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WELCOME

LOCAL GOVERNMENT NUTRITION


MONITORING AND EVALUATION
MELLPI PRO FORM CM 1: CITY/ MUNICIPALITY NUTRITION MONITORING

City/Municipality Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
1. VISION AND MISSION
1a Presence and A vision statement A vision statement A vision statement A vision statement A vision statement Local Nutrition
knowledge of vision for nutrition was for nutrition was for nutrition for nutrition for nutrition Action Plan
statement formulated but not formulated and program exists and program exists and program exists and
reflected in the reflected in the known by all stakeholders are stakeholders are
Local Nutrition Local Nutrition stakeholders aware of their aware of their and 1
Action Plan Action Plan contribution to the other stakeholders’
vision contribution to the
vision

1b Presence and A vision statement A vision statement A mission statement A mission statement A mission statement Local Nutrition
knowledge of mission for nutrition was for nutrition was for nutrition for nutrition for nutrition Action Plan
statement formulated but not formulated and program exists and program exists and program exists and
reflected in the reflected in the known by all stakeholders are stakeholders are
Local Nutrition Local Nutrition stakeholders aware of their aware of their and 3
Action Plan Action Plan contribution to the other stakeholders’
mission contribution to the
mission
PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
1. VISION AND MISSION
1c Presence of nutrition The ELA and/or AIP The ELA and/or AIP The ELA and/AIP The ELA and/AIP The ELA and/AIP Comprehensive
concerns in the includes includes includes includes for includes for Development Plan
Executive Legislative nutrition-specific nutrition-specific nutrition-specific nutrition-specific nutrition-specific
Agenda (ELA) and/or programs of one programs of two programs of programs and programs and Executive Legislative
Annual Investment office only offices only nutrition unit and operating expenses operating expenses Agenda
Plan (AIP) on nutrition-specific of nutrition unit of nutrition unit
nutrition programs of at and and Annual Investment 3
least two offices nutrition-specific nutrition-specific Plan
programs of at and
more than two nutrition-sensitive Approved Annual
offices programs of more Budget
than two offices

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2a Adoption, The LGU is aware The LGU has a The LGU allocated The LNC monitors The LNC processes Resolutions
implementation and that a Local resolution, budget for the implementation result of monitoring Ordinances
monitoring of local Nutrition Action ordinance and/or implementation of of the Local and make Executive Order
nutrition plan Plan was agreement the Local Nutrition Nutrition Action adjustments based Approved Annual
formulated adopting the local Action Plan Plan and provides on the results Budget
nutrition plan feedback Local Nutrition
Action Plan
Quarterly
Accomplishment
Report
Minutes of meeting
2b Adoption, The LGU is aware The LGU has a The LGU has The LGU has The LGU has Resolutions
implementation and of the provisions of resolution, activity(ies) to activity(ies) to activity(ies) to Ordinances
monitoring of EO 51 ordinance, implement and implement and implement and Executive Order
national/ regional Executive Order monitor monitor monitor
nutrition and/or agreement compliance to the compliance to the compliance to the Approved Annual
Executive and/or a line local ordinance, local ordinance/ local ordinance, Budget
Order 51: National budget item in the resolution or resolution or resolution or
Code of Marketing Approved Annual Executive Order Executive Order Executive Order Local Nutrition
Breastmilk Budget on EO 51 or and maintains a list and provides Action Plan
Substitutes, related concern of masterlist of feedback and
Breastmilk facilities monitored penalties to
Supplements, and violators as
Other Related applicable
Products

2c Republic Act 10028: The LGU is aware The LGU has a The LGU has Budgeted activities The LGU has Resolutions
Expanded of the provisions of resolution, activity(ies) to are fully institutionalized Ordinances
Breastfeeding RA 10028 and/or ordinance, implement and implemented compliance to the Executive Order
Promotion Act of DILG MC 2011-54 Executive Order monitor pursuant to the law through Approved Annual
2009 and/or agreement compliance to the laws issuance of local Budget
and/or a line local ordinance/ implementation policy, budget Local Nutrition
DILG Memorandum budget item in the resolution allocation and Action Plan
Circular 2011-54 Approved Annual relevant facilities Accomplishment/
Implementation and Budget on RA documentation
Monitoring of the 10028 or related report
National concern Masterlist of
Breastfeeding Policy establishments/
offices with
lactation stations

2d Republic Act 8172: An The LGU is aware The LGU has a The LGU has The LGU allocates The LGU has Resolutions
Act for Salt Iodization of the provisions of resolution, activities to budget for sustained Ordinances
Nationwide (ASIN RA 8172 ordinance, promote year-round implementation of Executive Order
Law) Executive Order compliance with activities relevant activities Approved Annual
and/or agreement the law and regularly Budget
and/or a line item monitors the Local Nutrition
budget in the implementation Action Plan
Approved Annual including having Minutes of meeting
Budget which relevant discussions Accomplishment/
supports R.A. 8172 during C/MNC documentation
meetings and report
adjustments
2e Republic Act 8976: The LGU is aware The LGU has a The LGU has The LGU allocates The LGU has Resolutions
Philippine Food of the provisions of resolution, activities to budget for sustained Ordinances
Fortification Act RA 8976 ordinance, promote year-round implementation of Executive Order
Executive Order compliance with activities relevant activities Approved Annual
and/or agreement the law and regularly Budget
and/or a line item monitors the Local Nutrition
budget in the implementation Action Plan
Approved Annual including having Minutes of meeting
Budget which relevant discussions Accomplishment/
supports R.A. 8976 during C/MNC documentation
meetings and report
adjustments

2f Republic Act 11148 The LGU is aware The LGU has a The LGU has The LGU allocates The LGU has Resolutions
First 1000 Days Law of the provisions of resolution, activities to budget for sustained Ordinances
RA 11148 ordinance, promote year-round implementation of Executive Order
Executive Order compliance with activities relevant activities Approved Annual
and/or agreement the law and regularly Budget
and/or a line item monitors the Local Nutrition
budget in the implementation Action Plan
Approved Annual including having Minutes of meeting
Budget which relevant discussions Accomplishment/
supports R.A. during C/MNC documentation
11148 meetings and report
adjustments

2g DOH Administrative The LGU is aware The LGU has a The LGU has The LGU allocates The LGU has Resolutions
Orders: of provisions in resolution, activities to budget for sustained Ordinances
1. 2010-0010: either of the DOH ordinance, promote year-round implementation of Executive Order
Revised Policy on Administrative Executive Order compliance with activities relevant activities Approved Annual
Micronutrient Orders and/or agreement the law and regularly Budget
Supplementation and/or a line item monitors the Local Nutrition
2. 2008-029: budget in the implementation Action Plan
Implementing Health Approved Annual including having Minutes of meeting
Reforms for Rapid Budget which relevant discussions Accomplishment/
Reduction of supports either during C/MNC documentation
Maternal and DOH-AO 2010-0010 meetings and report
Neonatal Mortality or 2008-0029 adjustments
2h DepED Orders: The LGU is aware The LGU has a The LGU has The LGU allocates The LGU has Resolutions
1. 59-2 S. 2017 of provisions in resolution, activities to budget for sustained Ordinances
Weekly Folic Acid either of the DepED ordinance, promote year-round implementation of Executive Order
Supplementation for Issuances Executive Order compliance with activities relevant activities Approved Annual
Female Adolescents and/or agreement the law and regularly Budget
2. 39 S. 2017 and/or a line item monitors the Local Nutrition
Operational budget in the implementation Action Plan
Guidelines for Approved Annual including having Minutes of meeting
School-based Feeding Budget which relevant discussions DepED Reports
Program 3. 13 S. supports either of during C/MNC
2017 Policy and the issuances meetings and
Guidelines on Healthy adjustments
Food Choices in
Schools 4. 10-1 S.
2016 Policy
Guidelines for
Comprehensive
WASH in Schools
DepED Memo No.
223 S. 2016
Strengthening
Implementation of
Gulayan sa Paaralan
Project

2i NNC Governing The LGU is aware The LGU procured LGU uses height LGU uses verified LGU uses verified Resolutions
Board Resolutions of either NNC GB any type of height and length height and length height and length Ordinances
Nos. 1) 3 S.2012: Resolution No. 3 and length measuring tools of measuring tools of measuring tools of Executive Order
Approving the S.2018 or No. 3. measuring tools wooden/ wooden/ wooden/ Approved Annual
Guidelines on the S.2012 non-wood material non-wood material non-wood material Budget
Fabrication, as prescribed in the as prescribed in the as prescribed in the Local Nutrition
Verification, and guidelines guidelines and guidelines and Action Plan
Maintenance of available in at least available in all Minutes of meeting
Wooden Height 50% of the barangays Accomplishment/
Boards 2) 3 S.2018: barangays documentation
Approving the report
Guidelines on the
Selection of
Non-Wood Height
and Length
Measuring Tool
2j Salt Iodization The LGU is aware The LGU Relevant activities Relevant activities Sustained Resolutions
Advisory Board of the law and implements a are implemented at are implemented implementation of Ordinances
Resolution No.1 activities to one-time activity in least once a year year-round activities across Executive Order
series of 2018: implement the law support of the NSIP resulting to years with Approved Annual
Adopting the Strategic Plan increased increased Budget
Strategic Plan of the awareness of awareness and Local Nutrition
National Salt people actual use of Action Plan
Iodization Program iodized salt in Minutes of meeting
2018-2022 households and Accomplishment/
establishments documentation
report

2k NNC Governing The LGU is aware The LGU has a Nutrition Nutrition is in the The LGU monitors Resolutions
Board Resolution of the provisions on resolution, perspective is ELA, LDP and the implementation Ordinances
No.1 series of 2017: either NNC GB ordinance, evident in the ELA activities are of nutrition Executive Order
Approving and Resolution or DILG Executive Order and local budgeted activities funded by Approved Annual
Adopting the MC and/or agreement development plan responsive to the the LGU, through Budget
Philippine Plan of and/or a line and nutrition local nutrition regular C/MNC Local Nutrition
Action for Nutrition budget item in the activities are committee’s meetings, program Action Plan
2017-2022 Approved Annual funded through the assessment of the reviews with Minutes of meeting
Budget of agencies various offices situation activities Accomplishment/
DILG MC 2018-42 and nutrition office throughout the documentation
Adoption and which supports year by majority of report
Implementation of NNC GB res.1 s the members
PPAN 2017-2022 2017. And/or DILG
MC 2018-42

2l NNC Governing The LGU is not The LGU aware of The LGU has The updated LNAP The updated LNAP Resolutions
Board Resolution aware of the the provisions of formulated/ has been approved, has been approved, Ordinances
No.3 series of 2014: provisions in the the resolution updated their LNAP budgeted and being budgeted, Executive Order
Approving and resolution organized for the guided by the implemented implemented with a Approved Annual
Adopting the C/MNC provisions of the C/MNC review Budget
Guidelines on Local NNC Guidelines conducted Local Nutrition
Nutrition Planning Action Plan
Minutes of meeting
Accomplishment/
documentation
report
2m NNC Governing The LGU is aware The LGU has a The LGU has The LGU has The LGU has Resolutions
Board Resolution No. of the provisions of resolution, implemented implemented more implemented more Ordinances
6 series of 2012: the resolution ordinance, activities in support than 1 activity in than 2 activities in Executive Order
Adoption of the 2012 Executive Order of NNC GB res.6 s support of NNC GB support of NNC GB Approved Annual
Nutritional Guidelines and/or agreement 2012 res.6 s 2012 with res.6 s 2012 with Budget
for Filipinos in support to NNC multi-stakeholder multi-stakeholder Local Nutrition
GB res.6 s 2012 participation participation Action Plan
with a Minutes of meeting
corresponding plan Accomplishment/
for implementation documentation
report

2n NNC Governing The LGU is not The LGU provided The LGU conducts OPT Plus maintains The LGU maintains Resolutions
Board Resolution aware of provisions orientation to OPT Plus and uses a master list of an inventory of Ordinances
No.2 series of 2012: of NNC GB res.2 s nutrition workers weight and height children who are weight and height Executive Order
Approving the 2012. involved in OPT plus measuring wasted, stunted measuring Local Nutrition
Revised equipment and overweight and equipment and Action Plan
Implementing prescribed in the prevalence of allocates budget Approved Annual
Guidelines on OPT Plus various nutrition for maintenance Budget
Operation Timbang Implementing problems and and/or OPT Plus Report
Plus (OPT Plus) Guidelines utilizes data for replacement Masterlist of
planning and Beneficiaries
targeting of Inventory of
programs measuring
equipment

2o NNC Governing The LGU does not The LGU designated The LGU has issued Nutrition Cluster Nutrition Cluster Resolutions
Board Resolution No. have a resolution, the lead or focal a resolution has been formed has been formed Ordinances
2 series of 2009: ordinance, point for organizing the and NIEm Plan with clarified Executive Order
Adopting the Executive Order Nutrition-in- nutrition cluster in formulation relational link with Local Nutrition
National Policy on and/or agreement Emergencies the area or its initiated/completed the local DRRMC Action Plan
Nutrition on NNC GB res.2 s equivalent body during emergencies, NIEM Plan
Management in 2009. NIEm Plan Minutes of meeting
Emergencies and formulated and Accomplishment
Disasters clear fund source report/
documentation
report
PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
3. GOVERNANCE AND ORGANIZATIONAL STRUCTURE
3a Presence of Local The LNC is The LNC is The LNC is The LNC is The LNC is Local Nutrition
Nutrition Committee organized but organized but does organized with the organized with the organized with full Action Plan
(LNC)* membership is not include all Local Chief Local Chief representation as Resolutions
limited to 3-4 member agencies Executive as Executive as stated in level 3 and Executive Order
agencies only of the NNC chairperson and is chairperson and is supported by a Organizational
Governing Board composed of LGU composed of LGU resolution Chart
(pursuant to PPAN counterparts of the counterparts of the indicating the
IG S.1981 and EO NNC Governing NNC Governing functions of each
234 S.1987) with Board member Board member member
LGU counterparts agencies agencies and
1. Office of the non-government
LCE organizations/
2. Health private sector/
3. Interior and people’s
Local Government organization
4. Agriculture
5. Social Welfare
and Development
6. Education
7. Planning and
Development
Budget

3b Functionality of the The LNC has met The LNC has met The LNC met at The LNC met at The LNC conducted Resolutions
Local Nutrition only once. twice for the year. least three times least three times quarterly meetings Ordinances
Committee and formulated and which included the Executive Order
LNAP is available funded the LNAP, following agenda: Local Nutrition
but no joint with updating on 1. OPT Plus results Action Plan
discussion on various nutrition 2. Local nutrition Approved Budget
progress and results projects during LNC planning and Minutes of meeting
of various meetings budgeting Functionality
programs 4. Resource checklist
generation PIR Documentation
5. Program report
Implementation
Review
3c Presence of Nutrition The LGU has There is a NAO The LGU has a The LGU has an The LGU has an Resolution
Office and Personnel designated a designate from one fulltime designate established established Executive Order
Nutrition Action of LGU offices, NAO working under separate nutrition nutrition office Local Nutrition
Officer (NAO) assisted by at least one of the LGU office with full time with full time NAO, Action Plan
without any staff to one staff offices with at least designate NAO, one more than one Organizational
provide assistance two support staff technical support technical staff and Chart
staff and one one support staff Approved Annual
support staff with with modest to full Budget
modest resource resource
complement for complement for
nutrition programs nutrition programs

3d Decision-making and The LNC is The LNC is The LNC meetings The LNC meetings LNC decisions are Minutes of meeting
Leadership of the convened only convened when are used to decide are used to decide made jointly by
Local Nutrition once for important important decisions on decisions and monitor members and LNC
Committee key program regarding the regarding planned progress on serves as clearing
decisions nutrition program activities with duly planned activities house for all
and other concerns signed with duly signed nutrition-related
on an adhoc basis documentation documentation matters including
emerging concerns

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS
4a Planning Local Nutrition LNAP exists in the LNAP is formulated LNAP is formulated A LNAP is Comprehensive
Action Plan is LGU and is by the members of by the members of formulated by the Development Plan
formulated but not formulated by the the LNC en banc the LNC en banc members of the Local Nutrition
signed nutrition action and updated at and updated once a LNC en banc and Action Plan
officer only least once within year updated twice a Minutes Meeting
the past three (3) year Accomplishment
years Report
Resolutions
Executive Order
4b LNC Mobilization Only 1-2 members Only 3-4 members All members of the All members of the All members of the Resolutions
of the LNC perform of the LNC LNC performs LNC performs LNC performs Executive Order
nutrition and performs nutrition nutrition and nutrition and nutrition and MOA with
nutrition-related and nutrition-related nutrition-related nutrition-related stakeholders
functions including nutrition-related functions and functions with functions with Documentation
attendance to LNC functions contributes support from the support from the report
activities resources to local peoples’ local peoples’ Minutes of the
activities organization who organization who Meeting
are non-LNC are non-LNC
members members and other
external partners
such as socio-civic
organizations,
international
organizations,
academic
institution

4c Advocacy for The LNC does not The LNC conducts The LNC regularly The LNC regularly The LNC regularly Local Nutrition
Nutrition Program conduct advocacy advocacy activities conducts advocacy conducts advocacy conducts advocacy Action Plan
and Nutrition activities for for nutrition and activities for activities for activities for Accomplishment
Workers nutrition and local local nutrition nutrition and local nutrition and local nutrition and local Report
nutrition workers workers to local nutrition workers nutrition workers nutrition workers Project/ Activity
decision makers to local decision to local and to local and Documentation
and legislators, but makers and national decision national decision Reports
on an ad hoc basis. legislators. makers and makers and
legislators./eij legislators and
external partners

4d Fund Source Not all LNAP The LNAP is funded The LNAP fund in The LNAP fund in The LNAP fund in Local Nutrition
activities are in the approved the approved the approved the approved Action Plan
funded annual LGU budget annual LGU budget annual LGU budget annual LGU budget Annual Investment
but limited to includes personnel includes personnel includes personnel Plan/ Approved
program budgets services, MOOE and services, MOOE and services, MOOE and Annual LGU Budget
program program with program with MOA with partners
additional support additional support Resolutions
in cash, kind or in cash, kind or
services from services from
community external partners
4e Interagency Progress of Monitoring and The LNC monitors The LNC monitors The LNC monitors Local Nutrition
Monitoring and implementation is evaluation of and evaluates the and evaluates the and evaluates the Action Plan
Evaluation only conducted at nutrition programs nutrition programs nutrition programs nutrition programs Monitoring/
midterm of the is conducted at least once a year at least once a year at least once a feedback report
PPAN period biannually and provides year, provides Documentation
feedback to the feedback and Report
city/ municipality or follows through the Minutes of Meeting
barangay recommendation in
monitored the succeeding
monitoring

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5a Infant and Young Child Feeding
Community-based health and nutrition support strengthening
1. Training on No nutrition Less than 70% of At least 70% of At least 85% of 100% of nutrition Local Nutrition
breastfeeding, counselor was nutrition workers nutrition workers nutrition workers workers trained on Action Plan
complementary trained on trained on trained on trained on breastfeeding, Accomplishment
feeding, relief breastfeeding, breastfeeding, breastfeeding, breastfeeding, complementary report
feeding, etc. complementary complementary complementary complementary feeding, relief Training report
feeding, relief feeding, relief feeding, relief feeding, relief feeding, etc. with Capacity map
feeding etc. feeding, etc. feeding, etc. feeding, etc. refresher as needed

2. Pool of trained Pool of trained Pool of trained Pool of trained Pool of trained Pool of trained Training report
mother -support nutrition counselor nutrition counselor nutrition counselor nutrition counselor nutrition counselor Capacity map
groups and established in less established in less established in at established in at established in all
counsellors for than 50% of than 70% of least 70% of least 85% of barangays and
lactating barangays barangays barangays barangays provided with
management, refresher course as
kangaroo mother necessary
care, growth
monitoring and
promotion,
complementary
feeding, early child
development and
acute malnutrition
for every barangay
established
Establishment of breastfeeding places in non-health establishments

3. Lactation stations The LGU does not The LGU has The LGU has The LGU has The LGU has (By ocular
established in have a lactation lactation stations in lactation station in lactation stations in lactation stations in inspection)
government facilities station in any of 1 or 2 of the the government several government any of the Documentation
such as major the areas government facility and public facilities and public government report
airports, sea ports, facilities places but not places, managed by facilities and public
public utility maintained personnel places, maintained,
passenger terminals, managed by
local government personnel and
offices and public accessible to the
places such as town public
plazas, public
markets, small shops
and multi-purpose
centers

Enforcement of Milk Code

4. 4th, 5th and 6th The LGU did not The LGU The LGU The LGU The LGU Resolution
class municipalities, establish a established a established and established and established and
independent monitoring and monitoring and implemented an implemented an implemented an Monitoring Report
chartered and reporting reporting integrated integrated integrated
component cities mechanisms of EO mechanisms of EO monitoring and monitoring and monitoring and
with established 51, RA 10028 and 51, RA 10028 and reporting reporting reporting
integrated other related other related mechanisms of EO mechanisms of EO mechanisms of EO
monitoring and issuances on IYCF issuances on IYCF 51, RA 10028 and 51, RA 10028 and 51, RA 10028 and
reporting other related other related other related
mechanisms of EO issuances on IYCF in issuances on IYCF in issuances on IYCF in
51, RA 10028 and 60% - 79% of the 80% - 99% of the 100% of the
other related barangays barangays barangays
issuances on IYCF in
every barangay
council for the
protection of
children
5b Philippine Integrated Management of Acute Malnutrition
Provision of services for SAM
5. Support to families The LGU provides The LGU provides The LGU provides The LGU provides The LGU provides Accomplishment/
with severely acute one-time support in intermittent periodic support in periodic support in periodic support in Documentation
malnourished cash or kind to support in cash or cash or kind to cash or kind for cash or kind for reports
children accessing families with kind to families families with medical needs of medical and other Masterlist of
Inpatient Therapeutic severely acute with severely acute severely acute severely acute needs of severely children with SAM
Care (ITC) and malnourished malnourished malnourished malnourished acute malnourished
Outpatient children accessing children accessing children accessing children accessing children accessing
Therapeutic Care ITC or OTC in any ITC or OTC in any ITC or OTC in any ITC or OTC in any ITC or OTC in any
(OTC) in hospitals and of the facilities of the facilities of the facilities of the facilities of the facilities
field health facilities

Building capacity of local implementers

6. Hospital and field The LGU have only The LGU have only The LGU have more The LGU have at The LGU have at Capacity map
health and nutrition one or hospital two hospital and/or than two hospital least 10% buffer of least 10% buffer of Training report
staff trained on the and/or field health field health and and field health and commodities and commodities and Documentation
appropriate and nutrition staff nutrition staff nutrition staff supplies and supplies and report
competencies to trained on the trained on the trained on the hospital and more hospital and more
identify, treat and management of management of management of than two field than two field
manage all forms of malnutrition and malnutrition and malnutrition and health and nutrition health and nutrition
malnutrition and delivery of nutrition delivery of nutrition delivery of nutrition staff trained on the staff including a
deliver quality services under services under services under management of physician trained
services both under routine health routine health routine health malnutrition and on the
routine health program and during program and during program and during delivery of nutrition management of
program and during emergencies emergencies emergencies services under malnutrition and
emergencies routine health delivery of nutrition
program and during services under
emergencies routine health
program and during
emergencies

7. Functional The LGU maintains The LGU has a The LGU has a The LGU has a The LGU has a Masterlist of
two-way referral a master list of two-way referral functional two-way functional two-way functional two-way children with SAM
system adopted children with system but caters referral system and referral system in referral system in Referral forms
severe acute to less than 50% of caters to at least at least 80% of more than 80% of
malnutrition but barangays with 50% of barangays barangays with barangays with
does not have a severe acute with severe acute severe acute severe acute
two-way referral malnutrition cases malnutrition cases malnutrition cases malnutrition cases
system
5c National Dietary Supplementation Program
Dietary supplementation of pregnant and lactating women
8. Nutritionally-at- The LGU does not The LGU has a The LGU has a The LGU has a The LGU has a NDSP Reports
risk pregnant women have a dietary dietary dietary dietary dietary
enrolled/ covered in supplementation supplementation supplementation supplementation supplementation
the dietary program for program for program for program for program for
supplementation pregnant and pregnant and pregnant and pregnant and pregnant and
program lactating women lactating women lactating women lactating women lactating women
but covers less than and covers at least and covers at least and covers more
80% of the target 80% of the target 80% of the target than 80% of the
for 90 days for 90 days target for 90 days

9. Health and The LGU provided The LGU provided The LGU provided The LGU provided The LGU provided Local Nutrition Action Plan
nutrition workers training on the training on the training on the training on the training on the Training report
capacitated on the management of management of management of management of management of Capacity map
management of dietary dietary dietary dietary dietary
dietary supplementation of supplementation of supplementation of supplementation of supplementation of
supplementation of pregnant women to pregnant women to pregnant women to pregnant women to pregnant women to
pregnant women less than 50% of less than 50% of at least 80% of at least 80% of more than 80% of
target health and target health and target health and target health and target health and
nutrition workers nutrition workers nutrition workers nutrition workers nutrition workers
but less than 80% and at least 80% and more than 80%
completed the completed the completed the
training training training

Dietary supplementation of infants and young children 6-23 months

10. Infants and young The LGU has a The LGU has a The LGU has a The LGU has a The LGU has a Local Nutrition
children 6-23 months dietary dietary dietary dietary dietary Action Plan
old enrolled in the supplementation supplementation supplementation supplementation supplementation Accomplishment/
dietary program for infants program for infants program for infants program for infants program for infants documentation
supplementation and young children and young children and young children and young children and young children report
program regardless 6-23 months old 6-23 months old 6-23 months old 6-23 months old 6-23 months old Masterlist of
of nutritional status but covers less than but covers less than and covers at least and covers at least and covers more children 6-23
50% of the target 80% of the target 80% of the target 80% of the target than 80% of the months
for less than 132 for 132 days target for 132 days
days
11. Health and The LGU provided The LGU provided The LGU provided The LGU provided The LGU provided Local Nutrition
nutrition workers training on the training on the training on the training on the training on the Action Plan
capacitated on the management of management of management of management of management of Training report
management of dietary dietary dietary dietary dietary Capacity map
dietary supplementation of supplementation of supplementation of supplementation of supplementation of
supplementation of infants and young infants and young infants and young infants and young infants and young
infants and young children 6-23 children 6-23 children 6-23 children 6-23 children 6-23
children 6-23 months months old to less months old to less months old to at months old to at months old to more
old including linkages than 80% of target than 80% of target least 80% of target least 80% of target than 80% of target
with services of other health and nutrition health and nutrition health and nutrition health and nutrition health and nutrition
programs e.g. workers workers workers but less workers and at workers and more
promotion of infant than 80% least 80% than 80%
and young child completed the completed the completed the
feeding, training training training
micronutrient
supplementation

Dietary supplementation of children in child development centers and supervised neighborhood play

12. Children in child The LGU is aware The LGU is aware The LGU provides The LGU provides The LGU provides Supplementary
development centers of the dietary of the dietary assistance in cash, assistance for the assistance for the feeding program
and supervised supplementation supplementation kind or services for dietary dietary report
neighborhood play program for program for the dietary supplementation supplementation Documentation
provided with dietary children in child children in child supplementation program for program for report
supplementation development development program for children in child children in child Minutes of LNC
centers and centers and children in child development development meeting
supervised supervised development centers and centers and Local Nutrition
neighborhood play neighborhood play centers and supervised supervised Action Plan
but does not and assists in supervised neighborhood play neighborhood play,
provide any form of disseminating neighborhood play and utilizes data in utilizes data in
assistance information about formulating program
the program programs for formulation and
preschool children monitors progress
of implementation
during Local
Nutrition
Committee meetings
Dietary supplementation of wasted school children

13. Support to the The LGU is aware The LGU is aware The LGU provides The LGU provides The LGU provides School-based
School-based Feeding of the of the support in cash, support to the support to the feeding program
Program (SBFP) School-based School-based kind or services to School-based School-based report
targeting children Feeding Program Feeding Program the School-based Feeding Program Feeding Program Documentation
from Kinder to Grade (SBFP) targeting (SBFP) targeting Feeding Program (SBFP) and utilizes (SBFP), utilizes data report
VI who are wasted children from children from (SBFP) data for for programs Minutes of LNC
Kinder to Grade VI Kinder to Grade VI formulation of formulation and meeting
who are wasted but who are wasted programs for monitors progress Local Nutrition
does not provide and provides school age children of program during Action Plan
any support assistance in Local Nutrition
disseminating Committee
information about meetings
the program

5d National Nutrition Promotion Program for Behavior Change*

5e Micronutrient Supplementation

14. Pregnant women Pregnant women Pregnant women Pregnant women Pregnant women Pregnant women FHSIS Report
provided with were provided with were provided with were provided with were provided with were provided with Master list of
iron-folic acid iron-folic acid iron-folic acid iron-folic acid iron-folic acid iron-folic acid pregnant women
covering less than covering less than covering at least covering more than covering more than receiving iron-folic
50% of the target 80% of the target 80% of the 80% of the target 90% of the target acid
target

15. Pregnant and Pregnant and Pregnant and Pregnant and Pregnant and Pregnant and FHSIS Report
lactating women in lactating women in lactating women in lactating women in lactating women in lactating women in Master list of
areas endemic to areas endemic to areas endemic to areas endemic to areas endemic to areas endemic to pregnant and
iodine deficiency iodine deficiency iodine deficiency iodine deficiency iodine deficiency iodine deficiency lactating women
provided with iodized were provided with were provided with were provided with were provided with were provided with receiving iodized oil
oil capsules* iodized oil capsules iodized oil capsules iodized oil capsules iodized oil capsules iodized oil capsules capsules
but covers less than but covers less than but covers at least and covers more and covers more
50% of the target 80% of the target than 80% of the than 80% of the than 90% of the
target target target
16. Vitamin A Vitamin A capsules Vitamin A capsules Vitamin A capsules Vitamin A capsules Vitamin A capsules FHSIS Report
capsules provided to were provided to were provided to were provided to were provided to were provided to Master list of
children 6 mos -5 children 6 mos -5 children 6 mos -5 children 6 mos -5 children 6 mos -5 children 6 mos -5 children 6 mos. to 5
years old years old but years old but years old twice in years old twice in years old twice in years receiving
averaging less than average coverage is the previous year the previous year the previous year vitamin A
60% for the two at least 60% of the and covers at least and covers 91% to and covers 100% of
supplementation target for the 90% of the target 99% of the target the target
periods supplementation
period

17. Micronutrient Micronutrient Micronutrient Micronutrient Micronutrient Micronutrient FHSIS Report


powder provided to powder provided to powder provided to powder provided to powder provided to powder provided to Master list of
young children 6-23 young children 6-23 young children 6-23 young children 6-23 young children 6-23 young children 6-23 children 6-23
months old months old but months old but months old and months old and months old and months receiving
covers less than covers less than covers at least 80% covers more than covers at more MNP
50% of the target 80% of the target of the target 80% of the target than 80% of the
with at least 80% target with more
compliance than 80%
compliance
18. Weekly provision Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid School-based
of iron-folic acid tablets provided to tablets provided tablets provided tablets provided tablets provided Weekly Iron Folic
tablets to adolescent less than 80% weekly to less than weekly to 100% of weekly to 100% of weekly to 100% of Acid
female learners in adolescent female 100% of adolescent adolescent female adolescent female adolescent female Supplementation
public schools learners in public female learners in learners in public learners in public learners in public Report
through Weekly Iron schools public schools schools for two schools for two schools for two LNC minutes of
Folic Acid (WIFA) cycles cycles and cycles, information meeting
Supplementation information on the on the benefits of
Program benefits of WIFA WIFA disseminated
disseminated among parents and
among parents Local Nutrition
Committee
provided updates
during LNC
meetings
19. Weekly Iron Folic Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid FHSIS Report
Acid (WIFA) provided tablets not tablets provided tablets provided tablets provided tablets provided Master list of
to adolescent provided to less weekly to less than weekly to at least weekly to more weekly to 100% of adolescents
females in Grade 7 to than 50% of 80% of adolescent 80% of adolescent than 80% of adolescent females receiving WIFA
10 from private adolescent females females through females through adolescent females through Barangay
schools, through Barangay Barangay Health Barangay Health through Barangay Health Stations for
out-of-school Health Stations Stations Stations for two Health Stations for two cycles
adolescent females cycles two cycles for two
and women aged cycles
10-49 years not
covered by WIFA in
public schools

5f Mandatory Food Fortification

20. Retail outlets Less than 50% of Less than 75% of At least 75% of the More than 75% of Consistently above Local Nutrition
selling iodized salt retail outlets not retail outlets selling retail outlets selling retail stores selling 90% of retail stores Action Plan
selling iodized salt iodized salt iodized salt adequately iodized selling adequately Master list of retail
salt iodized salt outlets selling
iodized salt

21. Bakery owners Less than 50% of Less than 75% of At least 75% of the More than 75% of Consistently above Local Nutrition
using vitamin A the bakery owners the bakery owners bakery owners are bakery owners are 90% of bakery Action Plan
fortified flour are using vitamin A are using vitamin A using vitamin A using vitamin A owners are using Master list of
fortified flour in fortified flour in fortified flour in fortified flour in vitamin A fortified bakeries using
baked products baked products baked products/eij baked products flour in baked fortified flour
products

22. Establishments Less than 50% of Less than 75% of At least 75% of More than 75% of Consistently above Local Nutrition
selling vitamin A selling vitamin A vitamin A fortified establishments establishments 90% of the Action Plan
fortified cooking oil fortified cooking oil cooking oil selling vitamin A selling vitamin A establishments Master list of
fortified cooking oil fortified cooking oil selling vitamin A markets selling
fortified cooking oil vitamin A fortified
cooking oil

5g Nutrition in Emergencies Program

23. NiEm Plan NiEm Plan NiEm Plan was NiEm Plan was NiEm Plan was NiEm Plan was Local Nutrition
integration in the developed but not developed and developed and developed, developed, Action Plan
DRRM-H plan and integrated in the integrated to the integrated to the integrated to the integrated to the Local DRRM Plan
Local DRRM Plan Local Nutrition Local Nutrition Local Nutrition Local Nutrition Local Nutrition Comprehensive
Action Plan Action Plan but not Action Plan, Action Plan, Action Plan, Development Plan
integrated to the DRRM-H plan and DRRM-H plan and DRRM-H plan and
DRRM-H plan and Local DRRM Plan Local DRRM Plan Local DRRM Plan,
Local DRRM Plan and implemented implemented and
reviewed
24. Staff trained and Personnel provided Less than 80% of At least 80% of Personnel trained Personnel trained Local Nutrition
capacitated on NiEm with NiEM target number of target number of on NiEm and on NiEm and Action Plan
and information materials but not personnel trained personnel trained information information Training report
management trained on NiEm on NiEm and on NiEm and management management Capacity Map
and information information information deployed and deployed and
management management management covered at least covered at more
80% of target 80% of target

25. Key supplies Key supplies Key supplies Key supplies Key supplies Key supplies NIEM Plan
stockpiled, available but not stockpiled or stockpiled or stockpiled or stockpiled or Inventory of
pre-positioned and pre-positioned pre-positioned but pre-positioned and pre-positioned and pre-positioned and nutrition supplies
mobilized per NIEM when needed less than the 10% within the required within the required within the required and commodities
Strategic Plan buffer stock of the 10% buffer stock of 10% buffer stock of 10% buffer stock of
2017-2022 when total quantity of the total quantity the total quantity the total quantity
needed commodities of commodities of commodities of commodities
a. Tents available at the available at the available at the available at the
b. Vitamin A RHU (Vitamin A, RHU (Vitamin A, RHU (Vitamin A, RHU (Vitamin A,
(100,000) and Micronutrient Micronutrient Micronutrient Micronutrient
200,000 IU) Powder, Iron-Folic Powder, Iron-Folic Powder, Iron-Folic Powder, Iron-Folic
c. Micronutrient Acid) Acid) Acid). Nutrition Acid). Nutrition
Powders assessment tools assessment tools,
d. Iron-Folic Acid and equipment also equipment and
e. Nutrition IEC available breastfeeding kit
materials also available
f. MUAC Tapes
g. Weighing scales
h. CGS reference
tables
i. Height boards
j. Ready-to-Use
Therapeutic Food
k. Ready-to-Use
Supplementary Food
l. Antibiotics,
deworming tablets
Breastfeeding kits
(bag, feeding cup
with cover, food
container with spoon
and fork, 1L glass
tumbler with cover,
IEC materials, birth
registration form
5h Overweight and Obesity Management and Prevention Program

26. Activities on the LGU conducted LGU conducted LGU conducted LGU conducted LGU conducted Local Nutrition
promotion of healthy only one activity on more than one more than one more than one more than one Action Plan
lifestyle (physical the promotion of activity on the activity on the activity on the activity on the Approved Annual
activity and healthy healthy lifestyle promotion of promotion of promotion of promotion of budget
eating) included in and not included in healthy lifestyle healthy lifestyle healthy lifestyle healthy lifestyle Accomplishment
the LGU budget the approved LGU and not included in included in the including including report/
budget the approved LGU approved LGU monitoring and monitoring and documentation
budget budget with allocation in with allocation in report
the approved LGU the approved LGU
budget budget and budget
from external
partners

27. IEC materials on IEC materials on LGU developed/ LGU developed/ LGU developed/ LGU developed/ Local Nutrition
healthy lifestyle healthy lifestyle distributed IEC distributed IEC distributed IEC distributed IEC Action Plan
developed and/or available at the materials on materials on materials on materials on Accomplishment
distributed LGU but not healthy lifestyle to healthy lifestyle to healthy lifestyle to healthy lifestyle to report
distributed to less than 80% of at least 80% of the more than 80% of 100% of the target Inventory of IEC
target population the target target the target materials
IEC materials

5i Nutrition-Sensitive Programs
NS Programs to increase income and improve economic access to food
28. Households with LGU does not LGU provides less LGU provides at LGU provides more LGU provides 100% Local Nutrition
nutritionally provide households than 80% of least 80% of than 80% of of households with Action Plan
vulnerable or with nutritionally households with households with households with nutritionally Accomplishment/
affected provided vulnerable or nutritionally nutritionally nutritionally vulnerable or Documentation
with livelihood affected with vulnerable or vulnerable or vulnerable or affected with report
opportunities livelihood affected with affected with affected with livelihood Master list of
opportunities livelihood livelihood livelihood opportunities beneficiaries
opportunities opportunities opportunities

NS Programs to improve physical access to food

29. Gulayan sa Less than 80% of At least 80% of 100% of schools 100% of the 100% of the Local Nutrition
Paaralan established the schools schools maintain a established a schools maintain a schools maintain a Action Plan
and maintained in maintain a Gulayan Gulayan sa Gulayan sa Gulayan sa Gulayan sa GPP reports
schools sa Paaralan Paaralan Paaralan with Paaralan with Paaralan during
produce used for produced used for school days and
the School-based School-based during summer with
feeding Program feeding Program produced used for
School-based
feeding Program
30. Households with LGU provide inputs LGU provide inputs LGU provide inputs LGU provide inputs LGU provide inputs Local Nutrition
nutritionally for home gardening for home gardening for home gardening for home gardening including seeds Action Plan
vulnerable or to less than 80% of to at least 80% of to more than 80% to 100% of contributing to any Accomplishment/
affected provided households with households with of households with households with two of the documentation
with inputs for home nutritionally nutritionally nutritionally nutritionally nutrients: reports
gardening vulnerable or vulnerable or vulnerable or vulnerable or carbohydrates, Master list of
affected affected affected affected protein and vitamin beneficiaries
A or iron to 100%
of households with
nutritionally
vulnerable or
affected

NS Programs to improve access to safe drinking water and sanitary toilet facilities

31. Households with LGU ensures that LGU ensures that LGU ensures that at LGU ensures that LGU ensures that Local Nutrition
nutritionally less than 50% of less than 75% of least 75% more than 75% of 100% of Action Plan
vulnerable or the households households households households households Accomplishment
affected provided with nutritionally especially those especially those especially those especially those report
with access to safe vulnerable or with nutritionally with nutritionally with nutritionally with nutritionally OPT Plus Family
drinking water affected are vulnerable or vulnerable or vulnerable or vulnerable or Profile
provided with affected are affected are affected are affected are
access to safe provided with provided with provided with provided with
drinking water access to safe access to safe access to safe access to safe
drinking water drinking water drinking water drinking water

32. Households with LGU ensures that LGU ensures that LGU ensures that at LGU ensures more LGU ensures that Local Nutrition
nutritionally less than 50% of less than 75% of least 75% of than 75% 100% of Action Plan
vulnerable or households households households households households Accomplishment
affected provided especially those especially those especially those especially those especially those report
with access to with nutritionally with nutritionally with nutritionally with nutritionally with nutritionally OPT Plus Family
sanitary toilet vulnerable or vulnerable or vulnerable or vulnerable or vulnerable or Profile
facilities affected provided affected provided affected provided affected provided affected provided Master list of
with access to with access to with access to with access to with access to household with
sanitary toilet sanitary toilet sanitary toilet sanitary toilet sanitary toilet access to sanitary
facilities facilities facilities facilities facilities toilets
33. Schools provided Schools implement Schools implement Schools Schools Schools DepED WinS
with access to safe less than 5 of the at least the 5 implementing the implementing the implementing the Reports
water, adequate crucial indicators crucial indicators WinS was given a WinS was given a WinS was given a
toilets, handwashing for the for the one-star rating two-star rating three-star rating
facilities through the implementation of implementation of based on the based on the based on the
WASH in Schools the WinS program the WinS program DepED WinS Three DepED WinS Three DepED WinS Three
(WinS) program/eij 1. Safe drinking Star Approach Star Approach Star Approach
water
2. At least one set
of gender
segregated toilets
3. Group
handwashing
facility with soap
4. Group
handwashing
activities
5. Access to
sanitary pads within
the school

NS Programs to prevent teen-age pregnancy

34. Adolescent LGU does not LGU implements LGU implements LGU implements LGU implements
Health Development implement the the Adolescent the Adolescent the Adolescent the Adolescent
Program Adolescent Health Health Health Health Health
implemented Development Development Development Development Development
Program Program but covers Program and covers Program and covers Program and covers
less than 80% of at least 80% of the more than 80% of 100% of the targets
the targets only targets the targets

5j Local Initiatives (e.g. The LGU does not The LGU The LGU The LGU The LGU Local Nutrition
Research, have a local implements at least implements more implements and implements, Action Plan
Development of initiative one (1) local than one local monitors more monitors and Project/ Activity
learning sites) initiative initiative than one local sustains more than Documentation
initiative one local initiative Reports

35. Local initiative 1

36. Local initiative 2

37. Local initiative 3


MELLPI PRO FORM B: BARANGAY PROFILE SHEET

Barangay Municipality/ City/


Province
Date of Monitoring Period Covered

TOTAL POPULATION NO. OF HOUSEHOLDS NO. OF SITIOS/ PUROKS

Population 6-11 mos 6-23 mos 12-59 mos 0-59 mos Pregnant Lactating
No. of households with Estimated
access to safe water Actual
11 1,2,3
No. of households with Nutritional Status of Preschool Children (0 - 59 months)
sanitary toilets yr yr yr
Normal
7 No. of Day Care Centers Underweight
Severely Underweight
8,15,25 No. of public elementary Overweight
schools
Normal
15,25 No. of public secondary Wasted
schools Severely Wasted
Overweight
16 No. of Barangay Health Obese
Stations
Normal
17,19 No. of retail outlets/ Stunted
sari-sari stores Severely Stunted
Tall
18 No. of bakeries
Nutritional Status of School Children
No. of public markets Normal
Wasted
No. of transport Severely Wasted
terminals Overweight
Obese
Percent of lactating mothers
exclusively breastfeeding Nutritional Status of Pregnant Women
until the 5th month Normal
Nutritionally at-risk
Terrain Overweight
Obese

Hazards (Type/ Month) LGU/ Households affected Land Use Classification Land Area Remarks
Residential
Commercial
Industrial
Agricultural
Forest land, Mineral land, National Park

INTERVENTIONS WITH ACTION LINES FROM NGA/ NEW STANDARDS

Intervention Type Source Available/ Date Volume/


Remarks
NGA/ LGU/ NGO/ Private Received Y/N received No. of Pax
4 I. Philippine Integrated
Managements of Acute Training
Malnutrition

II. National Dietary


Suppplementation Program

5 1. Pregnant Women Dietary Supplementation

6 2. Children 6-23 months Dietary Supplementation

III. Micronutrient Supplementation

11 1. Iron-Folic Acid
Supplementation for Commodity
Pregnant Women

12 2. Vitamin A
Supplementation for Commodity
children 6-11 months

13 3. Vitamin A
Supplementation for Commodity
children 12-59 months

14 4. Micronutrient Powder
for children 6-23 months Commodity

15 5. Weekly Iron-Folic Acid


Supplementation for
female adolescents in Commodity
public schools

16 6. Weekly Iron-Folic Acid


Supplementation for
female adolescents in Commodity
outside the public school
system

IV. Mandatory Food Fortification


Saktong Iodine sa ASIN
17 1. Retail outlets selling (SISA Seal) Yes
adequately iodized salt

MELLPI Pro Form B 24 of 84


Yes

OR($C$37="",$C$37=0,$C$3
V. Nutrition-in-Emergencies
20 1. NiEM Plan integrated in
the Local Disaster Risk Training
Reduction Management Plan

MELLPI Pro Form B 25 of 84


MELLPI PRO FORM B 1a: BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL DOCUMENT REMARKS/


ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
1. VISION AND MISSION
1a Presence and A vision mission A vision mission The vision mission The vision mission The vision mission Barangay Nutrition
knowledge of vision statement for statement for statement for statement for statement for Action Plan
mission statement nutrition was nutrition was nutrition program nutrition program nutrition program Minutes of Meeting
formulated but not formulated and exists and exists and exists and Documentation of
reflected in the reflected in the disseminated to disseminated to disseminated to dissemination
Barangay Nutrition Barangay Nutrition BNC members BNC members and BNC members,
Action Plan Action Plan other stakeholders stakeholders and to
the rest of the
community

MELLPI Pro Form B 26 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
1. VISION AND MISSION
1b Presence of Nutrition-related Nutrition-related PPAN-related PAP Nutrition-related Nutrition outcomes Barangay
nutrition-related PAP is integrated in PAP are integrated are integrated in at objectives are included in the Development Plan
concerns in the one of the sectoral in at least two of least three of the included in at least overall success
Barangay plans in the the sectoral plans sectoral plans in three of the indicators of the
Development Plan Barangay in the Barangay the Barangay sectoral plans Barangay
Development Plan Development Plan Development Plan Development Plan

1c Presence of At least one At least two At least three At least four More than four Annual Investment
nutrition-related nutrition-related nutrition-related PPAN-related PAP PPAN-related PPAN-related Program
concerns in the PAP integrated in PAP integrated in integrated in the PAP and/or PS for PAP and/or PS for
Annual Investment the Annual the Annual Annual Investment nutrition integrated nutrition integrated
Program Investment Investment Program in in
Program Program the Annual the Annual
Investment Investment
Program Program

MELLPI Pro Form B 27 of 84


MELLPI PRO FORM B 1a: BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2a Adoption, Barangay Nutrition The barangay passed a The barangay The PAPs in the The PAPs in the Resolutions
implementation and Action Plan formulated resolution adopting the passed a resolution Barangay Nutrition Barangay Nutrition Barangay Nutrition
monitoring of Barangay Nutrition adopting the Action Plan are Action Plan are Action Plan
Barangay Nutrition Action Plan Barangay Nutrition implemented and implemented and Approved Annual
Action Plan Action Plans and accomplishments are accomplishments are Budget
allocating funds reported during BNC reported during BNC PPAN
thereof meetings once a year meetings at least twice a Accomplishment
year Report
Minutes of meeting

2b Adoption of newly The barangay The law was discussed in The Barangay The barangay The barangay Copy of the law
passed national/ maintains a printed/ one of the Barangay Nutrition maintained a copy of implemented activities Minutes of meetings
sectoral policies electronic copy of RA Nutrition Committee Committee passed a the resolution in the to disseminate Resolution
11148 meetings within one resolution/ barangay hall provisions of the law to Documentation of
Republic Act 11148 year after it was enacted ordinance adopting the general public posting and/or
Kalusugan at RA 11148 dissemination
Nutrisyon ng activities
Mag-Nanay Act of
2019

MELLPI Pro Form B 28 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS

2c Republic Act 11037 The barangay The law was discussed in The Barangay The barangay The barangay Copy of the law
Masustansyang maintains a printed/ one of the Barangay Nutrition maintained a copy of implemented activities Minutes of meetings
Pagkain Para sa electronic copy of RA Nutrition Committee Committee passed a the resolution in the to disseminate Resolution
Batang Pilipino 11037 meetings within one resolution/ barangay hall provisions of the law to Documentation of
year after it was enacted ordinance adopting the general public posting and/or
RA 11037 dissemination
activities

2d Adoption, The barangay The barangay has a The barangay The barangay The barangay conducted Copy of the law
implementation and maintains a printed/ resolution/ ordinance/ conducted activities conducted activities activities to promote Resolution/
monitoring of electronic copy of EO Executive Order and/or a to promote to monitor and monitor compliance Ordinance
national/ sectoral 51 line item in the compliance to EO compliance to EO 51 to EO 51 and reporting Barangay Nutrition
nutrition policies Approved Annual Budget 51 of results during BNC Action Plan
on EO 51 - related meetings Approved Annual
Executive Order 51: concerns Budget
National Code of Documentation of
Marketing Breastmilk promotion and
Substitutes, monitoring
Breastmilk
Supplements and
Other Related
Products

MELLPI Pro Form B 29 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2e Republic Act 10028: The barangay The barangay has a The barangay The barangay The barangay conducted Copy of the law
Expanded maintains a printed/ resolution/ ordinance conducted activities conducted activities to activities to monitor Resolution/
Breastfeeding electronic copy of RA and/or budget in the to promote monitor compliance to compliance to RA 10028 Ordinance
Promotion Act of 10028 and/or DILG MC Approved Annual Budget compliance to the RA 10028 and maintains an Barangay Nutrition
2009 2011-54 on RA 10028 - related law updated masterlist of Action Plan
concerns establishments/ offices Approved Annual
DILG Memorandum with lactation stations Budget
Circular 2011-54 Documentation of
Implementation and promotion and
Monitoring of the monitoring
National Masterlist of
Breastfeeding Policy establishments/
offices with
lactation stations

2f Republic Act 8172: An The barangay The barangay has a The barangay The barangay The barangay conducted Copy of the law
Act for Salt Iodization maintains a printed/ resolution/ ordinance conducted activities conducted activities to activities to monitor Resolution/
Nationwide (ASIN electronic copy of RA and/or budget in the to promote monitor compliance to compliance to RA 8172 Ordinance
Law) 8172 Approved Annual Budget compliance to the RA 8172 and maintains an Barangay Nutrition
on RA 8172 - related law updated masterlist of Action Plan
concerns retail stores selling Documentation of
iodized salt promotion and
monitoring
Masterlist of
retail stores selling
iodized salt

MELLPI Pro Form B 30 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2g Republic Act 8976: The barangay The barangay has a The barangay The barangay The barangay conducted Copy of the law
Philippine Food maintains a printed/ resolution/ ordinance conducted activities conducted activities to activities to monitor Resolution/
Fortification Act electronic copy of RA and/or budget in the to promote monitor compliance to compliance to RA 8976 Ordinance
8976 Approved Annual Budget compliance to the RA 8976 and maintains an Barangay Nutrition
on RA 8976 - related law updated masterlist of Action Plan
concerns retail stores selling Approved Annual
fortified foods Budget
Documentation of
promotion and
monitoring
Masterlist of
retail stores selling
fortified foods

2h NNC Governing The barangay The activities in the The activities in the The BNC monitors The BNC discuss the Resolutions
Board Resolution maintains a printed/ Barangay Nutrition Barangay Nutrition implementation of the result of monitoring and Ordinances
No.1 series of 2017: electronic copy of NNC Action Plan are Action Plan are PPAN priorities in the identify action lines to Barangay Nutrition
Approving and GB Resolution No. 1 S. aligned with the aligned with the Barangay Nutrition improve Action Plan
Adopting the 2017 and/or DILG MC priorities of the priorities of the Action Plan implementation of the Approved Annual
Philippine Plan of 2018-42 PPAN 2017-2022 PPAN 2017-2022 PPAN priorities Budget
Action for Nutrition are allocated with Minutes of meeting
2017-2022 budget based on Minutes of meeting
the approved Accomplishment/
DILG MC 2018-42 annual budget Documentation
Adoption and reports
Implementation of
PPAN 2017-2022

MELLPI Pro Form B 31 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2i NNC Governing The barangay The barangay has any The barangay uses The barangay uses The barangay uses Approved Annual
Board Resolutions maintains a printed/ type of height and the type of height verified height and verified height and Budget
Nos. 1) 3 S.2012: electronic copy of NNC length measuring tools and length length measuring length measuring tools Local Nutrition
Approving the GB Resolution available in the barangay measuring tools of tools of wooden/ non- of wooden/ non-wood Action Plan
Guidelines on the No. 3 S. 2012 and No. 3 wooden/ non-wood wood material material as prescribed in OPT Plus Report
Fabrication, S. 2018 material prescribed prescribed in the the guidelines and
Verification, and in the guidelines guidelines allocates budget for
Maintenance of maintenance/
Wooden Height replacement of height
Boards 2) 3 S.2018: and length measuirng
Approving the tools as necessary
Guidelines on the
Selection of
Non-Wood Height
and Length
Measuring Tool

2j NNC Governing The LNC maintains a The barangay conducts The barangay The barangay The barangay conducts OPT Plus
Board Resolution printed/ electronic OPT Plus but not in conducts OPT Plus conducts OPT Plus as OPT Plus, utilizes the E- Implementing
No.2 S.2012: copy of NNC GB accordance to the as provided in the provided in the OPT tool and Guidelines
Approving the Resolution No. 3 guidelines on the ff: guidelines: guidelines and uses E- disseminates results Barangay Nutrition
Revised S.2012 1. Use of proper 1. Use of proper OPT during the BNC Action Plan
Implementing measurement tools measurement tools meetings Consolidated OPT
Guidelines on 2. At least 80% coverage 2. At least 80% Plus Report
OPT Plus 3. Timely submission coverage Masterlist of
3. Timely malnourished
submission children
Minutes of meeting

MELLPI Pro Form B 32 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
2. NUTRITION POLICIES AND LAWS
2k NNC Governing The barangay The barangay has a The barangay The barangay The barangay conducted Resolutions
Board Resolution No. maintains a printed/ resolution, ordinance, implemented at conducted more than more than one activity Ordinances
6 series of 2012: electronic copy of NNC Executive Order least one activity one activity to to promote the NGF Executive Order
Adoption of the 2012 GB Resolution No. 6 S. in support to the with multi- promote the NGF using more than one Approved Annual
Nutritional Guidelines 2012 resolution stakeholder media/ platform Budget
for Filipinos participation to Barangay Nutrition
promote the NGF Action Plan
Minutes of meeting
Accomplishment/
documentation
report

2l NNC Governing The barangay The barangay designated The barangay has Barangay Nutrition Barangay Nutrition Resolutions
Board Resolution No. maintains a printed/ the lead or focal point issued a resolution Cluster has been Cluster has been Ordinances
2 series of 2009: electronic copy of NNC for Nutrition-in- organizing the formed and planning formed and integrated Executive Order
Adopting the National GB Resolution Emergencies nutrition cluster in has been initiated/ with the BDRRMC with Barangay Nutrition
Policy on Nutrition No. 2 S. 2009 the area completed allocated budget Action Plan
Management in NIEM Plan
Emergencies and Minutes of meeting
Disasters

MELLPI Pro Form B 33 of 84


MELLPI PRO FORM B 1a: BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL DOCUMENT REMARKS/


ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
3. GOVERNANCE AND ORGANIZATIONAL STRUCTURE

MELLPI Pro Form B 34 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
3. GOVERNANCE AND ORGANIZATIONAL STRUCTURE
3a Presence of Barangay The BNC is The BNC is The BNC is The BNC is The BNC is Barangay Nutrition
Nutrition Committee organized but organized but does organized with the organized with the organized with the Action Plan
(BNC) membership is not include all Barangay Captain Barangay Captain Barangay Captain Resolutions
limited to 1 to 2 nutrition-related as chairperson and as chairperson, as chairperson, Executive Order
sectors only sectors as is composed of all composed of composed of Organizational
applicable in the nutrition-related nutrition-related nutrition-related Chart
barangay (pursuant sectors in level 2 as sectors in level 2 as sectors in level 2 as
to PPAN IG S.1981 applicable in the applicable in the applicable in the
and EO 234 S.1987) barangay barangay and is barangay and
1. Barangay supported by a external partners,
Captain resolution is supported by a
2. Kagawad on indicating the resolution
Health functions of each indicating the
3. Rural Health member functions of each
Midwife member and
4. Child reorganized as
Development necessary
Worker
5. School Principal/
Teacher
6. Agriculture
Technician (if
existing)
7. Barangay
Secretary

MELLPI Pro Form B 35 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
3. GOVERNANCE AND ORGANIZATIONAL STRUCTURE
3b Presence of Nutrition The barangay has The barangay The barangay The barangay The barangay Resolution
Office and Personnel designated a designated a BNS designated a BNS designated a BNS designated a BNS Executive Order
Barangay Nutrition and allocated with monthly with monthly with monthly Barangay Nutrition
Scholar budget for monthly honorarium, honorarium, honorarium, Action Plan
honorarium budget for supplies budget for supplies budget for supplies, Organizational
and designated a and designated a designated a BNS Chart
BNS desk BNS corner/ office corner/ office and Approved Annual
is assisted by Budget
Barangay Health
Workers or other
bgy personnel in
the conduct of OPT
Plus or other
activities

3c Decision-making and The BNC is The BNC is The BNC are The BNC The BNC are Minutes of meeting
Leadership of the convened only convened more convened at least are convened at convened at least Barangay Nutrition
Barangay Nutrition once for the than once to twice to: least three times to four times to Action Plan
Committee conduct of one disseminate 1. Disseminate accomplish accomplish Accomplishment
nutrition-related nutrition-related nutrition-related activities in level activites in level 4 Report
activity information information three and discuss and discuss
2. Formulate the implementation of progress of
Barangay Nutrition activities implementation of
Action Plan the Barangay
Nutrition Action
Plan

MELLPI Pro Form B 36 of 84


MELLPI PRO FORM B 1a: BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL DOCUMENT REMARKS/


ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS
4a Nutrition Assessment Updated Operation Only updated and Updated and OPT Plus and Nutrition situation Consolidated OPT
Timbang Plus consolidated OPT consolidated OPT school weighing prepared and used Plus reports
reports available Plus reports are Plus reports reports (as in the formulation School weighing
but not available available and applicable) used to of the Barangay reports
consolidated school weighing prepare nutrition Nutrition Action Nutrition Situation
reports as situation report Plan Barangay Nutrition
applicable and Action Plan
reported during
BNC meetings

MELLPI Pro Form B 37 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS
4b Planning Barangay Nutrition BNAP is formulated BNAP formulated BNAP formulated PAPs in the BNAP is Barangay Nutrition
Action Plan is and adopted and adopted in Level 3 is integrated in the Action Plan
formulated but not through a through a reviewed and Barangay Resolutions
adopted through a resolution with resolution with updated at least Development Plan Minutes of Meeting
resolution allocation of funds allocation of fund once a year Barangay
adopts a three year Development Plan
format

MELLPI Pro Form B 38 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS
4c Resource Generation Only one activity in The budget for the The PAPs in the The budget for The budget for Barangay Nutrition
and Mobilization the BNAP is funded BNAP is limited to BNAP are BNAP in the BNAP includes Action Plan
in the approved sectoral budgets in integrated in the approved annual honorarium/ Annual Investment
barangay budget the approved approved annual barangay budget allowance for BNS Program
barangay budget barangay budget includes and nutrition Approved Annual
Program honorarium/ program from the Barangay Budget
allowance for BNS approved annual Summary of
and nutrition barangay budget Income and
program budget and funding from Expenditures
and program external sources

Less than 70% of At least 70% of At least 90% of More than 90% of 100% of BNAP
BNAP budget in the BNAP budget in the BNAP budget in the BNAP budget in the budget in the
annual barangay annual barangay annual barangay annual barangay annual barangay
budget utilized budget utilized budget utilized budget utilized budget utilized

4d Service Delivery Less than 50% of More than 50% of At least 80% of the More than 80% of 100% of the Barangay Nutrition
the malnourished the malnourished malnourished are the malnourished malnourished are Action Plan
are targeted in are targeted in targeted in delivery are targeted in targeted in delivery Masterlist of
delivery of delivery of of barangay-funded delivery of of barangay-funded malnourished
barangay-funded barangay-funded nutrition programs barangay-funded nutrition programs children
nutrition programs nutrition programs nutrition programs Masterlist of
beneficiaries

MELLPI Pro Form B 39 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS

4e Monitoring and Monitoring Interagency Interagency Interagency Results of Barangay Nutrition


Evaluation conducted by BNS monitoring monitoring monitoring interagency Action Plan
only conducted but not conducted and conducted and monitoring Monitoring report
documented documented at documented at disseminated Documentation
least once a year least twice a year during BNC report
meeting/s and used Minutes of meeting
in BNAP
formulation

4f Capacity Only one member Only two members Barangay Captain, Three BNC More than three Barangay Nutrition
Development of the Barangay of the BNAP Kagawad on Health members in Level 3 BNC members Action Plan
Nutrition trained/ oriented and one BNC trained/ oriented in trained/ oriented in Accomplishment
Barangay Nutrition Committee trained/ on BNAP member trained/ BNAP formulation BNAP formulation Report
Committee members oriented on formulation oriented on BNAP and attended least and attended at Training Cetificates
Baranagy Nutrition formulation one nutrition- least one nutrition- Documentation
Action Plan related trainings/ related training/
formulation forums within the forum within the
year year

MELLPI Pro Form B 40 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
1 2 3 4 5 SOURCE EVIDENCE
4. LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS
Barangay Nutrition Less than 100% of 100% of BNSs 100% of BNSs 100% of BNSs 100% of BNSs Barangay Nutrition
Scholars BNSs trained in trained in Basic trained in Basic trained in Basic trained in Basic Action Plan
Basic Course for Course for BNS Course for BNS and Course for BNS and Course for BNS and Accomplishment
BNS at least one BNS at least one BNS at least one BNS Report
trained/ oriented trained/ oriented trained/ oriented Training Cetificates
on Barangay on Barangay on Barangay Documentation
Nutrition Action Nutrition Action Nutrition Action
Plan formulation Plan formulation Plan formulation
and less than 50% and more than 50%
of the BNSs of the BNSs
attended at least attended at least
one nutrition- one nutrition-
related training/ related training/
forum forum

MELLPI Pro Form B 41 of 84


MELLPI PRO FORM B 1a: BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL REMARKS/


ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5a Infant and Young Child Feeding
0.00
Community-based health and nutrition support strengthening ###

MELLPI Pro Form B 42 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
1. Functional Breastfeeding Breastfeeding Breastfeeding Breastfeeding Breastfeeding Written agreement on
breastfeeding support group support group support group support group support group estbalishment of
support group established in the oriented on Infant conducted conducted conducted activities Breastfeeding Support
barangay with and Young Child activities such as activities in Level 3 and maintains a list of Group
written agreement Feeding and Milk peer counseling, and maintains a list lactating mothers and Directory of members
of its establishment Code and provided sharing of of lactating status of Documentation of activities
and directory of guidance in the experience and mothers and status breastfeeding and/or Masterlist of lactating
members conduct of peer assistance in of breastfeeding complementary mothers with breastfeeding
counselling and breastfeeding and and/or feeding and conducts and complementary
referral complementary complementary follow through feeding status
feeding for feeding including activities until the
pregnant and information on lactating mother have
lactating mothers those with ransitioned from
breastfeeding or exclusive
complementary breastfeeding to
feeding challenge continued
breastfeeding with
complementary
feeding

s
0

MELLPI Pro Form B 43 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
Establishment of breastfeeding places in barangay facilities

2. Lactation stations The barangay has The barangay has The barangay has The barangay has The barangay has (By ocular
established in one lactation one lactation one lactation one lactation more than one inspection)
barangay facilities station but not station accessible station accessible station as lactation station as Documentation
such as Barangay maintained to the public and to the public, well- described in level 3 described in level 3 report
Health Stations, well-maintained maintained and has and maintains a and maintains a Lactation station logbook
multi-purpose hall accessible logbook of users logbook of users of users
and in public schools handwashing
facility,
comfortable seats
and proper
ventilation

Promotion of compliance to the Milk Code

3. Activities The barangay have The Barangay The Barangay The Barangay Members of the Milk code materials
conducted to Milk Code materials Health Station is Health Station issued a Barangay Nutrition Ocular inspection of the
promote compliance posted in the compliant to the includes the Milk resolution in Committee conduct Barangay Health Station
to Executive Order Barangay Health Milk Code Code in its Infant support of the Milk inspection in the IYCF classes learning
51, Milk Code Station and Young Child Code including Barangay Health materials
Feeding classes for regular inspection Stations at least Resolution
pregnant and of Barangay Health twice a year to Documentation Report
lactating mothers Station/s ensure compliance of
health workers and
clients in the public
health facility

MELLPI Pro Form B 44 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5b Philippine Integrated Management of Acute Malnutrition
0
Provision of services for Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)
4. Referral of The LGU only Barangay conducts Barangay conducts Barangay conducts Barangay conducts Masterlist of
severely and maintains a active case finding active case finding active case finding active case finding children with SAM
moderately acute master list of of SAM and MAM of SAM and MAM of SAM and MAM of SAM and MAM Referral forms
malnourished children with cases cases and refers cases, refers cases cases, refers cases to
children to Barangay severe and cases to the to the appropriate the appropriate
Health Stations moderate acute appropriate facility facility for PIMAM facility for PIMAM
and/or Rural Health malnutrition for PIMAM and monitors the and monitors the
Units progress of the progress of the SAM
SAM and MAM and MAM cases
cases enrolled but enrolled and reports
not reported monthly
monthly

5c National Dietary Supplementation Program


0.00
Dietary supplementation of pregnant women
5. Nutritionally-at- The barangay The barangay The barangay The barangay The barangay Barangay Nutrition Action
risk pregnant women monitors the implements/ implements/ implements/ implements/ Plan
enrolled/ covered in nutritional status of coordinates the coordinates the coordinates the coordinates the Accomplishment/
the dietary all pregnant dietary dietary dietary dietary Documentation reports
supplementation women supplementation supplementation supplementation supplementation NDSP Reports
program program and program and program and program and covers
covers less than covers at least 90% covers more than 100% of the target
90% of the target of the target 90% of the target pregnant women for
pregnant women pregnant women pregnant women 90 days
for 90 days for 90 days for 90 days days

1 0

MELLPI Pro Form B 45 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
Dietary supplementation of infants and young children 6-23 months

6. Infants and young The barangay The barangay The barangay The barangay The barangay Barangay Nutrition Action
children 6-23 months monitors the implements/ implements/ implements/ implements/ Plan
old enrolled in the nutritional status of coordinates the coordinates the coordinates the coordinates the Accomplishment/
dietary all infants and dietary dietary dietary dietary documentation
supplementation young children 6- supplementation supplementation supplementation supplementation report
program 23 months program and program and program and program and covers Masterlist of
covers less than covers at least 90% covers more than more than 100% of children 6-23
90% of all infants of all infants and 90% of all infants all infants and young months
and young children young children 6- and young children children 6-23 months
6-23 months for 90 23 months for 90 - 6-23 months for 90 for 90 - 120 days
- 120 days 120 days - 120 days

Dietary supplementation of children in child development centers and supervised neighborhood play

MELLPI Pro Form B 46 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
7. Children in child Child Development CDW shares BNC uses the data BNC implements BNC assesses the Minutes of meeting
development centers Worker (CDW) consolidated data on the nutritional the PAPs and effectiveness and Nutrition Situation
and supervised provides updates to the Barangay status of children in monitors the efficiency of the PAPs Local Nutrition Action Plan
neighborhood play on the Nutrition child development progress in formulated to Supplementary Feeding
provided with dietary Supplementary Committee and centers and improving the complement the Report
supplementation Feeding in Day Care used for the supervised nutritional status of supplementary Plan Implementation
Centers and preparation of the neighborhood play children in child feeding program in Report
Supervised nutrition situation for the development child development
Neighborhood Play in the area identification of centers and centers and
during the PAPs for preschool- supervised supervised
Barangay Nutrition age children in the neighborhood play neighborhood play
Committee local nutrition and provides
meeting/s action plan to recommendations to
complement the improve
supplementary implementation of
feeding program PAPs

0 0

Dietary supplementation of wasted school children

8. Support to the Barangay Nutrition BNC member from The progress of The barangay The barangay School-based feeding
School-based Feeding Committee DepED shares implementation is provides utilizes the data program report
Program (SBFP) member from consolidated data shared by the assistance as shared in the Documentation report
targeting children DepED provides to the Barangay school and agreed with the assessment and Minutes of BNC meeting
from Kinder to Grade updates on the Nutrition discussed by the school formulation of Barangay Nutrition Action
VI who are wasted School-based Committee and BNC to identify activities in the BNAP Plan
Feeding Program used for the areas where BNC for school age
during the preparation of the can provide children
Barangay nutrition situation assistance
Nutrition in the area
Committee
meeting

0 0

MELLPI Pro Form B 47 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES

5d National Nutrition Promotion Program for Behavior Change


0
9. Nutrition Nutrition Nutrition Nutrition Nutrition Nutrition Barangay Nutrition Action
promotion activities promotion promotion promotion promotion promotion Plan
for behavior change activities targeting activities targeting activities targeting activities targeting activities targeting Documentation reports
conducted for children conducted children and children and children and children and IEC materials
population groups adolescents adolescents and adolescents, adolescents, Sectoral accomplishments
conducted pregnant and pregnant and pregnant and
lactating women lactating women lactating women,
conducted and senior citizens senior citizens and
and PWDs PWDs and other
conducted population groups/
sectors conducted

10. Nutrition Activities in Activities in Activities in Activities in Activities in Barangay Nutrition Action
promotion for celebration of the celebration of celebration of celebration of celebration of Plan
behavior change National Nutrition National Nutrition National Nutrition National Nutrition National Nutrition Documentation reports
activities for the Month and Month conducted Month conducted Month and to Month and to IEC materials
public conducted conducted by the by the LGU with by the barangay promote the promote the
barangay with participation of at with participation Nutritional Nutritional Guidelines
participation from least two sectors of at least three Guidelines for for Filipinos
at least one sector sectors Filipinos conducted conducted by the
by the barangay barangay with
with participation participation of more
of at least three than three sectors
sectors

5e Micronutrient Supplementation
0.00

MELLPI Pro Form B 48 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
11. Pregnant women Iron-folic acid was Pregnant women Pregnant women Pregnant women Pregnant women FHSIS Report
provided with iron- prescribed to were provided with were provided with were provided with were provided with Masterlist of pregnant
folic acid pregnant women iron-folic acid iron-folic acid iron-folic acid iron-folic acid mothers who received
but not provided covering less than covering at least covering more than covering 100% of the iron-folic acid
90% of the target 90% of the target 90% of the target target for 180 days
for 180 days for 180 days

1 0
0

12. Vitamin A Vitamin A was One dose of One dose of One dose of One dose of vitamin FHSIS Report
provided to children prescribed to vitamin A provided vitamin A provided vitamin A provided A provided to 100% Masterlist of children 6-11
6-11 months old children 6-11 to less than 90% of to at least 90% of to more than 90% of children 6-11 months who received
months but not children 6-11 children 6-11 of children 6-11 months old Vitamin A
provided months old months old months old

13. Vitamin A Vitamin A was Two doses of Two doses of Two doses of Two doses of vitamin FHSIS Report
capsules provided to prescribed to vitamin A provided vitamin A provided vitamin A provided A provided 100% of Masterlist of children 12-59
children 12-59 children 12-59 to less than 90% of to at least 90% of more than 90% of children 12-59 months who received
months old months old but not children 12-59 children 12-59 children 12-59 months old Vitamin A
provided months old months old months old

14. Micronutrient Micronutrient Micronutrient Micronutrient Micronutrient Micronutrient FHSIS Report


powder provided to powder was powder provided to powder provided to powder provided to powder provided to Masterlist of children 6-23
young children 6-23 prescribed to young children 6- young children 6- young children 6- young children 6-23 months who received MNP
months old young children 6- 23 months old but 23 months old and 23 months old and months old and
23 months old but covers less than covers at least 90% covers more than covers 100% of the
not provided 90% of the target of the target 90% of the target target

MELLPI Pro Form B 49 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
15. Weekly provision Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid tablets School-based Weekly Iron
of iron-folic acid tablets prescribed tablets provided tablets provided tablets provided provided weekly to Folic Acid Supplementation
tablets to adolescent to adolescent weekly to less than weekly to 100% of weekly to 100% of 100% of adolescent Report
female learners in female learners in 100% of adolescent adolescent female adolescent female female learners in Minutes of meeting
public schools public schools but female learner in learners in public learners in public public schools for two
through Weekly Iron not provided public schools with schools with schools with cycles with parents'
Folic Acid (WIFA) parents consent parents consent for parents consent for consent, information
Supplementation two cycles two cycles and on the benefits of
Program information on the WIFA disseminated
benefits of WIFA among parents and
disseminated updates shared to
among parents Barangay Nutrition
Committee

0
$F$89)
="No")
),0,1)
16. Weekly Iron Folic Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid Iron-folic acid FHSIS Report
Acid (WIFA) provided tablets prescribed tablets provided tablets provided tablets provided tablets provided Masterlist of adolescents
to adolescent to adolescent weekly to less than weekly to at least weekly to more weekly to 100% of who received WIFA from
females in Grade 7 to females outside the 90% of adolescent 90% of adolescent than 90% of adolescent females Barangay Health Station
10 from private public school females outside the females outside the adolescent females outside the public
schools, out-of- system but not public school public school outside the public school through
school adolescent provided through Barangay through Barangay school through Barangay Health
females and women Health Stations Health Stations Barangay Health Stations
aged 10-49 years not Stations
covered by WIFA in
public schools

MELLPI Pro Form B 50 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5f Mandatory Food Fortification
0.00
17. Retail outlets The LGU monitors Less than 90% of At least 90% of the At least 90% of the More than 90% of Barangay Nutrition Action
selling iodized salt retail outlets selling retail outlets selling retail outlets selling retail stores selling retail stores selling Plan
table salt iodized salt iodized salt adequately iodized adequately iodized Master list of retail outlets
salt salt selling iodized salt

0 0
0
0
18. Bakery owners The LGU monitors Less than 90% of At least 90% of the More than 90% of 100% of bakery Barangay Nutrition Action
using vitamin A the type of flour the bakery owners bakery owners are bakery owners are owners are using Plan
fortified flour bakeries use are using vitamin A using vitamin A using vitamin A vitamin A fortified Master list of bakeries using
fortified flour in fortified flour in fortified flour in flour in baked fortified flour
baked products baked products baked products products

19. Retail stores The LGU monitors Less than 90% of At least 90% of More than 90% of 100% of the retail Barangay Nutrition Action
selling vitamin A retail stores selling the retail stores the retail stores the retail stores stores selling vitamin Plan
fortified cooking oil cooking oil selling vitamin A selling vitamin A selling vitamin A A fortified cooking oil Master list of markets
fortified cooking oil fortified cooking oil fortified cooking oil selling vitamin A fortified
cooking oil

5g Nutrition in Emergencies Program


0.00

MELLPI Pro Form B 51 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
20. NiEm Plan NiEm activities NiEm activities NiEm activities NiEm activities NiEm activities Barangay Nutrition Action
integration in the identified but not identified and identified and identified and identified and Plan
DRRM-H plan and integrated in the integrated to the integrated to the integrated to the integrated to the Barangay DRRMC
Local DRRM Plan Barangay Nutrition Barangay Nutrition Barangay Nutrition Barangay Nutrition Barangay Nutrition
Action Plan Action Plan but not Action Plan and Action Plan and Action Plan and
integrated to the Barangay DRRMC Barangay DRRMC Barangay DRRMC
Barangay DRRMC are implemented are implemented
and reviewed

1 0
0

MELLPI Pro Form B 52 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5h Overweight and Obesity Management and Prevention Program
0.00
21. Activities Information Information Information Information In addition to the Documentation report
promoting healthy dissemination on dissemination and dissemination, dissemination, parameters in Level IEC materials
diets and active Pinggang Pinoy and other activities distribution of IEC distribution of IEC 4, the LGU Resolution
lifestyle for active lifestyle for conducted to materials and other materials and formulated policies in Ocular inspection of safe,
preschool children preschool children promote Pinggang activities to conduct of other support of promotion open spaces and play areas
conducted conducted Pinoy and active promote Pinggang activities to of healthy diets and for children
lifestyle Pinoy and active promote Pinggang active lifestyle and
lifestyle Pinoy and active maintains safe and
implemented and lifestyle open spaces and play
covered at least implemented and areas for children
50% of preschool covered more than
children 50% of preschool
children

#REF!

22. Activities Information Information Information In addition to the In addition to the Documentation report
promoting proper dissemination on dissemination and dissemination, parameters in Level parameters in Level IEC materials
diet and healthy Pinggan Pinoy and other activities distribution of IEC 3, promotion of 4, the LGU maintains Resolution
lifestyle for the healthy lifestyle for conducted to materials and other proper diet and safe open indoor/ Ocular inspection of safe
general public the general public promote Pinggang activities healthy lifestyle is outdoor spaces for spaces for indoor/outdoor
conducted conducted Pinoy and active conducted to supported by a physical activities physical activities
lifestyle promote Pinggang policy
Pinoy and active
lifestyle

MELLPI Pro Form B 53 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
5h Nutrition-Sensitive Programs
0.00
NS Programs to increase income and improve economic access to food
23. Eligible Less than 30% of Less than 50% of At least 50% of At least 50% of More than 50% of Barangay Nutrition Action
households with eligible households eligible households eligible households eligible households eligible households Plan
nutritionally with nutritionally with nutritionally with nutritionally with nutritionally with nutritionally Accomplishment/
vulnerable or vulnerable or vulnerable or vulnerable or vulnerable or vulnerable or documentation report
affected provided affected included in affected included in affected included in affected included in affected included in Master list of beneficiaries
with seed capital/ the provision of the provision of the provision of the provision of the provision of
material seed capital/ seed capital/ seed capital/ seed capital/ seed capital/
assistance for material assistance material assistance material assistance material assistance material assistance
livelihood for livelihood for livelihood and market- and
linkages market-linkages

24. Eligible Less than 30% of Less than 50% of At least 50% of At least 50% of More than 50% of Barangay Nutrition Action
households with eligible households eligible households eligible households eligible households eligible households Plan
nutritionally with nutritionally with nutritionally with nutritionally with nutritionally with nutritionally Accomplishment/
vulnerable or vulnerable or vulnerable or vulnerable or vulnerable or vulnerable or documentation report
affected provided affected included in affected included in affected included in affected included in affected included in Master list of beneficiaries
with livelihood the provision of the provision of the provision of the provision of the provision of
training livelihood training livelihood training livelihood training livelihood training livelihood training
and industry- and industry-linkages
linkages

1 0
0

MELLPI Pro Form B 54 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
NS Programs to improve physical access to food

25. Gulayan sa Member of the BNC member from BNC uses the BNC implements BNC conducts data Minutes of meeting
Paaralan established Barangay Nutrition DepED shares data data in the PAPs in the monitoring of the Nutrition Situation
and maintained in Committee from to the local identification of barangay nutrition status of the Gulayan Local Nutrition Action Plan
school DepED provides nutrition PAPs in the action plan sa Paaralan and Documentation Report
updates on the committee and barangay nutrition complementing the determines possible
Gulayan sa used in the action plan to Gulayan sa assistance from the
Paaralan Project preparation of the complement the Paaralan Project BNC if necessary
during BNC nutrition situation Gulayan sa
meeting/s Paaralan Project

C$28>0),('LGU Profile'!$C$28=""),OR('LGU Profile'!$C$31>0),('LGU Profile'!$C$31="")),1,0)


26. Households with Barangay provides Barangay provides Barangay provides Barangay provides Barangay provides Barangay Nutrition Action
nutritionally technical assistance technical assistance technical assistance technical assistance technical assistance, Plan
vulnerable or to households in and inputs for and inputs for and inputs for inputs for the Documentation Report
affected provided establishing establishing a establishing a establishing a backyard vegetable Master list of beneficiaries
with inputs for backyard vegetable backyard vegetable backyard vegetable backyard vegetable garden and conducts Monitoring report
backyard vegetable gardens garden to less than garden to at least garden to more monitoring of the
gardening 80% of households 80% of households than 80% of status of the gardens
with nutritionally with nutritionally households with at least twice a year
vulnerable or vulnerable or nutritionally
affected affected vulnerable or
affected

MELLPI Pro Form B 55 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
NS Programs to improve access to safe drinking water and sanitary toilet facilities

27. Households have Barangay conducts Barangay ensures Barangay ensures Barangay ensures Barangay ensures Barangay Nutrition Action
access to safe data monitoring of that less than 90% that at least 90% that more than that 100% Plan
drinking water the number of of households of households 90% of households Documentation report
households with have access to have access to of households have access to Monitoring report
access to safe safe drinking water safe drinking water have access to safe drinking water OPT Plus Family Profile
drinking water safe drinking water Masterlist of households
with access to safe drinking
water

1 28. Households have Barangay conducts Barangay ensures Barangay ensures Barangay ensures Barangay ensures Barangay Nutrition
access to sanitary data monitoring of that less than 90% that at least 90% of that more than that 100% of ActionPlan
toilet facilities the number of of households have households have 90% of households households have Documentation report
households with access to access to have access to access to Monitoring report
access to sanitary sanitary toilet sanitary toilet sanitary toilet sanitary toilet OPT Plus Family Profile
toilet facilities facilities facilities facilities facilities Masterlist of households
with access to safe drinking
water

MELLPI Pro Form B 56 of 84


PERFORMANCE LEVEL REMARKS/
ELEMENTS DOCUMENT SOURCE RATING
1 2 3 4 5 EVIDENCE
5. NUTRITION INTERVENTION/ SERVICES
0 29. Schools provided Member of the Member of the BNC uses the data BNC conducts data BNC conducts Minutes of meeting
with access to safe Barangay Nutrition Barangay Nutrition in identification of monitoring of the data monitoring of Nutrition Situation
water, adequate Committee from Committee from PAPs in the access to safe WASH in Schools Barangay Nutrition Action
toilets, handwashing DepED provides DepED shares data Barangay Nutrition drinking water, and determines Plan
facilities through the updates on the to the BNC and Action Plan to access to functional possible assistance Monitoring Report
WASH in Schools WASH in Schools used in the complement the toilets and access from the BNC if
(WinS) program Program during preparation of the WASH in Schools to handwashing necessary
BNC meeting/s nutrition situation Program facilities in relation
to the nutritional
status of school
children

C$28>0),('LGU Profile'!$C$28=""),OR('LGU Profile'!$C$31>0),('LGU Profile'!$C$31="")),1,0)


NS Programs to prevent teen-age pregnancy

1 30. Reproductive Barangay conducts Barangay conducts Barangay conducts In addition to the In addition to the Barangay Nutrition Action
health programs for data monitoring of data monitoring on data monitoring, parameters in Level parameters in Level Plan
adolescents teenage teenage assists in provision 3, the barangay 4, the barangay also Monitoring Report
implemented pregnancies pregnancies and of services for also provides mobilized the Documentation Report
assists in the adolescents and policy support for Sangunianng Resolution
provision of conducts the Kabataan in
services for information Adolescent Health cooperation with the
adolescents (e.g. dissemination Development Barangay Health
counseling) activities on Program Station to lead the
reproductive health activities for the
among adolescents Adolescent Health
Development
Program

MELLPI Pro Form B 57 of 84


MELLPI Pro FORM B 1b: SUMMARY OF BARANGAY NUTRITION MONITORING

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

DIMENSION 1: VISION AND MISSION

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

1a. Presence and knowledge


0.00 0.00
of vision-mission statement

1b. Presence of nutrition-related concerns in the barangay


0.00 0.00
development plan of mission statement

1c. Presence of nutrition-related concerns in the Annual


Investment Program (AIP)
0.00 0.00

PERFORMANCE RATING 0.00

DIMENSION 2: NUTRITION LAWS AND POLICIES

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

2a. Adoption, implementation and monitoring of local


0.00 0.00
nutrition plan

2b. RA 11148 Kalusugan at Nutrisyon ng Mag-Nanay Act of


0.00 0.00
2018

2c. RA 11037 Masustansyang Pagkain para sa Batang Pilipino


0.00 0.00

2d. EO 51 National Code of Marketing of Breastfeeding


0.00 0.00
Substitutes, Breastmilk Supplements and related products

2e. RA 10028 Expanded Breastfeeding Promotion Act


0.00 0.00

2f. RA 8172 An Act for Salt Iodization Nationwide


0.00 0.00

2g. RA 8976 Philippine Food Fortification Act


0.00 0.00

2h. NNC GB Resolution No. 1 S. 2017 Approving and Adopting


the Philippine Plan of Action 2017-2022 0.00 0.00

2i. NNC GB Resolutions Nos.


1) 3 S.2012: Approving the Guidelines on the Fabrication,
Verification, and Maintenance of Wooden Height Boards 0.00 0.00

2) 3 S.2018: Approving the Guidelines on the Selection of Non-


Wood Height and Length Measuring Tool

MELLPI Pro Form B 60 of 84


2j. NNC GB Resolution No. 2 S. 2012 Approving the Revised
Implementing Guidelines on OPT Plus 0.00 0.00

2k. NNC Governing Board Resolution No.6 series of 2012:


0.00 0.00
Adoption of the 2012 Nutritional Guidelines for Filipinos

2l. NNC Governing Board Resolution No. 2 series of 2009:


Adopting the National Policy on Nutrition Management in 0.00 0.00
Emergencies and Disasters

PERFORMANCE RATING 0.00

DIMENSION 3: GOVERNANCE AND ORGANIZATIONAL STRUCTURE

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

3a. Presence of Barangay Nutrition Committee


0.00 0.00

3b. Presence of Nutrition Office and Personnel


0.00 0.00

3c. Decision-making and leadership of the Barangay Nutrition


0.00 0.00
Committee

PERFORMANCE RATING 0.00

DIMENSION 4: LOCAL NUTRITION COMMITTEE MANAGEMENT FUNCTIONS

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

4a. Nutrition Assessment 0.00 0.00

4b. Planning 0.00 0.00

4c. Resource Generation and Mobilization 0.00 0.00

4d. Service Delivery 0.00 0.00

4e. Monitoring and Evaluation 0.00 0.00

4f. Capacity Building 0.00 0.00

PERFORMANCE RATING 0.00

DIMENSION 5: NUTRITION INTERVENTIONS/SERVICES

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

1
5a. Infant and Young Child Feeding 0.00 0.00

5b. Philippine Integrated Management of Acute Malnutrition 1


0.00 0.00

1
5c. National Dietary Supplementation Program 0.00 0.00

1
5d. National Nutrition Promotion Program for Behavior Change 0.00 0.00

5e. Micronutrient Supplementation 1


0.00 0.00

5f. Mandatory Food Fortification 1


0.00 0.00

MELLPI Pro Form B 61 of 84


5g. Nutrition in Emergencies Program 1
0.00 0.00

5h. Overweight and Obesity Management and Prevention 1


0.00 0.00
Program

5i. Nutrition-Sensitive Programs 1


0.00 0.00

PERFORMANCE RATING 0.00

B-1c Diagram for Barangay Nutrition Monitoring

1. Vision and Mission


100.0

50.0
5. Nutrition Intervention/Services 2. Nutrition Laws and Policies

0.0

4. Local Nutrition Committee Management Functions 3. Governance and Organizational Structure


TARGET RATING
PERFORMANCE RATING

TARGET
DIMENSION RATING PERFORMANCE RATING
1. Vision and Mission 100.0 0.0
2. Nutrition Laws and Policies 100.0 0.0
3. Governance and Organizational Structure 100.0 0.0
4. Local Nutrition Committee Management Functions 100.0 0.0
5. Nutrition Intervention/Services 100.0 0.0

TOTAL RATING 100.0 0.0

REMARKS

MELLPI Pro Form B 62 of 84


MELLPI Pro FORM B 2a: CHANGES IN THE NUTRITIONAL STATUS IN THE BARANGAY

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

PERFORMANCE LEVEL DOCUMENT REMARKS/


ELEMENTS RATING
0 1 2 3 4 SOURCE EVIDENCE
1 Prevalence of Prevalence is Prevalence is Prevalence is Prevalence is Prevalence is Barangay Nutrition Prevalence
underweight children within very high within high level of within the middle within the lower within the low level Action Plan
0-59 months level of public public health to upper limit of limit of medium of public health Operation Timbang
health significance significance (10 to medium level of public health significance (<5%) Report (Previous
(>15%) in the year <15%) in the year public health significance (5 to in the year and current years)
evaluated evaluated significance (7.5 to <7.5%) in the year evaluated
<10%) in the year evaluated
evaluated

MELLPI Pro Form B 63 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
0 1 2 3 4 SOURCE EVIDENCE
2 Prevalence of Prevalence is Prevalence is Prevalence is Prevalence is Prevalence is Barangay Nutrition Prevalence
stunted children within very high within high level of within the middle within the lower within the low level Action Plan
0-59 months level of public public health to upper limit of limit of medium of public health Operation Timbang
health significance significance (20 to medium level of public health significance (<10%) Report (Previous
(>30%) in the year <30%) in the year public health significance (10 to in the year and current years)
evaluated evaluated significance (15 to <15%) in the year evaluated
<20%) in the year evaluated
evaluated

3 Prevalence of Prevalence is Prevalence is Prevalence is Prevalence is Prevalence is Barangay Nutrition Prevalence


wasted children within very high within high level of within the middle within the lower within the low level Action Plan
0-59 months level of public public health to upper limit of limit of medium of public health Operation Timbang
health significance significance (10 to medium level of public health significance (<5%) Report (Previous
(>15%) in the year <15%) in the year public health significance (5 to in the year and current years)
evaluated evaluated significance (7.5 to <7.5%) in the year evaluated
<10%) in the year evaluated
evaluated

MELLPI Pro Form B 64 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
0 1 2 3 4 SOURCE EVIDENCE
4 Prevalence of Prevalence is Prevalence is Prevalence is Prevalence is Prevalence is Barangay Nutrition Prevalence
overweight and within very high within high level of within the middle within the lower within the low level Action Plan
obese children level of public public health to upper limit of limit of medium of public health Operation Timbang
0-59 months health significance significance (10 to medium level of public health significance (<5%) Report (Previous
(>15%) in the year <15%) in the year public health significance (5 to in the year and current years)
evaluated evaluated significance (7.5 to <7.5%) in the year evaluated
<10%) in the year evaluated
evaluated

5 Prevalence of Increased No change in Decreased Sustained decrease Maintenance of the Barangay Nutrition Prevalence
wasted school prevalence from prevalence from prevalence from or prevalence prevalence of Action Plan
children previous year and previous year and previous year and maintained within malnutrition to Operation Timbang
the year evaluated the year evaluated the year evaluated medium public lower than public Report (Previous
health significance health significance and current years)
(<10%) from two (<5%) from two
years prior to the years prior to the
year evaluated year evaluated

MELLPI Pro Form B 65 of 84


PERFORMANCE LEVEL DOCUMENT REMARKS/
ELEMENTS RATING
0 1 2 3 4 SOURCE EVIDENCE
6 Prevalence of Increased No change in Decreased Sustained decrease Maintenance of the Barangay Nutrition Prevalence
overweight and prevalence from prevalence from prevalence from or prevalence prevalence of Action Plan
obese school children previous year and previous year and previous year and maintained within malnutrition to School Weighing
the year evaluated the year evaluated the year evaluated medium public lower than public Report (Previous
health significance health significance and current years)
(<10%) from two (<5%) from two
years prior to the years prior to the
year evaluated year evaluated

7 Prevalence of Increased No change in Decreased Sustained decrease Maintenance of the Barangay Nutrition Prevalence
nutritionally at-risk prevalence from prevalence from prevalence from or prevalence prevalence of Action Plan
pregnant women previous year and previous year and previous year and maintained within malnutrition to Prenatal records
the year evaluated the year evaluated the year evaluated medium public lower than public Barangay Health
health significance health significance Station reports
(<10%) from two (<5%) from two
years prior to the years prior to the
year evaluated year evaluated

8 Operation Timbang Operation Timbang Operation Timbang Operation Timbang Operation Timbang Operation Timbang Barangay Nutrition Prevalence
Plus Coverage Plus coverage is Plus coverage is Plus coverage is at Plus coverage is at Plus coverage is at Action
<60% in the year <80% or >110% in least 80% in the least 90% in the 100 - 110% in the PlanOperation
evaluated the year evaluated year evaluated year evaluated year evaluated Timbang
Report (Previous
and current years)

MELLPI Pro Form B 66 of 84


MELLPI Pro FORM B 2b: SUMMARY OF CHANGES IN THE NUTRITIONAL STATUS IN THE BARANGAY

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

CHANGES IN THE NUTRITIONAL STATUS IN THE BARANGAY

ELEMENTS PERFORMANCE LEVEL CURRENT RATING

1. Prevalence of underweight 0-59 months children 0.00 0.00

2. Prevalence of stunted 0-59 months children 0.00 0.00

3. Prevalence of wasted 0-59 months children 0.00 0.00

4. Prevalence of overweight and obesity among children 0-59 months 0.00 0.00
children

5. Prevalence of wasted school-age children

6. Prevalence of overweight and obesity school-age children

7. Prevalence of nutritionally at-risk pregnant women

8. Operation Timbang Plus Coverage 0.00 0.00

PERFORMANCE RATING 0.00

B-2c Diagram for Changes in Nutritional Status in the Barangay

100.0 1. Prevalence of underweight 0-59 months children

50.0

8. Operation Timbang Plus Coverage 0.0 2. Prevalence of stunted 0-59 months children

4. Prevalence of overweight and obesity among children 0-59 months children 3. Prevalence of wasted 0-59 months children
TARGET RATING
PERFORMANCE RATING

ELEMENTS TARGET RATING PERFORMANCE RATING

1. Prevalence of underweight 0-59 months children 100.0 0.0

2. Prevalence of stunted 0-59 months children 100.0 0.0

3. Prevalence of wasted 0-59 months children 100.0 0.0

4. Prevalence of overweight and obesity among children 100.0 0.0


0-59 months children

5. Prevalence of wasted school-age children

6. Prevalence of overweight and obesity school-age


children

7. Prevalence of nutritionally at-risk pregnant women

8. Operation Timbang Plus Coverage 100.0 0.0

TOTAL RATING 100.0 0.0


REMARKS

MELLPI Pro Form B 67 of 84


MELLPI PRO FORM B-3: DISCUSSION QUESTIONS FOR LEARNING AND ACTION

Barangay Municipality/ City/ Province

Date of Monitoring Period Covered

What are the good practices What are the issues and problems What local initiatives have been What are the immediate actions
Dimensions
done/initiated? and why? done? for improvement?
1 Vision and Mission

2 Nutrition Laws and Policies

MELLPI Pro Form B 68 of 84


What are the good practices What are the issues and problems What local initiatives have been What are the immediate actions
Dimensions
done/initiated? and why? done? for improvement?
3 Governance and Organizational
Structure

4 Local Nutrition Committee


Management Functions

5 Nutrition Interventions/ Services

MELLPI Pro Form B 69 of 84


What are the good practices What are the issues and problems What local initiatives have been What are the immediate actions
Dimensions
done/initiated? and why? done? for improvement?
6 Changes in Nutritional Status in
the Local Government Unit

MELLPI Pro Form B 70 of 84


MELLPI PRO FORM B-4: SU

Barangay

Date of Monitoring

B-1c Diagram for Barangay Nutrition Monitoring

1. Vision and Mission


100.0

50.0
5. Nutrition Intervention/Services 2. Nutrition Laws and

0.0

4. Local Nutrition Committee Management Functions 3. Governance and Organizatio

TARGET RATING
PERFORMANCE RATING
4. Local Nutrition Committee Management Functions 3. Governance and Organizatio

TARGET RATING
PERFORMANCE RATING

TOTAL SCORE: [( D1 + D2 + D3 + D4

Major Findings (Use extra sheets if necessary)

Recommendations (Use extra sheets if necessary)


Name of Team Member Design

Received: Date:
LPI PRO FORM B-4: SUMMARY OF EVALUATION AND RECOMMENDATION

Municipality/ City/ Province

Period Covered

B-2c Diagram for Changes in Nutritional Status in the Barangay

100.0

2. Nutrition Laws and Policies 50.0

8. Operation Timbang Plus Coverage 0.0

Governance and Organizational Structure


4. Prevalence of overweight and obesity among children 0-59 months children

TARGET RATING
PERFORMANCE R
Governance and Organizational Structure
4. Prevalence of overweight and obesity among children 0-59 months children

TARGET RATING
PERFORMANCE R

+ D5 )/5] *60 + ( D6 ) * .40 =


Designation and Office Signature
100.0 1. Prevalence of underweight 0-59 months children

50.0

0.0 2. Prevalence of stunted 0-59 months children

s children 3. Prevalence of wasted 0-59 months children

TARGET RATING
PERFORMANCE RATING
s children 3. Prevalence of wasted 0-59 months children

TARGET RATING
PERFORMANCE RATING
Signature Date Signed
CY _______ Annual Investment Program (AIP)
By Program/Project/Activity by Sector
LGU
Sector : Social Services

Schedule of AMOUNT of Nurition Program Budget


AIP Ref. Amount (P'000)
Implementation (in thousand pesos) Nutrition
Program/Project/Activity Implementing Expected
Sources of Funds Typology
Description Agency Output Nutrition- Nutrition-
Completion Personal Capital Enabling Code
Code Start Date MOOE Total specific sensitive
Date Services Outlay Mechanisms
(Direct) (Indirect)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

National -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
--
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
TOTAL (Barangay) - - - - - - -

TOTAL (City/Municipality) - - - - - - -
TOTAL (Provincial Government) - - - - - - -

TOTAL ( National) - - - - - - -

TOTAL (External) - - - - - - -

TOTAL SOCIAL SERVICES SECTOR - - - - - -

Sector : Economic Services


Schedule of AMOUNT of Nurition Program Budget
AIP Ref. Amount (P'000)
Implementation (in thousand pesos) Nutrition
Program/Project/Activity Implementing Expected Nutrition- Nutrition-
Completion Sources of Funds Personal Capital Enabling Typology
Code Description Agency Start Date Output MOOE Total specific sensitive
Date Services Outlay Mechanisms Code
(Direct) (Indirect)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
TOTAL (Barangay) - - - - - - -
TOTAL (City/Municipality) - - - - - - -
TOTAL (Provincial Government) - - - - - - -
TOTAL ( National) - - - - - - -
TOTAL (External) - - - - - - -
TOTAL ECONOMIC SERVICES SECTOR - - - - - - -

Sector : Others
Schedule of AMOUNT of Nurition Program Budget
AIP Ref. Amount (P'000)
Implementation (in thousand pesos) Nutrition
Program/Project/Activity Implementing Expected Nutrition- Nutrition-
Completion Sources of Funds Personal Capital Enabling Typology
Code Description Agency Start Date Output MOOE Total specific sensitive
Date Services Outlay Mechanisms Code
(Direct) (Indirect)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
-- Please select one
-- -
TOTAL (Barangay) - - - - - - -
TOTAL (City/Municipality) - - - - - - -
TOTAL (Provincial Government) - - - - - - -
TOTAL ( National) - - - - - - -
TOTAL (External) - - - - - - -
TOTAL ______________ SECTOR - - - - - -

BREAKDOWN OF FUNDS
MOOE
PERSONNEL SE CAPITAL OUTLAY Sourceoffunds
(PHP)
LGU funds ₱ - ₱ - ₱ - -- Please select one --
City/Municipal Funds ₱ - ₱ - ₱ -
Provincial Funds ₱ - ₱ - ₱ - Local
National Government Funds ₱ - ₱ - ₱ - Provincial Government
External funds ₱ - ₱ - ₱ - National
External
NUTRITION BUDGET City/Municipality
Total Annual LGU Budget excluding Infrastructure Php
Total Budget Approved by Sanggunian for Nutritio Php Percent of budget alloted for Nutrition %
Total Funds Released for Nutrition Php Percent of approved budget released for Nutrition %
Total Funds Expended for Nutrition Php Percent of approved budget expended for Nutrition %

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