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Friday, August 23, 2019

Special Report: Happy and healthy in day care (Last of three parts)

FEEDING children 2-4 years old in day care centers and supervised neighborhood play in Cebu has cut the incidence of underweight by half.

As its contribution to the Philippine Plan of Action for Nutrition (PPAN) 2017-2022, the Department of Social Welfare and Development (DSWD) conducts a 120-day Supplemental Feeding Program for all children in day care centers and Supervised Neighborhood Play (SNP), whether they are malnourished or not.

Melinda Cañares, the DSWD 7’s Supplemental Feeding Program focal person, reported that in Cycle 6 of its feeding program in Cebu last school year, 7.9 percent of the children were underweight at the start of the feeding program. This rate went down to 3.59 percent at the end of the 120 days.

As for the severely underweight, 1.31 percent were underweight at the start, but only 0.80 percent remained severely underweight at the end of the feeding.

Cycle 1 of the feeding program was in 2011.

Different government agencies attend to the feeding of children at different ages.

Under the PPAN, the Department of Health and local government units (LGUs) provide health systems and community-based support for infant and young child feeding, and supplementary feeding of pregnant women and children 6-23 months old.

From 2-4 years old, the DSWD and its partners have the Supplementary Feeding Program (SFP), while the Department of Education undertakes the supplementary feeding of enrolled children aged five to 11 (kindergarten to Grade 6).

Historically, the DSWD 7 has checked the effectiveness of its feeding only by using weight against age to determine if the child is still underweight.

It could not determine acute malnutrition, which requires a weight-for-height measurement, because without height boards, the day care centers could not collect height information.

“It is only starting this school year that we really required them to get the height since we already provided the day care centers with the tools. We have also provided weighing scales,” Cañares said.

Day care centers can now check for the three indicators of malnutrition: low weight for age (underweight), low weight for height (wasting) and low height for age (stunting).

During the feeding, the weight and height are taken monthly in coordination with the rural health unit.

Every barangay

Republic Act 6972 requires the establishment of a day care center in every barangay. Day care centers are run by the LGUs.

“Supervised Neighborhood Play (SNP) has the same sessions as day care, but they just don’t have a structure or a day care center. They hold their supervised sessions either in the barangay hall or chapel or any other structure in the barangay or sitio. There is still an LGU child development worker,” Cañares said.

“SNP came about because some places don’t have a day care center, or the center is too far, so they have a separate session. SNP caters to 2-4 years old, while day care is 3-4 years old,” she said.

SNP make up only about five percent of the day care centers and SNP in Cebu. Most of the LGUs that have SNP already have day care centers. SNP is not required by law.

Liquidation

Supplemental feeding is done in all day care centers. But when the LGU cannot liquidate its funds, it cannot receive the funds for the next feeding cycle, affecting the nutrition of the children.

“If they can’t liquidate what we gave them last year, we can’t give them for this year because they would still have to use those funds. Others used the funds, but were delayed in their food procurement. Some didn’t use the funds at all,” she said.

Last year, Cycle 6 of the feeding program, the targeted number of day care centers and SNP for feeding was 1,973 in Cebu.

“But we reached 1,412 only because some LGUs didn’t liquidate,” Cañares said.

In these 1,412 day care centers and SNP, 64,852 children were reached.

The 1,973 target itself represents just 95 percent of the day care centers and SNP in Cebu. The rest were not included due to non-submission of liquidation.

“For Cycle 6, we were not able to transfer funds to Minglanilla, Sibonga, Boljoon and Aloguinsan because they were unable to liquidate,” Cañares said.

“For this year, we weren’t able to transfer to Cebu City, Aloguinsan, Toledo, Pinamungajan, Bantayan, Borbon because they have not liquidated,” she added.

The DSWD official said changes in leadership in the LGU hamper the delivery of the feeding program to the children.

“If there is a change in administration, like a change in the mayor, most likely he changes the composition of the Bids and Awards Committee which deliberates on procurements. So the procurement is delayed,” she said.

At times, it’s a matter of a lack of manpower. For the SFP, the DSWD 7 does not deploy people at the local levels. It is the LGU that hires and pays the day care workers, and personnel to take care of the accounting of the funds for the feeding program.

“So if they say, ‘Ma’am, it is really difficult for me to do the liquidation because I’m the only one doing the work here in Accounting,’ or ‘There are just two of us here in the social welfare office,’” then the DSWD 7 cannot do anything about it, she said.

Cañares said they could also not impose on the day care workers to take on more of the tasks because these workers get only a small honorarium from the LGU. The DSWD does not give them an honorarium. It is the barangay that pays barangay nutrition scholars, health workers and day care workers.

“Some day care workers receive an honorarium of P1,500-P2,000 a month. That’s from the municipality. The barangay might also add P500 or P1,000 more, so the total would be P3,000. But some receive only a total of P2,000 from both the barangay and municipality already,” she said.

The delinquent LGUs can still be included in the program this year, however, if they submit their liquidation by August. Beyond that, the DSWD will have to program the funds to other needs.

“We have to use up the funds by December, unlike in previous years when we could continue using the funds till the next year,” she said.

Uncovered, unserved

Cañares said most barangays have only one day care center. But some big barangays have two to three day care centers.

Each day care center can accommodate 25 children per two-hour session. If there are many children, there is a morning and afternoon schedule.

But most centers have sessions at 8-10 a.m. only. The children are fed rice, chicken and soup, or a viand with vegetables, at the end of the session.

With day care centers accommodating so few children, it’s possible many more children, especially malnourished ones, could still be unserved by day care.

“The indigent are given priority,” Cañares said. “Some who can afford send their kids to learning centers.”

“We tap the nutrition action officers, who are mostly LGU health officers, and social welfare officers to review the Operation Timbang results, look for the severely underweight and underweight 3-4-year-olds not in day care, and enroll them in day care, especially if the LGU has no funds for supplementary feeding,” she said.

The mothers themselves share the blame for their children being unserved.

“Some mothers have many malnourished children because they are lazy. They do not bring their children to day care. The barangay and municipality have programs for the malnourished already. They only need to bring their children there and to participate. But they don’t,” Cañares said.

End of days

What happens after the 120 days, which is just six months of the 10-month school year?

Usually, the LGU takes care of continuing the feeding, but not all do, Cañares said.

“Before the DSWD came in with the Supplemental Feeding Program, the LGUs had that already because supplementary feeding is part of the devolved program of the LGU. But not all LGUs, because it depends on the LGU. DSWD is just augmenting this,” she said.

Some 25-30 percent of LGUs in Cebu provide their own supplementary feeding even without DSWD’s help, Cañares estimated.

“In some barangays, the parents themselves bring food to continue the supplemental feeding. The parents are organized. Part of social preparation prior to the start of feeding is that parents and barangay officials are oriented on their roles because they have a stake in the program. Getting the supplies from the municipal hall to the barangay, that’s the counterpart of the barangay or the parents,” she said.

DSWD funds are downloaded to the LGUs, which buy the goods through public bidding or small value procurement. The goods are usually delivered to the municipal hall if public bidding was done, so the day care workers get them from the Municipal Hall. Their transportation expense from the barangay to the municipal hall is not covered by DSWD program funds. DSWD funds only the cost of the viand and rice, so the transport cost is the counterpart of the barangay, parents or the city or municipality, she said.

If small value procurement was used, the funds are given to the day care worker or barangay treasurer, and the procurement is done in the barangay market.

But in one case, a barangay treasurer diverted a month’s worth of allocation for his personal use, Cañares said, so some LGUs no longer want to give money and just prefer to do a public bidding for the goods.

“But the problem with bidding is that if the area is very far, no supplier will make a bid, delaying the procurement,” she said.

In some cases, if the number of children suddenly grows, the amount the DSWD gave will no longer suffice for 120 days. Some LGUs don’t have the funds to continue the feeding.

“So they end at 100 days, but we require that they don’t go below 90 days,” she said.

Twice a day

Late last year, the Senate provided P1 billion more to the DSWD’s feeding budget, enabling the pilot implementation of the twice-a-day feeding in school year 2017-2018 in selected areas nationwide.

The share of Central Visayas in the P1 billion budget is P83 million.

Twice-a-day feeding will be done in day care centers and SNP in 39 LGUs in Central Visayas, 19 of them in Cebu, 18 in Bohol and two in Siquijor.

The 19 areas in Cebu were selected on the basis of their being good in liquidation, Cañares said.

Impact

Cañares said the feeding has improved not only the weight but also the attitude of the children.

Parents said their children learned to appreciate and eat vegetables, after eating these in day care.

“Day care workers said the children are also brighter now. They participate more in the sessions,” she added.

The parents also benefit because they learn to cook nutritious food using local ingredients.

Prior to the start of the feeding program, the parents are formed into groups and committees.

Assigned a different day of the week, a group of three to five parents takes care of cooking, washing the dishes and cleaning the area. If some parents are working, in lieu of their presence, they may be made to contribute spices, vegetables from their backyard garden, firewood or whatever else they can contribute.

“The program is not only about feeding,” Cañares said. “There are also a lot of inputs. They should also attend Parents’ Effectiveness Sessions. Day care workers conduct these every month. One of the modules is on nutrition,” she said.

Cañares said the budget from the DSWD is not enough to make the program work.

“The program will fail if the people supposed to handle it don’t focus on it,” she said. “It’s really more of the commitment of the people in the LGU because we all know that in the LGU, they have many other programs to implement.”

Beneficiaries of twice a day feeding in Cebu under the Department of Social Welfare and Development’s Supplemental Feeding Program
19 Municipalities and cities
33,993 Children
615 Day care centers
51 Supervised Neighborhood Play
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