The Nutritional Program After U.S. PL 480: Challengers and Opportunities PDF Print E-mail
FNRI DIGEST

*Impact of Food Assistance Programs in the Philippines
*The Philippine country paper for the ICN lists the following as objectives of the food assistance program
*Various food assistance programs or projects have been implemented by national government agencies and NGOs.
*PL 480 Food Commodities Phase-Out: Its Implications & Alternative Programs (DSWD Context) 
*CRS/Philippines' Experience in the Food Assistance Program

Impact of Food Assistance Programs in the Philippines

The food assistance program has always been a component of the national nutrition plan or program. It has also been tagged as an emergency and stop-gap measure to provide temporary relief from hunger. US PL 480 Title II food commodities have figured prominently in food assistance programs, being the major bulk of food used in the program.

Implicit in these efforts was a recognition that food assistance programs would still play an important role in improving the country's nutritional situation. The Philippine Plan of Action for Nutrition for 1993-98 still includes food assistance among its five impact programs. The design of the food assistance program of PPAN was based on an assessment of the nutrition situation when the plan was being formulated and documented experiences in the implementation of the program under the then Philippine Food and Nutrition Plan and the Philippine Nutrition Program, as well as anticipated developments in the 90's, particularly the phase-out of foreign food aid.

The food assistance program in the Philippines serves as an entry point in the conduct of nutrition education classes, food production, income generating activities and other nutrition-related health undertakings.

The Philippine country paper for the ICN lists the following as objectives of the food assistance program: 

  1. To reduce the prevalence of malnutrition among target groups;
  2. To supplement the diets of underweight infants, preschoolers and schoolers to improve their physical and mental development and nutritional health;
  3. To teach the value of utilization of indigenous foods; and,
  4. To provide practical opportunities for developing good food habits among mothers and their children. 

Various food assistance programs or projects have been implemented by national government agencies and NGOs. A sampling of these projects is as follows : 

  1. Supplementary Feeding Program and Food Security for Distressed Families of DSWD The Supplementary Feeding Program involved the provision of food supplements to severely and moderately underweight pre- schoolers without medical complications and uncovered by any other feeding programs. DSWD continued with the Food Security for Distressed Families Programs that provided supplementary feeding using local commodities.
  2. Targeted Food Assistance Program (TFAP) of the DOH The TFAP is the food assistance program of the DOH which targets severely and moderately underweight children aged 1 to 7. It is also covers pregnant and lactating mothers in their second and third trimesters of pregnancy, as well as underweight and anemic mothers.
  3. Targeted Maternal and Child Health Program (TMCHP) and Food Transition Strategy of CRS The doiceses of the Catholic church implement the TMCHP in coordination and technical guidance from the CRS. It covers 6-11 month old infants except those overweight; underweight 12-60 month old preschoolers; pregnant mothers in their third trimester and lactating women. The Food Transition Strategy, another scheme in anticipation of the phase-out, used local food commodities especially rice and mungbeans in supplementary feeding programs.
  4. Supplementary Feeding Programs of DECS The DECS has implemented various supplementary feeding programs. It has the Applied Nutrition Program that includes a supplementary feeding program together with food production and nutrition education. This operates on a self- help scheme. It also implemented both a CRS and CARE- assisted School Nutrition Program. In 1985, DECS started the Alternative School Nutrition Program. It provided targeted schools with seed money for school canteen operations. Proceeds go to supplementary feeding of severely and moderately underweight schoolers as snacks made from local commodities.
  5. Nutripak Development, Marketing, and Distribution by the NCP ,The Nutripak is a weaning food preparation composed of ground rice, ground shrimp, "dilis" or mungbeans, vegetable oil and milk. In the late 70's and early 80's, assistance to local governments was in setting-up Nutripak plants that produced the commodity for sale or free distribution in feeding programs. Currently, many of these plants are no longer operational. In addition, NCP also formulated Nutrinoodles and GRO biscuits that have been marketed commercially. The series of calamities in the 90's prompted NCP to design the three-day and five-day disaster packs consisting of GRO biscuits, Nutrinoodles and Nutripak distributed on a dry ration scheme.
  6. Feeding Programs of the Local Government Units Besides the nationally coordinated feeding programs and projects, LGUs have also been implementing various supplementary feeding programs, either by itself or in coordination with other agencies. For instance, the City of Cagayan de Oro has been operating a milk feeding program for schoolchildren in coordination with local milk producers.
  7. Pilot Food Price Subsidy Scheme A targeted food subsidy scheme was pilot tested in 1983-84 in three provinces in the Philippines. This aimed to assess the technical and administrative feasibility of a proposed scheme. It also hopes to determine its economic and nutritional effects using a survey on target and non- target areas before, during and after termination of the pilot testing (Garcia & Pinstrup-Anderson, 1987). The scheme consisted of price discounts on rice and cooking oil and a nutrition education component. Assessing the effectiveness of food assistance programs entails determining the extent of achieving the objectives of food assistance. Available literature on the matter, while seemingly scanty, suggests that to a certain extent, these were met.

Several studies have shown the effectiveness of supplemental feeding in increasing the weights of the beneficiaries. In 1981, Blumenfeld, et.al. evaluated PL 480 Title II Food Programs in the Philippines. They concluded that the MCH program was "having a positive impact on the nutritional status of the participants".

One of the indicators supporting this reflects on the five out of six centers studied where 70-100%of participants experienced improvement in nutritional condition. The same study showed differences in weight gain between beneficiaries of the Day Care Program and non- beneficiaries. Participants of the program gained approximately 6.5% standard weight-for-age in a six-month period, while the few non-participants who improved experienced a 3% gain. Baclig and Sagun (1982) showed the same trends when they studied the impact of the TMCHP nationwide.

The initial weights of the participants were compared with the weights taken during the rehabilitation period ranging from 3 to 24 months. Overall, there was a 50% and 36% reduction in the proportion of third and second degree cases, respectively. The DSWD reported in 1995 an indication of positive nutritional impact of the Food Security for Distressed Families Program. Data indicated that 39% of the program's 28,098 beneficiaries improved in weight and 21% attained normal weight.

Results of theTFAP evaluation study of Florencio in 1991 showed that there was no significant difference in the mean weight increment of children in the control group compared to the treatment group. Another angle is the impossibility of definitely establishing the effectiveness of school feeding programs in improving nutritional. There are limited studies showing the effect of food assistance programs on promoting nutrition knowledge and practice. However, Baclig and Antillon (1981), following an assessment of urban training centers mainly in Metro Manila observed that the nutritional status of younger siblings who have never participated in any nutrition programs was, in general, better than their older brothers' and sisters' pre-program nutritional status.

The TMCHP in Metro Manila that provides food assistance, nutrition education and backyard food production has a positive nutritional impact even after graduation from the program (Baclig & ntillon, 1981). A study conducted in Bulacan (Solon, 1985), where Nutripak was fed to a child daily, supplementary feeding was found to have a positive effect only during the program, after which the impact disappeared. The same study concluded that supplementary feeding programs appear valuable only as a short-term rehabilitation scheme for the malnourished unless logistics permit long term implementation with strong education components.

While weight gain has always been the foremost objective of supplemental feeding, a non-improvement of the beneficiaries' weight does not necessarily mean failure of the program. A study conducted by Florencio, et. al. (1991) showed that recipients of TFAP for three months improved in gross motor development even though no significant improvement in weight was noted. A similar finding was reported for the food assistance component of the LAKAS program. It is a community-based nutrition action program implemented by LGUs with funding assistance from the national government. Mothers of beneficiaries attested that the "previously underweight children generally had good appetite and socialized well with other children" (DAP, 1995).

The pilot food discount subsidy scheme, on the other hand, concluded that consumers are most likely to increase food consumption if foods are subsidized than if income is raised directly. This was still evident after two months of termination of the scheme (participants still spend more on food even without the subsidy). Results also showed decrease in caloric consumption to pre-implementation levels immediately after the termination of the scheme. Supplementary feeding programs are effective in increasing the weights of beneficiaries and perhaps in preventing further deterioration in nutritional status, as a rule.

Where no improvement in weight or nutritional status was noted, positive behavioral changes among preschoolers were noted. Study results on the sustainability of changes in weight and nutritional status presented may require further studies. An income transfer scheme through a rice and oil price discount also showed positive changes in expenditures, household and preschool calorie consumption and even the weight status of preschoolers. It is unfortunate however that studies reviewed did not provide other information that could give local insights to help answer some of the issues raised. Examples of such information are as follows:

  1. effectiveness of center-based feeding vis-_-vis home- based feeding;
  2. impact of supplementary feeding on pregnant and lactating women;
  3. effectiveness of supplementary feeding and food assistance in teaching the value and utilization of indigenous foods and for developing good food habits among children; and
  4. effective mix of partner programs for better impact of food assistance.

The absence of Philippine-based answers should not hinder the continued implementation of the food assistance program. Implementation may continue, this time using local resources and perhaps designed for specific situations existing in different parts of the country.Thus we may have various models of food assistance programs for adaptation to varioussettings. Further, they should have a well-designed research component that can provide local answers to aforementioned information gaps. When all is said and done, the phase-out of PL 480 food may mean immediate significant loss for efforts for nutrition improvement, but there is still life after PL 480. There is an exciting and challenging life ahead as the country continues with its food assistance program, this time relying on its resources.

PL 480 Food Commodities Phase-Out: Its Implications & Alternative Programs (DSWD Context) 


The Department of Social Welfare and Development is the lead agency in implementing the Food Assistance Program of NNC since 1976. The DSWD has developed the program designed to improve the nutritional status among the 0-6 year old preschoolers. The program started with support from CRS, a USAID-supported endeavor. With the passage of the Local Government Code, the program was devolved to the LGUs. Still, the DSWD should provide augmentation support, among others, to the CRS program but with a decreasing number of beneficiaries through the years. It is beyond reasonable doubt that the food support to the program under PL 480 will surely be phased-out in 1997. It is therefore imperative to look into the implications and evolve alternative strategies or programs so that the concern of children under this category shall not be jeopardized. It has been this very reason why the Bureau of Emergency Assistance (BEA) has been conceptualizing and even started pilot-testing alternative programs as safety net for the impact of the phase-out. The Food Security for Distressed Families (FSDF) was pilot-tested in 1994-95 by the DSWD through the BEA as an alternative strategy. It aimed at empowering the family and community to manage the program at their levels. The point of entry was the underweight child using the "Total Family and Community Approach" in solving the problem. It had the following components:

  1. Community Organization
  2. Nutrition Education
  3. Nutri-cum Livelihood
  4. Home Food Production
  5. Referral Services

The Socio-economic Assistance-Kaunlaran Kalusugan (SEA-KK) is a two-year DSWD-CRS collaborative project. It seeks to target organizing families into 15 SEA-KK Associations with 25 members per group to support the supplementary feeding of the moderately and severely underweight preschoolers. Each target barangay with feasible nutri-cum livelihood project is given priority for capital assistance. 

CRS/Philippines' Experience in the Food Assistance Program 


Catholic Relief Services assists the poor and the disadvantaged. Its mission is the alleviation of human suffering, the development of people, and the fostering of charity and justice. CRS works in over 75 countries throughout Africa, Europe, and Latin America. The CSR-Philippines is part of the worldwide effort to assist the poor. Its strategic goal from 1994-96 is "improved socio-economic well-being of these families". Along this goal are the efforts to alleviate poverty in three program areas: Agriculture, Enterprise Development, and Health.

The church-based organizations of dioceses, their social action centers and foundations, as well as non- church NGOs are the counterparts of these areas. It also works with the government through the DSWD. Food assistance using PL 480 food commodities is currently being implemented through three major programs that are under the umbrella of health programming area. The Food Assistance Program in Transition has been a basic component of CRS programming for many years. From 1945-1955, the dioceses were virtual multi-purpose centers managing the distribution of food to war orphans and malnourished preschoolers, establishing child welfare activities, and providing medical services, education and other emergency measures.

In 1956, an agreement was enacted providing for duty free entry of donated foods and other relief assistance. The areas of coverage expand to 32 dioceses as transportation, distribution, storage and support services improved. The program benefited close to 1.5 million people and had over 200,000 volunteers. Food for work program was initiated, including the construction of community centers, wharves, artesian wells, foot bridges, school buildings and even playgrounds. In 1962, CRS became the first agency to begin a "Food for Peace" program in the Philippines using PL 480 Title II food commodities.

The last half of the sixties saw the beginning of new initiatives designed to take full advantage of U.S. government food resources through USAID. The Voluntary Work Program (Food for Work) which provided food aid for voluntary labor for community development projects took center stage in 1966. A school feeding program was instituted which provided milk, flour, and butter for preparing lunch and snacks for schoolchildren. Eventually, there was provision for bulgur, rolled wheat, recipe books and nutribun.

The Maternal and Child Health Program began during this period and gradually grew. The mothercraft approach was pilot-tested with a combination of supplementation and nutrition education emphasizing on maternal and child health. Maternal and Child Health Programs complements socio-economic development programs. CRS also initiated food programs for persons in institutions like the prisoners, orphans, malnutrition ward occupants, and the elderly. The fourth decade of CRS-Philippines was marked by a significant strategic shift from an orientation of general relief and maternal distribution to a developmental community building aimed at eliminating dependency among beneficiaries. Various dioceses were responsible for establishing the Social Action Commission.

CRS and USAID began looking at modernization of food and appropriate mechanisms to support community development programs. On its fifth decade, the agency began to consolidate efforts and provide sharper focus in allocating resources. Monetization of the US government food assistance became a reality as CRS embarked on a Food Transition Strategy in 1991. Donated food commodities from the US were on sale commercially. Implementation of the FTS used the Local Food Supplementation, Small Enterprise Development and an LFS-SED combination. Evaluation results after the first year of implementation showed that the purely local food supplementation strategy was least sustainable among the FTS strategies.

The pure SED strategy enabled the diocese to earn from the interest generated from the landing activities. The combined SED and LFS strategy allowed the diocese to generate fund from administrative and operating expenses. The SED is viable for replication and is now the only FTS scheme being supported. In 1995, discontinuation of food assistance was inevitable in ten dioceses due to limited resources. The reduction of food assistance prompted CRS to limit food assistance to moderately and severely underweight 6-59 months old children. As part of the FTS, CRS will support DSWD's SEA-KK project that started this year.While supplementing the dietary requirements of the beneficiaries, monthly food ration of 8 pounds perbeneficiary was mainly a monthly reprieve of their already strained budget, essentially an income transfer and augmentation.

In most cases, the ration is not merely considered as a supplement but as the family's main food supply. In the evaluation of the Direct Feeding Program conducted by the FNRI, the proportion of beneficiaries that registered the highest improvement in nutritional status (75%) were the severely underweight children. However, the current eating pattern of sampled beneficiaries was poor, implying that the program effects were temporary. The food ration also creates an incentive for mothers to come together in a regular and organized manner for group activities like health and nutrition education, immunization and credit activities that provide long term benefits.

The food assistance program has permitted the church counterparts to demonstrate their concern for the poor and promote other activities as well. With the food assistance program, we have mobilized a considerable number of volunteer workers trained to assist in health programs. Another impact was the formation of mothers' associations and groups who trained to manage lending projects. Unfortunately, these groups were underutilized to sustain their health activities. The problem constraints include the following:

  1. Delayed shipment resulting to warehousing problems, overstocking, damage, delayed delivery and unfit commodities.
  2. Internal control weakness in accounting, management and auditing.
  3. Decreased attendance in the absence of ration or conflict in work schedules.
  4. Reduction of food resources.
  5. Limited number of weighing scales and lack of funds.
  6. Few skilled staff members
  7. High participant coverage vis-_-vis volunteers
  8. Food leakage to other family members.

Supplementary feeding itself is not sufficient to achieve nutritional impact especially when sharing with the whole family exists. Inclusion of complementary interventions will maximize the development impact of food supplementation and ensure sustainable health improvement. Utilization of commodities as an incentive for regular participation in health activities serves a dual purpose as an income transfer to the food insecure family.

However, utilization of food as an incentive is an expensive and non- sustainable activity. Community-based approaches that generate active participation of families to promote empowerment and sense of ownership and the provision of quality health packages ensure sustainability of health initiatives. Implementation of transition strategies such as linkage with health structures and community structures and development of financial self-sufficiency at the start of the program guarantees long-term sustainability. Ensuring effective targeting of both counterparts and beneficiaries ensures maximum program impact that should be need- driven and not resource-driven.

The timing of phasing-out PL 480 Title II food assistance at the end of 1996 is highly off and inappropriate and the phase-out itself is unreasonably severe. The CRS expedited the implementation of the Food Transition Strategy by adding 13 dioceses to implement the SED activities funded by the sales proceeds of the monetized soya meal. This allowed also our counterpart to be strict and manage their loaning activities for the sustainability of programs.

Another big challenge and opportunity for CRS after 1996 is the reduction of its health programming to a non- food based health program, increase its effectiveness and efficiency for higher impact and sustainability. There will be a need to look at targeting of beneficiaries where greatest impact can be achieved, improvement of health interventions and education practices, linkages with health structures and encouragement of effective associated development activities.

 

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