The Philippine Plan of Action for Nutrition:
An overview
Corazon Barba
Abstract
The Philippine Plan of Action for Nutrition (PPAN) is
the blueprint for an integrated programme of nutrition
interventions, formulated under the leadership of the
National Nutrition Council (NNC), which serves as the
coordinating body for the implementation of nutrition-
related programmes and projects and has responsibility
for monitoring and evaluation. The Governing Board of
the NNC is chaired by the Secretary of Agriculture and
nine cabinet Secretaries, and the heads of three private-
sector institutions sit as members. The PPAN goals are
consistent with the global call to eradicate malnutrition
made during the 1992 International Conference on Nutri-
tion. The PPAN also falls within the framework of the
Medium-Term Philippine Development Plan. The PPAN
aims to reduce protein–energy malnutrition among chil-
dren, chronic energy deficiency among adults, and micro-
nutrient deficiencies among all population groups, with
specific targets to be reached by the year 2004. Iron-
deficiency anaemia, vitamin A deficiency, and iodine-
deficiency disorders remain serious public health concerns.
PPAN programmes are implemented in the following
areas: home, school, and community food production;
micronutrient supplementation; food fortification; food
assistance; livelihood assistance; and nutrition education.
To support the implementation of the above programmes,
various enabling mechanisms have been or will be insti-
tutionalized: human resource development; advocacy;
research and standards; overall planning, coordination,
management, and surveillance; and resource generation
and mobilization. The paper provides brief descriptions
of all these programmes and enabling mechanisms.
Introduction
According to national nutrition surveys, persistent
The author is the Director of the Food and Nutrition Research
Institute, Department of Science and Technology (FNRI-
DOST), in Metro Manila, Philippines.
Food and Nutrition Bulletin, vol. 21, no. 4 © 2000, The United Nations University.
malnutrition problems, such as protein–energy malnu-
trition and micronutrient deficiencies (iron-deficiency
anaemia, vitamin A deficiency, and iodine-deficiency
disorders), continue to afflict a major proportion of
Filipinos, particularly infants and pre-school children,
pregnant women, and lactating mothers.
With cognizance of these problems, an integrated
plan of action for nutrition was formulated by the local
multisectoral nutrition community, consistent with
the global call to eradicate malnutrition made during
the International Conference on Nutrition (ICN) held
in December 1992. Our Philippine Plan of Action for
Nutrition (PPAN) is thus consistent with the ICN
goals of promoting, achieving, and maintaining the
nutritional well-being of individuals and also falls
within the framework of the Medium-Term Philip-
pine Development Plan. The signing of the Commit-
ment makes nutrition a governmental priority, to be
implemented by all branches of the executive, and
integrating nutrition objectives into all the develop-
ment efforts of the country.
Although the country’s fight against malnutrition
did not start with the signing of the Commitment, the
formulation of the PPAN made for more harmonized
policies, more focused programmes, and sustainable
strategies that augur well for the reduction of malnu-
trition.
The Philippine food and nutrition situation
The Food and Nutrition Research Institute of the
Department of Science and Technology is mandated
to periodically undertake assessments of the country’s
food situation and the nutritional status of the Filipino
population. Since 1978, five national nutrition surveys
have been conducted at intervals of five to six years.
The most recent and fifth survey in this series was
undertaken in 1998–99.
The usual nutrition survey has four elements: the
anthropometric survey, the food-consumption survey,
the clinical assessment, and the biochemical survey.
507
508 C. Barba

This approach to nutritional assessment, though com-
prehensive, is costly, tedious, and time-consuming.
The sampling design is primarily oriented towards
generating national estimates and, to some extent,
regional estimates. Because of the demand for more
frequent and more disaggregated data at the provincial
level, anthropometric surveys of children up to 10
years of age are being conducted every 2 to 3 years.
and Nutrition Research Institute Philippine Anthro-
pometric Standards [3], about 9.2% of 0- to 5-year-
old children were moderately or severely underweight,
5.4% were stunted, and 7.2% were wasted. Some 8.3%
of 6- to 10-year-old children were moderately or
severely underweight, 5.8% were stunted, and 8.7%
were wasted. According to the National Center for
Health Statistics (NCHS) standards, 31.8% of 0- to

Food-consumption pattern and nutrient adequacy levels

TABLE 2. Comparison of mean one-day per capita nutrient
The trends in per capita consumption of various intake: Philippines, 1987 and 1993
foods show a general decrease from 1978 to 1993
Intake
(table 1) [1, 2]. As a result of the general decrease
in food consumption, intakes of energy and other Nutrient 1987 1993 % change
nutrients, such as iron, calcium, and ascorbic acid, Energy (kcal) 1,753 1,684 –3.9**
also decreased (table 2). Although protein and retinol Protein (g) 49.7 49.9 0.4
intakes have increased, these increases are not statisti- Iron (mg) 10.7 10.1 –5.6**
cally significant. The recent economic crisis and rising Calcium (g) 0.42 0.39 –7.1**
prices of food can explain the worsening diets. Retinol equivalents (µg) 389.7 391.9 0.6
Thiamine (mg) 0.68 0.67 –1.5
Riboflavin (mg) 0.56 0.56 –0.0
Anthropometry
Niacin (mg) 16.3 16.1 –1.2
According to the 1998 update of the nutritional status Ascorbic acid (mg) 53.6 46.7 –12.9**
of 0- to 10-year-old Filipino children, using the Food ** Significant at α = 0.01.

TABLE 1. Comparison of mean one-day per capita food consumption: Philippines, 1978, 1982, 1987, and 1993

Consumption (raw, as purchased) in grams

1993
% change
Food group/subgroup 1978 1982 1987 1993 Urban Rural 1987–93
Total food 897 915 869 803
Cereals and cereal products 367 356 345 340 318 361 –1.4
Rice and rice products 308 304 303 282 273 290 –6.9*
Corn and corn products 38 34 24 36 17 55 50.0**
Starchy roots and tubers 37 42 22 17 13 21 –22.7**
Sugars and syrups 19 22 24 19 20 17 –20.8**
Fats and oils 13 14 14 12 14 10 –14.3**
Fish, meat, and poultry 133 154 157 147 161 133 –6.4**
Fish and fish products 102 113 111 99 98 100 –10.8**
Meat and meat products 23 32 37 34 44 23 –8.1
Poultry 7 10 9 14 19
Eggs 8 9 10 12 15 9 20.0**
Milk and milk products 42 44 43 44 64 24 2.3
Dried beans, nuts, and seeds 8 10 10 10 11 8 0.0
Vegetables 145 130 111 106 98 113 –4.5
Green leafy and yellow 34 37 29 30 25 34 3.4
Other 111 93 82 76 73
Fruits 104 102 107 77 82 73 –28.0**
Vitamin C–rich 30 18 24 21 27 15 –12.5
Other 74 84 83 56 55 58 –32.5**
Miscellaneous 21 32 26 19 23 16 –26.9**
** Significant at α = 0.01.
Philippine Plan of Action for Nutrition
59-month-old children were underweight, 32.0% were
stunted, and 6.6% were wasted.
Micronutrient malnutrition
The past five national nutrition surveys revealed a
persistent micronutrient malnutrition problem among
the most vulnerable population groups, particularly
infants, pre-school children, and pregnant and lactat-
ing women. Iron-deficiency anaemia, vitamin A defi-
ciency, and iodine-deficiency disorders remain serious
public health concerns.
Iron-deficiency anaemia
Iron-deficiency anaemia, as evidenced by haemoglobin
determination according to the cyanmethaemoglobin
method, had a prevalence rate of 30.6% of the popula-
tion surveyed in 1998 [4]. The highest prevalence,
56.6%, was observed among infants six months to one
year of age, followed by pregnant and lactating women
(50.7% and 45.7%, respectively).
Although the national prevalence of iron-deficiency
anaemia declined significantly from 37.2% in 1987
to 28.9% in 1993 [5], in 1998 the prevalence rate
increased slightly to 30.6% [6]. Iron-deficiency anae-
mia remains the most serious micronutrient problem
among the country’s vulnerable population groups.
Vitamin A deficiency
Vitamin A deficiency causes night-blindness, which
may lead to xerophthalmia and eventually to total
blindness. In the Philippines, many children go blind
each day, and about 4 million pre-schoolers are at risk
of going blind because of vitamin A deficiency.
This statement is based on the findings of the 1993
nutrition survey on the prevalence of vitamin A defi-
ciency [2]. In this survey, night-blindness and Bitot’s
spots were noted in 1.2% of Filipinos, particularly
those 6 months to 19 years old and pregnant and
lactating women. Biochemical tests showed that among
children aged 6 months to 6 years, the prevalence of
deficient serum vitamin A levels (< 10 µg/dl) was
10.4%, and the prevalence of deficient to low serum
vitamin A levels (< 20 µg/dl) was 35.3% [5]. These
prevalence rates of vitamin A deficiency indicate a
problem of public health significance, since they exceed
the World Health Organization cut-off points of 5%
and 15%, respectively [7, 8].
Iodine-deficiency disorders
Iodine deficiency may lead not only to visible goitre
but also to impaired physical and mental development.
Iodine deficiency is the most common cause of mental
retardation and causes a number of serious disorders,
such as deaf-mutism and cretinism, as well as being
associated with an increased risk of spontaneous abor-
tion, stillbirth, and birth defects.
509
The prevalence of iodine deficiency in the Philip-
pines, as manifested by goitre, doubled from 3.5% in
1987 to 6.7% in 1993, with markedly higher prevalence
rates among women than among men, particularly
pregnant and lactating women [9].
From the data of the 1998 survey, the iodine-defi-
ciency problem in the Philippines is of mild severity
based on the median urinary iodine excretion of 71
µg/L and using the WHO/UNICEF/ICCDD criteria
[10]. According to the percent distribution of urinary
iodine excretion values, 35.8% of 6- to 12-year-old
Filipino children have moderate to severe levels of
iodine deficiency [6].
The Philippine Plan of Action for Nutrition
The Medium-Term Plan of Action for Nutrition, also
known as the Philippine Plan of Action for Nutrition
(PPAN), is the country’s blueprint for achieving nutri-
tional adequacy for all Filipinos, and the Philippine
government’s commitment to eradicating hunger and
malnutrition [11].
The formulation of the Plan was spearheaded by the
National Nutrition Council (NNC), which also serves
as the coordinating body for the implementation of
programmes and projects and for the monitoring
and evaluation of nutrition-related activities in the
country.
The NNC is a multidisciplinary, multilevel network
established to promote the stable and equitable distri-
bution of food and services to the Filipino popula-
tion. The Council is composed of a Governing Board,
which is the highest policy-making body of the NNC.
It is chaired by the Secretary of the Department of
Agriculture. Nine Cabinet Secretaries sit as members
of the Governing Board, as well as the heads of three
other private-sector institutions, the Koalisyon Para
Alaggan at Isalba ang Nutrisyon (KAIN), the Nutri-
tion Center of the Philippines (NCP), and the Rural
Improvement Clubs of the Philippines (RIC).
The PPAN was formulated within the framework of
the Philippine Medium-Term Development Plan. It
upholds human development as the ultimate goal of
all development efforts in the country.
The PPAN aims to reduce protein–energy malnutri-
tion among children, chronic energy deficiency among
adults, and micronutrient deficiencies, particularly
vitamin A, iron, and iodine deficiencies, among all
population groups. By the year 2004, it is hoped that
the following targets will be achieved:
» reduction of the prevalence of protein–energy mal-
nutrition among pre-school children by 20%, as
measured by the NCHS standards for anthropom-
etry cited above;
» reduction of the prevalence of chronic energy defi-
ciency among adults by 20% ;
510
» reduction of the prevalence of iron-deficiency anae-
mia by 20%, as measured by blood haemoglobin;
» reduction of the prevalence of vitamin A deficiency,
as measured by serum retinol in 6-month- to 6-year-
old children, from 35.0% in 1993 to less than 15%;
» reduction of the prevalence of iodine-deficiency
disorders, as measured by urinary iodine excretion
among school-aged children, from 35.8% in 1998
to less than 20%;
» maintenance of the prevalence of overweight among
pre-school children at 1.0%; reduction of the preva-
lence of overweight among schoolchildren by 58%
and among adults by 20%;
» increase in the prevalence of exclusive breastfeeding
of infants 0 to 6 months of age by 50%;
» 20% reduction in the proportion of families whose
income falls below the food threshold.
The targeted percentage reductions are based on the
1993 and 1996 baseline data of the National Nutrition
Surveys. However, when the complete results of the
1998 national nutrition survey are available, there may
be a need for retargeting.
Programmes, projects, and activities
During the period from 1999 to 2004, the PPAN will
continue to be operationalized vigorously in a number
of impact programmes, as briefly summarized below.
Detailed discussions of these programmes are given
elsewhere in this issue [12–14].
The Home, School, and Community Food Produc-
tion Programme is a long-term, sustained measure to
alleviate protein–energy and micronutrient deficien-
cies among Filipinos. It involves the establishment
of kitchen gardens in homes, schools, and communi-
ties, using biointensive agricultural technologies; the
provision of the initial seed supply and gardening
implements; the dissemination of the rearing of small
animals; and the provision of water-supply systems.
The Micronutrient Supplementation Programme will
target nutritionally at-risk groups, particularly infants,
pre-schoolers, and pregnant and lactating women.
Pharmaceutical preparations of vitamin A, iron, and
iodine will be provided for the prevention and treat-
ment of micronutrient deficiencies.
The Food-Fortification Programme, as a preventive
and long-term food-based intervention, will be a con-
tinuing commitment. This is a collaborative undertak-
ing between government and private-sector industry.
To ensure commercialization of technologies on forti-
fied foods, partnerships with the food industry will
be undertaken.
The Food Assistance Programme consists of a social
safety net for nutritionally vulnerable groups during
periods of physical and economic displacement. The
programme will include regular supplementary feeding
schemes, emergency feeding, and food price discounts.
C. Barba
The Livelihood Assistance Programme provides capi-
tal loan assistance for small-scale income-generating
projects, thus creating employment and generating
additional sources of income for nutritionally at-risk
families. Skills training is provided to sustain income-
generating project initiatives.
The Nutrition Education Programme aims to increase
the level of nutrition awareness and appropriate
knowledge and practices to ensure nutritional well-
being. It is an integral component of other impact
programmes to ensure effectiveness.
Enabling mechanisms
To support and propel the implementation of the
programmes, various enabling mechanisms have been
or will be institutionalized.
Human resource development involves training of
implementers, service providers, and managers in
programme planning and project management, as
well as monitoring and evaluation, to equip them with
the necessary skills, knowledge, and attitudes for the
effective delivery of nutrition services.
Nutrition advocacy shall include legislative advocacy
for passing important nutrition bills, such as the
Salt Iodization Law, Nutrition Labelling, and Food
Fortification, among others. Policy advocacy shall be
strengthened to ensure the integration of nutrition in
all development efforts.
Nutrition research shall provide sound and scientific
bases for continually improving the PPAN implemen-
tation in terms of policy decision and programme
design. A five-year nutrition research agenda will be
developed in the areas of food fortification, functional
foods, standards and requirements formulation, nutri-
tion intervention modeling, and nutritional assess-
ment. Nutrition research and development will be led
by the Food and Nutrition Research Institute.
Overall planning, coordination, management, and
surveillance, as mandated, shall be conducted by the
NNC, coordinating and orchestrating all nutrition
activities from the national down to the barangay level
of implementation.
Resources for the implementation of the PPAN will
be generated from the pooled resources of the nutri-
tion network, including private sector and interna-
tional organizations supporting the PPAN.
Conclusions
The preliminary results of the Fifth National Nutrition
Survey for some parameters show a deterioration in
the nutrition situation of the country, despite the
efforts of all the key players in nutrition. This could
be attributed to the fact that the Philippines was not
spared by the Asian economic recession, the regional
Philippine Plan of Action for Nutrition
currency crisis, and the effect of natural calamities
(such as El Niño and La Niña). These setbacks should
not discourage us but rather may serve as guides for
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