Adoption of WHO Child Growth Standard for Filipino Children

Purpose and Policy Intent

The Order promotes optimum child growth and development through the enhanced implementation of GMP activities using the WHO-CGS.
The Order requires using the WHO-CGS as the standard in assessing child nutritional status and in conducting Growth Monitoring and Promotion (GMP) and Operation Timbang (OPT) activities.
The Order adopts the WHO-CGS to strengthen health and nutrition interventions by enabling earlier detection of malnutrition and earlier institution of preventive and promotive measures.

Coverage, Scope, and Who Must Follow

The Order applies to all national, regional and local government units.
The Order applies to public and private medical practitioners and health facilities.
The Order applies to other agencies and stakeholders involved in assessing nutritional status of children and conducting GMP and OPT activities.
The Order applies to children with growth and development assessment coverage covering 0–71 months of age.

Core Implementation Rules

The growth and development of children 0–5 years (0–71 months) old must be assessed by measuring weights and heights regularly.
For children 0–less than 2 years (0–23 months) old, weights and lengths must be measured once a month.
For children 2–5 years (24–71 months) old, weights and heights must be measured twice a year.
The child’s weight and height must also be measured every time the child comes in contact with the health care system, such as when the child is sick and brought in for consultation.

Operation Timbang Measurement Rule

Weights of children 0–71 months taken during Operation Timbang (OPT) must be done once a year (January–March).
OPT weights must cover at least 16.2% of the total population.
Underweight and overweight children identified during OPT must be referred to the health facility for regular growth monitoring and for the institution of appropriate interventions.

WHO-CGS Standard Indicators and Measurements

The WHO-CGS must be used as the standard in assessing a child’s nutritional status.
Standard measurement indicators are:
- Weight-for-age for children 0–71 months old.
- Length/height-for-age for 0–23 months old (length) or 24–71 months old (height).
- Weight-for-length/height for 0–23 months old (length) or 24–71 months old (height).
Weight-for-age reflects the child’s body weight relative to age on a given day and provides a rough estimate of present nutritional status.
Length/height-for-age reflects attained growth in length or height at the child’s age at a given visit, and length/height combined with age indicates stunting reflecting past and chronic malnutrition.
Length and height are measured to children under two (2) years and children above 2 years, respectively.
Weight-for-length/height reflects body weight in proportion to attained length/height and distinguishes current malnutrition (acute) from past malnutrition (chronic).

ECCD Card and Mother and Child Book Use

All newborns and children below 71 months old must be given an ECCD card as the tool for growth monitoring and promotion.
The ECCD card for boys and girls serves as the record of the essential services a child receives from 0–71 months old.
The ECCD card contains a chart where weights and heights must be plotted to observe growth trends and detect growth faltering so that immediate measures/interventions are instituted.
Newborns whose mothers have been issued a Mother and Child Book (MCB) must use the ECCD card attached in the MCB.

Who May Fill and Administer Cards

Filling-up of the ECCD Card and the MCB must be administered by a health professional such as doctors, nurses, midwives, and nutritionist.
Trained barangay health workers (BHWs) and barangay nutrition scholars (BNS) may administer filling-up of the ECCD Card and MCB.
Barangay health workers (BHWs) and barangay nutrition scholars (BNS) must administer filling-up under the supervision of the health professional.

Materials, Facilities, and Integration

WHO-CGS growth tables and charts, ECCD cards, and equipment such as weighing scales, infantometer, microtoise, height/length board, and similar tools must be used and made available in all Rural Health Units, public and private health and hospital facilities, or places where weight and height measurements are taken.
The reproduction of ECCD cards is the responsibility of the LGU, with augmentation from national agencies and other stakeholders, partners, and donors.
Assessing a child’s nutritional status and monitoring growth and development must be integrated into existing MNCHN service delivery channels and other approaches that reach children 0–71 months, including points of visit such as Garantisadong Pambata, Operation Timbang, IMCI, and EPI.

Referral and Outreach Requirements

Children needing immediate assistance must be referred to the appropriate institution/health system.
Promotion to encourage mothers to bring their children for growth monitoring and availment of health and nutrition services must be intensified.

Institutional Roles and Responsibilities

Department of Health: National Centers and Units

The DOH-National Center for Disease Prevention and Control (DOH-NCDPC) is primarily responsible for the overall execution and adoption of the revised policy and guidelines on child growth standard and GMP.
DOH-NCDPC must disseminate the Order and advocate adoption and implementation among concerned stakeholders.
DOH-NCDPC must provide technical inputs for operationalizing WHO-CGS and GMP, mobilize funds for trainings of trainers, roll out trainings at CHD/provincial levels, and advocate additional resources for CGS.
DOH-NCDPC must monitor and evaluate field implementation and establish coordination and networking with FNRI, NNC, and other stakeholders in planning, implementation, monitoring, and evaluation of WHO-CGS adoption.
The National Center for Health Promotion must develop prototype materials on WHO-CGS and GMP with coordination with DOH-NCDPC.
The National Center for Health Promotion must provide technical assistance to CHDs to help LGUs adopt and implement WHO-CGS and GMP, and must promote adoption among concerned agencies and practitioners.
The National Nutrition Council level must coordinate and facilitate adoption of WHO-CGS at the local level, mobilize resources for localization of WHO-CGS, and evaluate progress of the CGS.

Center for Health Development and Hospitals

Center for Health Development (CHD) must disseminate the revised Order and advocate adoption and implementation by LGU health systems in its region.
CHD must provide technical assistance to LGUs, NGOs, academes, and other stakeholders on WHO-CGS adoption and GMP implementation and generate additional resources for implementation.
CHD must conduct orientation and training on WHO-CGS and GMP and monitor regional implementation.
Hospitals must ensure all growth tables and charts are WHO-CGS based.
Hospitals must provide budgetary allocation for procurement of ECCD cards and equipment for taking weight and height measurements.
Hospitals must conduct orientation and/or training of hospital staff in using WHO-CGS and GMP and monitor implementation of WHO-CGS adoption and GMP implementation in the hospital.

Local Government Units and Private Sector

LGUs must ensure funding for implementation of WHO-CGS and GMP.
LGUs must ensure availability of equipment and supplies, including weighing scales, microtoise, infantometers, height boards, ECCD cards, WHO-CGS tables and charts, and other necessary supplies.
LGUs must ensure all growth charts and tables used in LGU health facilities/day care centers are WHO-CGS based.
LGUs must conduct orientation and training of field health workers, including barangay health workers and barangay nutrition scholars, in using WHO-CGS and GMP.
LGUs must monitor and evaluate implementation in their localities and establish coordination and networking among concerned agencies in WHO-CGS and GMP implementation.
Private sector and professional groups must disseminate and promote the use of WHO-CGS among private health practitioners and generate resources for implementation by the private sector.

Repeal and Effectivity

Administrative Order No. 25, s. 2003 and all other orders and related issuances inconsistent with DOH Administrative Order No. 2010-0015 are rescinded.
The Order takes effect immediately.