpartum check is as high
as 30.1% in Eastern Visayas and 30% in ARMM, compared to 0.4% in Ilocos and 0.5%
in NCR. These disparities are also mirrored in the quality of the postpartum check
whereby women with less income and education are more likely to get a postpartum
check from a traditional birth attendant as opposed to a skilled health provider such as a
doctor, nurse or midwife.

Postnatal checks for newborns have similar disparity patterns both in coverage and
quality. In terms of coverage, nationwide 1 out of 10 newborns (11.2%) do not receive
any postnatal checks. In the poorest households, 1 out of 5 (22.9%) newborns do not
receive any postnatal check. Among newborns whose mothers do not have any
education, 2 out of 3 (61%) do not receive any postnatal check. Across the regions,
ARMM is an outlier with 44.5% of newborns not receiving any postnatal checks. Among
the remaining regions, the rates range from 24.1% in Zamboanga to 1.2% in Ilocos. In
terms of quality, nationwide the postnatal check received within the first 2 days after
birth by 86.3% of newborns includes the performance of at least two signal functions,
such as measuring temperature, weighing, counseling on danger signs, and counseling
on breastfeeding (PSA NDHS 2017). This figure is notably lower for newborns who
were not born in a health facility (72.4%), newborns born in ARMM (62.1%), newborns
born to mothers who have no education (44.1%).

GOOD PRACTICES FOR SUPPORTING THE GOOD HEALTH OF PREGNANT WOMEN, NEW
MOTHERS AND NEWBORNS: SARANGANI PROVINCE

The province of Sarangani has undertaken several successful health initiatives to ensure the good health
of new mothers and infants, including the three described below:

Paaral sa Sarangan is a scholarship program providing opportunities to Indigenous People (IP) and
especially those IP living in Geographically Isolated Disadvantaged Areas (GIDA) to study to become
midwives. Anchored on the provincial poverty alleviation program, the program addresses the scarcity of
health personnel in the province. Selected scholars are asked to sign contracts committing themselves to
serving in GIDA once they are licensed as a health professional.

Tutok Buntis is a one-stop shop service for pregnant women living in GIDA. Pregnant women are
provided a package of services including laboratory tests, ultrasounds, micronutrient supplementation,
deworming tables, tetanus toxoid immunization, and conseling services. In malaria and dengue-infested
areas, they are also provided with insecticide-treated bednets.

True Love Waits is a program aiming to mitigate the increase number of teenage pregnancies in
Sarangani province. The program emphasizes the value of “waiting for the right time and the right person”
in addition to giving information on values and sexual reproductive health.

(Information based on interviews in Alabel and Malungon, Sarangani)

16
Healthy Mothers, Healthy Infants and Toddlers - Birth to 23 Months: The health of
the mother and the infant during the first 23 months after birth continue to be tightly
connected to each other. As suggested by the infant mortality rates that have generally
been stagnant over the last two decades, various factors related to mortality and
morbidity during the period from birth to 23 months continue to require more effective
interventions. These include healthy and appropriate breastfeeding and feeding
practices, household access to clean water and sanitation facilities, exposure to
environmental pollutants and toxic chemicals, provision of a safe environment for infants
and toddlers for the prevention of accidents, among others. Please note that nutrition
related factors and outcomes for these factors are taken up in the next section.

In terms of households’ access to clean water, the majority of households in urban

areas (98 %) and rural areas (93 %) use an improved source of drinking water,
including piped water, public tap, protected well, and bottled water/refilling station [PSA
NDHS 2017].4 However, access to improved source of water varies across regions and
household income with about one out of three households in ARMM (29 %) using
unimproved source of water (compared to 0.5 % in NCR) and with about one out of six
households in the poorest quintile (16.3 %) using unimproved source of water
(compared to 0.5 % of households in the wealthiest quintile) (PSA NDHS 2017). Using
unimproved source of water for drinking, cooking and handwashing increases the risk of
young children suffering from waterborne diseases that are likely to deteriorate their
health and nutrition status.

Another critical component to a young child’s health is the household’s access to

improved toilet facilities. In terms of sanitation, the majority of households in urban
areas (76 %) and rural areas (76 %) use non-shared toilets that prevent contact with
human waste and reduce transmission of diseases (PSA NDHS 2017). Another 20 % of
households in urban areas and 15 % of households in rural areas use shared toilet
facilities of an acceptable type (PSA NDHS 2017). Those young children living in the
remaining households (3% of households that use unimproved facilities and 5% of
households not using any facility (open defecation) are at greater risk of diarrheal
diseases as well as typhoid and cholera. Similar to clean water access, regional and
income-based disparities are notable. In ARMM, half of the households either use an
unimproved facility (31.6 %) or do not use any facility (21.8 %) (PSA NDHS 2017). In
Central Visayas, one out of seven households either use an unimproved facility (2.0 per
cent) or do not use any facility (12.6 %) (PSA NDHS 2017). Among households in the
poorest quintile, about one out of three either use an unimproved facility (10.5 %) or do
not use any facility (19.2 %) (PSA NDHS 2017).

Part of the link between a young child’s health and the household’s access to improved
toilet facilities concerns appropriate disposal of children’s stool (defined as stool
being put or rinsed into a toilet or latrine, burried, or the child using a toilet or latrine)

4
NDHS classifies households that use bottled water or refilling stations for drinking as using an
improved source only if the water they use for cooking and handwashing comes from an improved
source (PSA NDHS 2017).

17
(PSA NDHS 2017). Overall, only 17.6% of 0-2 year-old children’s stools are disposed of
appropriately. The rate is lowest in wealthiest households (3.9%) and in households
using an improved sanitation facility (16.7%) (PSA NDHS 2017). The inverse
relationship between wealth/improved sanitation and appropriate disposal of children’s
stool can partially be explained by the high prevalence of disposing of stools in the
garbage in these households (Coram International 2018).

Notable policies and programs to improve overall water and sanitation services
and basic hygiene practices include the National Sustainable Sanitation Promotion
Program providing the basis for all plans and activities on sustainable sanitation, DOH’s
Zero Open Defecation Program promoting collective behavior change, strong supply
chains and improved public services, DILG’s SalinTubig Program providing water
supply systems for waterless municipalities and improving local capacity for
management of water supply facilities, DPWH’s Sewerage and Septage Management
Program promoting technologies for the management of community sewage waste.
Efforts to improve water, sanitation and hygiene in day care centers and in schools are
particularly pertinent for young children. In this regard, DepEd Order No. 10 “Policy and
Guidelines for Comprehensive Water, Sanitation and Hygiene in Schools Program” and
DILG-DepEd Joint Memorandum Circular for Water, Sanitation and Hygiene in ECCD
provide the legal basis for efforts in this regard.

Indoor air pollution is also relevant to a young child’s health as exposure increases
the risk of acute respiratory diseases, which is among the main causes of under five
mortality. The majority of households (76.9 %) cook inside their houses; about two out
of three households in rural areas (66.6 %) and one out of four households in urban
areas (24.9 %) use solid fuels for cooking which leads to indoor air pollution.
Additionally, in about one out of four households (27.7 %) someone smokes inside on a
daily basis, which also creates indoor air pollution.

Vaccine coverage is another critical factor in ensuring young children are in good
health through early childhood and onwards. In 2017, 9.4% of 12-23 months-old
children and 14% of 24-35 months-old children were reported not to have received any
vaccinations. Relatedly, only 70% of 12-23 months-old children were received to have
received all basic vaccinations despite the National Immunization Program/Expanded
Programme on Immunization under the leadership of Department of Health. This figure
signals an overall decline over the last 25 years: in 1993, 72% of children in this age
group were reported to have received all basic vaccinations and in 2008, this figure was
as high as 80%. This declining trend in vaccination coverage has become particularly
alarming with recent spikes in morbidity and mortality rates associated with various
vaccine-preventable diseases, including measles, diphteria, and whooping cough (The
Philippine Immunization Program Strategic Plan for 2016-2022).

The low rates of coverage combined with a sharply declining trend in recent years is
alarming especially when combined with notable variation in coverage rates across
regions and income groups. ARMM and SOCCSKSARGEN emerge as outliers with
almost half of 12-23 months-old children (43.7%) in ARMM and about one out of three

18
12-23 months-old children (31.1%) in SOCCSKSARGEN reported as not having
received any vaccinations. For the rest of the regions, this figure ranges from 16.6% in
Central Visayas and 15.7% in Western Visayas to 0.7% in Davao and 0.8% in Eastern
Visayas. When we turn to income-based disparities, 15.9% of 12-23 months-old
children living in the poorest households were reported to have not received any
vaccinations compared to 4.3% of their peers living in the wealthiest households. It is
worth noting that one out of four 12-23 months-olds living in the wealthiest households
do not receive all age-appropriate vaccinations (PSA NDHS 2017).

Vaccine coverage is particularly low for vaccines administered several months after
birth, which has been linked to limited availability of effective capture points (Panelo
et.al., 2017; pg.112). Vaccines are delivered in all health centers but only in some
barangay health stations and rural health units, which are generally located closer to
communities. The fact that vaccines are delivered only in some and not all barangay
health stations and rural health units has been linked to variable capacity in storing
vaccines and managing inventories, and an increase in the workload of community
health personnel that leads some to give vaccination lower priority (Dayrit et.al., 2018).
In terms of identifying effective capture points for succeeding doses of vaccines and
boosters, day care centers and child development centers remain an under-explored
opportunity (Panelo et.al., 2017; pg 177).

Several factors have been highlighted as potentially contributing to the decline in

vaccination coverage rate, including problems with Department of Health central
procurement and logistics (Panelo et.al., 2017), notable variation in LGUs’ ability to
routinely administer vaccines (Panelo et.al., 2017), recent rise in public concern about
vaccine safety, and the absence of sanctions and incentives to ensure that LGUs use
their resources optimally to administer vaccines. Efforts to improve cold chain
management for safe delivery of vaccines across the country have been underway in
recent years yet the need to upgrade cold chain equipment remains in many provinces.
More generally, the need remains for strengthening immunization supply chain, for
improving the quality of immunization data, and for effectively promoting the demand for
vaccines especially given the recent public concerns about vaccine safety.

Ensuring all children and especially children who are at risk of developmental delays
and children with disabilities are reached via regular post-natal checkups is another
area requiring additional attention. Regular post-natal checkups during the first three
months after birth and regular well-baby visits during the first two years of a child’s life
are critical to ensuring infants, toddlers and their mothers are in good health and young
children are set on a course of healthy development. These checkups can contribute to
prevention of diseases by encouraging better hygiene practices and timely
administration of vaccines, and to timely interventions for adequate and appropriate
nutritional practices, among others. Regular post-natal checkups and well-baby visits
are also essential for the prevention and early detection of disabilities, along with
regular pre-natal checkups and newborn screening. The mother-and-baby book
emerges as a relevant tool in this regard despite its limited use. As a comprehensive
tool integrating mother and child’s health records and providing basic information for the

19
healthy growth and full development of young children, the mother-and-baby book could
complement regular post-natal checkups and well-baby visits.

Department of Health’s Child Development and Disability Prevention Program is worth

highlighting in this context. The Program comprises of: (i)newborn screening, follow-up
and intervention of metabolic diseases, (ii) newborn hearing screening, follow-up and
early intervention of infants with detected congenital hearing loss, and (iii) child injury
prevention efforts. The newborn screening components of the Program are not readily
available in all birthing facilities, including those at the barangay level. Components of
the Program that are in more nascent stages of implementation are (i)interventions for
young children who tested positive of metabolic diseases; (ii)early childhood
development that integrates developmental delay screening, promotion of growth,
development and responsive care into the provision of routine child health and nutrition
services, and (iii) early intervention for child rehabilitation including expansion of facility-
based pediatric rehabilitation services. Also worth mentioning is the recent development
of the System for Early Identification, Prevention, Referral and Intervention by the
ECCD Council, which is being introduced in selected municipalities as of late 2018.

Tools for detection of disabilities for this age group, such as the early childhood care
and development checklist Child Record 1 (for 0-2 year old children) and the EDPID
(early detection, prevention and intervention of disability among 0-6 year olds) tool, are
available though they are not yet administered regularly or systematically. In this regard,
recent efforts by DOH and UNICEF to adapt the early childhood care and development
checklist Child Record 1 and pilot its implementation in selected LGUs is worth noting,
particularly given complementary efforts in preparing the service providers to provide
quality diagnostic and rehabilitative services. These pilot studies could benefit from
incorporating a user centered design perspective for further adapting the tools and
before intensifying efforts to scale them up. These recent efforts could also feed directly
into future ones to improve systems for data collection and data use, and other efforts to
improve early detection of disabilities, timely referrals and effective interventions for
children with disabilities.

Also associated with good health of young children is policies supporting paid parental
leave. The health benefits of paid parental leave include stronger bonding between
mother and children, increased initiation and duration of breastfeeding, improved
likelihood of infants being vaccinated and receiving preventive care, and increased
involvement of fathers with their children (WHO, UNICEF & World Bank, 2018). The
Philippines has a mandated paid maternity leave of 60 days for those who had normal
delivery and 78 days for those who had a caesarian section and a paid paternity leave
of 7 days but this is applicable to only those who work full time. Employees on short
contracts in the formal sector and those employed in the informal sector do not have the
legal right to any parental leave. One in five working adults (18%) are underemployed,
including employees on short contracts and non-regular contracts. Another one in three
working adults (38%) are employed in the informal sector (PSA labor market figures).
Efforts are currently underway to expand the benefits from 60 days to 100 days of paid
leave with an option of additional 30 days of unpaid leave.

20
Health: 24 months to 59 months
While cross-regional disparities exist for deaths at all stages of early childhood, the
scope and nature of cross-regional disparities vary across different stages, which
suggests that the factors giving rise to early childhood mortality and the bottlenecks in
services may vary across regions. For instance, the regions with the highest neonatal
mortality rates are Western Visayas (33 deaths during the first month after birth per
1000 live births) and Bicol (22 deaths per 1000 live births) while the regions with the
highest postnatal mortality rates are ARMM (18 deaths from the second month after
birth until the first birthday per 1000 live births) and MIMAROPA (15 deaths) and the
regions with the highest mortality rates from age 1 to age 5 are SOCCSKSARGEN (19
deaths per 1000 live births) and ARMM (18 deaths per 1000 live births) (PSA NDHS
2017). This variation in cross-regional disparities in mortality rates at different stages of
early childhood must be taken into account in designing programs and policies for
preventable early childhood deaths.

Looking at causes of mortality for children who are 1-59 months old, acute respiratory
infections (particularly pneumonia), injuries and accidents, and diarrheal diseases stand
out (CHERG 2010 data). One out of four deaths (27.4%) for this age group is due to
pneumonia, one of out six deaths (15.1%) is due to injuries and accidents, and one out
of ten deaths (10.8%) is due to diarrheal diseases.

Thus, nurturing care by caregivers becomes particularly critical when young children
suffer from illnesses, such as acute respiratory infection, fever and diarrheal diseases.
Caregivers’ ability to recognize symptoms, practice effective treatment, and seek advice
and medical treatment promptly when appropriate, is fundamental to preventing
mortality and long-term debilitating morbidity. Estimates based on NDHS 2017 suggest
that among children under age five who had acute respiratory infection symptoms, for
two out of three (67%), advice or treatment was sought. Among children under five who
had a fever, for one out of two (52%), advice or treatment was sought. Among children
under five who had diarrhea, for two out of five (42%), advice or treatment was sought.
It is worth noting that caregivers were more likely to seek advice or treatment when
boys had diarrhea (50%) versus girls (33%). Many caregivers did not use appropriate
feeding practices and treatment during diarrhea: 30% of young children with diarrhea
were given less liquid than usual or no liquid at all, 42% of young children with diarrhea
were given less food than usual or no food at all, 23% of young children with diarrhea
did not receive any oral rehydration treatment or recommended homemade fluids.

The increasing coverage of PhilHealth and the Universal Health Care Act of 2019 are
pertinent developments in this regard. As of 2015, PhilHealth coverage is at 92% of the
population of which 40% are the poor population subsidized with premium payments
(Dayrit et.al., 2018). Also pertinent in this regard is the recent momentum gained in the
implementation of the Integrated Management of Childhood Illnesses (IMCI) strategy.
IMCI’s integrated approach to the health of young children that involves routine
assessments for nutritional, immunization and deworming status positions it well to

21
become one of the building blocks for integrated and continuous early childhood care
and development services.

2.3 NUTRITION OUTCOMES AND ENABLING EFFORTS

The previous section on the health of young children has touched on some aspects of
adequate and appropriate nutrition for pregnant and lactating women, and young
children. This section expands on these points to analyze the state of nutritional
outcomes for pregnant and lactating women, and young children in the Philippines.

The growing body of research on the effects of undernutrition and the impact of nutrition
interventions put forward several relevant findings.
- Adequate and appropriate nutrition early in life (and especially during the first
1000 days, i.e. from conception to 23 months) is important not only for
physical growth but also cognitive development in subsequent stages of life.
- Poor nutrition especially when combined with repeated infections in this early
period can lead to stunting, that is the impaired growth and development of
children.
- Earlier studies had suggested that stunting was largely irreversible and thus,
nutrition interventions during the first 1000 days was critical.
- More recent studies further demonstrate the importance of adequate and
appropriate nutrition early in life for physical growth and cognitive
development but they also suggest that nutrition investments beyond the first
1000 days can act as a partial remedy for early nutrition and cognitive deficits
(Young Lives 2016).
- Studies also suggest that the negative effects of undernutrition on cognitive
development can be mitigated with not only correcting the nutritional status
but also with early psychosocial stimulation (Lancet 2017)

Nutrition: Prenatal Period

Inadequate maternal nutrition poses a significant threat to healthy pregnancies and
increases the risk of maternal mortality, miscarriages, stillbirths as well as low birth
weight and preterm birth, both of which in turn increase the risk of developmental
difficulties, infant mortality and morbidity rates.

An indicator being used in the Philippines to identify nutritionally at risk pregnant women
is a classification based on weight-for-height measures (Magbitang et.al, 1988 cited in
DOST FNRI NNS 2013). Accordingly, one out of four (24.8%) pregnant women were
found to be nutritionally at-risk in 2013 (National Nutrition Survey 2013). A higher ratio
of women living in the poorest households (30.0%) were identified as nutritionally at-
risk. Furthermore, teenage mothers are found to be nutritionally at-risk (calculated
based on weight-for-height classification) at higher rates compared to other age groups
(37.2% compared to 23% for 20-29 year-olds and 14.8% for 30-39 year-olds).It should
be noted that the trends in the prevalence of nutritionally-at risk pregnant women have
been stagnant since 2003 (26.6%) (National Nutrition Survey 2013).

22
Prevalence of anemia during pregnancy is another indicator for inadequate maternal
nutrition. In 2013, one out of four pregnant women (25.2%) and one out of six lactating
women (16.6%) were anemic (National Nutrition Survey 2013). While these rates are
somewhat high, they represent a notable improvement in preceding years. In 1998, for
instance, one out of two pregnant women (50.7%) and lactating women (45.7%) were
anemic.

These positive trends on the prevalence of anemia in pregnant women needs to be

interpreted with figures on access to iron and folate supplementation during pregnancy
in mind, which is a critical component of management of anemia in pregnant women
and have been promoted by the Department of Health under the Nutrition across the
Life Stages Program alongside with food fortification. In 2017, more than 9 in 10 women
(91.9 %) indicated that they took iron tablets during their most recent pregnancy with
about half of women (51%) taking iron tablets for 90 days or more (PSA NDHS 2017). It
is noteworthy that this rate is high across all regions with limited variation (with Eastern
Vasayas as the highest with 97.7% and Bicol as the lowest with 89.5%). The only
exception is ARMM where only 57.9% of pregnant women took iron tablets (PSA NDHS
2017). It is worth noting that a higher ratio of women living in the poorest households
(14.1%) did not receive any iron tablets during their most recent pregnancy. The ratio
was even higher for women living in extremely poor households (as captured by them
not having any education) at 32.8% (PSA NDHS 2017).

Nutrition: From Birth to 23 Months

Nutritional outcomes for young children in the Philippines suggest a persisting crisis of
undernourishment with improvement in only some areas. About two out of five (39.4%)
children who are 6-11 month-olds were anemic in 2013 despite notable improvements
from an astounding figure of 66.2% in 2003 (National Nutrition Survey). 5 The prevalence
rates are particularly high for 6-11 month-olds living in rural areas (49.7%). Among 12-
23 months-old children, the prevalence of anemia goes down to 24.6%, which also
represents a major improvement from the prevalence rate of 53% in 2003 (2013
National Nutrition Survey). It appears that anemia rates peak during the 6-12 month
period and stunting rates peak during the 12-24 month period (see below), respectively
marking the introduction of complementary feeding 6 and the transition from
breastfeeding to solid foods.

Early initiation of breastfeeding and exclusive breastfeeding until 6 months of age are
important factors in preventing stunting and wasting among young children. The
Department of Health’s Infant and Young Child Feeding Program promoting early
breastfeeding initiation in birthing facilities, exclusive breastfeeding in the first 6 months,

5
Authors of this report could not identify any analytic studies on the factors that contributed to
this decline in rates of anemia among young children.
6
For 6-11 month-old infants, breastmilk alone cannot meet their iron needs. For this age group
adequate, age appropriate and nutritious complementary food is crucial to support an infant’s
iron needs. If inadequate, the complementary feeding can be supplemented by multiple
micronutrient powders or iron syrup.

23
and age-appropriate, timely and quality complementary feeding with continued
breastfeeding from 6 months onwards must be noted in this regard. In 2017,
breastfeeding was initiated early, i.e. within one hour of birth, for 56.9% of newborns
(PSA NDHS 2017). A total of 84.7% of newborns started breastfeeding within one day
of birth (PSA NDHS 2017). Yet, early initiation of breastfeeding varies across regions
and income groups. Central Luzon and ARMM are outliers in this regard with only
68.1% and 76.6% of newborns starting breastfeeding within one day of birth
respectively (PSA NDHS 2017). There is also a negative relation between wealth and
early initiation of breastfeeding with newborns in wealthier households being initiated
breastfeeding within one day of birth at lower rates (76.9% for wealthiest households
compared to 90.5% for poorest households). More generally, 94% of children younger
than 2 months, 66% of 12-15 months-old children and 54% of 18-23 months-old
children were being breastfed (PSA NDHS 2017). The median duration of breastfeeding
has increased notably over the last 25 years from 14.1 months in 1993 to 19.8 months
in 2017 although median duration of breastfeeding continues to be low for children living
in the wealthiest households (6.2 months).

Another enabling factor in ensuring young children receive good nutrition concerns
breastfeeding policies. The Milk Code of 1986, The Rooming-On and Breastfeeding Act
of 1992, and the Expanded Breastfeeding Promotion Act of 2009 together provide a set
of supportive policies for breastfeeding mothers. Provisions under these legislations
include the establishment of lactation stations in every private enterprise and public
agency, provision of lactation periods for breastfeeding employees, and various
limitations on the promotion of breastmilk substitutes. More generally, while Philippines
is characterized by comprehensive breastfeeding policies, challenges remain vis-a-vis
the effective implementation of these policies and supplementary efforts in community-
based promotion and support (Mangasaryan et.al. 2012).

Complementary feeding practices for children older than 6 months of age is also an
important factor in preventing stunting, wasting and anemia. Children older than 6
months of age need frequent and diverse complementary feeding in addition to breast
milk to ensure that they receive the necessary micronutrients and caloric intake. Yet,
among 6-8 months-old children only 57.9% were both breastfeeding and consuming
complementary foods with another 22.4% consuming complementary foods but not
breastfeeding (PSA NDHS 2017). Dietary diversity and meal frequency are also critical
to the nutritional status of children older than 6 months of age. Among 6-23 month-old
children, only 15.4% meet the minimum dietary diversity and this figure is as low as
10.3% in poorest households in rural areas (DOST FNRI NNS, 2013). A majority of 6-23
month-old children meet the minimum meal frequency (94.1%) although this figure is
lower among those living in the poorest households in rural areas (90.4%) (DOST FNRI
NNS, 2013).

GOOD PRACTICE: ALIVE & THRIVE INITIATIVE

Alive & Thrive is a global nutrition initiative with a focus on social behavior change for optimal
breastfeeding and complementary feeding practices. As of 2018, Alive & Thrive Initiative is active in five
countries - Bangladesh, Burkina Faso, Ethiopia, India, and Nigeria. Recently, the Alive & Thrive Initiative

24
has launched a social behavior change communication campaign in Nigeria that features traditional
media spots, posters, pamphlets, messages shared through social media influencers, and targeted
outreach materials such as sermon guides for religious leaders. Campaign themes have focused on the
importance of early initiation of breastfeeding, exclusive breastfeeding, and dietary diversity.

(Information based on the website of Alive & Thrive Initiative)

To prevent micronutrient deficiency, direct supplementation is recommended by DOH

with iron supplements, Vitamin A supplements and deworming medication as the more
common interventions. The Department of Health’s Nutrition Across Life Stages
Program must be noted in this regard. The Program aims to provide micronutrient
powder sachets for 6-23 month-old children, weekly iron and folic acid tablets and twice-
a-year vitamin A capsules for children 12-59 months. It also includes promotion of the
consumption of fortified foods and iodized salt. Yet in 2017, 28% of 6-59 month-old
children received iron supplements in the past 7 days and 76% of the same age group
took Vitamin A supplements in the past 6 months, and 43% were given deworming
medication in the past 6 months (PSA NDHS 2017). However, these figures on direct
supplementation varies across regions. For iron supplements, Central Luzon and
ARMM are outliers with 10.1% and 13.9% of 6-59 months-old children receiving iron
supplements in the past 7 days. For Vitamin A supplements, ARMM is an outlier
(44.6%). For deworming medication ARMM (24.8%) and Central Luzon (25.5%) are
outliers (PSA NDHS 2017). The relationship between income and direct
supplementation is less clear except for the extremely poor children (captured by their
mother having no education) who have lower levels of access to direct supplementation
despite their arguably higher needs of such intervention. Among 6-59 months-old
children whose mothers have no education, only 9.9% received iron supplements, only
56.3% received Vitamin A supplements, and only 33.5% received deworming
medication (PSA NDHS 2017).

One out of eight 0-5 month-olds (13.1%), one out of six 6-11 month-olds (16.2%) and
one out of three 12-23 month-olds (31.5%) were stunted in 2013 (NNS). Relatedly, one
out of eight 0-5 month-olds (13.4%), one out of nine 6-11 month olds (11.4%) and one
out of ten 12-23 month-olds (10.6%) were wasted in 2013 (NNS). These figures had
been relatively stable over the preceding five years. The Department of Health’s
Philippine Integrated Management of Acute Malnutrition must be highlighted in this
regard. The program focuses on the management of moderate and severe acute
malnutrition of 6-59 month-old children through case finding in the community and
referring them to outpatient therapeutic centers and inpatient therapeutic centers.

It is worth highlighting that efforts for the management of moderate and severe acute
malnutrition have so far treated wasting and stunting in seperate silos. As highlighted in
the Global Nutrition Report 2018, important evidence points at the double burden of
wasting and stunting whereby children experiencing both wasting and stunting at a
notably elevated risk of dying compared with children experiencing severe wasting. In
other words, the Report argues that “it is in combination that wasting and stunting confer
the highest mortality risk to potentially a larger proportion of the child population than
that affected by severe wasting”, and recommends dealing with wasting and stunting

25
together. The evidence in this regard remains to be reflected in recommendations of
international organizations and the targeting guidelines of DOH regarding efforts in the
management of acute malnitrution.

GOOD PRACTICE: USING GEOSPATIAL DATA ON CHILD GROWTH TO TARGET INTERVENTIONS

AND TO TRACK PROGRESS

Geospatial data on child growth provides new information on how the burdens of malnutrition and rates of
change vary within a country, a region or a province. Spatial analysis using geospatial data enables
identification of hotspots of malnutrition based on various nutritional indicators such as weight, height,
exclusive breastfeeding practice in the first six months, anaemia in women of reproductive age. Such
spatial analyses guides better targeted nutrition interventions.

(Information based on Global Nutrition Report 2018)

Poor nutrition, especially when combined with repeated infections in this early period,
particularly worm infections and waterborne infectious diseases that bring about
diarrheal episodes, increase the risk of stunting. These infections in young children are
closely linked to households’ access to safe water and sanitation, and hygiene
practices. Overall, access to safe water and sanitation has improved in recent years
despite continuing income-based disparities (World Bank 2018a; pg.46) and regional
disparities (WHO and UNICEF 2017; pg.38-40). (See previous section for more details
on access to safe water and sanitation).

Nutrition: 24 Months to 59 Months

As highlighted earlier in this section, the years following the first 1000 days present a
significant opportunity to mitigate the negative effects of undernutrition during the critical
first 1000 days. Thus, the below figures on prevalence of anemia, stunting and wasting
are particularly disconcerting as they signal a missed opportunity in mitigating the
negative effects of undernutrition during the first 1000 days. [All figures below are from
National Nutrition Survey 2013]

One out of seven (14%) of 24-35 month-olds, one out of twelve (8.5%) of 36-47 month-
olds, and one out of eighteen (5.8%) of 48-59 month-olds were anemic. These figures
represent major improvements from 2003 when anemia prevalence rates were 34.8%,
24.8% and 18.8% for the respective age groups. The overall prevalence rate for anemia
among 12-59 month-olds was 11.3% in 2013 (NNS). These rates are characterized by
income-based disparities where 14.1% of children in this age group living in the poorest
households are anemic compared to only 4.8% of their peers living in the wealthiest
households.

Approximately one out of five 24-59 month-olds were underweight in 2013 (21.8% of 24-
35 month-olds, 22.3% of 36-47 month-olds, 21.0% of 48-59 month-olds) (NNS).
Approximately one out of three 24-59 month-olds were stunted in 2013 (35.7% of 24-35
month-olds, 35.4% of 36-47 month-olds, 32.7% of 48-59 month-olds) (NNS).

26
Approximately one out of fifteen 24-59 month-olds were wasted in 2013 (6.4% of 24-35
month-olds, 5.8% of 36-47 month-olds, 5.5% of 48-59 month-olds) (NNS). Children from
the poorest households were more than three times more likely to be stunted than their
peers living in the wealthiest households (44.2% stunting rates among under five
children living in the poorest households versus 13.1% among those living the
wealthiest households).

Figure 2.3: Rates of stunting for children under 5, by wealth quintile (2013) 7

Figure 2.4: Stunting rate for children under five by region, 2015 8

7
This figure is from World Bank (2018) and the underlying data is FNRI (2015).
8
This table is from World Bank (2018) and the data source is Philippine Food Nutrition and
Research Institute (2016).

27
In addition to the Philippine Integrated Management of Acute Malnutrition Program and
Nutrition Across Life Stages Program of the Department of Health described in the
previous section on 0-23 month-old children, the supplementary feeding programs and
growth monitoring for children enrolled in day care centers and child development
centers, and deworming programs are other enabling efforts for improving the nutritional
status of this age group. It is also worth noting that supplementary feeding programs
continue for underweight children enrolled in kindergarten and subsequent grades of
primary education. An evaluation of the program in primary education and monitoring
reports of the supplementary feeding programs in day care centers suggest observable
positive effects on the prevalence of malnutrition (Tabunda et.al., 2016). However,
these suggestive findings would need to be confirmed with further studies given both
their methodological constraints and the mixed evidence emerging globally regarding
the effects of supplementary feeding programs on health and cognitive outcomes
(Jomaa et.al. 2011; Tanner et.al. 2015). Relatedly, deworming programs are also
implemented in schools through primary and secondary education. Water and sanitation
programs in day care centers and child development centers emerge as another
enabling effort by encouraging young children to adopt safe hygiene practices. Currently
available administrative data on water and sanitation facilities in day care centers and
child development centers does not allow for a national-level analysis.

LESSONS LEARNED: SUPPLEMENTARY FEEDING PROGRAMS FOR 6-36 MONTH OLD CHILDREN
Timely and effective nutrition interventions are critical for ensuring that all young children get
adequate and appropriate nutrition early in life. Given the spikes in the prevalence of anemia and stunting

28
during the 6-36 month period, supplementary feeding programs for young children in this age group have
been used in several countries as a preventive measure. Two systematic reviews of supplementary
feeding programs for young children (Kristjansson et.al. (2016) and Gillespie (1999)) present some
valuable lessons learned from different countries.
These reviews underscore the importance of several factors in ensuring program effectiveness
such as:
- Factors concerning timing and frequency, such as the importance of timing the programs so they
coincide with seasonal food shortages, the need to have the programs run for a long-enough period of
time to show sustained effect (with 18-24 months identified as a minimum duration and where possible
starting at month 6 and continuing until month 36), the need to have the feeding frequent enough to show
any effect;
- Factors concerning the quality and quantity of the supplementary food, such as the amount of calories
provided, nutrient density of the supplement, children’s willingness to consume the supplement. Relatedly
the reviews discuss the risks and benefits associated with good choices, including ready-to-mix food and
pastes (internationally procured ones versus locally adapted alternatives), fortified snacks, enriched dry
take-home rations, low-cost fortified and blended foods;
- Factors concerning distribution systems, such as the reliability of the supply chain, logistical costs and
risks of on-site feeding programs versus take-home rations.
It is also worth noting that one of the systematic reviews (Gillespie 1999) identifies take-home
rations as the more efficient option compared to on-site feeding, despite the likelihood of sharing within
the household. The review explains that where the sharing within the household starts undermining the
benefits to young children, some countries have designed the supplement so as to promote self-selection
by young children (e.g. acidified and fortified milk used in Chile’s National Complementary Feeding
Program).
(Information based on Kristjansson et.al, 2016 and Gillespie, 1999)

2.4 DEVELOPMENTAL OUTCOMES FOR YOUNG CHILDREN AND ENABLING

EFFORTS
Only recently, researchers and policymakers are understanding the critical importance
of responsive caregiving and opportunities for learning during the early years for
cognitive and socioemotional development in subsequent years. Indeed, learning does
not begin in pre-primary classes but it begins in the earliest days of life with an infant
acquiring skills and capacities in relationship with other people through smiling, eye
contact, talking, singing, modeling, imitation and simple games (WHO, UNICEF & World
Bank, 2018). Affectionate and responsive caregiving is critical in this phase of early
social learning.

Early Learning: Prenatal Period to 23 months

Indicators to capture responsive caregiving and opportunities for early learning during
the first 1000 days exist yet data for these indicators are yet to be collected in the
Philippines. It should be noted that a tool to assess the development of 0-35 month old
children in different domains was developed in the Philippines (ECCD Checklist Child’s
Record 1) yet systems have not been developed for this tool’s systematic and regular
administration. Only recently, DOH and UNICEF have initiated efforts to adapt and pilot
the implementation of the tool with frontline health workers identified as the primary
point of contact. However, the tool’s de facto primary goal has become the early
identification of potential developmental delays to trigger referral for diagnosis and
treatment. In this regard, it has moved away from its other original goal concerning the
systematic assessment of young children’s access to learning opportunities and
responsive caregiving with a view to support caregivers in these domains.

29
 GOOD PRACTICE: HOME VISITS TO SUPPORT RESPONSIVE CAREGIVING FOR YOUNG
CHILDREN AND CAREGIVERS WITH ADDITIONAL NEEDS
Home visiting programs are voluntary programs that match parents with trained frontline workers to
provide information and support during pregnancy and throughout their child’s first years. Although the
programs vary in objectives, targeting and content of services, they usually combine parenting and health
care education, child abuse prevention, and early intervention and education services. The content of the
services provided during home visits may involve developmental screenings, information on child
development and early learning, social support, referrals to ancillary social services, linkages for
enrollment in public benefits. The intensity, frequency and content of home visiting programs can be
tailored to the specific needs of the young child and the parents. Examples of successful home visiting
programs include the Nurse-Family Partnership program in the United States of America, Cuna Mas
Program in Peru, and Reach Up Program in Jamaica.

(Information based on the website of Zero to Three)

Many enabling efforts for early learning in the Philippines focus on primary caregivers
through parenting support interventions and information sessions held by various
frontline workers including barangay health workers, and barangay nutrition scholars.
These one-on-one and group interactions are intended to support caregivers in
acquiring knowledge and skills to support their young children’s development. For
instance, the breastfeeding orientation sessions targeting pregnant mothers provide
information not only on breastfeeding but also on self- and child-care, and psychosocial
stimulation of young children. Likewise, parent effectiveness sessions undertaken by
barangay health workers and day care workers aim to provide parents with the
necessary knowledge about child development and skills for effective parenting. More
recently, Infants and Toddlers Early Development Program has been introduced in
some National Child Development Centers and Child Development Centers whereby a
developmentally appropriate curriculum is used to train caregivers in supporting their
infants’ and toddlers’ development through early stimulation, early learning, proper
health & nutrition. Also more recently, Idol Ko Si Nanay Learning Modules for the First
1000 Days has been developed by the National Nutrition Council as part of the First
1000 Days Initiative. Among these parenting support interventions, Family Development
Sessions organized as part of the 4Ps have the widest reach (see details on FDS in the
next section on early learning for 24-59 month-old children). The overall coverage and
impact of these interventions using one-on-one and group interactions remains to be
monitored and evaluated.

Center-based day care and early learning programs for this age group include both
private and public providers. Some private companies and corporations provide care
services on their premises to allow mothers to work while also attending their children in
addition to private providers offering care services. Private day care centers are
accredited by DSWD and their operations are to be monitored by DSWD and LGUs.
Public provision of center-based early learning programs for this age group is limited in
coverage and includes DSWD’s child minding centers and expansion programs held by
some National Child Development Centers for this age group and their caregivers.

GOOD PRACTICE: INFANT AND TODDLER EARLY DEVELOPMENT PROGRAM, MUNTINLUPA CITY

30
As part of its efforts to support the development of young Muntinlupeno children, Muntinlupa City
implements the Infant and Toddler Early Development Program. The program targets parents and primary
caregivers and provides them with information on how to stimulate their children’s development at home.
In 2018, a total of 920 children benefited from this program.

(Information based on interviews conducted by CSF team members)

Early Learning: 24 Months to 59 Months

The learning that begins in the earliest days of life continues rapidly through the early
years of a child’s life. Research shows that while a great deal of brain architecture is
shaped during the first three years after birth, regions of the brain dedicated to higher-
order functions continue to develop beyond age 3 (Center on the Developing Child at
Harvard University website). Affectionate and responsive caregiving continues being
critical for 24-59 month-old children. Having access to high quality early learning
opportunities in center or community based programs also becomes important for this
age group.

There is currently no data on the linguistic, cognitive and socioemotional outcomes for
24-59 month-old children in the Philippines that allows for national or sub-national level
analysis. While a tool measuring the development of 37-59 month old children in
different domains exists (ECCD Checklist Child’s Record 2) and is to be administered
by service providers in day care centers, supervised playgroups, and child development
centers, it does not presently allow for sub-national or national level aggregation. The
tool’s primary purpose is to monitor a child’s growth and development in different
domains and to help identify children at risk for developmental delays so as to facilitate
early, appropriate interventions. Unlike the ECCD Checklist Child’s Record 1, the tool
has been rolled out nationally but there is no system in place for aggregating the data
collected with this tool to LGU or national levels. Additionally, there has been no
assessments or evaluations about how this tool is currently being used by service
providers. As discussed in the previous section on children under 24 months, existing
household surveys do not collect data on parenting practices and several critical areas
of early childhood development concerning access to early learning opportunities.

Various nationwide and local efforts exist to enable young children of this age group to
access learning opportunities including center-based programs, home-based programs,
parenting support interventions and mobile early learning services. Yet participation
rates in early learning programs for 3 and 4 year-olds remain relatively low. According to
household survey data, only around 30% of 3-4 year-old children participated in pre-
school programs in 2015 (analysis in World Bank 2018a based on LFS data). According
to DSWD’s administrative data on supplementary feeding programs, about 1.78 million
children were enrolled in day care centers in 2018, representing about 40% of 3-4 year-
old children (Coram International 2018; DSWD administrative data on SFPs). 9 The need

9
Administrative data on supplementary feeding programs remains the main source of administrative data
on enrollment in day care centers. Although a computer-based ECCD information system has been
established by DSWD, the figures from this system on the number of children enrolled in daycare
centers/child development centers are not reliable due to its under-utilization with average utilization rates
around 75% (based on information provided by DSWD, January 2019).

31
remains to conduct studies and collect data on the reasons for so many 3 and 4 year-
olds to be not benefiting from early learning programs. Drawing on data on 6-11 year-
olds’ reasons for not attending school (FLEMMS 2013), potential reasons could include
“lack of personal interest”, “illness/disability”, “too young to go to school”, and “family
income not sufficient to send child to school”.

(i) Center-based programs include day care centers, child development centers,
national child development centers, non-state providers of early childhood education
including Tahderiyyah program, a culture-specific early childhood education in southern
Philippines with recognized appropriate curriculum through DepEd Memorandum
36/2013, privately-run day care centers and pre-kindergarten programs, community and
church-based programs.

Among these programs, over 55,000 public day care centers and child development
centers financed by local governments units reach the largest number of children across
the country. 36-59 month old children can attend these programs for part of the day with
often a caregiver required to be in attendance. Benefiting from services at day care
centers and child development centers is either free or a minimal fee is charged to
cover center’s expenses. The program at day care centers and child development
centers present children with opportunities for early learning, development of socio-
emotional skills, and acquisition of positive hygiene habits.

Another center-based program is the National Child Development Centers, which is the
ECCD Council’s flagship program that aims to serve as a resource and training center
for early childhood development service providers and caregivers in addition to
providing holistic services for 0-4 year-old young children. As of 2018, 600 National
Child Development Centers have been constructed across the country where there are
a total of 1489 municipalities and 122 cities. NCDC model is envisaged as a one-stop
shop for 0-4 year-old children where parents and caregivers of 0-2 year-olds participate
in the Infant and Toddler Early Learning Program to acquire the knowledge and skills to
stimulate their children’s growth and development, and 3-4 year-olds participate in pre-
kindergarten programs. Child development teachers and assistants are trained to
coordinate with community service providers so that children enrolled in NCDCs have
access to health and nutrition services. The implementation and impact of the ECCD
model is yet to be evaluated.

(ii) Home-based and community-based programs for 24-59 month old children generally
cater to vulnerable households who cannot access day care centers due to distance.
The most notable among these programs is the supervised neighborhood playgroups
(SNPs) implemented by local government units. SNPs are held in private houses and
community centers. Another community-based program for this age group is
KapitBahay-Aralan implemented by Save the Children.

Currently, there is no national-level data on the number of children benefiting from

home-based/community-based early learning programs generally, and the SNPs
specifically. A descriptive study on home-based early learning programs reveals notable

32
variation vis-a-vis their target age group, qualifications of service providers, and benefits
for service providers (UPPI 2015). SNPs are also included as part of DSWD-supported
supplementary feeding program whereby children in SNPs receive hot meals for 120
days over the course of a year. The aforementioned study found benefits of attendance
in home-based early learning programs both in terms of the children’s social skills and
nutritional status, and parents’ parenting skills. Main challenges highlighted in the study
include limited institutionalization of the services and its staffing, which increase the
likelihood of abrupt cessation of services and high turnover rates among staff.

While center and home-based/community-based organized early learning programs

have the potential to contribute both to early childhood developmental outcomes and
life-long wellbeing, when the programs provide low quality services where children are
neglected or verbally abused and the physical conditions are not safe, they may in fact
pose a risk to the healthy development of young children. Thus, efforts to ensure that
center-based and home-based/community-based programs provide high quality early
learning opportunities are critical. To this end, standards and guidelines for both center-
based and home-based programs were put in place by DSWD in 2004 and 2008
respectively. The ECCD Council have reviewed and updated existing standards by
issuing “Standards and Guidelines for Center-Based Early Childhood Programs for 0-4
years-old Filipino Children” in 2015. These new standards are to serve as a tool for the
assessment of center-based programs for accreditation, self-monitoring and regular
evaluation. The new standards are comprehensive and reflect the policies on integrated
services. More recently, the ECCD Council has also initiated efforts to review and
update the standards and guidelines on home-based programs to improve their delivery
and effectiveness.

Interviews conducted for this report reveal several remaining challenges in the efforts to
ensure that home-based and center-based programs provide high quality early learning
opportunities. Some of these challenges relate to confusion between old and new
standards for center-based programs, which can potentially be remedied by additional
dissemination efforts. Other challenges are related to some local stakeholders’
concerns about the appropriateness of the standards to the diverse realities of
communities. As such, some local stakeholders consider the new standards to be
unrealistically high given the limited resources in disadvantaged communities and
limited availability of land in poor urban communities. Some other challenges include
the weakness of systems for continued quality assurance once a center is accredited.
These challenges demonstrate the tensions inherent to standard setting for high quality
services in resource poor contexts where efforts to raise quality can become a
constraint to increasing access to these services in some communities.

(iii) Parenting support interventions or programs introduced for 0-23 month-old children
continue for this age group. Among these services, the Family Development Sessions
of the Pantawid Pamilyang Pilipino Program (4Ps) have the widest reach with over 4
million households benefiting from the 4Ps in 2018. Attendance by parents in these
monthly training programs is a conditionality under the 4Ps. Several of the guides used
for Family Development Sessions concern young children, such as “early childhood

33
care and development”, “positive approaches to child discipline”, “effective parenting”,
“proper sanitation”. As part of an evaluation of Family Development Sessions, these
guides were assessed by experts with respect to their content, structure, visual design,
relevance, coherence and ease of use; and they were all found to be “very satisfactory”
(FSP program assessment). While beneficiaries generally found the program
satisfactory in terms of its content and delivery, socio-behavioral changes attributable to
the program were found in only some areas leading the assessors to suggest further
enhancement of delivery and implementation of Family Development Sessions.

Other parenting support interventions and programs include Family Support Program
provided to parents of children enrolled in child development centers, Parent
Effectiveness Sessions (PES)10 and Program for the Empowerment and Reaffirmation
of Paternal Abilities (ERPAT) implemented by DSWD in coordination with local
government units and non-governmental organizations. Administrative figures could not
be obtained with regards to the coverage of these programs. Similarly, recently
conducted assessments or evaluations on the impact of these programs could not be
identified.11

(iv) Mobile Early Learning Services: Some local government units have initiated mobile
early learning services, mostly using re-assembled vehicles and horses. The vehicles
are driven and managed by day care workers that go around densely populated urban
poor communities to provide early learning and play opportunities for children not
enrolled in day care centers. Likewise, horses are used by day care workers in remote
rural areas to bring early learning opportunities to children who do not have access to
day care services.

Inclusion in early learning programs has been receiving particular attention in more
recent years. Training programs for child development teachers and child development
workers include a course focusing on the education of young children with disabilities
and developmental delays. The ECCD Council is also in the process of preparing a
guidebook on inclusion in early education. Additionally, the Family Development
Sessions of the 4Ps include a module on disabilities and a session on caring for and
nurturing a child with disability. The Sensory Therapeutic and Activity Center is another
initiative implemented in some local government units to support early learning services
for children with disabilities.

GOOD PRACTICE: EARLY LEARNING FOR ALL - USING DIFFERENT PROGRAM MODALITIES

10
With the Amended Omnibus Guidelines in the Implementation of the Supplementary Feeding Program
(DSWD Administrative Order 4/2016, Parenting Effectiveness Sessions have been integrated into the
Supplementary Feeding Program. Accordingly, parents are to be encouraged to complete nine sessions
to improve their knowledge, attitude, skills and practices on parenting; and the sessions are to be
facilitated by LSWDO or trained staff.
11
The only evaluation that could be identified was an evaluation of PES conducted in 1997 that was
based on the results of a perception survey of beneficiaries and stakeholders. (UPSARDFI 1997)

34
Davao City has progressively increased coverage of early learning for 3-4 year old children by
implementing a combination of center-based programs, home-based programs, a mobile program and
parent training program. As part of the mobile program, a van moves around densely populated urban
poor communities with low access to center-based early learning programs, and provide psychosocial
stimulation and educational experiences to young children. The van is equipped with teaching-learning
materials, manipulative toys, storybooks, game and sports equipment. Child development workers
facilitate learning and work with volunteer parents to ensure that community spaces used to conduct
educational activities and play are secure and safe. The Parents Teaching Other Parents program is
another modality; it engages volunteer parent leaders to reach out to and teach parents and caregivers to
become the educators of their young children.12 It teaches parents and caregivers strategies for providing
stimulating activities to their children at home. The combined services of 546 day care centers, 115 home-
based programs and the mobile program have enabled the City to reach 76% of 3-4 year old children with
organized early learning programs.

Sarangani Province has successfully implemented a combination of diverse early learning program
modalities and has increased access to early learning programs from 41.8% in 2015 to 58.4% in 2018.
This was accomplished by increasing the number of day care centers from 369 to 383, and the number of
home-based programs from 140 to 167. Additionally, there has been an increase in the number of
children served by a mobile early learning program. As part of this mobile program, child development
workers use horses to reach 3-4 year-old children living in the highlands and hard to reach communities
where road network is unpassable by regular vehicles. These child development workers are equipped
with learning materials, manipulative toys and storybooks, and they go to cluster areas on horse provided
by the province to conduct learning sessions with young children. Since 2012, the mobile program has
served 4140 children, majority of whom come from Indigenous Populations, who otherwise would have
not had the chance to participate in any form of organized early learning.

Muntinlupa City has increased the percentage of 3-4 years old children benefiting from organized early
learning opportunities by implementing a combination of center-based programs and home-based
programs (supervised neighborhood playgroups (SNPs)).To accommodate the large number of
beneficiaries, the city has separate classes for 3 year-old and 4 year-old children. The city has reached a
total of 8504 children and 520 of these children participated in an SNP. SNPs were implemented in
densely populated villages where the number of 3-4 year-old children outnumbers the capacity of child
development centers. In SNPs, volunteer mothers are trained to facilitate learning sessions and play with
children who are mostly her neighbors. The volunteer workers are usually the most respected mothers in
the neighborhood vouched for by community leaders.

Early Learning: School Readiness and Transition to Elementary School

While early learning is a continuum that goes all the way up to age 8, this report is
mandated to analyze only school readiness and transition to elementary school for
children older than 59 months.

With respect to school readiness, unlike 0-23 months and 24-59 months age groups,
there exists some data on the developmental outcomes of 5 and 6 year-old children,
which respectively is the age of entry to public kindergarten and Grade 1 both of which
are part of universal compulsory K-12 basic education. The source of data on
developmental outcomes is a longitudinal study on the learning experiences and
performance of kindergarten, Grade 1 and 2 students (ACER, DFAT & UNICEF 2018). 13
Administrative data on the developmental outcomes for this age group is not available

12
A rapid assessment of Parents Teaching Other Parents program has been conducted recently.

35
for analysis. While kindergarten and Grade 1 teachers are required to complete
developmental checklists for each child, this data does not get aggregated.

Analyses of data from this longitudinal study highlights substantive cross-regional and
cross-income disparities in the domains of literacy, mathematics, social and emotional
development outcomes for children in this age group. The study findings also suggest
there to be a positive contribution of attending pre-kindergarten programs. More
specifically:
- Achievement gap in literacy and mathematics between children sampled from
schools classified as conflict-affected and other children at the end of
kindergarten is found to be large “constituting a lag of approximately two
years of schooling”. According to the study, without targeted and sustained
interventions, the students from conflict-affected schools risk falling further
behind.
- Children from low socio-economic backgrounds had the lowest average
performance in all three domains compared with their peers from mid and
high socio-economic backgrounds. However, they also had the highest
growth in literacy and mathematics from end of kindergarten to the end of
Grade 1.
- Children who attended pre-kindergarten demonstrated higher performance in
literacy, mathematics, social and emotional development in kindergarten and
Grade 1. Children who attended pre-kindergarten 4-5 days per week
performed better in literacy, mathematics and social and emotional
development than their peers who attended pre-kindergarten 3 days or less
per week. Children who attended private pre-kindergarten performed notably
better than their peers who attended public pre-kindergarten.

The study findings on the substantive cross-regional and cross-income disparities at this
early stage of schooling underscore the critical importance of high quality pre-
kindergarten programs targeting children from disadvantaged backgrounds in ensuring
that regardless of their socio-economic backgrounds all children are prepared to start
and succeed in school.

Similar to pre-kindergarten attendance contributing to young children’s developmental

outcomes and their transition to kindergarten, kindergarten attendance also contributes
to school readiness of young children and their transition to Grade 1. As suggested by
the findings of an evaluation study on a kindergarten program in poor communities
(Silid Pangarap), quality and integrated services (accomplished through building the
capacity of kindergarten teachers, improving parental involvement, providing necessary
physical facilities, incorporating feeding programs) enhance the contribution of
kindergarten attendance to school readiness. 14 Thus, the increasing trend in enrollment

13
Another relevant study in this respect is the preschool research “The Various Preschool Programs: An
Assessment of Effectiveness” conducted in 2009 and published by DepEd in 2010. Given the structural
changes in kindergarten program in recent years, the findings of the report are somewhat outdated .
14
DepEd & AGAPP, Impact Evaluation Study on the implementation of the Project “Enhancing Access to
Quality Early Childhood Education Services for Children in Poor Communities”, 2016.

36
and attendance rates in kindergarten programs and enhanced focus on the quality of
kindergarten programs are particularly worth highlighting especially as the overall
increase in enrollment has been accompanied by a decrease in the gap between the
rates for children in the poorest and richest households (World Bank 2018a). More
specifically:
- Kindergarten enrollment doubled in absolute terms from 2005 to 2013 with
the largest increases among the poorest households (BEST program review).
- Among 5 year-old children, only 1 out of 11 (8.5 %) did not attend any kind of
school in 2013. 72.5 percent of 5 year-old children were attending pre-primary
school and 19 percent were attending primary school. (UNESCO & UNICEF,
2016)
- The Enhanced Basic Education Act of 2013 made kindergarten mandatory
and further efforts have since been undertaken to make it universal. Gross
enrollment rate in kindergarten (SDG Indicator 4.2.4) has reached 95.5% and
adjusted net enrollment rate for the one year before the official primary entry
age (SDG Indicator 4.2.2) was 79.6% in 2016 (UIS SDG).

Children have to complete kindergarten to be eligible to enroll in Grade 1. Given that

kindergarten programs currently do not have universal coverage, such a requirement
risks posing a barrier to the timely enrollment of some children in Grade 1. The
Department of Education presents the option of implementing kindergarten catch-up
programs as an alternative model for children five and older who were unable to attend
or finish kindergarten during the school year. The program is to be implemented over
either a two-month or a five-month period as stipulated by the DepEd Order 11/2014
Implementing Guidelines. The program uptake has not been high with less than 10% of
children not enrolled in kindergarten participating in this program. Among the barriers to
scaling up of this alternative kindergarten model are limited knowledge of the program
among the LGUs, limited availability of kindergarten teachers and limited demand (OPM
2017).

In remote and geographically challenged areas where regular or catch-up kindergarten

programs do not exist, private programs exist as the main alternative. In cases where
such programs are not accredited by DepEd and issued a “permit to operate”, and the
children are not issued a learner reference number, which is necessary for them to
enroll in Grade 1, then DepEd conducts assessments of these children’s school
readiness and uses the results from these assessments to allow enrollment in Grade 1
or to require an additional year in an official kindergarten program.

Interviews conducted for this report underscored some procedural bottlenecks to the
smooth transition of these children to Grade 1. First and foremost, school readiness
assessments are reported to be infrequent and administered in locations that are not
easily accessible to children and their parents. The bottlenecks are particularly
disconcerting for participants in the Tahderiyyah program, a culturally-sensitive early
childhood development program implemented in Southern Philippines. Despite DepEd’s
approval of the Tahderiyyah curriculum in 2013, the overwhelming majority of over 300
Tahderiyyah centers are still to secure a “permit to operate”. This has hindered the

37
smooth transition of those children who completed kindergarten in Tahderiyyah centers
to Grade 1 as most had to repeat kindergarten and thus were overage when they
enrolled in Grade 1 (UNICEF & AAN Associates, 2018). Partly as a result of these
bottlenecks, the education system is characterized by a high ratio of late entrants with
14.5% of 6-year-olds not-in-school and 25% still in kindergarten (UNESCO & UNICEF,
2016).

DepEd’s efforts for the expansion of kindergarten program’s coverage have been
accompanied by complementary efforts to establish basic standards for quality in the
provision of kindergarten services. The Omnibus Policy on Kindergarten Education
(2016) is particularly relevant in this regard. The policy covers curriculum, instruction,
assessment, learning space and environment, and establishes the basis of accreditation
and evaluation for the standard delivery of kindergarten services. It must, however, be
noted that interviews conducted for this report highlighted challenges with respect to the
effective dissemination and consistent implementation of the policy. Policy
implementers were observed to have differing interpretations of the standards outlined
in the policy and technical support from supervisors was deemed to be limited due to
inadequate financial and human resources allocated to supervisory services.

Also directly relevant to the quality of kindergarten services is DepEd’s draft inclusive
education policy. The draft policy builds on DepEd’s 2017-2022 Strategic Directions that
establishes the expansion of the coverage of inclusion programs as a key strategic
objective. The draft policy emphasizes the importance of varied programs and diverse
modalities to fit the needs of diverse learners, which include special education, mother-
tongue based multilingual education, Madrasah education, indigenous people’s
education, differentiated instructions and alternative modes of education to reach all
children. Accordingly, all teachers are expected to use multi-factor assessments to
identify children who need additional support and to introduce instructional,
environmental and assessment accomodations in the classroom. If classroom-based
interventions are not adequate to meet the additional needs of a child, then the teachers
are expected to refer the student to specialists for potential diagnosis of learning
difficulties and disabilities. The effective implementation of the inclusive education policy
in kindergarten and Grade 1 will be a critical component of wider efforts to address
disparities in children’s levels of school preparedness and in diagnosing learning
difficulties and disabilities with a view to providing early, effective interventions.

Despite positive trends in the enrollment rates in kindergarten programs and efforts to
improve the quality of the kindergarten services, young children’s transition to
elementary school remains a challenge as demonstrated by the unusually high drop-out
rates in Grade 1 (4.6%) (UNESCO & UNICEF 2016). The challenges of transition of
young children to elementary school may be related to various factors, some of which
are highlighted below:

(1) Linguistic, cognitive and socioemotional school readiness of children: In

response to the challenges of transition to Grade 1, the Department of Education
has implemented several initiatives described above, including the expansion of

38
 kindergarten programs and the introduction of first language based multilingual
education whereby first language is used as the medium of instruction through
Grade 3. Another relevant program in this regard is DepEd’s school-based
remedial education programs that provide extra support to children at risk of
dropping out.

(2) Alignment of language of instruction and curriculum across pre-school programs

and kindergarten-Grade 1: While first language based multilingual education is
implemented from kindergarten to Grade 3, English emerges as a preferred
medium of instruction in some daycare centers and child development centers
despite efforts of the ECCD Council in promoting the use of first language. As a
result, this remains as an area of non-alignment that needs to be addressed.
Similarly, the learning objectives and assessment methods are not fully aligned
between pre-school programs and kindergarten/Grade 1 programs, making this
an area ripe for closer collaboration between DepEd, DSWD and the ECCD
Council. The National Early Learning Framework and the Early Learning
Development Standards could be relevant tools in this regard (UNICEF 2016).

(3) Readiness of Grade 1 teachers to receive young children: Problems encountered

in the transition of young children to Grade 1 might also be the result of a
mismatch between teachers’ expectations and developmentally appropriate
behavior of children at this age (UNESCO & UNICEF 2016, pg 31). In other
words, part of the challenge may be about children not being ready for school but
the other, and possibly more important, part of the challenge may be about
schools and teachers not being ready for children in this age group. Thus,
improvements in pre-kindergarten and kindergarten attendance rates may have
only limited impact on improving the smooth transition of young children to Grade
1 if it is the case that Grade 1 teachers, pedagogy and curriculum are built on
unrealistic expectations about behavior of 6-year-old children.

(4) Easing transition to Elementary School: Starting elementary school and

particularly transitioning to Grade 1 is a major life event for young children and
their families. Efforts to ease the social and emotional aspects of this transition
can have an important supplementary role to play. Efforts to ease young
children’s transition to elementary school include the nationwide early registration
program and home visits by kindergarten teachers, as well as various locally
initiated efforts such as school tours for to-be entrants and their families, and
preparatory visits of kindergarten students to Grade 1 classrooms. Local-level
synergies at the barangay, city and municipality levels between child
development centers/day care centers and elementary schools are particularly
pertinent in this regard.

2.5 SECURITY AND SAFETY OF YOUNG CHILDREN AND ENABLING EFFORTS

The components of safety and security of young children range from protecting them
from accidents and environmental risks, preventing experiences of abuse, maltreatment
and exploitation, and supporting young children and their caregivers through adversities

39
such as poverty and disasters. It is as much about protecting young children as it is
about ensuring that their caregivers are in good mental health so they are able to
provide nurturing care to their children through adversities. Another component of
ensuring the safety and security of young children is birth registration, which constitutes
a critical step for effective legal and social protection and access to services.

Data on causes of death for children under five years of age and particularly the
prevalence of injury and accident caused deaths emerge as a possible indicator of
caregivers’ ability to ensure the safety and security of young children. In 2010, one out
of six deaths (15.1%) for 1-59 months-old children were due to injuries and accidents
[CHERG data]. The Department of Health’s efforts around child injury prevention under
Child Development and Disability Prevention Program are worth noting in this context.
These efforts focus on the prevention of deaths, morbidity and disabilities among young
children due to falls, road traffic injuries, drowning, burns, chemical hazards and
poisoning.

Prevention of severe neglect and abuse emerge as a critical dimension of ensuring

security and safety of young children. Findings from recent studies underline four critical
areas that have immediate implications for protection efforts targeting young children.
- Toxic stress response in young children, defined as the prolonged activation
of stress response systems in the absence of protective relationships, can
lead to physical and chemical disruptions in the development of brain
architecture that can last a life time. These biological changes can affect
multiple organ systems and increase the risk of both cognitive impairments,
and physical and mental health outcomes (Center on the Developing Child at
Harvard University website). Toxic stress response can occur when a young
child experiences strong, frequent, and/or prolonged adversity such as
physical or emotional abuse, chronic neglect, exposure to violence without
adequate adult support. (Center on the Developing Child at Harvard
University website)
- Severe neglect appears to be as great a threat to health and development of
young children as physical abuse (Center on the Developing Child at Harvard
University website). Young children experiencing prolonged periods of neglect
exhibit more serious cognitive impairments, attention problems, language
deficits, academic difficulties and problems with peer interaction as they get
older (Center on the Developing Child at Harvard University website)
- Children who are exposed to adversity or violence are at greater risk for
adverse impacts on their brain development but they do not invariably have
poor outcomes, especially if nurturing relationships with caregivers is
established quickly and appropriate treatments are provided (Center on the
Developing Child at Harvard University website)
- While removing a child from a dangerous environment is of outmost
importance, the removal will not automatically reverse the negative impacts of
the experience. These children have to be provided with a safe, supportive
and predictable environment, and may require therapeutic and supportive

40
 care to recover. (Center on the Developing Child at Harvard University
website)

Existing data on violence against children suggest high prevalence of physical and
emotional violence affecting young children either as a direct target or as a witness. The
only nationally representative survey on violence against children, National Baseline
Study on Violence against Children conducted in 2016, does not provide direct data on
children who are 0-23 months old. For 13-18 years-old children, survey results suggest
that two out of three children (66.3%) experienced any form of physical violence during
childhood with more than half of them (60%) experiencing it at home. Most common
cases of violence at home was corporal punishment (54.5%) while a third (30.3%)
suffered from more severe forms of abuse. Mothers, followed by the fathers, brothers
and sisters were the most commonly based perpetrators of physical violence in the
home. We also know that across the world, toddlers are the age group that is most often
harshly punished, being beaten with objects including sticks and belts (WHO, UNICEF
& World Bank, 2018), which suggests that the prevalence of violence against toddlers is
likely to be even higher.

Other studies provide additional evidence about the high prevalence of violence
affecting young children in the Philippines (Child Protection Network et.al., 2016). A
comparative study on harsh child discipline found that mothers in the Philippines were
more likely to use harsh verbal discipline, moderate physical discipline and harsh
physical discipline that involved hitting the body compared to mothers in Brazil, Chile,
Egypt, India and the United States (Runyan et al 2008). Among mothers surveyed in a
community in Manila, 51% used harsh verbal discipline for their child younger than 2
years-old and 77% used it for their 2-6 years-old child; 25% used harsh physical
discipline that involved hitting the body of and shaking their child younger than 2 years-
old and 52% used it for their 2-6 years-old child (Runyan et al 2008). A comprehensive
literature review of studies on violence against children in the Philippines suggests that
the frequent use of violent forms of discipline is driven by a toxic combination of factors
including financial stress, substance misuse, parental histories of physical abuse, and
social norms around the use of violent discipline. (Child Protection Network et.al., 2016)

In light of these figures, the recent launch of the Philippine Plan of Action to End
Violence against Children is of outmost importance. A key result area under the Plan of
Action concerns parenting and positive discipline with DSWD charged with leading the
efforts in promoting evidence-based, age appropriate and gender-responsive parenting
programs, capacity building, and communication for behavior change. As part of this
key result area, an evaluation of existing parenting programs has been initiated with a
view to identifying effective program components and ways to integrate positive
discipline into existing training programs of frontline workers and supervisory staff, and
into parenting programs.

Relatedly, it must be noted that corporal punishment is unlawful in alternative care

facilities, day care centers and schools, yet it is still not prohibited by law at home. A
pertinent bill that passed both houses in 2018, known as the Act of Promoting Positive

41
and Nonviolent Discipline of Children, was subsequently vetoed by the President. The
bill sought to develop a comprehensive program to provide parents and caregivers with
adequate parenting tools and learning resources in employing a positive and nonviolent
way of disciplining their children.

Relatedly and more generally, various efforts exist at the national and local levels to
prevent and mitigate the effects of abuse, neglect, violence and exploitation. In this
regard, the Local Councils for the Protection of Children play a critical role in creating a
protective environment for all children. Yet it must be noted that the legislative
framework guiding the efforts of LCPCs neither makes specific provisions for prioritizing
efforts for the prevention of violence to the early childhood period given it “presents a
unique window of opportunity to break the vicious cycle of violence, abuse and neglect”
(UNSG-SRVoC, 2018) nor does it stipulate for counseling and reporting mechanisms
adapted to the needs of young children. Early learning programs can also play a role in
the prevention and early detection of violence, abuse and neglect; the Tahderiyyah
Center Protocol on Reporting and Referring Child Abuse, Violence, Exploitation is a
noteworthy example in this regard.

Supporting young children and their caregivers through adversities, such as

poverty, health crisis, and disasters is critical to ensuring that young children continue
receive response caregiving during difficult times.

Social protection and welfare programs play a critical role in this regard:
 As discussed under the section on health, the national health insurance program
PhilHealth provides a range of benefit packages including the Z Benefit Package
for catastrophic illnesses coverage so as to ensure that health problems do not
trigger a crisis for vulnerable households.

 Pantawid Pamilyang Pilipino Program (4Ps) provides the poorest 4.1 million
households with conditional cash assistance to enable them to invest in their
children’s health and education. As of September 2018, 4,050,124 households
were benefiting from the 4Ps cash assistance. According to the Compliance
Verification System (CVS), compliance rates were high: 92% for Day Care/Pre-
School Attendance, 95% for school attendance of 6-14 year-old children, 91%
for school attendance of 15-18 year-old children; 98% for check-up/immunization
for pregnant women and 0-5 year-old children, 98% for deworming of 6-14 year-
old children, and 94% for parents’ attendance to Family Development Sessions.
Type of assistance under the 4Ps include the health grant (P500 per month per
household), P300 per month for 10 months in a school year for 3-14 year-old
children, P500 per month in a school year for 15-18 year-old children, P600 per
month as rice subsidy for each compliant house and a P200-300 monthly
unconditional cash assistance to mitigate the effects of a tax reform introduced in
2018. It should, however, be noted that 0-5 year-old children constitute a
relatively small group compared to 6-14 year-olds and 15-18 year-olds: Only
2.3% of children living in households receiving conditional cash assistance are
under five (DSWD 2019).

42
 Impact evaluations of the 4Ps program have shown mixed effects on various
desired outcomes with puzzling differences across evaluation studies conducted
since 2011 (Filmer et.al. 2018; World Bank 2018c). The studies have found
generally a positive effect of the 4Ps on the use of basic health services in
beneficiary families. The studies have also found that the prevalence of stunting
among young children residing in beneficiary households decreased during the
initial phase but these results were not sustained. Furthermore, it was found that
the prevalence of stunting among those young children in the same communities
residing in non-beneficiary households increased. The studies have found a
positive effect on the use of antenatal and postnatal maternal health services
and delivery at a health facility. Findings have, however, been mixed on the
effects of the 4Ps on enrollment rates and regular attendance among 3-5 year-
old children. Recent implementation reports also draw attention to the decline in
the number of young children being monitored by the 4Ps over the years (World
Bank 2018b).

 The Modified Pantawid Pamilyang Pilipino Program targets beneficiaries who are
not covered by the 4Ps such as those rendered homeless by natural and man-
made disasters and with no means of livelihood, homeless street families, and
Indigenous People in geographically isolated and disadvantaged areas. A total of
228,905 households were benefiting from the Modified 4Ps as of September
2018.

 In accordance with the Foster Care Act of 2012, the declared policy of the state
is to provide children who are abandoned, neglected or orphaned, children
whose family members are temporarily or permanently unable or unwilling to
provide adequate care, children who are victims of abuse or exploitation,
children with special needs, children under socially difficult circumstances (such
as children living on the street or children who are victims of trafficking) with an
alternative family that will provide love and care as well as opportunities for
growth and development. The Act deems foster care more beneficial to a child
than institutional care in most cases. In addition to the procedures on placement
and monitoring, a foster child is entitled to a monthly subsidy from DSWD to
support the expenses of the child and is to be entitled to health insurance
benefits under PhilHealth. The Act also requires DSWD and the social service
units of LGUs to provide support care services to foster parents including
counseling, training on child care and development, respite care, skills training
and livelihood assistance. It is worth noting that the Act does not have any
specific arrangements for young children and their foster families despite the
particular developmental needs of early childhood years. 15

15
The authors of this report were not able to access any information on the implementation of this Act,
including its coverage and barriers. Similarly, administrative figures on residential care facilities and
alternative parental care programs could not be identified/accessed.

43
The value of the above-mentioned social protection and welfare programs in supporting
young children and caregivers through adversities becomes more evident when we
consider that more than one fifth of the country’s total population (21.6%) was living
below the national poverty line in 2015 with another one tenth of the population 11.9 per
cent considered to be vulnerable to poverty (World Bank, 2018). Young children are
more likely to be living below the national poverty line: 32.5% of children under the age
of five were living in poor households in 2015 (PSA Child Poverty Figures 2015).

Furthermore, regional disparities in income remain a major challenge with the wealthiest
region (NCR) having a real per capita income that is 16 times that of the poorest region
(ARMM) (World Bank, 2018). Relatedly, 70.2% of the population in the ARMM live in
households in the poorest quintile compared to 0.6% of the population in NCR. Other
regions where a notably high percentage of the population live in the poorest quintile
include Zamboanga Peninsula (45.4 %) and SOCCSKSARGEN (38.1 %). 16 Poverty in
the Philippines remains a predominantly rural phenomenon with 4 out of 5 people (78.9
per cent) below the national poverty line living in rural areas (rural poverty rate 29.8 %;
urban poverty rate 10.6 %). Among the urban poor, over 1.5 million informal settler
families are particularly vulnerable (World Bank, 2018).

Overall, the need to strengthen social protection and welfare programs with a focus on
young children remains. The recently enacted Universal Health Care Act is a highly
positive development in this regard. Similar efforts are necessary in expanding and
improving existing programs, particularly the 4Ps and the Modified 4Ps. While the 4Ps
has a relatively high coverage among the poorest households (45.6%) (World Bank
2018c) and has an explicit focus on children living in poor households, children under
the age of five constitutes a small part (2.3%) of the total number of children benefiting
from the 4Ps (about 8.7 million) (DSWD 2019), a number that has been diminishing
over the years (World Bank 2018b).

Disasters and displacement emerge as a particularly relevant adversity for young

children and their families in the Philippines, which is one of the most disaster-prone
countries in the world. Young children are particularly vulnerable in the face of disasters
as a result of being at higher risk of morbidity, mortality, injury and separation from their
families. If young children are deprived of responsive caregiving in the aftermath of
disasters, they would be put at risk of toxic stress response with lifelong ramifications,
some of which are highlighted earlier in this section. Therefore, it is critical to ensure
that not only special measures are put in place both for the specific health, nutrition,
protection, water, sanitation, and education needs of young children but also their
parents are supported so that they can continue providing responsive care to their
young children even in the aftermath of a disaster.

In response to the onslaught of disasters in recent decades, robust policies for effective
disaster response have been put in place, such as the Philippines Disaster Risk
Reduction and Management Act of 2010 (Republic Act 10121). The Act creates regional
16
By definition of “wealth quintile”, the nationwide figure is 20%.

44
and local bodies and establishes local offices in every local government unit, which are
responsible for developing and implementing disaster risk reduction programs locally. It
must, however, be noted that interviews conducted for this study highlighted limited
resources as an obstacle to adequate preparedness of disadvantaged communities,
which are in fact more prone to be affected by disasters. Additionally, it was reported
that the very institutions and frontline workers that are critical for supporting young
children in the aftermath of disasters, such as daycare centers and daycare workers,
are redirected to other tasks related to disaster relief.

With respect to young children, the most pertinent policy has been established under
the Children’s Emergency Relief and Protection Act of 2016 (Republic Act 10821). It is
particularly worth noting that the Act gives priority to the specific health, protection and
nutrition needs of children under five years of age along with pregnant women, lactating
mothers, newborn babies, and children with special needs. The Act also stipulates the
prompt resumption of educational services including early childhood care and
development for children under five years of age in addition to the establishment of
child-friendly spaces. The law also requires specific reporting on implementation of
services for children under five years of age.

As stipulated by the Act, the development of a comprehensive emergency program for

children (CEPC) was completed in late 2018, which will serve as the basis for handling
disasters to protect children, pregnant and lactating mothers, and support their
immediate recovery. The CEPC puts special emphasis on young children, pregnant and
lactating women during emergency response and emphasizes the need for the
resumption of health, protection, nutrition, early learning services immediately. More
specifically, CEPC stipulates the establishment of evacuation centers with spaces for
breastfeeding and are safe, inclusive, child-friendly, gender-sensitive and responsive. It
mandates that transitional centers prioritize orphans, separated or unaccompanied
children, and pregnant and lactating women. Health, medical, nutritional and water and
sanitation and hygiene needs of newborns, infants and young children, adolescents,
pregnant and lactating women must also be provided immediately where they are.
Furthermore, the Program requires coordination between Philippine National Police and
other government agencies and LGUs in monitoring and ensuring the safety and
security of children. CEPC also requires that basic and comprehensive emergency
obstetric and newborn care, prenatal care services and counselling on breastfeeding
and nutrition, nutritional assessment, micronutrient supplementation for pregnant
women, postpartum care and services including breastfeeding support and postnatal
care of the newborn to be provided during emergencies.

The localization of CEPC remains to be carried out. The localization process presents
an opportunity to build awareness among members of Local Disaster Risk Reduction
and Management Council (LDRRMC) and of Local Council for the Protection of Children
(LCPC) about the unique needs of young children in times of disaster and the
importance supporting their caregivers in an effort to prevent young children from
experiencing prolonged toxic stress with life-long implications for their wellbeing.

45
Finally, it must be underscored that the need for effective disaster response that
prioritizes the wellbeing of young children will become increasingly acute as an
increasing number of communities will be forced to relocate in coming decades as a
result of climate change and resulting rising water levels, typhoons and changes in the
location of fisheries.

Birth registration constitutes a critical step in providing legal protection to a young

child. According to estimates based on NDHS 2017, among 0-23 month old children,
90.6 % were registered though only 65.7 % had a birth certificate. Regional and income-
based disparities in birth registration are worth noting whereby 83.1 % of children’s
births in the poorest households were registered compared to 97.7 % of their peers in
the wealthiest households.17 In the two regions with the lowest birth registration rates,
59.8 % of children (ARMM) and 83 % of children (SOCCSKSARGEN) had their births
registered.

2.6 PATTERNS AND SOURCES OF DISPARITIES - SYNTHESIS

As highlighted by the various outcome- and access-related indicators discussed earlier
in this section, all dimensions of the wellbeing of young children is characterized by
income-based and cross-regional disparities, which are in fact closely linked to each
other given substantive differences in poverty rates across regions. In the absence of a
multivariate analysis, the specific factors underlying the disparities in outcome indicators
cannot be pinpointed. For instance, poor households may be less able to access health,
nutrition, education services for their children for a number of reasons such as (i) they
cannot afford the direct and indirect costs associated with these services; (ii) they are
more likely to live in rural areas, remote areas and geographically isolated areas where
distances hinder access to services; (iii) they are more likely to have less education and
lower levels of awareness about the value of these services; (iv) they are more likely to
have more children and have less time per child for responsive caregiving; and/or (v)
they are more likely to live in local government units that have limited financial
resources to provide high quality and accessible services.

The case of ARMM is particularly worth highlighting in this regard as it performs notably
worse than other regions with respect to many ECCD outcomes. In addition to deep
poverty, the peace and security situation in ARMM is a relevant factor in this context.
The region has experienced conflict for decades with communities and families still
struggling to rebuild their lives and sources of livelihood.

It must be noted that the patterns of disparities highlighted in discussing the various
outcome- and access-related indicators are limited by the type of disaggregation
allowed by the available household survey data. Thus, the analyses could not
investigate disparities based on disabilities, ethnicities, being affected by disasters,
being a member of an indigenous community, or living in a geographically isolated area.
However, interviews and group discussions conducted as part of the research
underlying this report underscored several other sources of disparities affecting young

17
Note that this figure is for 0-5 year-old children.

46
children. The following groups of young children (listed in no particular order) were
identified as being particularly vulnerable: children with disabilities, children with
developmental delays, children whose parents are subsistence farmers and fisher folks,
children living in indigenous communities (especially those that are mobile and
migratory), children living in geographically isolated and disadvantaged areas, children
living in conflict areas, children living in disaster-affected areas, children living in urban
poor areas, children living on the streets.

47
 Mapping of ECCD Programs
Age Health Nutrition Early Child Protection Social
group Learning protection
0-23 1. Reproductive 1. Infant and 1. Parent 1. Mandated birth 1. National
health and young child education registration insuranc
maternal care feeding program e
program 2. Philippine 2. Family 2. Maternity and systems
2. New born Integrated development paternity 2. Pantawid
care program Management sessions leaves Pamilyan
3. National of Acute 3. Family g Pilipino
Immunization Malnutrition support 3. Anti-violence Program
Program or (PIMAM) program and child (4Ps)
Expanded 3. National 4. National protection laws 3. Services
Program on Dietary Child (including RA for
Immunization supplementa Developmen 7610, RA 9775, orphans
(EPI) tion program t Center RA 9208) and
4. Child 4. National (Bulilit vulnerabl
Development nutrition Center) 4. Comprehensiv e
and Disability promotion 5. Camp Bulilit e Emergency children
Prevention 5. Micronutrient 6. Infant and Program for
Program supplementa child care Children
(newborn tion services (CEPC)
screening, 6. Food
newborn fortification
hearing 7. Growth
screening, monitoring
rare and
diseases, promotion
early child 8. Overweight
development, and obesity
injury management
prevention, and
and child prevention
rehabilitation, program
including 9. Community
children with gardening
disabilities) 10. TARGET
5. Oral Health and child
across the nutrition
Life Stages 11. Family
6. Integrated development
Management sessions
of Childhood 12. Adolescent
Illness (IMCI) health and
nutrition
development
13. SALIN
TUBIG
Water
Program and
other WASH
projects

24-59 1. Child 1. Infant and 1. Family 1. Anti-violence

Development young child development laws
 and Disability feeding sessions 2. CEPC
Prevention program 2. Parent
(injury 2. Philippine education
prevention, Integrated program
and child Management 3. National
rehabilitation, of Acute Child
including Malnutrition development
children with (PIMAM) centers
disabilities) 3. National 4. Camp Bulilit
2. National dietary 5. Child
immunization supplementa Developmen
program tion program t Center/Day
(booster 4. National care Service
vaccinations) nutrition 6. Supervised
3. As promotion neighborhoo
appropriate 5. Micronutrient d play (SNP)
for age, supplementa 7. Other
promotion of tion alternative
enrollment of 6. Food modes of
young fortification early
children in 7. Deworming childhood
day care or (24 M education
child onwards, (e.g.
development twice a year Tahderiyyah
programs at - at the DCC program)
age 3 years and school) 8. Kindergarten
using the 8. Growth program
health sector monitoring
platform to and
inform promotion
parents and 9. Overweight
care givers and obesity
4. Oral Health management
Across the and
Life Stages prevention
5. Integrated program
Management 10. Community
of Childhood gardening
Illness (IMCI) 11. TARGET
and child
nutrition
12. Family
development
sessions
13. SALIN
TUBIG
Water
Program,
WASH in
day care
centers and
other WASH
programs

60-71 1. School-based 1. National 1. Kindergarten

interventions dietary program
 in supplementa 2. Alternative
coordination tion program forms of
with the 2. National early
Department nutrition childhood
of Education promotion education or
and the local 3. Micronutrient kindergarten
government supplementa program
units. tion (e.g. KCEP,
2. National 4. Food Tahderiyyah
Immunization fortification program)
Program or 5. Growth 3. Family
Expanded monitoring development
Program on and sessions
Immunization promotion in
(EPI) on schools
selected 6. WASH in
vaccine- schools
preventable including,
diseases, deworming
including 7. Overweight
MMR and obesity
booster) management
3. Child Injury and
Prevention prevention
(falls, road program
traffic injuries, 8. Gulayan sa
drowning, Paaralan
burns, (school
chemical gardens)
hazards and 9. Family
poisoning) development
sessions
SECTION 3 - INSTITUTIONS
This section presents a general description of the institutional landscape relevant for the
planning, financing and implementation of early childhood care and development
programs in the Philippines. The section is composed of five parts. The first part
focuses on institutions at the national level with a focus on the key agencies of
Department of Health, Department of Social Welfare and Development, and Department
of Education. The second part presents a review of the relevant coordinating councils at
the national level with a particular focus on the ECCD Council and National Nutrition
Council. The third part turns to local government units and the fourth part focuses on
service providers. The fifth and final part of the section reviews the legislation directly
relevant to ECCD programs and services in the Philippines.

This section is intended to be more descriptive in style. Findings about the critical
issues, gaps and opportunities emerging from the review of young children’s outcomes
and ECCD programs and services presented in the previous section and the review of
institutions presented in this section are put forward in the next section of the report.

3.1 KEY NATIONAL-LEVEL AGENCIES FOR EARLY CHILDHOOD PROGRAMS

1. Department of Health is the lead agency for health, the steward of the health of the
nation, with the overarching mandate to provide national policy direction, develop
national plans, technical standards and guidelines on health. The Children’s Health
Development Division (CHDD) under the Disease Prevention and Control Bureau of
DOH is the division responsible for ECCD policies and programs. The main functions of
CHDD include developing policies, plans, programs and services, and setting standards
and guidelines on children’s health and diseases. It also provides technical assistance,
conducts monitoring and evaluation, mobilizes resources, and promotes coordination
and collaboration among health sector agencies.

With respect to ECCD related programs, DOH is the lead agency for almost all health
services for young children and their caregivers, including maternal health, safe
delivery, newborn care, infant and young child feeding, immunization, child development
and disability prevention program, program for the management of childhood illnesses,
and various nutrition programs. Until recently, routine child health and nutrition services
were focused solely on preventable diseases, illness management, prevention and
management of malnutrition. In recent years, DOH has initiated efforts to integrate a
more holistic approach to early childhood development into its routine child health and
nutrition services. Although still in nascent stages of planning, the Early Child
Development program under the Child Development and Disability Prevention Program
would involve the integration of promotion of growth and development; prevention, early
identification and early intervention of childhood delays and disabilities; and promotion
of responsive care across child health and nutrition programs.

Coordination for ECCD related policies and programs inside DOH takes place at
different levels of governance. At the national-level, coordination among divisions and
bureaus on ECCD-related policies and programs is currently facilitated by a recently
formed committee. Coordination across national, regional and local levels for health-
related ECCD is captured in Figure 3.1 (Devlin 2016) on the general health system
structure that includes the managing bodies, service delivery points and key actors at
each level.

Figure 3.1 Health System Structure18

The DOH Regional Offices (Centers for Health and Development) is tasked with
supporting local health systems and bridging DOH Central Office and attached agencies
with local government units. They provide strategic leadership, management and
coordination of field implementation. Thus, their role is critical in effective policy
implementation and quality assurance for all health programs including those related to
ECCD. Local government units continue to receive guidance on health matters from the
DOH through its network of DOH representatives under the supervision of the Regional
Centers for Health and Development. DOH also hires cadres of health professionals –
doctors, nurses, dentists, midwives – to support local health systems and deploys them
mainly to hospitals and rural health units in low-resource local government units (HSR
2018). In 2017 alone, over 500 doctors, 400 dentists, 17,000 nurses and 20,000
midwives were deployed by DOH to local government units (HSR 2018). These health
professionals are at times hired as health associates and are tasked specifically with

18
Devlin (2016).
improving the implementation of programs and services, including those targeting
maternal health, infant health and children’s health (HSR 2018).

Financing of ECCD-Related DOH Programs: Although many programs related to

ECCD are implemented by DOH, including the National Safe Motherhood Program,
the Essential Newborn Care, the Expanded Program on Immunization, the Integrated
Management of Childhood Illness (IMCI), the Newborn Screening Program, and the
Women and Children Protection Program, no detailed information was made
available on these specific programs. However, most of them appear to fall under the
Family Health, Nutrition and Responsible Parenting (FHNRP) Sub-Program and the
National Immunization Sub-Program of the Public Health Program, for which national
budget information is available. Of the National Immunization Sub-Program, which is
only composed of commodities (vaccines and associated injection devices, custom
duties and taxes, and freight and handling), approximately 84% were programmed
for infant vaccines in 2019. Assuming this share was stable over time, approximately
PhP 6.3 billion were spent on infant vaccination in 2018. As for FHNRP, out of the
program’s PHP 3.64 billion budgeted in 2018, PHP 2.55 billion (70%) was for infants
and pregnant or lactating women. In sum, in 2018, a total of PhP 8.81 billion was
appropriated to DOH for the implementation of these two sub-programs for ECCD, all of
which was for MOOE. This represents approximately 8% of the total DOH budget.

Table 3.1: Budget of DOH ECCD-related programs, 2018

ECCD related programs Appropriated Amount
(PhP millions)
Family Health, Nutrition and Responsible Parenting 3,640
Of which: for infants and pregnant/lactating women: 2,552
National Immunization 7,437
Of which: for infants: 6,260
Total estimated for infants 8,812
Total DOH budget 109,807
ECCD related programs as % of total DOH budget 8.03%
Source: General Appropriation Act FY2018.

There is no commonly used target for the financing of ECCD health services. One
article (Emily Vargas-Barón, 2008) suggests that “nations should devote at least 0.3%
to 0.5% of GDP to maternal and child health care. Progressively, over a period of five to
ten years, nations should invest from 14% to 20% of their health budgets in maternal
and child health, with the ultimate goal of investing up to 25%.” Although these targets
seem very optimistic and challenging, the levels of ECCD financing in DOH appear
particularly low in comparison, with an estimated 0.05% of GDP spent on ECCD health
services.

2. Department of Social Welfare and Development is the lead agency for social
protection with the overarching mandate to lead in the formulation, implementation and
coordination of social welfare and development policies and programs for and with the
poor, vulnerable, and disadvantaged. DSWD has undergone a major transformation
since the introduction of the colossal Pantawid Pamilyang Pilipino Program (4Ps) in
2008. As of 2015, DSWD is implementing programs covering more than 30 million
(about 30% of the population) with a budget close to 1% of the GDP (World Bank,
2016).

DSWD serves a wide range of clients and beneficiaries who are generally
disadvantaged, marginalized and vulnerable individuals, groups, families and
communities. They include a) abandoned, neglected, orphaned, abused, exploited
children, children in need of special protection and children in conflict with the law; b)
out-of-school youth and other youth with special needs; c) women in especially difficult
circumstances; d) persons with disabilities or differently-abled persons; e) senior
citizens; f) marginalized and disadvantaged individuals, families and communities e.g.
indigenous groups, those in crisis situations, internally displaced due to armed conflict
and other developmental projects; and g) victims of natural and man-made
calamities/disasters.

With respect to ECCD related programs, DSWD is the lead agency for several critical
enabling efforts across early learning, nutrition, responsive caregiving, child protection
and social welfare. It regulates, sets standards for and recognizes daycare centers,
child minding centers, and supervised neighborhood play to ensure that young children
are provided with a responsive, nurturing, stimulating and consistent care from stable,
well-trained staff.19 It regulates and funds the supplementary feeding program targeting
young children attending day care centers, child development centers, child minding
centers, and supervised neighborhood play programs. It develops and monitors the
implementation of various parenting support interventions including Family
Development Sessions, Parent Effectiveness Service and Empowerment and
Reaffirmation of Paternal Abilities. DSWD is also the lead agency for protection efforts
for all children including children under five years of age. It both runs public residential
care facilities for abandoned, neglected and abused children, and regulates and
monitors non-governmental entities providing such services. It supports families facing
adversities such as poverty and disasters through cash assistance programs, such as
the 4Ps, which enables caregivers to continue providing nurturing care to their young
children even in the face of adversities. It is also mandated to monitor the
implementation of the adoption and foster care program.

Coordination for ECCD-related policies and programs at DSWD are facilitated by the
ECCD Subgroup of the Child Development Technical Working Group convened and
chaired by the Office of the Undersecretary for Policy and Plans. The overall monitoring
and quality assurance for many ECCD programs, including day care centers, child
minding centers, SNPs; supplementary feeding program, parenting support
interventions, is the responsibility of Program Management Bureau (formerly
Community Programs and Services Bureau). Technical assistance on the development
of standards, including ECCD programs, is provided by the Standards Bureau. New

19
According to the Early Years Act of 2013, among the functions of the ECCD Council, of which DSWD is
a member, is establishing ECCD program standards that reflect developmentally appropriate practices for
ECCD programs.
strategies and program approaches on ECCD are developed by the Social Technology
Bureau. Finally, the Capacity Building Bureau (formerly Social Welfare Institutional
Development Bureau) is responsible for enhancing competencies of DSWD stafff and
partners in performing and achieving its goals. The Capacity Building Bureau also
provides technical assistance on effective implementation of capability building
activities, including those for ECCD programs.

DSWD with UNICEF’s support created the Early Childhood Care and Development
Information System (ECCD-IS) in 2009 as a component of monitoring and reporting
mechanisms designed for the effective implementation of ECCD programs. ECCD-IS
was deployed to LGUs in 2012 and a memorandum circular was issued in 2015 for its
institutionalization. The encoding rates increased from 17% in 2012 to 74% in 2018 for
day care services. Yet the ECCD-IS is yet to reach an optimal encoding rate so as to
provide comprehensive and regular monitoring data on services provided in day care
centers and child development centers, as well as other social welfare services
targeting young children and their families.

Coordination for ECCD-related policies and programs with LGUs is primarily governed
by the Guidelines on the Provision of Technical Assistance and Resource Augmentation
to Local Government Units issued in 2018. 20 The Guidelines aims to enhance capacity
of local social welfare and development offices through technical assistance, such as
trainings, training of trainers, demonstration sessions, coaching and mentoring, and
through resource augmentation, such as the provision of supplies and materials,
funding, and interim deployment of DSWD staff. DSWD Field Offices established in the
regions play a critical role in the implementation of both technical assistance and
resource augmentation efforts. For instance, in providing financial support to LGUs, a
Memorandum of Agreement is executed between DSWD-Field Office and the
Provincial/City/Municipal LGU which defines the roles and responsibilities of each party.
For the Supplemental Feeding Program for instance, DSWD Central Office releases
funds to DSWD Field Offices and transfer these to the City, Municipal or Provincial
LGU.

Financing of ECCD-Related DSWD Programs: The DSWD is in charge of numerous

programs associated with child protection and young children in particular. Among
those, the administration of the 4Ps program represented in 2018 almost two thirds
(63%) of the Department’s total budget (PHP 89.4M out of a total of PHP 141.9M). The
Supplemental Feeding Program, of great importance at LGU level, only amounts to 2%
of the total Department’s budget, with PHP 3.4M (see Table 3.2 below).

Table 3.2: DSWD 2018 budget, PHP millions

% of
Recurrent Capital
Agency Activity Total DSWD
Exp. Exp.
Total
Office of the General management and supervision 699 - 699 0%
Secretary Pantawid Pamilyang Pilipino Program 89,408 - 89,408 63%
20
https://www.dswd.gov.ph/issuances/MCs/MC_2018-010.pdf
 (Implementation of Conditional Cash
Transfer)
Protective services for individuals and
5,711 - 5,711 4%
families in difficult circumstances
Supplementary Feeding Program 3,428 - 3,428 2%
Assistance to Persons with Disability and
12 - 12 0%
Older Persons
Other programs 40,408 1,843 42,252 30%
Council for the Welfare of Children 91 5 97 0%
Inter-Country Adoption Board 51 6 57 0%
National Council on Disability Affairs 50 7 57 0%
Juvenile Justice and Welfare Council 94 122 216 0%
Total DSWD 139,953 1,984 141,937 100%
Total ECCD-related programs 92,836 - 92,836 65%
Source: General Appropriation Act FY2018.

In 2015, the DSWD targeted 2,568,811 children in 53,463 DCCs/SNPs in 1,630 LGUs
for the Supplemental Feeding Program, while the same year, PhP4.32 billion was
earmarked for the program (UNICEF 2016). This suggest a unit cost of PhP 1,682 per
year and per child for the Supplemental Feeding Program. It should also be noted that
although funds for Supplemental Feeding Program had been transferred from DSWD to
LGUs in the past, DSWD is expected to start spending the funds directly as a result of a
recent policy direction from the President.

3. Department of Education is the lead agency for education with the mandate to
formulate, implement and coordinate policies, plans, programs and projects in the areas
of formal and non-formal basic education. It supervises the mandatory kindergarten
program as well as all elementary and secondary education institutions, including
alternative learning systems. It also provides for the establishment and maintenance of
a complete, adequate, and integrated system of basic education relevant to the goals of
national development.

With respect to ECCD related programs, the kindergarten program is the most relevant
DepEd program. Relatedly, facilitating the smooth transition of young children to
kindergarten and grade 1 is central to DepEd’s efforts in ECCD. It is also worth noting
that EYA stipulates for DepEd to recognize the national ECCD program as the
foundation of the learning continuum and to promote it for all 0-4 year-old children.

Coordination of ECCD programs inside the central office of DepEd has not been
institutionalized. The primary responsibility for the kindergarten program lies with the
Bureau of Learning Delivery and Bureau of Curriculum Development under the
Curriculum and Instruction Strand since the department’s reorganization in 2015. A
relevant coordination body for ECCD is a technical working group on WASH in Schools,
led by the Bureau or Learner Support Services. Though the body does not have a
particular focus on the early childhood phase, the scope of its work makes it pertinent
for inter-sectoral collaboration for ECCD services for 50-71 month-old children. Finally, it
must be noted that EYA stipulates for the Secretary of Education to be the ex officio
Chairperson of the ECCD Council although the chairpersonship has since been
delegated to the Undersecretary for Curriculum and Instruction.

Currently, the Central Office maintains the overall administration of basic education at
the national level and the Field Offices established in the 16 regions and ARMM are
responsible for the regional and local coordination and administration of the
Department’s mandate. There are also 221 provincial and city school divisions headed
by schools division superintendents, and 2602 school districts headed by district
supervisors. DepEd is a non-devolved agency, hence, public education is centrally
managed. At the local level, the DepEd maintains school divisions and districts
corresponding to the three biggest local government units – the provinces, cities and
municipalities. The divisions and districts in turn supervise K – 12 education.

Financing of ECCD-Related DepEd Programs: : Apart from the chairing of the ECCD
Council, which appears under DepEd’s budget, little information is available on the
specific expenses made by DepEd in relation to ECCD. As part of the reporting to the
UNESCO Institute for Statistics, DepEd itself declares for pre-primary education that the
amounts are “nil or negligible”. Pre-primary education is part of the K to 12 Program,
which covers 13 years of basic education with the following key stages: Kindergarten to
Grade 3, Grades 4 to 6, Grades 7 to 10 (Junior High School) and Grades 11 and 12
(Senior High School). Budgets for kindergarten are however difficult to distinguish from
that of higher level, as they are integrated in the GAA under “Personnel Services,
Capital Outlay and MOOE of “Operation of Schools - Elementary (Kinder to Grade 6)”.

A very rough estimate can be made of the expenses relating to Kindergarten, using the
share enrolment in Kindergarten as an estimate of the share of the expenses for K-6
dedicated to that level. In 2018, Kindergarten learners represented 13% of K-6 total
enrolment. The same year, approximately PhP 210 billion were appropriated for the
operation of K-6 schools. However, a larger estimate of PhP 343 billion can be
estimated for ECE in total, including a prorated share of the non-level-specific budgets
(facilities, general management and supervision, etc.). Applying the share of enrolment
in Kindergarten to these amounts provides low and high estimates for the budget
appropriation for ECE, of respectively PhP 27 billion and PhP 44 billion, representing
5% to 8% of DepEd’s budget (excluding agencies).

Table 3.3: DepEd budget for ECE, 2018

Number of learners
Enrolment in Primary Education 14,293,635
Enrolment in Kindergarten (ECCD) 2,119,579
Percentage of K-G6 enrolment in Kindergarten 13%
PhP millions
Operation of Schools - Elementary (Kinder to Grade 6) 209,702
Estimated total budget for K-6 343,451
Estimated Operation of schools for ECCD 27,081
 Estimated total cost for ECCD 44,353
Total DepEd Budget (excluding agencies) 579,419
ECCD as % of Total DepEd budget 5% - 8%
Source: Enrolment data: UNESCO Institute for Statistics. Budget data: General Appropriation
Act FY2018 and calculation of the authors.

3.2 NATIONAL-LEVEL COORDINATION MECHANISMS

Coordinating councils have been the default structure to facilitate government’s
national-level response to policy challenges that require harmonized efforts from
multiple sectoral departments and agencies. Those coordinating councils most pertinent
for early childhood are Early Childhood Care and Development Council (ECCDC),
National Nutrition Council (NNC), Council for the Welfare of Children (CWC), Juvenile
Justice and Welfare Council (JWC), and National Council on Disability Affairs (NCDA).
The Inter-Agency Committee on Environmental Health overseeing WASH policy and
programming at national level could also become a pertinent coordination body for early
childhood development yet it currently lacks a focus on children and does not have
relevant agencies, such as DSWD and DepEd, among its members.

Membership: An examination of membership in these councils (see Table 2) shows

that the same agencies are members across the different councils, i.e. DOH, DSWD
and DepEd. In some cases, one coordinating council is a member of another one, such
as the case of NNC being a member of ECCDC and CWC, and of CWC being a
member of JWC.

Mandates and Areas of Focus: Given their shared reason for existence, their
mandates are similar and include formulating policies, proposing legislations,
conducting consultative meetings, undertaking monitoring and evaluation, conducting
studies, research and databases, and providing technical support in the implementation
of programs and services. Their particular areas of focus have potential overlaps, which
necessitates effective collaboration to ensure such overlaps do not affect the
performance of the councils. Potential overlaps that are most pertinent for early
childhood policies concern young children with disabilities (ECCDC and NCDA), young
children in contact with the justice system (ECCDC and JWC), nutritional status of
young children (ECCDC and NNC) and most generally rights of young children (ECCDC
and CWC).

While the membership of NNC on ECCDC provides an institutionalized solution to one

of these areas of overlap, the other three areas of overlap require other responses from
the concerned councils. In this regard, the Memorandum of Agreement among councils
and committees on children, and the operational guidelines for convergence among
them is a noteworthy effort. The need, however, remains for further harmonization of the
efforts of these national-level councils both with respect to their strategic plans and day-
to-day operations.

“Mother Agency” Affiliation: Through the years, there has been continuing “rigodon”
or transfer of council affiliation to different Departments (See Table 2). For instance,
NNC used to be attached to the Department of Agriculture but was moved to DOH
because nutrition has evolved to encompass issues beyond the provision of food. CWC
used to be with the Office of the President but was reverted to an attached agency to
DSWD in 2007. CWC used to function as the National ECCD Coordinating Council until
2009, at which point the CWC and the ECCD Council became two distinct and separate
councils attached to DSWD. With the Early Years Act of 2013, the ECCD Council
became attached to DepEd. It must be noted that the “Mother Agency” affiliation is far
from being a sheer formality as it has implications for the general focus of a council’s
efforts and the council’s clout over national and sub-national agencies.

Challenges: Coordinating councils as a mechanism for cross-sectoral collaboration

present several challenges with implications for their overall effectiveness. The first
challenge concerns their influence over member organizations. The influence of the
Chair of a particular council over its member organizations is highly relevant in this
regard. A Chair’s influence over council members is dependent on several factors
including the relative power of the “mother agency” derived mostly on its formal
authority and resources, position of the chair in the bureaucratic hierarchy, and personal
reputation of the Chair. Also, it is not uncommon for a lower ranking official to be
designated to chair a council on behalf of the Council’s Secretary and for junior officials
to be assigned to attend council meetings on behalf of their superiors despite lacking
the authority to make decisions and commitments. These dynamics may impair and
delay the decision-making and implementation functions of a council.

The second challenge concerns the relationship between the national councils and local
government units given the devolved nature of program implementation and service
delivery. The structural bottlenecks stemming from the devolved governance system
pose challenges to the effectiveness of coordinating councils given the legal limitations
on national-level agencies’ engagement in policy implementation, program financing
and fund transfers, human resource deployment. Consequently, coordinating councils
are left with a limited and generally weak toolbox for influencing local government units
program priorities and supporting effective program implementation. The rest of this
section focuses on the ECCDC and NNC from among the national-level coordinating
councils given their particular relevance for early childhood policies and program.
 Table 3.4. Council Membership and Legal Basis of Selected Councils
Council for the Welfare National Council on
ECCD Council National Nutrition Council of Children Juvenile Justice and Welfare Disability Affairs
Council21
Chair DepEd Secretary DOH Secretary DSWD Secretary USEC of DSWD DSWD Secretary
Members 1. DOH 1. DOH 1. DOH 1. DOH 1. DOH
2. DepEd 2. DepEd 2. DepEd 2. DepEd 2. DepEd
3. DSWD 3. DSWD 3. DSWD 3. DSWD 3. DSWD
4. DILG 4. DILG 4. DILG 4. DILG
4. NNC 5. DA 5. DA 5. DOJ 5. DOLE
5. ULAP 6. DBM 6. DOLE 6. CWC 6. DTI
6. ECCD Private 7. DOLE 7. NEDA 7. CHR 7. DPWH
Practitioner 8. DTI 8. NNC 8. NYC 8. DTC
7. ECCD Council 9. NED, 9. DOJ 9. League of Provinces 9. DFA
Secretariat 10. DOST 10. CWC Secretariat 10. League of Cities 10. DOJ
11 - 13 Private sector 9 -11. Private sector 11. League of Municipalities 11. PIA
representatives representatives 12. Liga ng mga Barangay 12. TESDA
13. NGOs 13 – 18 Private
individuals
Legal Basis RA 10410 (2013) Presidential Decree No. 491 Presidential Decree Republic Act No. Executive Order No.
RA 10157 (2012) (Nutrition Act of the No. 603 and Executive 10 934424 70925
Philippines, 25 June 1974)22 Order No. 708 (1981)23
Previous Council for the Department of Agriculture Office of the President Department of Justice Used to be a
mother Welfare of Commission
agency Children
Mandates  Establish  Formulate national food  Initiate, promote  Oversee implementation  Policy-making,
National and nutrition policies and and advocate of RA 109344 and advise planning,
Standards strategies and serve as adoption of the President on all monitoring,
 Develop the policy, coordinating policies and matters and policies coordinating and
Policies and and advisory body of measures to relating to juvenile justice advocating for the
Programs food, nutrition and health protect child rights and welfare. prevention of the
 Ensure concerns;  Build strong  Assist the concerned causes of
Compliance  Coordinate planning, networks, agencies in the review disability
monitoring, and partnerships and and redrafting of existing  Rehabilitation and
21
https://www.dswd.gov.ph/download/implementing_rules_and_regulations_irrs/Revised-Implementing-Rules-and-Regulations-of-RA-9344-as-amended-by-RA-10630.pdf
22
http://www.nnc.gov.ph/index.php/about-us.html
23
https://cwc.gov.ph/about-us/vision-mission-mandate-legal-bases.html
24
https://www.dswd.gov.ph/download/implementing_rules_and_regulations_irrs/Revised-Implementing-Rules-and-Regulations-of-RA-9344-as-amended-by-RA-10630.pdf
25
http://www.ncda.gov.ph/disability-laws/executive-orders/executive-order-no-709/
 Provide evaluation of the coordination policies/ regulations or in equalization of
technical national nutrition mechanisms to the formulation of new opportunities in
assistance program; ensure concerted ones. the concept of
and support to  Coordinate the hunger efforts in the  Periodically develop a rights-based
the ECCD mitigation and implementation of comprehensive 3 to 5- society for
service malnutrition prevention Child 21 and CRC year national juvenile persons with
providers program to achieve  Create an intervention program disabilities
relevant Millennium environment that  Coordinate the  Lead in the
Development Goals; enables children to implementation of the implementation of
 Strengthen develop their full juvenile intervention programs and
competencies and potentials programs and activities projects.
capabilities of  Facilitate  Formulate and
stakeholders through institution-building recommend policies and
public education, of partners and strategies in consultation
capacity building and other stakeholders with children for the
skills development;  Monitor and prevention of juvenile
 Coordinate the release evaluate the delinquency and the
of funds, loans, and implementation of administration of justice
grants from government policies and  Collect relevant
organizations (GOs) and programs information and conduct
nongovernment  Undertake continuing research and
organizations (NGOs); research and support evaluations and
and development studies on all matters
 Call on any department, activities relating to juvenile justice
bureau, office, agency and welfare.
and other  Conduct regular
instrumentalities of the inspections in detention
government for and rehabilitation facilities
assistance in the form of  Initiate and coordinate the
personnel, facilities and conduct of trainings for
resources as the need the personnel of the
arises. agencies involved in
juvenile justice and
welfare system
1. Early Childhood Care and Development (ECCD) Council is composed of the
ECCD Governing Board (GB) and the ECCD Council Secretariat. The Governing Board
is composed of the Secretary of the Department of Education as the Chair, Executive
Director of the ECCD Council as Vice-Chair, the Secretaries of the Department of Social
Welfare and Development, Department of Health, Executive Director of the National
Nutrition Council, President of the Union of Local Authorities of the Philippines and a
Private Sector Representative/ ECCD Practitioner as Members. To support the mandate
of the ECCD Council, a Technical Working Group (TWG) has been formed. Members of
the TWG are representatives from GB member agencies and other stakeholders
working on ECCD with the Department of the Interior and Local Government (DILG)
joining in 2017 as a member. The TWG is to identify and recommend priorities,
amendments to policies, standards, plans, programs, systems and tools; prepare
integrated annual work and financial plan; recommend areas for capacity building; and
identify opportunities for collaboration with all stakeholders.

The Council Secretariat provides support services for the coordination and monitoring of
the implementation of policies and plans formulated by the GB. The Council Secretariat
is headed by an Executive Director (ED) who is also the Vice-Chair of the Governing
Board. The ED is supported by administrative and technical staff. Due to the nature of
authorization by the Department of Budget and Management, all staff members of the
Secretariat with the exception of the Executive Director are hired either under
contractual or job order type of service. These limitations on staffing have potential
implications for recruitment and retention of qualified personnel to effectively carry out
the functions of the ECCD Council Secretariat.

Mandate and Accomplishments: As stipulated by law, the responsibilities of the

ECCD Council are to: (a) establish national standards; (b) develop policies and
programs; (c) ensure compliance; and, (d) provide technical assistance and support to
the ECCD service providers. In accordance with its responsibilities, the ECCD Council
has so far accomplished the following:

(a) Establishment of National Standards: The national standards set by the ECCD
Council Secretariat include the standards for center-based early childhood programs for
0-4 years-old children, and standards for teaching competencies for child development
teachers and child development workers. To accompany the teaching competency
standards, the Self-Assessment Tool on Teaching Competencies was developed and is
being currently utilized by city/municipal social welfare and development officers as part
of their efforts in Leading and Managing an Integrated ECCD Program. The
implementation and impact of the tool has not yet been evaluated. The ECCD Council
Secretariat is also in the process of developing new standards for home-based ECCD
programs by organizing consultations, reviewing existing national and international
standards, and identifying the features of a workable home-based program.

(b)Policy and Program Development: The flagship program of the ECCD Council
Secretariat is the establishment of National Child Development Centers (NCDC) and
conversion of a fixed number of existing Day Care Centers close to NCDCs to Child
Development Centers. The NCDC is a community-based and ground level venue for

62
the implementation of integrated set of ECCD activities and services. Establishment of
NCDC includes technical and infrastructure support as well as equipping the centers
with computers, signages, furniture, equipment and other ECCD related materials.
Establishment of NCDC involves the signing of a Memorandum of Agreement between
the City/Municipal Mayor and the ECCD Council represented by the ECCD Council
Secretariat Executive Director.

(c) Ensuring Compliance to Standards: The ECCD Council is in the process of

conceptualizing a system to monitor and ensure compliance by NCDCs and CDCs to
the standards set by the ECCD Council.

(d) Providing Technical Assistance and Support to ECCD Service Providers: To fulfill
this responsibility, the ECCD Council Secretariat has so far focused on the systematic
professionalization of early childhood education service providers through pre-service
and in-service training programs. Part of these efforts has included the establishment of
a registration and credential system for child development teachers and child
development workers. So far, the ECCD Council Secretariat’s focus has been on early
childhood education and so the Council has not provided technical assistance and
support to other providers of ECCD services in health, nutrition and protection. As part
of its efforts towards professionalization of early childhood education service providers,
the ECCD Council Secretariat has developed and implemented the following programs:
(i) Early Childhood Teacher Education Program (ECTEP) is a six week long
training program implemented in collaboration with state universities that equips child
development teachers with the necessary knowledge and skills to support the provision
of developmentally-appropriate and high-quality early learning services in their localities.
As the final output of the program, participants develop an improvement plan for their
respective NCDCs that serves as a blueprint in quality early learning activities.
(ii) Early Childhood Education Program (ECEP) is a customized training course
designed for child development workers and is implemented in collaboration with state
universities. Its objective is to equip child development workers with the technical
knowledge, skills, attitudes and values necessary for the effective provision of early
childhood education for 0 to 4 year-old children.
(iii) Leading and Managing an Integrated ECCD Program (LMIEP) is developed
for city/municipality social welfare and development officers. The Program covers topics
such as registration and granting of permits to private and public entities providing early
childhood programs, establishment of ECCD Local Committees, conversion of day care
centers to child development centers, and conversion of day care workers and teachers
to child development workers and teachers. As the final output of the program, the
participants prepare a re-entry strategic plan for implementation in their city/municipality.
(iv) Human Resource Development Program on becoming a child development
teacher is an experiential learning workshop covering topics such as assessment-based
child-centered planning of activities, physical learning environment, temporal learning
environment and affective learning environment.

Coordination among ECCD Council Members: The ECCD Council Governing Board
is required by law to meet once a month or upon the call of the Chairperson or at least

63
three members of the GB. In practice, the meetings occur less frequently. It is not
uncommon for these meetings to be attended by delegated officials and as a result, to
involve different people of various ranks.

As discussed earlier in this section, the coordinating council is a frequently employed

institutional arrangement to ensure collaboration between similarly mandated agencies
on a cross-sectoral policy area. The underlying premise for the current composition of
the ECCD Council Governing Board is that ECCD outcomes can be optimized through
joint efforts of DOH, DSWD, DepEd, NNC, and local government units (represented by
ULAP). The challenge of ensuring efficient information flow and joint decision making
among member agencies remains. This challenge is further aggravated when agency
mandates overlap and accountabilities are blurred. Arguably the most evident cases of
such mandate overlap are early childhood learning, parenting support interventions and
nutrition programs for 36-59 month-olds.

Another remaining challenge concerns local level implementation of policies, programs,

and tools developed by the ECCD Council. One aspect of this challenge concerns the
DILG not being a member of the ECCD Council Governing Board as DILG is one of the
four national oversight agencies that can issue procedures for harmonizing local
planning, investment programming, revenue administration and budgeting of LGUs. The
second aspect of this challenge concerns the lack of clarity about LGU-level institutional
counterparts for coordination of ECCD efforts, an issue taken up in the next section.

Financing for ECCD Council Activities: Under Rule IX of the Implementing Rules and
Regulation of RA 10410, the fundamental principle in financing of ECCD Council efforts
is through a combination of public and private funds. Additional funds may be generated
from intergovernmental donors and government financial institutions. The main budget
of the ECCD Council Secretariat appears under that of the Department of Education, as
an attached agency. The vast majority of it is composed of capital investment, under the
Special Account for the establishment of the National Child Development Centers,
which is funded from the Philippine Amusement and Gaming Corporation (PAGCOR) in
the amount of PHP 500M per year from 2014-2018 as per the Republic Act 10410. In
2018, this appropriation actually amounted to PHP 409.7M, 85% of the total PHP
483.4M ECCD Council budget (See Table 3.5).

The ECCD Council’s recurrent budget of 2018 amounted to PHP 73.7M, of which
slightly less than half (44.5%) was dedicated to general management and supervision,
mostly in the form of operating expenses (MOOE). Personal Services for the
management of the ECCD council represented 12% of the total recurrent ECCD Council
budget (PHP 8.8M). The operations of the ECCD Council represented the other half of
its recurrent budget (55.5%), and was spread between three ECCD programs: the
development of policies, standards and guidelines (PHP 9.5M, 23% of the total
operations budget), capacity building and institutional development of intermediaries
and other partners (PHP 31.3M, 87%), and the accreditation of service providers (PHP
116,000, i.e. 0.3% of the operations budget).

64
Table 3.5: ECCD Council budget appropriation, 2018, PHPs
Regular General General PS 8,780,000
Agency Fund Administration Managemen MOO 24,031,000
and Support t and E
supervision
Operations ECCD MOO Development of Policies, 9,485,000
Program E Standards and Guidelines
Capacity building and institutional 31,311,000
development of intermediaries
and other partners
Accreditation of service providers 116,000
Sub-total 73,723,000
Special Operations ECCD MOO Establishment of National Child 409,694,000
Account - Program E Development Centers
Locally Sub-total 409,694,000
Funded
Total 483,417,000

Source: Statement of Appropriations, Allotments, Obligations, Disbursements and Balances Q3 2018.

Because the ECCD Council’s budget is essentially driven by the cost of establishing the
NCDCs, it has been very closely following the number of LGUs targeted for NCDC
establishment each year. More precisely, the Special Account funds the construction of
the NCDCs, their equipment, the conversion/modelling of DayCare Centers (DCC) to
NCDCs, and administrative costs for these activities (See Table 3.6 below).
However, starting next year, with RA 10410 expiring, no funds from PAGCOR are
expected to support the Council, which may have implications for its activities regarding
the establishment of NCDCs and the staff of the Council itself, who will not have
budgets to implement. As GOP is moving to annual cash-based budgeting in 2019,
previous budgets were obligation-based and cannot be examined in terms of execution,
but only in terms of obligations (although physical accomplishments were also reviewed
by DBM to monitor the status of execution of programs). The obligation rate of the
ECCD Council budget has remained high, at 90, 94 and 89% respectively in 2016, 2017
and 2018.

Table 3.6: ECCD Council budget appropriations and activities, 2016-2018, thousand PHPs
FY 2016 FY 2017 FY 2018

Particulars Physical Target Total Physical Target / Total FY Physical Target Total FY
/ Remarks FY 2016 Remarks 2017 / Remarks 2018

65
GAA (General Fund)

General Administration   31,865   30,745   32,811

and Support Services
(Budget for the ECCD
Council Office
Operations)

Special Account in the General Fund 

Construction of 200 LGUs 483,000 100 LGUs 241,500 100 LGUs 257,250
NCDCs @ PhP2.3M @ PhP2.3M @ PhP2.450M
+ 5% + 5% +5%
Contingency Contingency Contingency

Equipping NCDCs 200 LGUs 183,600 100 LGUs 91,800 100 LGUs 92,200
(Furniture, Equipment @ PhP . @ PhP . @ PhP .
and Instructional 918/NCDC 918/NCDC 922/NCDC
Materials

Conversion/Modelling 50 LGUs 50,000 50 LGUs 50,000 41 LGUs 41,000

of DayCare Center @PhP 1 Mil per @PhP 1 Mil per @PhP 1 Mil per
(DCC) to Child LGUs LGUs LGUs
Development Center
(CDC)

Administrative Cost Salary and 27,922 Salary and 26,224 Salary and 19,244
for Establishment of Monitoring of Monitoring of Monitoring of
NCDCs3 Project Unit Project Unit Project Unit

Grand Total, By   807,418   480,367   483,417

Fiscal Year
Source: ECCD Council.

2. National Nutrition Council (NNC) is the other national-level coordinating council

whose mandate and program are pertinent for the effective provision of ECCD
programs to support the wellbeing of young children. NNC was created in 1974 as the
country’s highest policy-making and coordinating body on nutrition. It is composed of a
Governing Board and a Secretariat. NNC Governing Board is chaired by the Secretary
of Health is composed of ten governmental organizations (DOH, DA, DILG, DepED,
DSWD, DTI, DOLE, DOST, DBM and NEDA) represented by their secretaries, and
three representatives from the private sector. The NNC Secretariat serves as the
executive arm of the NNC Governing Board.

With respect to ECCD-related Programs, various nutrition programs implemented

under the leadership of NNC directly or indirectly benefit young children. These include
the following:
(1) Early Childhood Care and Development Intervention Package (ECCD IP) (or
First 1000 Days Initiative (F1K)) under the Philippine Plan of Action for Nutrition
(PPAN) aims to provide integrated services of health, nutrition, early education,

66
 and social services during the first 1000 days of life, i.e. from conception up to
the second year of life. Initiated in 2016, F1K has so far been implemented in
selected Accelerated and Sustainable Anti-Poverty Program municipalities and
cities (a total of ten cities and 37 municipalities during Phase 1) in ten Category 1
provinces (out of a total of 81 provinces), targeting women, 0-23 months-old
children, and parents/caregivers. Starting in 2019, the implementation of F1K is
being expanded to cover more municipalities.
(2) Barangay Nutrition Scholar Program is the human resource development
strategy of PPAN. It involves the training, deployment and supervision of
volunteer workers or barangay nutrition scholars (BNS).
(3) Promote Good Nutrition Component of the Accelerated Hunger Mitigation
Program aims to improve the nutrition knowledge, attitudes and practices of
families to increase demand for adequate, nutritious and safe food. Its specific
objectives are to: (i)increase the number of infants 0-6 months who are
exclusively breastfed; (ii) increase the number of infants 6-11 months old who are
given calorie and nutrient-dense complementary foods; and (iii) increase the
number of families with improved diets in terms of quality and quantity and
involved in food production activities;
(4) “Operation Timbang Plus” involves the annual weighing and height measurement
of all 0-71 months-old children in a community to identify and locate the
malnourished children. Data generated through OPT Plus are used for local
nutrition action planning, particularly in quantifying the number of malnourished
and identifying who will be given priority interventions in the community.
Comparing results of OPT Plus against previous years help provide verifiable
data for evaluating effectiveness of nutrition and nutrition-related interventions.
Annually, NNC processes OPT Plus results and generates a list of nutritionally
depressed cities/municipalities which are disseminated to government and non-
government organizations so that these areas are given priority attention in
nutrition programming planning and intervention.

Ensuring effective coordination internally at the national level has posed a challenge to
NNC’s effectiveness particularly in the past due mostly to the structural factors shared
by all coordinating councils discussed earlier in this section. NNC has been able to
address these factors to some extent by establishing temporary sub-committees under
the NNC Technical Committee, which is composed of heads of major department
bureaus involved in nutrition and NGOs, and acts as a clearing house of all policies to
be vetted to the NNC Governing Board.

With respect to the challenge concerning effective coordination with local government
units, NNC has benefited from the existence of nutrition committees at the regional,
provincial, city, municipal and barangay levels. These committees also have a
multisectoral composition and are organized to manage and coordinate the planning,
implementation, monitoring and evaluation of local hunger-mitigation and nutrition action
plans as a component of the local development plan (NNC website). Local chief
executives serve as the chairperson of these nutrition committees while designated or
appointed nutrition action officers attend to the day-to-day operations of the local

67
nutrition programs. Yet a recent study has pointed to some unaddressed bottlenecks in
this regard whereby due to NNC’s slim regional presence and inadequately trained
personnel, vigorous LGU mobilization is often not viable (National Nutrition Council,
2016).

Financing Related to ECCD: The NCC budget appears in the national budget under
that of the Department of Health. Slightly more than half of it (51%) is dedicated to the
ECCD/Nutrition Intervention Package for the First 1000 Days Initiative, which consists
exclusively of MOOE (PHP 370M). The other main programs in terms of funding are the
assistance to national, local nutrition and related programs (PHP 189K) and the
promotion of good nutrition (PHP 105K). For both programs, MOOE constitute the vast
majority of the budget. General management and supervision of the Council represent
5% of the total budget (PHP 33K).

Table 3.7: National Nutrition Council 2018 budget appropriation, thousand PHPs
Personn % of
Capital
el MOOE Total NNC
Exp.
Services Total
General management and supervision 19,631 12,470 1,100 33,201 5%
ECCD/Nutrition Intervention Package for
the First 1000 days (NIP/First 1000 369,943 369,943 51%
Days)
Assistance to national, local nutrition and
32,565 156,431 188,996 26%
related programs
Promotion of good nutrition 5,814 98,862 104,676 14%
Philippine food and nutrition surveillance 6,795 14,711 21,506 3%
Nutrition policy, standards, plan and
9,777 714 10,491 1%
program development and coordination
Human Resource Development 1,630 1,630 0%
Total 74,582 654,761 1,100 730,443 100%
Source: General Appropriation Act FY 2018.

3.3 LOCAL GOVERNMENT UNITS

This section of the report describes local government units at the province,
city/municipality and barangay levels as they relate to the planning, implementation and
funding of ECCD efforts in health, nutrition, early learning, and social welfare as well as
the cross-sectoral coordination of these efforts. Overall, however, it should be noted that
due to the decentralized nature of most ECCD services and wide variation in the
capacities, resources, interest of LGUs for the provision of these services, there are
observable variations across LGUs in the availability and quality of ECCD services
provided. Hence, effective collaboration between national-level agencies and LGUs with
a view to address capacity constraints and resource limitations (See Section 4.4)
remains crucial to the provision of equitable and quality ECCD services across all
LGUs.

Health & Nutrition

68
At the provincial level, the provincial health office and the provincial nutrition committee
determine the health and nutrition priorities for the province, adapt policies and capacity
building measures, fund and support programming (Devlin 2016). Local Health Boards
are also relevant in program planning and allocation of funds for health.

The city and municipal LGUs are responsible for providing primary care including
maternal and child care and nutrition services through rural health units and barangay
health stations (Devlin 2016). The municipal/city health office and the municipal/city
nutrition committee support the implementation of health and nutrition policies and
programs, and support community level service providers. Local Health Boards are also
relevant in program planning and allocation of funds for health.

At the barangay level, the barangay captain is responsible with overseeing the activities
of the barangay health worker and barangay nutrition scholar, and supporting them
alongside the barangay council (Devlin 2016). The barangay nutrition committee is the
relevant coordinating mechanism for all nutrition-related activities and the barangay
council for the protection of children is the relevant coordinating mechanisms for all child
related activities at this level.

Early Learning
Organized early learning programs include psychosocial stimulation and early learning
programs for 0-23 month-old children, center-based and home-based programs for 24-
59 month-old children, and parent training services and education programs, as well as
the kindergarten program (regular and catch-up) for 60-71 month-old children.

The Local Social Welfare and Development Office at the province and city/municipality
levels is responsible for organized early learning programs for 0-23 and 24-59 month-
old children and for parent training services and education programs. LGUs are
responsible for funding most of the expenses for the implementation of early learning
programs for this age group. DepEd is responsible for funding and implementing
kindergarten programs (regular and catch-up).

While DepEd is not devolved and has school divisions at the provincial and city levels
and school districts at the municipal level, the local school boards (LSBs) have been a
relevant institution with respect to the provision of education services for all children,
including those who are of kindergarten age. DepEd representative acts as the co-chair
of the LSB. One of the duties of the LSB has been to apportion the Special Education
Fund (SEF) for the supplementary needs of the public education system. The SEF is an
additional 1% levy that is collected together with property taxes paid to the local
government. Another important duty of the LSB is to provide advice to the LGU on
education priorities and programs, which can include early childhood education.

Given its duties, LSBs emerge as a critical body at the LGU level with regards to the
planning and funding of organized early learning programs as part of integrated ECCD
efforts. The Early Years Act of 2013 stipulates that LGUs shall include allocations from
the SEF for early childhood care and development programs. To support the

69
implementation of this stipulation, DepEd, DBM and DILG issued a joint circular in 2017
on the use of the SEF that enables early learning activities taking place outside of the
public education system to be covered under the SEF. Accordingly, among allowable
expenses chargeable against SEF is funding for the ECCD program particularly for: (i)
direct services such as salaries/allowances for child development teachers and day
care workers; (ii) organization and support of parent cooperatives to establish
community-based ECCD programs; (iii) provision of counterpart funds for the continuing
professional development of ECCD service providers; (iv) provision of facilities for the
conduct of the ECCD program; and (v) payment of expenses pertaining to the
operations of NCDCs where they exist.

Social Welfare and Child Protection

The Local Social Welfare and Development Office at the province and city/municipality
levels are headed by a social welfare and development officer and is responsible for
overseeing the implementation of social protection and child protection programs at the
LGU, including the provision of services for solo parents and children with special
needs. As highlighted above, the office is also responsible for supervising daycare
centers/child development centers, and delivering parenting training programs.

At the barangay level, the Barangay Council for the Protection of Children oversees the
planning and implementation of programs for the advancement of all child rights but the
Council has evolved to have a particular focus on child protection efforts.

ECCD Coordination at the Local Government Units

The ECCD Act of 2000 had stipulated the organization of ECCD Coordinating
Committees in local government units to ensure the sustained inter-agency and multi-
sectoral collaboration. At the province level, the Committee was headed by the
Governor, at the municipal/city and barangay levels, the Committees were chaired by
the mayor and by the barangay captain, respectively. 26 The Early Years Act of 2013,
however, did not stipulate for the setting up of ECCD Coordinating Committees but put
forward allocation of funds to ECCD programs as the sole responsibility of local
government units. As a result, the existence of a coordination body on ECCD or even
an ECCD focal person in a province, city or municipality has become dependent solely
on the initiative and priorities of the local chief executive. At the barangay level, the
barangay council for the protection of children is the most relevant coordination body yet
it does not currently have a particular focus on ECCD.

Interviews conducted at the LGU-level for this report suggest a range of institutional
arrangements emerging at the LGUs for coordinating ECCD activities across sectors.
These include setting up of sub-committees under the Local Council for the Protection
of Children, including ECCD under the official mandate of an existing sub-committee of
the Local Council for the Protection of Children, appointment of a focal person for ECCD
activities, setting up of a stand-alone cluster on ECCD, or other non-institutionalized
coordination processes driven by individuals. Interviews also suggest that LSWDO is
often designated as the lead in these various institutional arrangements and the scope
26
https://link.springer.com/article/10.1007/2288-6729-5-1-65

70
of coordination efforts are focused almost entirely on early learning and parenting
education programs at the expense of health, nutrition, social welfare and protection
efforts in early childhood. Thus, the challenge to change the perceptions of key
stakeholders about the scope of ECCD remains, and is a critical first step in ensuring
that planning and implementation efforts encompass not only early learning but also
health, nutrition, social welfare, and protection.

This challenge is further complicated by the presence of several sectoral coordination

bodies including the Local Council for the Protection of Children (LCPC), Local School
Board (LSB), Local Health Board (LHB), Local Nutrition Committee (LNC) whose
mandates are all relevant for programs targeting early childhood. The need remains to
clarify in each LGU how these coordination bodies relate with each other in so far as
early childhood programs are concerned.

Financing related to ECCD at the LGUs

LGUs, who are the main implementing actor of the ECCD programs, are mainly (and
sometimes exclusively) funded through the Internal Revenue Allotment (IRA). The IRA
distributes the national revenue to LGUs according to a formula, defined in Republic Act
7160, based upon the type of LGU (Provinces receive 23% of the total IRA amount,
Cities 23%, Municipalities 34%, and Barangays 20%) and their population and land area
(Population: 50%, Land Area: 25% and Equal sharing 25%, except for barangays:
Population 60% and Equal sharing 40%).

LGUs are required to use their IRA according to the following formula: 20% for
Development Fund, 5% for GAD, 1% for the LCPCs, and another 1% for the Disaster
Risk Reduction and Management Fund. All of these funds, as well as the Special
Education Fund discussed earlier in the report, could be used towards the provision of
health, nutrition, early learning, social welfare, and protection programs for young
children and their families. For instance, the Development Fund could be used for the
construction and rehabilitation of public infrastructure and facilities including health
centers, rural health units, daycare centers, and the purchase of equipment for the
provision of mobile health, nutrition and early learning services. The GAD Fund, the
fund for LCPCs, and SEF could be used for ECCD services in a wide range of manners,
including, as stipulated by EYA, salaries and allowances for frontline service providers
working with young children and their families, supporting parent cooperatives for
community-based early learning programs, contributing towards training programs and
other capacity strengthening efforts for frontline service providers. LGUs can also
establish local public-private partnerships to expand and improve health, nutrition, early
learning, social welfare, and protection services for young children and their families.

Yet, there is no fixed ratio to be spent on ECCD activities nor a separate budget line for
reporting ECCD-specific spending. As a result, the amount spent on ECCD at the LGU
level varies considerably with no easy way to identify ECCD-specific spending. It is
therefore extremely difficult, short of reviewing all LGUs’ budgets, to know the total
amount of budget spent on ECCD at the local level. A UNICEF-commissioned study

71
however reviewed the ECCD budget of 36 Municipalities and Cities in the Philippines in
2016 (UNICEF, 2016).

Because these LGUs represent a very small portion of the total number of LGUs in the
Philippines, they cannot be representative of the whole country. However, the study
provides some insight into the level and nature of ECCD financing that happens at the
LGU level. The proportion of the LGUs’ budget that was allocated to ECCD increased
between 2013 and 2016, from 1.9% to 2.7% on average (See Figure 3.2 below). It is
however important to note that there are great variation between the LGUs examined,
that percentage ranging from 0.2% to 17.5% over the 36 LGUs in 2016. It is therefore
dangerous to generalize on such on small sample of LGUs.

Figure 3.2: Average Proportion of selected LGUs’ Budget Allocated to ECCD, 2013-
2016
3.0%
2.7%
2.6%
2.5%

1.9%
2.0%
1.7%

1.5%

1.0%

0.5%

0.0%
2013 2014 2015 2016
Source: Source: UNICEF, 2016 and authors’ calculations.

This increase of proportion, combined with an increase of the total amount of IRA
distributed to LGU resulted in an increase of the amount spent on ECCD in 33 out of the
36 LGUs studied, with 11 LGUs more than doubling their ECCD budget over 2013-2016
(See Figure 3.3 below)

72
Figure 3.3: Percentage increase in selected LGUs’ budgets allocated to ECCD; 2013-
2016
+350%
+300%
+250%
+200%
+150%
+100%
+50%
+0%
-50%
Si Al Q Ka Si Pu Ar Ca Bo La Pr Pa Pa U Mi La M M So Ar M Le Mi Co Ca Ba Da Pa M Za Le Ta Pa Vi M Si
nd eo ue la asi er or pa bo bo esi ra sa pi ds ng al ap ut ak a ba la ta w su va ra er m on m ra nz on ay
an sa zo m to oy lo n de ng y ay uy un an h an m k gr ba ay d o cal ce bo B. pil ng on re an
ga n n an Pr ng nt Cit ap an go as U as os to an cit e de an Po isa s al
n Cit sig in a Ro y n pi ap Cit y s ga sti n
y ce xa an y Cit go
sa s o y
Cit
y

Of these amounts, 91% were spent on average on Health (37%), Nutrition (32%) and
Early Education (23%, including 18% for Day Care Program and 6% for preschool) (see
Figure 3.4 below). While the combined share of these 3 sectors was stable over 2014-
2016, the important variations amongst them over the period call for caution about these
exact numbers. On average over the 3 years, Health appears to receive the most of the
ECCD funding (see Figure 3.4 below).

Figure 3.4: Distribution of selected LGUs’ ECCD Budget by Sector Program, 2016
6%

18%
37%

7%
1%
1%

32%

Source: UNICEF, 2016 and authors’ calculations.

73
Notes: Health includes: general child health care, EPI, CDD-CARI, newborn screening, other health care
needs for 0-8. Nutrition includes: OPT, growth monitoring, micronutrient supplementation, breastfeeding,
supplementary feeding. WASH includes: toilet and handwashing facilities, hygiene education, provision of
hygiene kits for DCCs/SNPs and kindergartens. LCPC, LECCDCC includes: meeting expenses, other
relevant costs. Others includes: construction, rehabilitation of DCCs/SNPs, support to preschool and
kindergarten.

Figure 3.5: Distribution of selected LGUs’ ECCD Budget by Sector Program, 2013-2016
100%
7% 5% 7% 6%
1%
2% Others
1%
2%
0% 1%
1% 1%
90%
9% 11%
31% 17%
80% LCPC, LECCDCC
32%
70% 1% WASH
0%
6%
60% 46%
51% Nutrition
44%
50%
31% Health
40% 37%
3%
30% Preschool
3% 7% 5%
20% 6% Day Care
33% Programme
27% 24% 25%
10% 18%

0%
2013 2014 2015 2016 Av. 2014-16

Source: UNICEF, 2016 and authors’ calculations.

Figure 3.6: Selected LGUs’ ECCD budget execution rate, 2015

74
Source: UNICEF, 2016.

The authors of the study were not able to identify a link between awareness of ECCD or
planning capacity on the one hand, and increased ECCD funding on the other.
However, since LGUs can also use their own revenue to complement their budget,
highly urbanized cities with higher revenue sources expectedly had higher budget
allocations for ECCD in contrast to IRA-dependent municipal LGUs.

At the point of delivery, the UNICEF ECCD study also examined the finding of Child
Care Centers. These draw not only from the LGU sources of funding, but also from
external sources and their own fund-raising, as well as from parents and Day Care
workers. The study estimates that, in the examined barangays, parents pay
approximately PhP 5,000 per year and per child for them to attend the Child Care
Centers, mostly spent on transportation and food. Day Care workers also participate in
the expenses of the Child Care Centers out of their own salary, around PhP 19,000 per
year.

Table 3.8: Sources of Funds for DCCs/SNPs

Expense Items Government External Sources Community

Barangay City/ Provinc National External Fund- Parents/ Day care

LGU municipal e sources raising communit worker
LGU y
Salary of day care worker √ √
Supplies - non-consumables √ √ √ √
Materials - consumables √ √ √ √ √
Furniture √ √
Utilities – electricity √ √ √
Utilities – water √ √

75
 Training of DCW √ √ √
Uniform or special clothing √ √ √ √
Repair of DCC √ √
Cleaning of DCC √ √
Others √ √ √
WASH facilities √ √ √

Source: UNICEF, 2016

Figure 3.7: Estimated annual cost of parents’ contribution per child, and out-of-pocket
expense of Day Care Workers
30,000
19,696 19,198
20,000

10,000 4,880 5,074

0

Average Median

Source: UNICEF, 2016 and authors’ calculations.

3.4 ECCD SERVICE PROVIDERS

Up-to-date information on ECCD service providers is limited particularly with respect to
the skills, capacities, working conditions and sources of motivation of frontline workers
such as Barangay Nutrition Scholars (BNS), Barangay Health Workers (BHW) and Day
Care Workers (DCW). These frontline workers are primarily volunteers from the
communities where they serve. Typically, they do not have contracts with benefits and
instead receive an honorarium for their services. The honorarium is funded from the

76
barangay budget and is determined by the barangay council within the limits set by
allocation rules. Thus, the amount of the honorarium is generally low (e.g. P500/month
is a commonly cited figure) with some variation across barangays (Booker et.al. 2017).

A study conducted ten years ago on day care services provides additional insights into
the skills, capacities and working conditions of DCW although some of the findings
(particularly those concerning training and ICT use) are likely to have become invalid
given changes in accreditation policy and technology use (SEAMEO-Innotech, 2010).
According to the study, DCWs are almost all female and the majority have children
(81%). About half of the DCWs surveyed had a college degree. The average DCW
reported receiving about 15 trainings related to early childhood development in the
preceding five year period yet about 1 out of 10 DCWs reported having not received any
training. Majority of the DCWs surveyed did not have a permanent position. Regardless
of their employment status, on average a DCW earned PhP 3,668 per month, worked 4
hours per day and 5 days per week, and taught 32 children.

Interviews conducted for this report suggest that these frontline workers are generally
intrinsically motivated individuals who are working in difficult conditions with limited tools
and equipment. They are generally required to implement a plethora of programs with
limited supervision and mentoring. This is particularly the case with BHWs. Seminars
and workshops are the most frequently used tool to strengthen the knowledge base and
skills of frontline workers yet they occur in the absence of training needs assessments
and individualized training plans. In this respect, the Phased Training Programs
implemented by Save the Children is worth noting as an alternative. One-on-one
supervision visits, distance learning, peer-to-peer mentoring are not commonly used
tools to support frontline workers. Local federations barangay health workers,
federations of barangay nutrition scholars, and federations of day care workers emerge
as potentially valuable umbrella institutions that bring together frontline workers on a
regular basis and provide them with learning opportunities.

3.5 FINANCING FOR ECCD

ECCD services are funded through a variety of channels and actors, including domestic
public sources at national and local levels, domestic private sources, and external
donors. The research undertaken for this report underscored the limited availability of
readily accessible aggregate data on funding for ECCD services particularly by LGUs
but also by national-level agencies and external donors. Given the importance of
adequate funding for equitable quality ECCD services, establishing mechanisms for
measuring and monitoring funding for the provision of these services remains crucial.

Public Funding
National-level agencies support ECCD through various types of programs, as described
in Sections 3.1 and 3.2. The following table summarizes their financial contributions to
ECCD based on the financial figures for the main programs implemented by each
agency:

77
 DSWD; ECCDC; 483 NNC; 730 Table 3.9: Funding by National-Level
3,428 mil; mil; 1% mil; 1%
Agencies
6%
Agency
DOH; 8,812
2018 ECCD budget,
mil; 15% PHP millions

DepEd 44,353
DepEd;
44,353 mil;
DOH 77%8,812

DSWD 3,428

ECCD 483
C

NNC 730

Total 57,807

DepEd is the largest contributor at the central level, with the provision of Early
Childhood Education to the vast majority of Filipino children of age 5, for an estimated
PHP 44 billion in 2018 – 77% of central level funding to ECCD. DOH comes second,
with the Immunization and FHNRP programs covering infants and pregnant and
lactating women, for a total of PHP 8.8 billion (15% of the total central ECCD budget).
DSWD’s Supplementary Feeding Program for children in child development centers and
day care programs, with PHP 3.4 million, represents 6% of the total funding for ECCD at
central level. Finally, the ECCD Council and the National Nutrition Council represent 2%
of this total.

Given the decentralized nature of most mandates concerning ECCD services, LGUs
play a crucial role in financing the provision of ECCD services at the local level.
However, little is known on the total amounts budgeted and spent by LGUs for ECCD
(See Section 3.3).

Private Funding
The private cost of ECCD is mostly borne by parents, caregivers and communities in
general. Costs incurred by families may include: (1) for children participating in public
programs at child minding centers, child development centers and day care centers:
snacks (“baon”), transportation, contribution to CDC/DCC workers’ salaries, contribution
to CDC/DCCs’ equipment or utilities, uniforms; (2) for children participating in private
nurseries and daycare centers, tuition in addition to above mentioned costs; (3) health
care costs not covered by PhilHealth insurance; (4) food, clothing, toys and books for
young children. Unfortunately, only anecdotal information is available on these
expenses, as this report was not able to include an analysis of survey data on
household income and expenditure.

78
Private foundations, non-governmental organizations and faith-based organizations also
provide various services to young children and their families. Aggregate financial figures
for these programs, however, are not readily available.

External Funding
In the absence of a coordinated development partners group on ECCD, it is difficult to
estimate the total external funding to the sector. According to the OECD –DAC Credit
Reporting system, in 2017 Germany and Japan supported ECE, through, respectively,
an NGO support to Improved Early Childhood Education and a UNICEF peace-building
and education support for children in the conflict-affected Mindanao, for a total of USD
6.5 million disbursed in 2017. In addition, Canada, EU Institutions, Japan, Korea,
Norway, UNFPA, UNICEF, United States, and the World Health Organization supported
programs in reproductive health care in 2017, although support to that area has been
sharply decreasing since 2013. These figures from OECD-DAC are only indicative and
do not necessarily capture all external funding for ECCD.

Figure 3.8: External Funding to ECCD

18

16
USD millions (Constant 2017)

14

12

10

8
Disbursement,

0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Early childhood education Reproductive health care

Funding Gaps
Estimating aggregate spending on ECCD at the national level and the local level poses
significant challenges, some of which have been discussed earlier in this section. Even
if aggregate spending figures could be calculated, given the importance of equitable
services and resource distribution, an assessment on funding gaps based solely on
aggregate spending figures would still not provide a complete and accurate
understanding of funding gaps at the local level. Thus, future efforts in capturing
spending data would need to focus not only on accuracy of program level data
collection but also the distribution of program resources across LGUs.

79
3.6 LEGISLATIVE FRAMEWORK
The Philippines is a front-runner in Southeast Asia and arguably globally in creating a
rich, progressive and enabling legislative framework and policy environment for early
childhood care and development programs (ADB, 2012). Overall, a review of the past
and existing body of legislation related to health, nutrition, early learning, social
protection and child protection reveal a robust and comprehensive legislative framework
not only facilitating but in fact stipulating the undertaking of a wide range of enabling
efforts to ensure that all young children receive nurturing care (Coram International,
2018; ADB, 2012). It must also be noted that sector-specific legislative reviews have
highlighted the remarkable efforts by Philippines with respect to the ratification of
international treaties and conventions related to children and the body of national
legislation is generally in line with international law (Coram International, 2018;
Development Academy of the Philippines, 2018; Lebegue, 2016). As Table 1
demonstrates, the 2006-2016 period is particularly impressive in this regard with respect
to the strengthening of existing legislation and introduction of legislation to address
newly identified concerns. A limited number of concerns regarding the legislative
framework are raised in the next section of the report.

The current umbrella legislation for the planning and implementation of integrated early
childhood care and development programs in the Philippines is Republic Act No. 10410
or The Early Years Act of 2013. This Act seeks to promote the rights of all children to
survival, development and special protection with full recognition of the nature of
childhood. Furthermore, it mandates the need to provide developmentally appropriate
experiences to address children’s needs and to support parents as primary caregivers
and children’s first teachers. The Act recognizes the age from 0 to 8 as the first crucial
stage of educational development of which the age 0-4 shall be the responsibility of the
ECCD Council. The responsibility to develop children in years 5-8 shall be with the
Department of Education. The law also mandates the institutionalization of a national
system for ECCD that is comprehensive, integrative and sustainable, involving multi-
sectoral and interagency collaboration at national and local levels.

Table 3.10. Republic Acts, Presidential Decrees, Executive Orders Related to ECCD.
Legislation
Republic Act 4881: An Act Creating
a Council for the Protection of
Children in Every City and
Municipality of the Philippines
Presidential Decree 603: Child and
Youth Welfare Code
Presidential Decree 1567
Year Description
1967 The Act stipulates that the Council is to be composed of
the Mayor as Chair, two Councilors, Health Officer,
Supervising Teacher, Chief of Police, Social Welfare
Administrator and Parents Teachers Association
representative.
1974 The decree provides definitions of children, minors and
youth and enumerated the rights and responsibilities of
the child. It also stipulates the duties and responsibilities
of parents, the community and various stakeholders in
promoting the welfare of Filipino children and youth (0 to
21), and created the Council for the Welfare of Children
(CWC) as the national coordinating body on children and
youth concerns.
1977 The decree mandates the establishment of a Day Care
Center in every Barangay. The decree is meant to help
pre-school children 0-6 years old who are the “most

80

Executive Order No. 51: National
Code of Marketing of Breastmilk
Substitutes, Breastmilk
Supplements (known as Milk Code)
Republic Act No. 6972: An Act
Establishing a Day Care Center in
Every Barangay, Instituting Therein
a Total Development and Protection
of Children Program
Republic Act 7160 known as “Local
Government Code”
Republic Act 7610: An Act Providing
for Stronger Deterrence and Special
Protection Against Child Abuse,
Exploitation and Discrimination
Republic Act 7277 known as
“Magna Carta for Disabled Persons”
Republic Act 9227
Republic Act 10070
Republic Act 7875 known as the
National Health Insurance Act
(amended by Republic Act 10606
known as National Health Insurance
Act of 2013
Child 21 Framework 2000 – 2025
and the National Plan of Action for
Children
vulnerable to the ill-effects of malnutrition and lack of
social and mental stimulation”.
1986 The executive order intensifies the dissemination of
information on breastfeeding and proper nutrition while
regulating the advertising, marketing, and promotion of
breastmilk substitutes and other products, including
feeding bottles and teats.
1990 The Act reiterates the establishment of a Day Care
Center all over the country and appropriated funds for
instituting programs to development and protect children.
It declares that State shall “defend the right of the
children to assistance, including proper care and
nutrition, and to provide them with special protection
against all forms of neglect, abuse, cruelty, exploitation
and other conditions prejudicial to their development.”
1991 The Act stipulates the provision of a more accountable
local government structure instituted through a system of
decentralization and mandating the devolution of basic
services.
1992 The Act provides for stronger deterrence and special
protection against child abuse, exploitation and
discrimination, and its corresponding penalties.
1992 The Act and its amendments grants the rights and
(2003, privileges for disabled persons by providing for the
2010, rehabilitation, self-development and self-reliance of
2016) disabled persons and their integration into the
mainstream of society. It covers the rights and privileges
of disabled persons, including but not limited to: equal
opportunity for employment, access to quality education,
National Health Program, Auxiliary Social Services,
Telecommunications, Accessibility (barrier-free
environment), Political and civil rights.
1995 The Act stipulates the provision of an integrated and
(2013) comprehensive approach to make essential goods,
health and other social services available to all the
people at affordable cost. According to the Act, priority of
the needs of the underprivileged, sick, elderly, disabled,
women, and children shall be recognized. Likewise, it
shall be the policy of the State to provide free medical
care to paupers.
1999 Child 21 or the Philippine National Strategic Framework
for Plan Development for Children 2000 to 2025 is the
Philippines’ road map for the implementation of the UN
CRC. It provides a framework in all the life stages of
Filipino children. It details the objectives and goals for
each stage. These aim to give direction to policy
development and program planning for the progressive
implementation of the Philippine government’s
commitment to the UN CRC. The National Plan of Action
for Children (NPAC) is the operational plan for Child 21.
The Council for the Welfare of Children is the agency
responsible to prepare, update and monitor
implementation of the plan. Currently, there is no update
81

Republic Act 8980: An Act
Promulgating a Comprehensive
Policy and a National System for
Early Childhood Care and
Development
Republic Act 8976 known as the
Philippine Food Fortification Act
Republic Act 9262: Anti-Violence
Against Women and Their Children
Republic Act 9288 known as the
“Newborn Screening Act”
Republic Act 9344 known as
"Juvenile Justice and Welfare (JJW)
Act”
Executive Order No.685: Expanding
Preschool Coverage to Include
Children Enrolled in Day Care
Centers
Republic Act 9227: An Act
Establishing A Universal Newborn
Screening Program for the
Prevention, Early Diagnosis and
Intervention of Hearing Loss
Republic Act 10028: Expanded
Breastfeeding Promotion Act
NPAC.
2000 The Act stipulates for the provision for a Comprehensive
Policy and a National System for Early Childhood Care
and Development. It defines Early Childhood Care and
Development System as “the full range of health,
nutrition, early education and social services
development programs that provide for the basic holistic
needs of young children from age zero (0) to six (6)
years; and to promote their optimum growth and
development. It provides for the development of Center
and Home-based programs, defines ECCD Service
Providers, enumerates the framework and components of
the ECCD System, namely: ECCD Curriculum, Parent
Education and Involvement, Advocacy, and Mobilization
of Communities, Parent Education and Involvement,
Advocacy, and Mobilization of Communities, ECCD
Management, Quality Standards and Accreditation.
2000 The Act regulates the implementation of food fortification
to compensate for the inadequacies in Filipino diet,
based on present-day needs as measured using the
most recent Recommended Dietary Allowances (RDA)
2004 The Act aims to protect the family and its members
particularly women and children, from violence and
threats to their personal safety and security.
2004 According to the Act, the National Newborn Screening
System shall ensure that every baby born in the
Philippines is offered the opportunity to undergo newborn
screening and thus be spared from heritable conditions
that can lead to developmental delays, disabilities and
death if undetected and untreated.
2006 The “Juvenile Justice and Welfare Act” defines the
Juvenile Justice and Welfare System as a system dealing
with children at risk and children in conflict with the law,
which provides child-appropriate proceedings, including
programmes and services for prevention, diversion,
rehabilitation, re-integration and aftercare to ensure their
normal growth and development.
2008 The Executive Order directs DepEd to expand preschool
program coverage to include preschool children enrolled
in day care centers. The day care workers shall be
provided with teacher training on the curriculum and
competencies for preschool education and appropriate
instructional materials. To ensure universal participation
and total elimination of drop-out and repetition in grades
1-2 through quality assured program for preschool and
early childhood care and development for 3-5 year-old
children.
2009 The Act stipulates the provision of a comprehensive
program for the prevention, early detection and diagnosis
of congenital hearing loss among newborns and infants
based on applied research and consultations with the
sectors concerned.
2009 The Act encourages, protects and supports the practice
of breastfeeding by providing an environment where
basic physical, emotional, and psychological needs of
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Republic Act 10152 known as
“Mandatory Infants and Children
Health Immunization Act”
Republic Act 10157 known as
“Kindergarten Education Act”
Republic Act 10165: An Act to
Strengthen and Propagate Foster
Care
Republic Act 10533 known as
“Enhanced Basic Education Act”
Republic Act 10410: An Act
Recognizing the Age from 0 to 8
Years as the First Crucial Stage of
Educational Development and
Strengthening the Early Childhood
Care and Development System,
known as Early Years Act
Republic Act 10821 known as
“Children Emergency Relief and
Protection Act”
The Philippines Development Plan
(PDP) for 2017-2022
Republic Act 11148 known as “First
1000 Days Act”
mothers and infants are fulfilled through the practice of
rooming-in and breastfeeding.
2011 The Act adopts a comprehensive, mandatory and
sustainable immunization program for vaccine
preventable diseases for all infants and children.
2012 The Act recognizes the importance of kindergarten
education to the academic and technical development of
people, mandates the institutionalization of kindergarten
education into the basic education system
2012 The Act provides every child who is neglected, abused,
surrendered, dependent, abandoned, under sociocultural
difficulties, or with special needs with an alternative
family that will provide love and care as well as
opportunities for growth and development
2013 The Act strengthens basic education by enhancing the
curriculum and increasing the number of years for basic
education from 10 to 12 years and mandating
kindergarten as the first stage of compulsory basic
education.
2013 The Act recognizes the age from zero (0) to eight (8)
years as the first crucial stage of educational
development of which the age from zero (0) to four (4)
years shall be the responsibility of the Early
Childhood Care and Development (ECCD) Council. It
calls for the institutionalization of a National System for
Early Childhood Care and Development that is
comprehensive, integrative and sustainable, that involves
multisectoral and interagency collaboration at the
national and local levels. It defines ECCD as the full
range of health, nutrition, early education and social
services development programs that provide for the basic
holistic needs of young children from age zero (0) to four
(4) years; to rpomote their optimun growth and
development.
2016 The Act outlines the responsibilities of the state for the
implementation of a comprehensive program of action to
provide the children and pregnant and lactating mothers
affected by disasters and other emergency situations with
utmost support and assistance necessary for their
immediate recovery and protection.
2016 This is the blueprint for the country’s development under
the Duterte Administration. It is the first of four medium-
term plans that will work towards realizing AmBisyon
Natin 2040, a long-term collective vision of national
development. ECCD is embedded under Pagbabago
(inequality reducing transformation), which is one of the
three strategic pillars of PDP. Under this pillar are two
strategic goals that are related to ECCD: (1) nutrition and
health for all improved; (2) lifelong learning opportunities
for all ensured
2018 The Act aims to scale up the national and local health
and nutrition programs through a strengthened integrated
strategy for maternal, neonatal, child health and nutrition
in the first one thousand days of life. The law stipulates
the provision of evidence-based nutrition interventions
83
and nutrition-specific and nutrition-sensitive mechanisms,
strategies, programs and approaches.

84
SECTION 4 – SYNTHESIS ON CRITICAL GAPS AND KEY OPPORTUNITIES
This section presents a synthesis of critical gaps and key opportunities identified in
analyzing the current state of outcomes, institutions, policies and programs pertinent to
the wellbeing of young children in the Philippines. As demonstrated by the synthesis,
recent achievements and current efforts represent a strong foundation on which a
comprehensive and integrated national strategic plan for early childhood care and
development can be built.
4.1 CHALLENGING OUTCOME AREAS
The analyses on health outcomes, nutrition outcome, developmental outcomes, and
safety and security outcomes for young children reveal four areas that require more
concerted efforts. These are:
- malnutrition,
- neonatal mortality,
- cognitive and socio-emotional outcomes of young children from
disadvantaged households,
- developmental outcomes of young children with disabilities and young
children with developmental delays, and
- violence experienced by young children in their homes.

Additionally, as discussed in section 2.6, certain groups of young children are at a

disadvantage across all outcome areas, including but not limited to young children
affected by disasters and armed conflict, young children with disabilities, young children
living in an indigenous community, young children living in a geographically isolated
area, young children living on the streets. Providing the extra services needed by these
groups of children remains a major challenge.

4.2 CRITICAL GAPS AND KEY OPPORTUNITIES IN ENABLING EFFORTS

Based on the analyses presented in Sections 2.2-2.5, this section underscores some
critical gaps and key opportunities with regards to the existing ECCD efforts.

Services for Young Children with Disabilities or Developmental Delays and their
Caregivers: Prevention, early detection and intervention for young children with
disabilities and developmental delays have become a policy focus only in recent years.
Department of Health has initiated efforts that aim to: (i) integrate developmental delay
screening into the provision of routine child health and nutrition services, (ii) deliver
interventions for young children who tested positive for metabolic diseases during
newborn screening; (iii) and ensure early intervention for identified children including by
expanding facility-based pediatric rehabilitation services. These efforts are still in
nascent stages of implementation. Another recent effort in this area concerns the
development of a System for Early Identification, Prevention, Referral and Intervention
by the ECCD Council. There also tools available for the initial identification of
impairment and development delays by service providers such as child development
workers and teachers (ECCD Checklists, EDPID) but these tools face similar challenges
vis-a-vis regular and systematic administration. Given that young children with
disabilities and developmental delays have recently become a focus area for several
actors, it is critical that their efforts are coordinated to avoid replication and encourage
synergies.

These efforts are particularly timely given the recent expansion of PhilHealth’s Z benefit
package to cover children with developmental delays. A related opportunity in this
regard concerns the 4Ps and its possible expansion to provide additional cash transfers
to families who have children with disabilities both to encourage early identification and
to facilitate access to services given the transportation costs associated with accessing
services for children with disabilities.

First 1000 Days Program: Launched in 2017 in selected provinces and expanded by
the Republic Act 11148 at the end of 2018, the First 1000 Days Program (F1K) is a
multi-agency program that aims to deliver basic health, nutrition, social services, and
early learning opportunities to women and children from pregnancy to the first two years
of life. The Program emerges as a solid foundation to build upon vis-a-vis future efforts
in advancing early childhood care and development for 0-23 month old children.

Parenting Support Interventions: As described in section 2, several parenting support

interventions are being implemented by both governmental and non-governmental
actors. The largest of these is the Family Development Sessions of the 4Ps
implemented by DSWD and reaching over 4 million households on a monthly basis.
Other parenting support interventions include Parent Effectiveness Service (PES) and
Program for the Empowerment and Reaffirmation of Paternal Abilities (ERPAT)
implemented by DSWD; Family Support Program (FSP) and Infants and Toddlers Early
Development Program implemented by the ECCD Council Secretariat; and most
recently, Idol Ko Si Nanay Learning Modules for the First 1000 Days developed by the
National Nutrition Council. It should also be noted that breastfeeding orientation
sessions targeting pregnant women also provide information on self- and child-care,
and psychosocial stimulation of young children.

The wealth of parenting support interventions presents a tremendous opportunity to join

forces to draw on effective materials and delivery methods. Yet these interventions are
currently implemented with limited collaboration or integration. In the absence of such
collaboration, the relevant stakeholders risk replicating each others’ efforts and
suboptimal use of limited resources. Thus, a comprehensive review and evaluation of
existing parenting support interventions is needed to improve content and delivery, and
enhance harmonization and coordination across these interventions.

It must, however, be noted that group trainings are only one method of delivery for
improving parenting practices, and arguably one of the less effective ones given that
bringing about behavioral change and sustaining that change is a tremendously
challenging objective. In this respect, home visit programs in other countries where the
frontline worker has the opportunity to observe parenting practices and make concrete
suggestions to improve responsive caregiving, have been found to be relatively more
impactful (WHO, UNICEF & World Bank, 2018). Home visit programs allow for
adaptation to the particular needs of a young child or caregiver. For instance, home
visits to a family that has a young child with a disability could be adapted both in terms
of its frequency and to reflect the needs of the child and the caregiver. Such home visits
programs have been implemented in the Philippines with a limited number of vulnerable
households. These models could be a fruitful starting point in efforts to scale them up.

It must also be noted that despite the impressive reach of Family Development
Sessions, to the best of our knowledge, efforts to encourage positive parenting among
all parents by using media and ICT are limited with Save the Children’s recently
launched iMulat parenting app as the only exception. Additional concerted efforts could
entail regular text messages to new parents, health and nutrition apps for parents of
young children, television drama series, and public awareness ads. There are several
effective interventions from other countries that could be drawn upon in addition to the
popular parenting programs that were aired on radio during the 1990s in the Philippines
as well as Radyo Bulilit, a parenting program of the ECCD Council Secretariat aired on
Radyo Pilipinas every Saturday. This is also an area that is highly conducive to
partnerships with private sector actors, such as mobile service providers, television
stations, film production companies, and communication firms.

Dual Challenge of Increasing Coverage and Improving Quality of Early Learning

Services: Despite their impressive efforts, both ECCD Council members and LGUs
continue facing the dual challenge of increasing coverage and improving quality of early
learning services for 24-59 month-old children. This challenge has been particularly
difficult to tackle given the devolved nature of governance vis-a-vis early learning
services. On their own, existing delivery models and current approaches to scaling up
quality early learning services are unlikely to bring about the desired results in the
medium term.

So the need remains to scale up existing alternative delivery models, to identify new
alternative models, to implement existing standards more efficiently, and search for new
approaches to scaling up.
 ECCD Council members, particularly DSWD and DepEd, could consider
improving and expanding home-based and community-based early learning
programs (such as the SNPs), expanding existing alternative delivery models
such as mobile day care centers and alternative pre-school programs to deliver
services to remote communities, and identifying new alternative models.
 Furthermore, ECCD Council members, particularly DSWD and DepED, could
work together towards better dissemination, adoption and implementation of the
new standards for center-based services catering to 24-59 month-old children.
 DSWD and LGUs could also consider expanding partnerships with the private
sector to strengthen efforts for scaling up organized early learning programs and
child care programs for working parents. Such partnerships could involve the
construction of new DCCs/CDCs, repurposing of other facilities to be used as
DCCs/CDCs, and upgrading of existing DCCs. The Sponsor-a-School model of
DepEd could provide a relevant example in this respect.
  Finally, DSWD and DILG could consider encouraging LGUs to more narrowly
target their early learning programs given the global evidence suggesting that
young children from disadvantaged households benefit significantly more from
high quality early learning programs than their peers from advantaged
households. So while the overall coverage rate of public early learning programs
would not increase, the programs would benefit a higher proportion of young
children from disadvanted backgrounds.

Challenge of Providing Integrated Early Childhood Services anchored in Early

Learning Programs: The contact frequency of health programs decrease rapidly
beyond the first 12 months of a child’s life. Thus, anchoring integrated early childhood
services in health services becomes challenging after infancy and toddlerhood. Thus,
early learning programs for 24-59 month old children emerge as a potential, and
arguably the most appropriate, entry point for the delivery of integrated early childhood
care and development services. The NCDC model has been developed with this idea in
mind yet scaling the model up remains a challenge.

Variable Quality of Health Facilities, Ante-Natal Care and Post-Natal Care: In the
face of stagnant neo-natal mortality rates, efforts have been underway to improve the
quality of health facilities. The need remains to further prioritize this issue in planning
and budgeting exercises at the national and LGU-levels. Additionally, the progress
achieved in improving the quality of ante-natal care and post-natal care needs to be
sustained particularly in regions that are lagging behind.

Preventive Care for Young Children: Preventive care for infants (0-11 months),
toddlers (12-23 months) and older young children (24-59 months) remain a critical
challenge. In this regard, the decline in vaccination coverage rate is worth noting as it is
indicative of the challenges encountered in ensuring regular contact of young children
with frontline service providers.

This challenge is particularly acute for 12-35 month-old children; they are not expected
to have regular contact with any of the frontline service providers. There is, thus, an
imperative to address this temporal void in the provision of early childhood care and
development interventions. Well-child visits, i.e. preventive care visits beyond age 1, is
one relevant model in this regard that would ensure that a higher percentage of young
children and their caregivers particularly from vulnerable households continue to have
regular contact with health providers. Well-child visits could be designed so that they
serve as an opportunity for supporting caregivers in providing responsive caregiving and
for early detection of developmental delays and disabilities. Another relevant model
could be anchored on the NCDCs where they are established and NCDTs would be
responsible for having regular contact with 0-59 month-old children from vulnerable
households and their caregivers to ensure that the children benefit from responsive
caregiving and nurturing care.

Gaps in Nutrition Efforts: Recent efforts under PPAN and particularly F1K are
laudable and critical given the high prevalence of malnutrition in the Philippines. For
these efforts, a major challenge is identifying appropriate models for supplementary
nutrition for pregnant women (in addition to the provision of iron tablets) and
supplementary nutrition for 6-36 month-old children, and scaling them up. FNRI’s DOST
PINOY using complementary food technology and other existing nutrition interventions
providing ready-to-mix food and pastes to young children could serve as starting points
in this regard. Additionally, to the best of our knowledge, one overlooked area in these
comprehensive efforts is nutrition interventions during the pre-pregnancy phase beyond
adolescence.

Introducing Narrowly Targeted Programs and Tailored Programs: Most efforts in

early childhood care and development are either universal or widely targeted. In other
words, services for young children in health, nutrition, early learning and social
protection are either available free-of-charge to all young children (such as newborn
care and vaccination programs) or targeted to a large segment of the population (such
as the 4Ps, early learning services at day care centers, supplementary feeding at day
care centers). Some exceptions include the provision of essential interventions for
preterm and small newborns, and the Philippine Integrated Management of Acute
Malnutrition Program where young children with moderate and severe acute
malnutrition are identified and referred to therapeutic centers.

As discussed in the Nurturing Care Framework also, while universal and widely targeted
programs are valuable for young children, adequate resources must also be allocated to
ensure that narrowly targeted programs and tailored programs can be implemented for
young children and their caregivers who have particular vulnerabilities and/or additional
needs. Examples of such programs include intensive home visits for young children with
disabilities and young children who have developmental delays, intensive and longer
post-natal care for preterm infants, intensive support to mothers experiencing perinatal
depression and young children without caregivers.

Narrowly Targeted Social Assistance: Providing financial support to families facing

adversities is critical to ensuring that parents/caregivers are able to continue providing
nurturing care to their young children during difficult times. Narrowly targeted social
assistance programs that allow for more intensive support to those families who have
extra needs, such as households caring for a child with a disability, households headed
by a single parent, households caring for an orphaned or abandoned child, could be an
effective intervention. Expansion of the 4Ps could be one possible option to consider in
this regard whereby those narrowly targeted households who are already 4P
beneficiaries would qualify to receive higher amounts of cash assistance.

Availability of Program Implementation Tools: During the visits conducted to points

of service delivery as part of the research for this report, the absence of tools deemed
essential to the effective implementation of programs was a surprisingly common
occurrence. Day care workers did not have manuals and guidebooks to facilitate their
activities, day care centers lacked basic materials to promote early literacy skills,
barangay health stations did not have any supplies of micronutrient powder or Vitamin
A, barangay nutrition scholars did not have access to reliable weight and height
measurement tools. Regardless of what the reasons underlying the limited availability of
tools critical for the effective implementation of ECCD program may be, it is of utmost
importance that frontline workers are at least well-equipped to carry out their
challenging tasks in difficult circumstances.

Service Delivery in Far Flung Barangays: Interviews and group discussions

conducted in preparation of this report have highlighted inadequate services and
unfavorable outcomes for young children in far flung barangays as a major challenge.
Currently implemented center-based service delivery models fall short of addressing
this challenge. Thus, there is a need to identify non-center-based models that are
scalable to far flung barangays while ensuring adequate quality of services. Models of
service delivery from other countries, such as integrated Community Case Management
(Ghana) and Last Mile Health (Liberia), could be relevant in this regard.

Violence against Young Children: Violence against children has emerged as a priority
policy area in recent years culminating in the recent launch of PPAEVAC. To date,
however, research studies and programs in this realm have had an implicit focus on
adolescents and youth. Given the particular vulnerability of young children in the face of
physical and psychological violence, it is of critical importance that young children are
brought to the forefront of discussions on the prevention of violence against children. It
is also of utmost importance that the knowledge and capacity of LCPCs and BCPCs are
strengthened to recognize signs of maltreatment in young children and respond in age-
appropriate ways to these cases. Finally, the need remains to adapt counseling and
reporting mechanisms for young children to ensure that they take into account the
characteristics of early childhood phase. PPAEVAC is currently in the process of
development on its localization at the LGU-level with a focus on LCPCs and BCPCs.
Thus, there is a short window of opportunity that is currently open for incorporating the
particular needs and vulnerabilities of young children in the face of violence.

4.3 CRITICAL GAPS AND KEY OPPORTUNITIES IN DATA COLLECTION AND USE
Household Survey Data
The tremendous efforts of the Philippine Statistics Authority in recent years have made
a wealth of household survey data available, including NDHS, APIS and FIES. This data
has made it possible to identify patterns of disparities in different dimensions of
household and individual wellbeing. With respect to the wellbeing of young children,
however, there remains the need for additional efforts on this front particularly on early
childhood development, parenting practices, violence against young children, and
young children with disabilities. Furthermore, while existing household surveys collect
data on several dimensions of access to services for young children (such as birthing at
a health facility, postnatal care, vaccinations, health insurance, nutrition interventions
(iron tablets, Vitamin A), there remains gaps in some other areas of services (such as
organized early learning programs, supplementary feeding).

As discussed below, the Multiple Indicator Cluster Surveys implemented over 40

countries have the relevant modules to collect data on these topics. PSA could consider
the inclusion of existing MICS modules in its upcoming APIS or NDHS surveys.
Data on Early Childhood Development and Parenting Practices
Indicators and survey tools to capture responsive caregiving and opportunities for early
learning for young children exist yet data for these indicators are yet to be collected in
the Philippines. For instance, the Multiple Indicator Cluster Surveys, household surveys
implemented by over 40 countries to collect data on the situation of children and
women, has a module for children under five that collects data on access to toys and
picture books, access to learning activities such as singing, storytelling, playing,
possible delays in a child meeting developmental benchmarks, child discipline practices,
feeding practices and nutritional intake. The module also collects comprehensive
information on young children’s access to a range of health, nutrition, early learning
and protective services.

Data on Children with Disabilities

In terms of household survey data on children with disabilities, the national census is
currently the only nationally representative data available on prevalence of disability and
the questions in the census do not allow for calculating reliable figures on young
children with disabilities. Figures from the national census conducted in 2010 suggest
that 0.7% of children under five, i.e. 72,931 young children, are reported as having a
disability, which is a notable underestimation compared with the global estimates of
8.4% (Lancet, 2018). While efforts are underway by PSA for conducting a disability
prevalence survey, the survey will not have a separate module on child functioning as
recommended by the Washington Group on Disability Statistics. It is worth noting that
the most recent round of Multiple Indicator Cluster Survey implemented in over 40
countries incorporate this module. In terms of administrative data on children with
disabilities, the Department of Health is in the process of developing and
operationalizing a registry for persons with disabilities.

Data on Violence against Young Children

While the National Baseline Study on Violence against Children conducted in 2016
provides a wealth of data on violence against children, it falls short of capturing young
children’s experiences of violence. Given the difficulty of collecting such data directly
from young children, the above-mentioned Multiple Indicator Cluster Survey’s module
on child discipline practices could be an appropriate data collection tool for this purpose.

Administrative Data
The research conducted for the preparation of this report, including review of existing
reports, and interviews/group discussions/workshops with stakeholders, strongly
suggests critical weaknesses in the collection, validation and use of administrative data
in all relevant sectors. Problems with the reliability and coverage of administrative data,
inadequate data validation, challenges with aggregating administrative data on a regular
basis, and limited capacity with respect to using administrative data for monitoring and
planning purposes have been put forward in interviews, group discussions and
workshops. Similarly, currently available administrative data does not consistently allow
for disaggregation by sex of the child, disability status of the child, or socio-economic
status of the child, all of which are critical to the provision of equitable services.
Strengthening of data collection within the framework of an integrated information
management system remains a major challenge not only for early childhood programs
but more generally for all health, nutrition, early learning programs. Yet the potential
contribution of effective use of administrative data for improving coverage, quality and
impact makes this a highly worthwhile effort. As the wider coordination framework for
statistics, the Philippine Statistical Development Program (PSDP, 2018-2023) is critical
in this regard. More specifically, DSWD’s National Household Targeting System,
Listahanan, with a coverage of 75% of the population and a focus on the poor and near-
poor, emerges as a possible anchor in improving administrative data systems for health,
nutrition and early learning programs. Similarly, the Community Based Monitoring
System (eCBMS) implemented by the DILG could be a pertinent system to work with in
this regard if it were to be augmented by child-specific information systems. In this
regard, the recently piloted Project CHILD (Children Information and Location
Database), which gathered information on all children in every household across
sectors and linked the data to eCBMS, is noteworthy. Also relevant in this regard is the
currently pilot-tested enhanced indicator “established and updated data on children” for
the Child Friendly Local Governance Audit of DILG and CWC.

More generally, the need remains for a more general review of data collection practices
in early childhood care and development services. Limited observation in points of
service delivery suggests that data is being collected mostly to report up and is not used
effectively by the frontline workers to inform their efforts or to provide feedback to
caregivers. In some cases, the same type of data is collected multiple times by different
frontline workers, as it is the case for 3-5 year-old children whose weight and height is
measured multiple times in a year by the barangay health worker/nutrition scholar as
part of the Operation Timbang Plus and by the day care worker/child development
worker as part of the Supplementary Feeding Program. Discussions on the introduction
of new data collection tools, such as the ECCD Checklist for 0-2 year-old children or the
wider implementation of existing data collection tools, such as the ECCD Checklist for
3-5 year-old children, must be accompanied by discussions and assessments about
data collection and management systems.

4.4 CRITICAL GAPS AND KEY OPPORTUNITIES IN INSTITUTIONAL FRAMEWORK

Building on the analyses put forward in Section 2 and Section 3, this section elaborates
on critical gaps and key opportunities to ensure a robust institutional framework is in
place for the effective planning, coordination, implementation of ECCD efforts.

Collaboration between National-Level Departments and LGUs:

More than 25 years after the devolution in the Philippines, effective collaboration
between national-level departments and LGUs still remain an overarching challenge.
With respect to most ECCD efforts, national-level departments have generally
attempted to cascade down programs and models with the expectation that LGUs would
be willing and able to implement them. Yet, the performance of the LGUs in
implementing these programs and models have varied notably with some LGUs willing
but not able to implement and others not willing but arguably able to implement. For
those LGUs that are willing but not able to implement, the overload of programs and
models may have brought about the risk of a “capability trap” whereby they end up not
being able to delivery on any of the programs because they become overwhelmed and
their human and financial resources end up being too thinly spread.

Thus, the need remains to identify working models to improve the performance of LGUs
– both those that are willing but not able and those that are not willing but arguably able.
Some positive examples identified include delegation of staff by DOH and direct
resource transfer by DSWD for supplemental feeding. Other models could include co-
funding in the form of in-kind contributions when an LGU chooses to use a pre-
approved model or meet minimum standards for accreditation.

Relatedly, additional resources and effective models are needed for establishing core
knowledge base and support systems at the regional and provincial levels given their
critical role in capacity strengthening of LGUs. In this respect, the critical shortages of
staffing at the LGU level particularly in the social welfare and development office needs
to be addressed using creative staffing solutions such as delegation and secondement.
Another aspect of the collaboration between national-level departments and LGUs, and
between service providers and LGUs concern the limited availability of institutionalized
feedback loops. Feedback loops are critical for ensuring that challenges encountered in
implementing programs are quickly and efficiently relayed upward so the necessary
interventions can be made to address them. Some relevant mechanisms of feedback
loops include hotdesks, regular meetings, regular supervision visits, and designated
websites for feedback.

Collaboration between National-Level Agencies: Based on the analysis put forward

in Section 3.1 and 3.2, collaboration between national-level agencies has been
generally functional with some challenges remaining in areas where agency mandates
overlap. These areas of overlapping mandates include:
 early childhood learning (DSWD, ECCD Council, DOH (0-2 year-olds), NNC (0-2
year-olds);
 parenting support interventions (DSWD, ECCD Council, DOH (0-2 year-olds),
NNC (0-2 year-olds);
 nutrition programs for 36-59 month-olds (DOH, DSWD, NNC)
 nutrition programs for >60 month-olds (DSWD, DepEd, NNC)

The need for clarification of responsibilities and effective collaboration in these areas
has become even more important given the planned expansion of F1K. Intensive
technical collaborations in each of these areas between the relevant agencies as well
as other technical stakeholders could be a possible first step in this regard. Technical
sub-committees under NNC and ECCD Council could be a viable institutional
arrangement for this purpose. NCDA’s institutional arrangement regarding thematic sub-
committees could be a relevant model in this regard.

Quality Assurance for ECCD Services and Programs: Variable quality of service
delivery and program implementation emerges as a major challenge across all sectors.
The devolved nature of ECCD program implementation compounds this challenge. In
addressing this challenge of quality variation, national-level agencies and LGUs use a
variety of tools, including:
 setting standards, recognizing adherence to standards and ensuring compliance
(such as DSWD and ECCD Council’s work with DCCs/CDCs)
 pre-service and in-service training for frontline workers (such as DOH’s work with
CHWs; NNC’s work with BNSs; DSWD’s work with DCWs; ECCD Council’s work
with CDTs)
 supervision/mentoring for LGU counterparts and frontline workers (such as
efforts by DOH’s and DSWD’s regional offices)
 mechanisms for citizen feedback on service quality (such as DepEd hotline,
Citizens Complaint Hotline 8888)
 data collection on outcome indicators (such as Operation Timbang Plus)
 performance based payment (such as performance based top-ups for DCWs in
some LGUs)
 performance based awards/recognition (such as awards for child friendly cities
and municipalities)

Across all ECCD programs, the need remains to think about quality assurance more
systematically and allocate adequate human and financial resources for the effective
use of multiple quality assurance tools in a complementary manner for each program.

Procurement, Distribution and Supply Chain Management: The challenge posed to

effective program implementation by the limited availability of the necessary
implementation tools (such as multinutrient powder for nutrition programs, educational
materials for early learning programs, vaccines for health programs) was discussed in
the preceding section. At the heart of this challenge is system-level problems with
procurement, distribution and supply chain management. While the nature of these
problems vary by the nature of the tool (for instance, supply chain management for
vaccines is fundamentally different from supply chain management of education
materials for day care centers), improvement of these systems either directly for the
national-level agencies themselves or indirectly by providing technical support to LGUs
remains a fundamental precondition of effective service delivery.

LGU Level Coordination Efforts: As discussed in Section 3.3, several coordination

bodies at the LGU level have mandates that are related in varying degrees to the
wellbeing of young children and their families, such as the LCPC, LSB, LHB, and LNC.
Given its wider mandate, LCPC is better positioned to be the coordination body for
ECCD services at the LGU level as long as its efforts are coordinated with the other
sectoral bodies. Yet in order for LCPCs (and for that matter BCPCs) to take on this
coordination role, there remains the need to reorient them so they approach child
wellbeing in a more holistic manner that extends beyond maltreatment of children. To
this end, it is critical that LCPCs and BCPCs receive technical assistance from not only
PSWD but also regional and provincial offices for health, nutrition and education.
Relatedly, the need remains to encourage LCPCs and BCPCs to have age-conscious
discussions so the special needs of young children (and for that matter pre-adolescents,
adolescents, etc.) are not overlooked.

Local Executive Chiefs and Municipal Councils (Sangguniang Bayan): Interviews

and group discussions conducted to collect input into the preparation of this report
highlighted the role played by the local executive chiefs in determining the level of policy
attending and funding early childhood care and development efforts receive at the LGU
level. Assuming that the local executive chiefs’ perception about the importance of early
childhood matter, then this raises the need for a strategic and well-coordinated
advocacy effort targeting local executive chiefs with a strong communications
component. Similarly, the Municipal Councils as the legislative branch of local
governments have a crucial role in the passing of ordinances and resolutions for the
administration and funding of policies and programs relevant for early childhood
development. To the best of our knowledge, advocacy efforts targeting Local Executive
Chiefs and Municipal Councils have been limited to attempts at person-to-person
persuasion and a well-coordinated advocacy effort has not been undertaken to date.

Fragmented implementation of programs: While having a multitude of programs at

the national level does not pose a problem in and of itself, integration at the point of
service delivery is critical to increase their positive effect on young children. Yet these
programs are currently cascaded down in silos to LGUs, which leads to frontline
workers experiencing and implementing them separately (potentially at the expense of
some less well promoted programs). It remains critical that DOH, NNC and DSWD
collaborate to re-orient LGU counterparts and frontline workers for a holistic approach to
young children’s wellbeing. Such re-orientation could place an emphasis on the value of
taking initiative to pursue opportunities for synergies at the point of service delivery.
Regular in-service training programs and meetings of federations of CHWs and DCWs
could be potential points of entry to deliver this message with concrete examples about
such synergies.

Workforce: There is limited up-to-date information on ECCD service providers,

particularly the frontline workers, to inform potential revisions to current human resource
management policies in an effort to improve their performance. In fact, a study
conducted in 2009 on daycare services provided some critical information on daycare
workers that have since informed several efforts to improve their performance, such as
the national competency standards for child development workers. Thus, a
comprehensive evaluation of the skills, capacities, working conditions, sources of
motivation of BNSs and BHWs, and an update of the study for DCWs would be
essential to inform future human resource management policy decisions. Such policies
could entail general improvements in benefits, introduction of performance based
incentives and/or strengthening of supervision, mentoring and monitoring efforts.

Relatedly, deployed nurses of DOH, if re-purposed, present an opportunity to both

supervise and support barangay-level health workers and to implement the kind of
intensive tailored programs for young children with disabilities and developmental
delays, mothers experiencing postpartum depression, young children orphaned,
abandoned or living in disrupted households. More generally, reviving IMNCI presents
an opportunity to redistribute some work within the RHU to free up human resources for
new interventions in critical areas for young children and their families.
4.5 CRITICAL GAPS AND KEY OPPORTUNITIES IN LEGISLATIVE FRAMEWORK
As underlined also in section 3.5, there exists a robust and comprehensive legislative
framework not only facilitating but in fact stipulating the undertaking of a wide range of
enabling efforts to ensure that all young children receive nurturing care. This section
highlights a limited number of areas where gaps remain in the legislative framework. It
should be noted that it refrains from presenting a discussion about legislation on public
administration and financing that pose structural challenges to the effective provision of
ECCD services, such as: (i) the fact that the distribution formula of the Internal Revenue
Allotment falls short of addressing disparities across LGUs by not taking into account
LGU poverty levels in its formula, (ii) how the legislated limits on the proportion of LGU
budgets spent on human resources hinder adequate compensation of barangay-level
workers. For the purposes of the national strategic plan for ECCD, such legislation
constitute a structural constraint and not an area of action.

Corporal Punishment at Home: As discussed in detail by the Global Initiative to End

All Corporal Punishment’s country report, although corporal punishment is unlawful in
alternative care settings, day care centers and schools (as per Family Code 1987,
Article 233; Administrative Order 141/2002, Article 1.4), it remains lawful in the home
with a number of legal defenses for its use in childrearing (Family Code 1987, Article
220; Child and Youth Welfare Code 1974, Article 45; Revised Penal Code, Article 263;
Rules and Regulations on the Reporting and Investigation of Child Abuse Cases, Article
2). Since 2007, a number of bills prohibiting corporal punishment have been introduced
to Parliament but have failed to be approved by both houses and the President. Given
the high prevalence of harsh physical punishment and the recently initiated PPAEVAC,
the prohibition of corporal punishment at home remains an important legislative gap.

Social and Economic Status of Frontline Service Providers: As discussed in section

3.4 on service providers and frontline workers, improvement of the social and economic
status of barangay health workers, barangay nutrition scholars, and day care
workers/child development workers is critical to the recruitment and retention of high
quality personnel and the effective delivery of health, nutrition and early learning
services to young children. While Magna Carta laws exist for barangay health workers
and barangay nutrition scholars, despite years of efforts led by DSWD and the approval
of a Magna Carta for Day Care Workers by the House of Representatives in 2017, such
a legislation has yet to come into effect for daycare workers and child development
workers. Additionally, the need remains to legally ensure a minimum compensation and
benefits package even for those frontline service providers not covered by their
respective magna cartas. Such a legal arrangement could also address the constraints
placed on the LGUs with the existing budget cap on human resources.

Limitations posed by Early Years Act: As highlighted in section 3.2, RA 10410 poses
two challenges for the effective implementation of the Act. Firstly, it remains mostly
silent on the Act’s implementation at the sub-national level. Unlike the provisions in RA
8990 that stipulated the establishment of an ECCD Coordinating Committee at the LGU
level and provided detailed description of the Committee’s composition, function and
salary, RA 10410 does not have any provisions in this regard. The need remains to
have a legal regulation on this matter that recognizes the diverse realities of LGUs and
accomodates each LGU to identify an appropriate institutional arrangement for
coordinating its efforts to support young children and their families. The delegation of an
ECCD focal person, the establishment of an ECCD sub-committee under existing
councils, or amending the responsibilities of LCPCs and BCPCs in ways that encourage
prioritizing young children are among viable institutional models that can be legally
regulated. Relatedly, the non-inclusion of DILG (with its oversight functions on LGUs)
as a member of the ECCD Council has further complicated the Act’s implementation at
the sub-national level.

The second area in which RA 10410 poses a challenge to the effective implementation
of the mandates described in the Act concerns the time-bound financing arrangement
and the ECCD Council Secretariat’s staffing arrangement. There remains an urgent
need to address both these aspects to ensure that the ECCD Council can continue
delivering on its mandate effectively in the years to come.
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Oxford Policy Management (OPM) (2017). Evaluation of the UNICEF Philippine Country
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Puerta, M.L.S., A. Valerio, & M.G. Bernal (2016). Taking Stock of Programs to Develop
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Carolina: American Academy of Pediatrics.

Save the Children (n.d). Analysis of Public Investments in Maternal, Neonatal, Child
Health and Nutrition (MNCHN) and Early Childhood Care Development (ECCD)
programs in Caloocan, Malabon, Navotas, Taguig, Paranaque, Pateros and Manila
(Tondo). Makati City: Save the Children.

Save the Children (2016). Cost of Hunger: Philippines. Makati City: Save the Children

SEAMEO Innotech (n.d.).Raising the Standard of Early Childhood Care and

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Taylor, A. & ACER (n.d.). Studying early childhood education in the Philippines.

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Violence Against Children (2018). Violence prevention must start in early childhood.
New York: United Nations.

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UNICEF Tahderiyyah Programme (2010-17) Funded by DFAT. Manila: United Nations
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2018-001.pdf

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York: United Nations Children’s Fund.
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Childhood Development. New York: United Nations Children’s Fund.

United Nations Children’s Fund, Republic of Philippines Department of Health &

National Nutrition Council (2017). Business Case for Nutrition Investment in the
Philippines.

United Nations Children’s Fund (2016). Strengthening Child Protection Systems in the
Philippines Child Protection in Emergencies. New York: United Nations Children’s Fund.

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United Nations Children’s Fund (2016). A Study on Factors Affecting LGU Budget
Allocation for ECCD at City and Municipal Levels. Manila: United Nations Children’s
Fund Philippines.

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Budget Allocation for ECCD. Pasig City: Philippines.

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(2015). Child Poverty in the Philippines. Manila: UNICEF & PSA.

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Nations Children’s Fund (n.d.). ALL CHILDREN IN SCHOOL BY 2015 Global Initiative
on Out-of-School Children. Manila: UNICEF Philippines.

United Nations Educational, Scientific, and Cultural Organization (UNESCO), & World
Bank, & Global Partnership for Education, & UNICEF (2014). Educational Sector
Analysis Methodological Guidelines – Volume 2. New York: UNESCO.

University of the Philippines Social Action and Research for Development Foundation
(UPSARDFI) (1997). Evaluation of Parent Effectiveness Service. Quezon City,
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University of the Philippines Los Baños (UPLB), Department of Human and Family
Development Studies, College of Human Ecology (2017). Assessment of Family
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Vargas-Barón, Emily. 2008. Toward establishing national and international investment

targets to expand early childhood services. Coordinators’ Notebook 30: 17. Toronto:
The Consultative Group on Early Childhood Care and Development.

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Instrument. Washington, D.C.: World Bank Group.

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Development Reform Project. Washington, DC: World Bank Group.

World Bank (2018a). Making growth work for the poor: a poverty assessment for the
Philippines. Washington, D.C.: World Bank Group.
World Bank (2018b). Implementation Status & Results Report – Philippines Social
Welfare Development and Reform Project II. Washington, DC: World Bank Group.

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Washington, DC: World Bank Group.

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Nurturing care for early childhood development: a framework for helping children
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Young Lives Oxford Department of International Development (ODID) (2016). Early

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Legislations/Government issuances

National Laws

Children’s Emergency Relief and Protection Act, Republic Act No. 10821 (2015)

Kalusugan at Nurtrisyon ng Mag-Nanay Act, Republic Act No. 11148 (2018)

ECCD Act, Republic Act No. 8980 (2000)

Early Years Act (EYA) of 2013, Republic Act No. 10410 (2010)

ECCD Council (2013). Implementing Rules and Regulations of Republic Act No. 10410
otherwise known as “The Early Years Act of 2013”

Kindergarten Education Act, Republic Act No. 10157 (2011)

Redefining the Functions and Organizational Structure of the National Council for the
Welfare of Disabled Persons which is Renamed as the National Council on Disability
Affairs and Attached to the Office of the President, and Amending for the Purpose
Executive Order 676 (2007) and Executive Order 232 (1987), Executive Order No. 709
(2008)

The Philippine Disaster Risk Reduction and Management (PDRRM) Act of 2010,
Republic Act No. 10121 (2009)

Administrative Orders/Circulars
Early Childhood Care and Development Council. Reconstituting the ECCDC-TWG to
include DILG as a member (Resolution No. 17-02).

Department of Budget and Management, Statement of Appropriations, Allotments,

Obligations, Disbursements and Balances Q3 2018.

Department of Budget and Management, National Expenditure Program FY 2018.

Department of Education (2012). Implementing Rules and Regulations of RA 10157,

otherwise known as The Kindergarten Act (DepEd Order No. 32 S. 2012). Pasig City,
Philippines: DepEd

Department of Education (2016). Omnibus policy on kindergarten education (DepEd

Order No. 47 S. 2016). Pasig City, Philippines: DepEd.

Department of Education (2014). Policy guidelines on the implementation of the

kindergarten catch-up education program (DepEd Order No. 11 S 2014). Pasig City,
Philippines: DepEd.

Department of Education, Department of Budget and Management, and Department of

Interior and Local Government. Revised Guidelines on the Use of the Special Education
Fund (Joint Circular No. 1 S 2017).

Department of Social Welfare and Development (2018) Adopting the Department of

Social Welfare and Development (DSWD) Strategic Plan (2018-2012) (Administrative
Order No. 10). Quezon City, Philippines: DSWD.

Department of Social Welfare and Development (2010). Guidelines on the

Implementation of the Comprehensive Program for Children/Persons with Disabilities
(C/PWDs) (Administrative Order No. 19 S 2010). Quezon City: DSWD.

Department of Social Welfare and Development (2018). Guidelines on the Provision of

Technical Assistance and Resource Augmentation to Local Government Units through
Local Social Welfare and Development Offices (Memorandum Circular No. 10 S 2018).
Quezon City: DSWD.

Department of Social Welfare and Development (2011). Guidelines in the

Implementation of the Supplemental Feeding Program (Administrative Order No. 04 S
2011). Quezon City: DSWD.

Juvenile Justice and Welfare Council (2014). Revised Rules and Regulations
Implementing Republic Act No. 9344, as amended by R.A. 10630 (Council Resolution
No. 2, S 2014). Quezon City: JJWC.

Others
Memorandum of Agreement on the Convergence Among Councils and Committees on
Children (2014)

Operational Guidelines for Convergence Among Councils and Committees on Children

National Nutrition Council, Submission of BP Forms 206 and 206A for the ECCD
Intervention Package for the First 1000 Days.