Health and Nutrition Programs for 1,000 Days

Policy declarations and objectives

Section 2 declares that the right to health is a fundamental principle guaranteed by the State under Section 15, Article II of the 1987 Constitution, and that the State protects and promotes the right to health and instills health consciousness.
Section 2 guarantees State support for adequate food, care, and nutrition to pregnant and lactating mothers, including adolescent girls and women of reproductive age, and especially children from zero (0) to two (2) years old.
Section 2 commits to improving quality of human resource, and to reducing maternal and child mortality and stunting, consistent with the Philippine Development Plan and national nutrition plans.
Section 2 declares determination to eliminate hunger and reduce all forms of malnutrition, prioritizing integrated nutrition for adolescent females, pregnant and lactating women, and infants and young children through a whole-of-government approach in collaboration with civil society organizations and the private sector.
Section 3 sets objectives that include comprehensive, sustainable, multisectoral strategies for health and nutrition across the first one thousand (1,000) days, integrating short, medium, and long-term government plans to end hunger, improve health and nutrition, and reduce malnutrition.
Section 3 directs the Act to strengthen the roles of the Department of Health (DOH), the National Nutrition Council (NNC), and other agencies in implementing nutrition programs in the first one thousand (1,000) days.
Section 3 requires evidence-based nutrition interventions that integrate responsive caregiving and early stimulation in a safe and protective environment, using nutrition-specific and nutrition-sensitive mechanisms aligned with UNICEF and WHO recommendations.
Section 3 directs institutionalization and scaling up of nutrition in relevant national and local planning instruments, including LGU investment plans, prioritizing areas with high poverty incidence, Geographically Isolated and Disadvantaged Areas (GIDA), and hazard and conflict zones.

Coverage and prioritization rules

Section 5 covers nutritionally-at-risk persons, especially pregnant and lactating women, particularly teenage mothers, women of reproductive age, adolescent girls, and all Filipino children newly born up to age twenty-four (24) months.
Section 5 mandates priority to those residing in disaster-prone areas and GIDA, including isolated areas due to distance, inaccessibility to transportation, and weather conditions, as well as unserved and underserved communities and other areas with high poverty incidence.
Section 5 prioritizes persons in vulnerable sectors and communities in or recovering from situations of crisis or armed conflict recognized by a government body.
Section 5 requires the NNC to prioritize LGUs that meet at least one of the following:
- (a) Highest prevalence of undernutrition and nutrient-deficiency among pregnant and lactating women and children aged zero (0) to two (2) years;
- (b) Availability of facilities or capability to implement the program; and
- (c) Prioritization of the program in the locality and willingness to provide counterpart resources for implementation.

Defined terms used in the Act

Section 6 defines Breastmilk Substitute as any milk type (liquid or powdered), including soy milk and follow-up formula, specifically marketed for feeding infants and young children up to age three (3) years.
Section 6 defines First one thousand (1,000) days of life as the period from conception (nine (9) months in the womb) to first twenty-four (24) months after birth.
Section 6 defines GIDA as areas isolated due to distance/geographical isolation, weather conditions, and lack of transportation modes, including unserved/underserved communities, and areas with access/service delivery problems, high incidence of poverty, vulnerable sector presence, and communities in or recovering from crisis or armed conflict, recognized by a government body.
Section 6 defines Malnutrition as deficiencies, excesses, or imbalances in intake of protein, energy (carbohydrates and fats), and/or nutrients, covering undernutrition (including suboptimal breastfeeding, stunting, wasting/thinness, underweight, and micronutrient deficiencies/insufficiencies) and overnutrition (including overweight and obesity).
Section 6 defines Stunting using WHO child growth standards as percentage of children zero (0) to fifty-nine (59) months below minus two (2) SD (moderate stunting) and minus three (3) SD (severe stunting) from the median.
Section 6 defines Severe Acute Malnutrition (SAM) as weight-for-length/height less than three (3) SD below the WHO median (<-3SD), characterized by visible severe wasting or bipedal pitting edema, or MUAC <115mm.
Section 6 defines Moderate Acute Malnutrition (MAM) as weight-for-length/height between two (2) and three (3) SD below WHO median (<-2 up to -3 SD) or MUAC <125mm and ≥115mm.
Section 6 defines Overweight and obesity using adult BMI thresholds (BMI ≥25 overweight; BMI ≥30 obese) and child growth classification using WHO standards as above two (2) SD (overweight) and above three (3) SD (obese) from the median.
Section 6 defines Responsive caregiving as prompt and close attention by the caregiver with appropriate response to the child’s immediate behavior, needs, and developmental state.
Section 6 defines Early Stimulation as external stimuli enabling infants and young children to interact with others and their environment to optimize cognitive, physical, emotional, and social abilities.
Section 6 defines Nutrition-specific interventions and programs and Nutrition-sensitive interventions and programs by their determinants addressed (immediate vs. underlying determinants), and how nutrition-sensitive programs can serve as delivery platforms.
Section 6 defines Low birth weight as less than 2,500 grams (or 5.5 pounds, or 5 pounds and 8 ounces).
Section 6 defines Nutritionally-at-risk pregnant women using predisposing factors such as low pre-pregnancy BMI, insufficient weight gain, narrowly-spaced pregnancies/births, low-income families and economic food purchase problems, large number of dependents, history of preterm or low birth weight infant, and other unfavorable prognostic factors such as obesity or anemia, and diseases affecting nutritional status including diabetes, tuberculosis, drug addiction, alcoholism, and mental disorder.
Section 6 defines CSOs as non-State actors aiming neither to generate profits nor seek governing power, including specified types of organizations and groups.
Section 6 defines Chronic Energy Deficiency (CED) as negative energy balance due to inadequate food/nutrient intake, absorption problems, and nutrient loss mostly due to infections and malignancies.

Implementation structure and roles

Section 7 assigns responsibility for implementation to the DOH, in coordination with the NNC, DA, LGUs, and other concerned NGAs.
Section 7 requires barangay-level implementation through rural health units and/or barangay health centers, in coordination with the Sangguniang Barangay.
Section 7 mandates mobilization of Barangay Nutrition Scholars (BNS) and Barangay Health Workers (BHWs), and provides that they must be given resources and benefits to carry out their tasks.
Section 7 encourages LGUs to integrate maternal, neonatal, child health and nutrition programs in local nutrition action plans and investment plans.
Section 7 requires the NNC and other concerned NGAs to provide technical assistance to LGU counterparts in development, formulation, and implementation.
Section 10 directs the inclusion of cross-cutting program components by LGUs, NGAs, CSOs, and other stakeholders, including:
- national and local health and nutrition investment planning and financing;
- policy, standards, and guideline development;
- health and nutrition promotion and education, social mobilization and community organization (including advocacy);
- service delivery;
- human resources capacity development;
- sectoral collaboration and partnerships;
- logistics and supply management;
- knowledge management and information;
- monitoring and evaluation, and research and development.

Core program components by life stage

Section 8 provides that the program includes health and nutrition services and interventions across different life stages, delivered through joint work by LGUs, NGAs, CSOs, and other stakeholders.
Section 8(a) (Prenatal Period; first two hundred seventy (270) days) requires facility and community prenatal care services that include, among others:
- pregnancy tracking and enrollment to ANC;
- regular follow up to complete recommended minimum number of quality ANC visits with proper referral for high-risk pregnancies;
- maternal immunizations including tetanus and diphtheria toxoid vaccine and other appropriate vaccines;
- empowering women for birth and emergency plans and breastfeeding and rooming-in plans, including counselling;
- counselling on maternal nutrition and appropriate infant and young child feeding practices;
- early identification and management of nutritionally-at-risk pregnant women and pregnant adolescent females, and provision of Ready-to-Use Supplementary Food (RUSF) in addition to dietary supplementation;
- micronutrient supplements such as iron, folic acid, calcium, iodine, and other necessary micronutrients;
- promotion of iodized salt and fortified foods with necessary micronutrients;
- assessment of risk for parasitism and provision of anti-helminthic medicines;
- oral health services including oral health assessment;
- counselling on hand-washing, environmental sanitation, and personal hygiene;
- counselling on responsible parenthood and family, and health services;
- counselling on nutrition, smoking cessation, and adoption of healthy lifestyle practices;
- PhilHealth enrollment and linkages to facility and community-based health and nutrition workers and volunteers;
- social welfare support for access to health and nutrition services, including dietary supplementation and healthy food products/commodities for nutritionally-at-risk pregnant women in poorest-of-the-poor families, including persons with disabilities;
- maternity protection during pregnancy;
- counselling and psychosocial support prioritized for high-risk pregnant women and adolescent females in poorest-of-the-poor families;
- counselling and support to parents and caregivers on parent/caregiver-infant/child interaction for responsive care and early stimulation;
- others based on international/national guidelines and locally generated evidence.
Section 8(b) (Women about to give birth and immediate postpartum period) requires facility and community health and nutrition services including, among others:
- adherence to couple’s birth, breastfeeding, and rooming-in plans;
- provision of mother-friendly practices during labor and delivery consistent with:
  - Mother and Baby-Friendly Health Facility Initiative (MBFHFI),
  - Republic Act No. 10028 (Expanded Breastfeeding Promotion Act of 2009),
  - Executive Order No. 51 (Milk Code),
  - and other related DOH administrative issuances on maternal and newborn care;
- monitoring labor progress and well-being of mother and fetus, with interventions for arising health issues;
- identification of high-risk newborns (premature, small for gestational age (SGA), and/or low birth weight) and preventive interventions to reduce prematurity or low birth weight complications;
- coverage and utilization of PhilHealth benefit packages for maternal care (as stated: PMHealth benefit packages);
- nutrition counselling and provision of nutritious food and meals at the facility for women who delivered preterm, SGA, or low birth weight infants until discharge;
- lactation management services supporting breastfeeding initiation and exclusive breastfeeding for six (6) months, especially after caesarean deliveries, and thereafter until discharge;
- counselling on hand-washing, sanitation, and personal hygiene;
- counselling and utilization of modern family planning methods and access to reproductive health care services under Republic Act No. 10354 (Responsible Parenthood and Reproductive Health Act of 2012);
- maintenance of non-separation of mother and newborn and rooming-in for early breastfeeding initiation;
- assurance of women- and child-friendly spaces during calamities, disasters, or emergencies;
- support to fathers and caregivers for commitment to proper health and nutrition care and counselling/positive parenting support;
- counselling and support to parents and caregivers on responsive care and early stimulation;
- others based on international/national guidelines and locally generated evidence.
Section 8(c) (Postpartum and lactating women) requires facility and community services including, among others:
- follow-up visits after birth;
- home visits for women in difficult-to-reach communities, especially in GIDA;
- lactation support and counselling from birth up to two (2) years and beyond, including women returning to work, in informal economies, and those with breastfeeding difficulties;
- nutrition assessment and counselling to meet lactation demands in health facilities and workplaces;
- identification and management of malnutrition of CED and nutritionally-at-risk postpartum and lactating women (including adolescent mothers) and provision of RUSF in addition to dietary supplementation as appropriate;
- community-based mother support groups and peer counsellors for breastfeeding;
- lactation breaks for women in workplaces, including micro, small and medium enterprises;
- lactation stations in workplaces (government and private), informal economy workplaces, and public places/public transportation as stipulated in Republic Act No. 10028 and its IRR;
- workplace breastfeeding support groups coordinated with occupational health workers and human resource managers trained in lactation management;
- provision of micronutrient supplements including iron, folic acid, Vitamin A, and other necessary micronutrients;
- promotion of iodized salt and fortified foods with necessary micronutrients;
- oral health services;
- counselling on family planning and access to reproductive health care services under Republic Act No. 10354;
- social welfare support for access to health and nutrition services for CED and nutritionally-at-risk postpartum/lactating women in poorest-of-the-poor families;
- women-friendly and child-friendly spaces to continue breastfeeding during calamities/disasters/emergencies;
- support to fathers and caregivers for proper health and nutrition care and counselling/positive parenting support;
- responsive care and early stimulation counselling and support to parents and caregivers;
- others based on international/national guidelines and locally generated evidence.
Section 8(d) (Birth and newborn period; twenty-eight (28) days) requires facility and community services including, among others:
- baby-friendly practices during delivery consistent with MBFHFI and DOH essential newborn care protocols in facilities providing birthing services;
- early and continuous skin-to-skin contact for full-term babies and continuous kangaroo mother care for small babies born preterm and low birth weight, following DOH newborn protocols in birthing facilities;
- non-separation from birth for early breastfeeding initiation and exclusive breastfeeding;
- routine newborn care including eye prophylaxis, Vitamin K supplementation, and immunizations;
- newborn screening and newborn hearing screening;
- availment and utilization of appropriate PhilHealth benefit packages for newborns including preterm, low birth weight, and small babies;
- early referral to higher level facilities to manage illness and/or complications;
- availability of human milk pasteurizer in strategic level 2 and 3 facilities with neonatal intensive-care units for breastmilk supply for preterm and low birth weight infants within facility/service delivery network and for emergencies/disasters;
- child-friendly spaces for exclusively breastfed infants during calamities/disasters/emergencies;
- social welfare support for newborns from poorest-of-the-poor families;
- facilitate prompt birth and death registration, including fetal deaths, and restoration/reconstruction of documents destroyed in disasters;
- counselling/support to parents and caregivers on responsive care and early stimulation;
- support for parents/caregivers on early stimulation and responsive care;
- others based on international/national guidelines and locally generated evidence.
Section 8(e) (First six (6) months of infancy; one hundred eighty (180) days) requires facility and community services including, among others:
- continuous support for exclusive breastfeeding, including referral to trained lactation management health workers for breast conditions;
- timely immunization services integrated with breastfeeding assessment, early child development, growth monitoring/promotion, and Infant and Young Child Feeding (IYCF) counselling;
- growth and development monitoring/promotion for infants less than six (6) months, especially low birth weight, stunted, or acute malnutrition cases;
- counselling on hand-washing, sanitation, and personal hygiene;
- early referral to higher level facilities for common childhood illnesses including acute malnutrition;
- identification and management of moderate or severe acute malnutrition among infants less than six (6) months and lactation management and treatment of medical conditions contributing to malnutrition;
- responsive care and early stimulation counselling/support;
- social welfare support to improve access for newborns from poorest-of-the-poor families;
- support for fathers and caregivers to provide proper health and nutrition care and counselling/positive parenting support;
- assurance of women- and child-friendly spaces during calamities/disasters/emergencies where services are provided;
- others based on international/national guidelines and locally generated evidence.
Section 8(f) (Infants six (6) months up to two (2) years) requires community-level services including, among others:
- timely introduction of safe, appropriate, nutrient-dense complementary food with continued and sustained breastfeeding from six (6) months up to two (2) years, emphasizing suitable nutrient-rich home-prepared locally available foods prepared and fed safely;
- nutrition counselling on complementary food preparation and feeding;
- dietary supplementation of age-appropriate nutrient-dense complementary food;
- growth and development monitoring/promotion in health facilities and at home;
- routine immunizations based on latest DOH guidelines;
- micronutrient supplements deemed necessary;
- management of common childhood illnesses based on WHO and DOH guidelines;
- management of moderate and severe acute malnutrition using national guidelines with proper referral to higher levels as appropriate, especially with serious medical complications;
- oral health services including fluoride varnish application to prevent dental caries;
- anti-helminthic tablets for children one (1) to two (2) years old as appropriate;
- potable source of water availability, counselling on hand-washing/sanitation/personal hygiene, and support for household sanitation to reduce food, water, and vector-borne diseases;
- counselling/support to parents and caregivers on responsive care and early stimulation, plus referral for development delays and disabilities for prevention, treatment, and rehabilitation;
- social welfare support to improve access for infants six (6) months and above from poorest-of-the-poor families, including dietary supplementation/complementary food and referral for development delays/disabilities;
- home kitchen gardens wherever feasible;
- locally available grown crops, vegetables and fruits for complementary feeding and dietary supplementation;
- protection against child abuse, injuries, and accidents including first aid, counselling, and proper referrals;
- others based on international/national guidelines and locally generated evidence.
Section 9 requires health and nutrition services for adolescent females ten (10) to eighteen (18) years old at facility, school, and community levels including, among others:
- assessment of health and nutrition status and identification of nutritionally-at-risk adolescent girls, with provision of ready-to-use supplementary food or ready-to-use therapeutic food as appropriate;
- age-appropriate immunizations under latest DOH guidelines;
- oral health services including oral health assessment;
- anti-helminthic drugs for deworming;
- counselling on hand-washing, sanitation, and personal hygiene;
- micronutrient supplements according to DOH guidelines in partnership with DepEd;
- promotion of iodized salt and fortified foods with necessary micronutrients;
- referral for menstruation irregularities/abnormalities contributing to anemia and blood loss, and management of complicated illnesses including moderate and severe acute malnutrition;
- counselling on proper nutrition, mental health, avoidance of risk-taking behaviors, smoking cessation, healthy lifestyle practices, and family health;
- others based on international guidelines and locally generated evidence.

Disasters, donations, and emergency priorities

Section 11 mandates that areas affected by disasters and emergency situations—natural and man-made—are prioritized for health and nutrition services and psychosocial interventions.
Section 11 requires NGAs and LGUs to immediately provide emergency services and food supplies for proper nourishment of pregnant and lactating mothers and children from zero (0) to two (2) years old.
Section 11 requires preparation and readiness of women and infant/child-friendly spaces to accommodate women and children and provide daily necessities such as food, clothing, clean water, and shelter.
Section 11 requires ready breastfeeding support and counselling for children up to two (2) years or beyond, and guidance on appropriate complementary food for children over six (6) months old.
Section 11 prohibits donations of milk formula, breastmilk substitutes, and/or products covered by the Milk Code without approval of the Inter-Agency Committee (IAC) created under Executive Order No. 51, Series of 1986, including before, during, and after disasters.
Section 11 allows immediate, conflict-free private sector donations or assistance in the aftermath of natural disasters when there are no conflicts of interest or when donors are not involved in manufacture, marketing, and sales of Milk Code-covered products.
Section 11 requires strict compliance with the Milk Code and its revised IRR, and provides for options to mothers with breastfeeding problems such as mobilization of breastfeeding support groups or strategic local milk banks.
Section 11 directs DOH and relevant departments, in coordination with the National Disaster Risk Reduction and Management Council (NDRRMC), to formulate guidelines and mechanisms considering humanitarian, inclusive, gender and culture-sensitive standards consistent with Republic Act No. 10821 (Children’s Emergency Relief and Protection Act) and its IRR and the Comprehensive Emergency Program for Children.

Capacity building and volunteer support

Section 12 requires DOH and NNC, in coordination with LGUs, to provide practical and effective training courses to BNSs, BHWs, and other concerned personnel to upgrade their skills and competence in implementing the program’s women and child health and nutrition services and interventions.

NNC Governing Board and authority

Section 13 establishes the National Nutrition Council (NNC) Governing Board with the following members:
- Secretary of DOH as ex officio Chairperson;
- Secretary of DA as ex officio Vice Chairperson;
- Secretary of DILG as ex officio Vice Chairperson;
- Secretary of DepEd;
- Secretary of DSWD;
- Secretary of DTI;
- Secretary of DOLE;
- Secretary of DOST;
- Secretary of DBM;
- Secretary of NEDA; and
- Three (3) representatives from the private sector appointed by the President.
Section 13 limits private-sector representatives to those from any of: health and nutrition professional organizations; women sector; farmer and fisherfolk; urban poor; organization/association of community health workers or BNS; CSOs; and academe and research institutions, serving a term of two (2) years.
Section 13 allows the heads of departments to be represented by designated representatives with rank not lower than an Assistant Secretary.
Section 13 prohibits private-sector members with conflicts of interest, especially those described in Executive Order No. 51, Series of 1986, from being members of the Council.
Section 13 requires maintenance of the composition of the NNC’s Secretariat and Technical Committee as defined in Executive Order No. 234, series of 1987 (“Reorganizing the National Nutrition Council”).

NNC functions and roles of agencies

Section 14 designates the NNC as the highest policy-making and coordinating body on nutrition and grants it functions and powers including:
- formulating national nutrition policies, plans, strategies, and approaches for nutrition improvement, including women, infant and young child, and adolescent nutrition;
- overseeing and serving as focal point for integration of nutrition policies and programs of all member agencies implementing nutrition laws, policies, rules and regulations;
- coordinating, monitoring, and evaluating nutrition programs and projects of public/private sectors and LGUs to ensure alignment with national policies;
- receiving grants, donations, and contributions for nutrition programs and projects, provided no conditions contradict the Act’s policies or provisions;
- coordinating joint planning and budgeting to ensure funds, secure fund release under approved programs/projects, and monitor implementation and track public expenditure;
- calling upon any government agency/instrumentality for needed assistance to implement the Act.
Section 15 requires NNC member agencies to:
- ensure implementation of nutrition programs and projects;
- develop promotive, preventive, and curative nutrition programs;
- integrate health and nutrition concerns into their respective policies and plans; and
- provide additional resources in any form, including technical assistance, sourced from their budgets to support local nutrition programs.

Procurement, monitoring, and appropriations

Section 16 mandates that the Government Procurement Reform Act (Republic Act No. 9184) shall not hinder implementation because agencies must establish a liberalized mode of procurement for this program, subject to approval of the Government Procurement Policy Board.
Section 16 requires public procurement for the program to prioritize participation of local and community-based producers, suppliers and/or service contractors.
Section 17 requires NGAs and LGUs concerned to regularly monitor, review, and assess the program’s impact and effectivity in consultation with stakeholders.
Section 18 provides that initial implementation funding is charged against appropriations of DOH, DA, NNC, and other relevant agencies, and continued implementation sums must be included in the annual General Appropriations Act (GAA).
Section 18 requires DBM, in coordination with DOF, DOH, DA, NNC, and other relevant agencies, to consider prevalence of malnutrition and child mortality in determining annual appropriations.
Section 18 provides that priority LGUs identified by the NNC are eligible to receive from concerned NGAs supplementary funds necessary for implementation, and that such subsidy must be included in the GAA.

Implementing rules and final clauses

Section 19 directs DOH, in coordination with the NNC Governing Board and in consultation with public and private sector stakeholders, to promulgate Implementing Rules and Regulations (IRR) within ninety (90) days from the Act’s effectivity for effective implementation.
Section 20 establishes separability by providing that invalidity or unconstitutionality