National Nutrition Cluster Strategic Plan for Nutrition in Emergencies(2015-2022)

Table of Contents

I. Situational Analysis II. Nutrition Cluster

A. VisionB. MissionC. GoalsD. ObjectivesE. Members and StructureF. Roles and ResponsibilitiesG. Coordination Mechanisms (intra-cluster, inter-cluster)H. Information ManagementI. Nutrition AssessmentsJ. ReportingK. Capacity MappingL. Supplies

III. List of Preparedness Activities (Minimum Preparedness Actions)IV. Response Plan

A. Caseload EstimatesB. Response ActionsC. Key Indicators

V. AnnexesA. Cluster Contact ListB. Geographic Capacity MapC. Caseload Estimates

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Acronyms and Abbreviations

ACF Action Contre la FaimAdComm WG Advocacy and Communications Working Group AFP Armed Forces of the PhilippinesAMWG Assessment and Monitoring Working GroupAO Administrative OrderASG Abu Sayyaf Group CALABARZON Cavite, Laguna, Batangas, Rizal, and Quezon CAR Cordillera Administrative RegionCHED Commission on Higher EducationCLA Cluster Lead AgencyCMAM Community-based Management of Acute MalnutritionCMAM WG Community-based Management of Acute Malnutrition Working GroupCWC Council for the Welfare of Children DepEd Department of EducationDHS Demographic and Health SurveyDILG Department of Interior and Local Government DND Department of National DefenseDOH Department of HealthDOST Department of Science and Technology DReAMB Disaster Response and Management Bureau Reduction DRRM Disaster Risk Reduction and ManagementDSWD Department of Social Welfare and Development DTI Department of Trade and IndustryETC Emergency TelecommunicationsEO 51 Executive Order 51 (Milk Code)FDA Food and Drug AdministrationFHO Family Health OfficeFHSIS Field Health Survey Information SystemFNI Food and Non-Food ItemsFNRI Food and Nutrition Research InstituteHEARS Health Emergency Alert Reporting SystemHEMB Health Emergency Management BureauHOM Health Organization of MindanaoIASC Inter-Agency Standing CommitteeIMAM Integrated Management of Acute MalnutritionICM International Care MinistriesIDP Internally Displaced PeopleIEC Information, Education and CommunicationIM Information ManagementIMC International Medical CorpsIMO Information Management Officer

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IPC Integrated Food Security Phase ClassificationITP Inpatient Treatment ProgramIYCF Infant and Young Child FeedingIYCF WG Infant and Young Child Feeding Working GroupIYCFE Infant and Young Child Feeding in EmergenciesKMI Kalusugan ng Mag-Ina, Inc.LGU Local Government UnitLNS Lipid-based Nutrition Supplements MAM Moderate Acute MalnutritionMDG Millennium Development GoalMDM Management of the Dead and the MissingMHPSS Mental Health and Psychosocial SupportMILF Moro Islamic Liberation Front MIMAROPA Occidental Mindoro, Oriental Mindoro, Marinduque, Romblon and

PalawanMIRA Multi-Cluster/Sector Initial Rapid AssessmentMNLF Moro National Liberation Front MPAs Minimum Preparedness ActionsMSF Medecins Sans Frontieres MUAC Mid-upper Arm CircumferenceNCR National Capital RegionNDRRMC National Disaster Risk Reduction and Management CouncilNEDA National Economic Development Authority NGO Non-governmental organizationNIED Nutrition Information and Education DivisionNiEm Nutrition in EmergenciesNNC National Nutrition CouncilNNS National Nutrition Survey NPPD Nutrition Policy and Planning DivisionNSD Nutrition Surveillance DivisionOCD Office of Civil DefenseOPT Operation TimbangOTP Outpatient Treatment ProgramPAR Philippine Area of ResponsibilityPCAs Partnership and Cooperation AgreementsPCCM Protection Camp Coordination and Management PDNA Post-Disaster Needs AssessmentPhilCAN Philippine Coalition of Advocates in Nutrition SecurityPHIVOLCS Philippine Institute on Volcanology and Seismology PLW Pregnant and Lactating WomenRA Republic ActRNA Rapid Nutrition AssessmentRUSF Ready-to-Use Supplementary Food RUTF Ready-to-Use Therapeutic Food

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SAM Severe Acute MalnutritionSCG Strategic Core GroupSMART Standardized Monitoring, and Assessment of Relief and TransitionsSOCCSKSARGEN South Cotabato, Cotabato, Sultan Kudarat, Sarangani, General SantosSOPs Standard Operating ProceduresSPEED Surveillance in Post Extreme Emergencies and DisastersSRP Strategic Response PlanSRR Search, Rescue and RetrievalTOR Terms of ReferenceTOT Training of TrainerstSFP Targeted Supplementary Feeding ProgrammeTWG Technical Working GroupUN OCHA UN Office for the Coordination of Humanitarian AffairsUNICEF United Nations Children’s FundVAC Vitamin A CapsuleWASH Water, Sanitation and HygieneWFP World Food ProgrammeWHO World Health Organization3W Who, What, Where4W Who, What, Where, When

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The National Nutrition Cluster Strategic Plan for Nutrition in Emergencies is a framework developed by the Philippine Nutrition Cluster to guide its members in undertaking key actions for a comprehensive approach in handling nutrition in emergencies. A well-timed and effective response effort is built on extensive preparations made before the onset of disasters and emergencies. Through this plan, the Nutrition Cluster aims to establish cluster capacities to respond to a range of different situations through a broad set of preparedness measures.

This plan seeks to build on identified challenges and lessons learned from past events to determine priorities in the various levels of planning for an effective response. Due to the changing nature of disaster preparedness and response, this document is flexible and can/should be updated to capture new developments from future emergency response. The plan does not seek to replace the individual preparedness plans of cluster members as they have their own responsibilities and mandates, rather, it aims to enhance points of collaboration and alignment for emergency nutrition activities. Preparedness plans developed at the regional, provincial, and municipal level can use this as a template ensuring that it is linked and consistent with the National Plan.

I. Situational Analysis

The Philippines continues to face many challenges in its efforts to bring down rates of malnutrition. According to the 8th National Nutrition Survey (NNS) in 2013, underweight prevalence has gone down to 19.9% but has been relatively unchanged for the past 10 years (20.7% in 2003), making it unlikely for the Philippines to achieve the MDG goal of reducing underweight prevalence by half. Wasting/thinness has been consistently increasing from 5.8 in 2005 to 7.9% in 2013. This is considered poor based on the WHO cut-off points in determining the magnitude and severity of wasted children (FNRI). Stunting on the other hand has shown a decrease from 33.9% in 2003 to 30.3% in 2013; however it has decreased at a slower rate than previously targeted. Children in the second year of life (12-23 months) were reported to have the sharpest increase in underweight (4.9% higher than the 6-11 months old).

The 2013 NNS noted regional variations in terms of percentage of underweight, stunting and wasting in children 0-5 years old. The lowest rates of underweight, stunting and wasting/thinness are from the urban areas for underweight in the regions of NCR (12.9%), CAR (16.5%) and Central Luzon (17.7%); for stunting – NCR (22.4%), Central Luzon (23.1%), and CALABARZON (25.3%); for wasting/ thinness – CAR (5.9%), NCR (6.5%) and SOCCSKSARGEN (6.6%). On the other hand, the highest prevalence of underweight, stunting and wasting is among those in the rural areas and in the poorest quintile. Among the regions, the top 3 with the highest undernutrition prevalence are: for underweight – MIMAROPA (27.5%), Western Visayas (25.9%) and Bicol (24.6%); for stunting – Bicol (39.8%), ARMM (39%) and Zamboanga Peninsula (38.7%); for wasting/ thinness – MIMAROPA (9.8%), Ilocos Region (9.8%), and Western Visayas (8.9%).

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Figure 1. Stunting and Wasting Prevalence by Region in Philippines, NNS 2013

Based from the UNICEF Global Nutrition Database in 2012, eighty percent (80%) of the world’s stunted children live in 14 countries, and Philippines ranked ninth among the 14 countries with the largest numbers of children under five who are moderately and severely wasted. On the other hand, Philippines ranked tenth among the 10 most affected countries with children under five who are moderately or severely wasted.

Due to its unique location, the Philippines is prone to many types of risks. Being located along the typhoon belt in the Pacific, the Philippines is visited by an average of 20 typhoons every year. The country’s geographical location and physical environment also contributes to its high-susceptibility to hydro-meteorological events such as tropical storms/typhoons, sea level rise, storm surges, landslides, flash flooding, and even drought. At the same time, the country is situated along the “Pacific Ring of Fire” which makes it vulnerable to frequent geophysical events such as earthquakes and volcanic eruptions. In 2012, the Philippines ranked second, closely behind China, among 28 Asian countries hit by the most number of disasters. Thus, the common disasters and emergencies encountered by the country are the following:

1. Hydro-meteorological (Tropical Storms, Typhoons, Storm surge)

Tropical cyclones and its sequential effects of rain and windstorms, as well as floods are the most prevalent types of hydro-meteorological hazards in the country given that the Philippines is located along the typhoon belt in the Pacific.

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Analysis of trends of tropical cyclone occurrence or passage within the so-called Philippine Area of Responsibility (PAR) show that an average of 20 tropical cyclones form and/or cross the PAR per year. Moreover, the analysis on tropical cyclone passage over the three main islands (Luzon, Visayas and Mindanao), the 30-year running means show that there has been a slight increase in the Visayas during the 1971 to 2000 as compared with the 1951 to 1980 and 1960-1990 periods.

In 2011, the country particularly in Northern Mindanao, the Visayas, and Palawan was hit by Typhoon Sendong which was considered as the strongest that year. It caused the lives of more than 1,000 people and damaged properties amounting to billions of pesos. Less than a year later, another strong typhoon, Typhoon Pablo, struck Mindanao that caused similar deaths and damage as Typhoon Sendong. On 8 November 2013, Typhoon Yolanda that swept through the central Philippines was considered the strongest ever-recorded typhoon with maximum sustained winds of 235 km/hour and severe gusts of 275 km/hr. The damages to life and property were overwhelming. There were 3,424,593 families affected, displacing 890,895 families in the process. More than a million houses were destroyed.

2. Geophysical (Earthquakes, Volcanic Eruptions)

The Philippines is situated along a highly seismic area lying along the Pacific Ring of Fire and is highly-prone to earthquakes. According to the Philippine Institute on Volcanology and Seismology (PHIVOLCS), the country experiences an average of five (5) earthquakes a day. Earthquake disasters are not as frequent as the typhoons and flooding that take place in the Philippines. Nevertheless, the impact generated on affected communities is usually massive and devastating. Earthquake-induced disasters were few in numbers and in terms of casualties. The Philippines is also prone to volcanic eruptions being situated along the Pacific Ring of Fire where two major tectonic plates (Philippine Sea and Eurasian) meet. This explains the occurrence of earthquakes and tsunamis and the existence of around 300 volcanoes of which 22 are active. The most recent devastating earthquake in the Philippines happened in Bohol in October 2013, causing significant damage, displacement, and loss of life.

According to the Metro Manila Earthquake Impact Reduction Study, Metro Manila is expected to have a big earthquake anytime soon. The faultline is located along residential and business areas and a high magnitude earthquake will cause significant problems. Hence, preparation is necessary for when that happens.

Volcanic eruptions are another example of geophysical hazards in certain parts of the country. In 2014, Mt. Mayon in Region V (Bicol) threatened eruption and

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the surrounding areas were alerted for preemptive evacuation resulting in the displacement of many residents of certain towns and cities of Albay. In the first half of 2015 in the same region, Mt. Bulusan also showed signs of activity and the alert level was raised to alert level 1 twice, displacing 34,280 individuals living in 22 barangays in the five municipalities of Sorsogon.

3. Conflict

Violence continues in the country, with most of the fighting in Mindanao. Intense fighting between government forces and the Moro Islamic Liberation Front (MILF) during the first half of year 2009 resulted in the displacement of hundreds of thousands of civilians. On the other hand, the Abu Sayyaf Group (ASG), labelled a terrorist organization, continued to carry out bombings and rebels were killed during clashes with the military in the latter part of 2009. On 9 September 2013, an armed conflict between government forces and a separatist group of the Moro National Liberation Front (MNLF) broke out in Zamboanga City. These human-induced disasters caused by armed fighting in the South continue to threaten the security of civilian communities which result into loss of lives, properties, livelihoods, massive sporadic and in some areas protracted displacement, disease outbreaks, prevalence of malnutrition, disease outbreaks, limited access of local communities to basic social services, and major protection issues.

4. Biologic/Epidemics

Nutritional problems may also arise from indirect consequences of a disaster, such as poor conditions in evacuation centers. As such it is important to maintain optimal nutritional status to avoid epidemics. Overcrowding in evacuation centers and lack of access to food and health care increase the susceptibility to infectious diseases such as measles. In January 2014, the Department of Health declared a measles outbreak in evacuation centers in some parts of Metro Manila. There were a total of 1,724 measles cases nationwide and 21 of which lead to death. This highlights the importance of both strengthened implementation of programs on immunization and vitamin A supplementation, and the active participation of caregivers/mothers with under-five children.

Furthermore, in 2014, National Economic Development Authority has mapped out cities and provinces in the country in terms of which are experiencing growth but with high poverty incidence to allow specific government interventions. Thus, three categories are identified, namely: Category 1 - provinces with very high numbers of the poor although the incidence of poverty is not very high; Category 2 - provinces with very high proportion of the population who are poor; and Category 3 - 30 provinces that are exposed and prone to multiple hazards, such as landslides and flooding.

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Table 1. Category 3: Provinces exposed to multiple hazards

Region ProvinceRegion I: Ilocos Ilocos NorteRegion I: Ilocos Ilocos SurCordillera Administrative Region AbraCordillera Administrative Region BenguetRegion II: Cagayan Valley CagayanRegion II: Cagayan Valley QuirinoRegion II: Cagayan Valley IsabelaRegion II: Cagayan Valley Nueva VizcayaRegion III: Central Luzon ZambalesRegion III: Central Luzon PampangaRegion III: Central Luzon AuroraRegion IV-A: CALABARZON CaviteRegion IV-A: CALABARZON LagunaRegion IV-A: CALABARZON RizalRegion V: Bicol CatanduanesRegion VI: Western Visayas AntiqueRegion VI: Western Visayas IloiloRegion VII: Central Visayas BoholRegion VIII: Eastern Visayas Eastern SamarRegion VIII: Eastern Visayas LeyteRegion VIII: Eastern Visayas Northern SamarRegion VIII: Eastern Visayas Southern LeyteRegion IX: Western Mindanao Zamboanga del SurRegion IX: Western Mindanao Zamboanga SibugayRegion XIII: Caraga Dinagat IslandsRegion XIII: Caraga Agusan del SurRegion XIII: Caraga Surigao del NorteRegion XIII: Caraga Surigao del Sur

Thus, the above mentioned emergencies and disasters can exacerbate underlying nutrition problems in vulnerable areas. Due to displacement or inadequate access to food and health services, the nutrition status particularly of vulnerable groups can worsen and lead to disease and death. This is most especially problematic in areas where malnutrition rates are high which are also frequently hit by disasters. However, it is important to note that pre-crisis acute and chronic malnutrition rates at provincial level may not be available at all times which can lead to overestimation of targets when planning for disasters, and so the need for further revision of targets has to be made. Information management remains as a major challenge in disaster response as reporting tools and mechanisms are only used and revised when the disaster

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happens. Information is collected during disasters through baseline and endline SMART surveys, but is not translated into useful information during preparedness phase. Information from regular programming is also not readily available to be used in anticipating emergency nutrition actions. Mapping of skills and resources is incomplete. Likewise, geographic risk mapping for vulnerable areas (using data on disaster prone areas, wasting rates, poverty rates) has been suggested numerous times but has not been undertaken despite the available information.

As such, the Nutrition Cluster has established Nutrition in Emergencies as a priority action. The goal of NiE is to prevent the worsening of the nutrition situation and prevent deaths through the provision of life-saving and preventive interventions and linking with other cluster/sector groups and establishing capacities at all levels. Emergency preparedness requires a multi-sectoral approach. Past activities have engaged cluster partners including both relevant government and non-government entities in the planning process to ensure broader stakeholdership and ownership of the strategic plan, most notably in documentation of good practices and follow-up actions for identified gaps and constraints. Hence, the Nutrition Cluster has identified the following operational constraints:

Operational ConstraintsInformation Management Not all areas have the same level of nutrition

information available pre-disasterIneffective documentation system to capture actual experiences, lessons learned and milestones in emergency and disaster management

Accessibility of affected areas Geographic and security hazards may prevent access to affected areas

Personnel/Capacity Building Number of Skilled Partners Available: few local NGOs availableNo existing Capacity Assessment/Training Needs Assessment ToolCapacity Mapping mechanisms not yet implemented and formalizedCapacity Mapping information is still incompleteCapacity Building: availability of trained staff for CMAM, IYCF, NiEm, Information Management, surveys

Program National program for CMAM yet to be implementedReferral systems for CMAM need to be strengthenedHigh caseload for MAM and limited government capacities to handle caseload

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Operational ConstraintsGuidelines for MAM still under developmentSource and availability of supplies treatment and prevention of acute and moderate malnutrition.

Policy Implementation and Development Policies for CMAM, IYCF guidelines are still being finalized

Plan Development No consolidated Emergency Preparedness and Response Plan

Physical Infrastructure Development No local procurement mechanisms for CMAM supplies (done through partners UNICEF and WFP)

Indeed, it is very appropriate and essential to develop a specific strategy for Nutrition in Emergencies during the different phases of a disaster in consideration of the past experiences from major emergencies and disasters, and the identified operational constraints. This document aims to highlight necessary preparedness actions to address the operational constraints and lessons learned from past experiences. The cluster has decided to develop a Strategic Plan (2015 – 2022) that will serve as a common platform for the members of the National Nutrition Cluster in conducting preparedness and response activities. It also aims to guide sub-national Nutrition Clusters in preparing their own strategic nutrition preparedness and response plan.

II. National Nutrition Cluster

A. Vision

To be a model Nutrition Cluster that is trained, fully equipped, capable of timely and comprehensive actions for emergency preparedness and response.

B. Mission

To organize, capacitate, and provide the enabling environment for the Nutrition Cluster to provide nutrition services that are equitably responsive and sustainable to address the nutritional needs of the most vulnerable groups throughout the different phases of emergencies from preparedness, response, recovery, and rehabilitation.

C. Goals

1. To ensure an effective and efficient operation of the Nutrition Cluster that can provide appropriate support to sub-national clusters

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2. To ensure access for all communities to quality and sufficient supply of nutrition products and services

3. To improve competence and motivation of service providers to enhance service delivery

4. To extend capacity of partners to scale up interventions for CMAM, IYCF, and other emergency nutrition services

5. To empower communities to improve resiliency such that communities will be able to capably handle nutrition emergencies on their own

D. Objectives

1. To promote and enforce policies and other relevant issuances on Nutrition in Emergencies (NiEm)

2. To build capacity of all members on NiEm, CMAM, IYCF, coordination, IM3. To enhance cluster coordination mechanisms within and external4. To efficient distribution/deployment of services and resources5. To develop and implement an efficient and effective monitoring and evaluation

scheme for NiEm6. To promote and advocate good nutrition to affected population, and other

clusters7. To enhance and develop the cluster’s capacities for promotion and advocacy of

key nutrition issues8. To review and update the strategic plan, as needed, in consultation with cluster

members and other stakeholders

E. Members and Structure

Under Republic Act (RA) 10121, the National Disaster Risk Reduction and Management Council (NDRRMC) is the designated coordinating body in charge during disasters and emergencies. The NDRRMC is chaired by the Department of National Defense (DND) and oversees four committees with the vice-chairs designated below:

1. Disaster Prevention and Mitigation – Department of Science and Technology (DOST)

2. Disaster Preparedness – Department of Interior and Local Government (DILG)3. Disaster Response – Department of Social Welfare and Development (DSWD)4. Rehabilitation and Recovery – National Economic Development Authority (NEDA)

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Below is the organizational structure of the NDRRMC:

Figure 2. Organizational structure of NDRRMC

Under the Vice-Chairperson for Response (DSWD), there are eight “response clusters” each having their own lead agency that will primarily supervise, coordinate and report all activities of their cluster partners during disaster. The eight response clusters are the following:

1. Food and Non-Food Items (FNI)2. Health (WASH, Health, Nutrition and Psychological Services)3. Protection Camp Coordination and Management (PCCM) – Previously,

CAMP/IDP Management, Emergency Shelter and Protection)4. Logistics5. Emergency Telecommunications (ETC)6. Education7. Search, Rescue and Retrieval (SRR)8. Management of the Dead and the Missing (MDM)

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Below is the organizational structure of the National Response Clusters:

Figure 3. Organizational structure of National Response Clusters

Under the Health Cluster, there are four sub clusters namely: health, nutrition, water sanitation and hygiene (WASH), and mental health and psychosocial support (MHPSS). The designated government lead for these four sub clusters and representative to NDRRMC is the Department of Health - Health Emergency Management Bureau (HEMB).

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Figure 4. Organizational Structure of Health Cluster

In 2013, the National Nutrition Council was designated as the new chair of the National Nutrition Cluster (under Department Personnel Order 2007-2492-A: “Creation of Health Emergency Management (HEM) Clusters”). The cluster is composed of partner agencies from government, the United Nations, and non-government organizations all of whom have active roles and responsibilities for ensuring preparedness and response mechanisms for nutrition in emergencies. Based from the DPO 2007-2492-A, although not limited to, the members of the National Nutrition Cluster are the following:

Table 2. Members of the National Nutrition Cluster

Members of the National Nutrition ClusterGovernment Organizations Non-government Organizations1. DOH – National Nutrition Council (NNC)2. DOH – Health Emergency Management

Bureau (HEMB)3. DOH – Women, Men, Child Health and

Nutrition4. DOH – Health Facility Development Bureau

(HFDB)5. DOH – Health Promotion and

Communication Service (HPCS)6. Food and Drug Administration (FDA)7. DOST – Food and Nutrition Research

Institute (FNRI)8. DSWD – Disaster Response and

Management Bureau Reduction and (DReAMB)

9. DSWD – Council for the Welfare of Children (CWC)

10. Department of the Interior and Local Government (DILG)

11. Department of Trade and Industry (DTI)12. Department of Education (DepEd)13. Commission on Higher Education (CHED)

1. United Nations Children’s Fund (UNICEF)2. World Health Organization (WHO)3. World Food Programme (WFP)4. Save the Children5. Plan International6. Action Against Hunger (ACF)7. Philippine Red Cross8. Medecins Sans Frontieres (MSF)9. Child Fund10. Merlin11. Helen Keller International (HKI)12. World Vision13. Arugaan14. Kalusugan ng Mag-Ina, Inc. (KMI)15. International Medical Corps (IMC)16. International Care Ministries (ICM)17. Health Organization of Mindanao (HOM)

Membership of Nutrition Cluster is open and welcome to any organization/agency that is willing to abide with principles of partnership, i.e., complementarity, transparency, results-oriented, responsibility, and equality. In addition, organizations are requested to register at Bureau of International Health Cooperation of DOH.

The full contact list for the National Nutrition Cluster is attached in Annex 1.

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F. Roles and Responsibilities

Government

The National Nutrition Council NNC is the designated cluster lead for nutrition at the country level, and also acts as the National Nutrition Cluster Coordinator. Even during the non-disaster phase, the National Nutrition Cluster remains active and oversees the organization of regional and sub-national Nutrition Clusters. NNC leads the cluster in priority actions such as the 1) strengthening the nutrition service delivery system for better preparedness through development and review of national guidelines, protocols, tools; 2) capacity building of system at regional level; and 3) coordination with other clusters for inclusion of nutrition concerns in their cluster guidelines. In times of disasters, the National Nutrition Cluster steps up its activities and focuses on the coordination of response efforts in affected areas. NNC coordinates with cluster partners in the deployment of surge teams for essential nutrition assessments and interventions.

The following are the functions of the Nutrition Cluster:

1. Conduct rapid nutritional assessment in the affected areas2. Ensure timely and appropriate delivery of quality package of nutrition

interventions to affected population particularly on the promotion and protection if infant and young child feeding practices, micronutrient supplementation, supplementary feeding, integrated management of acute malnutrition and others;

3. Ensure that the foods provided and distributed are nutritionally adequate especially for vulnerable groups;

4. Conduct trainings and other various capacity building activities related to nutrition

5. Provide nutrition counselling to affected populations; and6. Establish and promote coordination, networking, planning, social mobilization,

advocacy, surveillance, monitoring, evaluation, and good reporting mechanisms within the nutrition cluster

The DOH – Health Emergency Management Bureau (DOH-HEMB) is the operations center tasked to prepare for and respond to emergencies and disasters in the health sector. While chairmanship of the Nutrition Cluster has been handed over to NNC, DOH-HEMB continues to provide support in the implementation of emergency nutrition services. The designated government lead for the said four sub clusters and DOH’s representative to NDRRMC, is primarily responsible for leading in organizing and coordinating efforts of the sub clusters, other clusters, agencies and organizations for health emergency preparedness and response. Significantly, HEMB is guided by the 10P’s Strategy – policy formulation and development, plan

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development, people, partnership building, program development, physical infrastructure development, practices, peso and logistics, promotion and advocacy, and packages of services.

UN Agencies

UNICEF

UNICEF is the Cluster Lead Agency (CLA) for Nutrition at the global level. UNICEF has the responsibility to ensure inclusion of key humanitarian partners, establish and maintain humanitarian coordination, lead planning, strategy development, advocacy and resource mobilization within the nutrition sector. Further, UNICEF is responsible for acting as the provider of last resort to meet agreed priority needs.

UNICEF has the global mandate for the management of severe acute malnutrition (SAM). As such, for the Philippine Nutrition Cluster, UNICEF carries out this mandate through leading technical supervision of the Outpatient Treatment Program (OTP) and In-patient Treatment Program (ITP), including provision of therapeutic nutrition supplies, measuring equipment and essential drugs needed for systematic treatment. As global lead for Nutrition, UNICEF also serves as provider of last resort and can take on the roles of other cluster members as needed.

World Food Programme

The World Food Programme (WFP) has the global mandate for the management of moderate acute malnutrition (MAM). WFP is responsible for the prevention of acute malnutrition, and management of MAM through the blanket supplementary feeding program, and targeted Supplementary Feeding Programme (tSFP) component of CMAM for children and PLW, respectively. Capacity strengthening on both MAM and SAM management and establishing an organized referral system is an essential priority. As WFP has the mandate for MAM treatment globally, it can, on request of the government implement tSFPs. In the event that WFP is unable to fulfill its global mandate for MAM management, it should inform the cluster and coordinate endorsement of MAM management.

World Health Organization

The World Health Organization provides technical support for implementation of health and nutrition services at both the national and regional level. In other countries, WHO is also responsible for the management of SAM children with complications who require admission to an Inpatient Treatment Program (ITP) in a Stabilization Center. Currently, ITP treatment is managed by UNICEF, but may be handed over or shared with WHO if decided by the cluster. In the event that WHO is unable to provide ITP services, it should inform the cluster and coordinate endorsement of ITP management.

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Non-Government Organizations

Currently, the cluster relies on the presence of local and international NGOs to carry out nutrition interventions in emergencies. NGOs enter into Partnership and Cooperation Agreements (PCAs) that are aligned with the goals of the cluster such as engaging in rapid assessments, providing CMAM services, IYCF counselling, and others. Cluster partners also have the responsibility to collect and report data on nutrition services provided for monitoring and evaluation.

Cluster Coordinators

The National Nutrition Council acts as cluster coordinator at the national level. Nutrition Cluster Coordinators (NCC) are responsible for facilitating a timely and effective nutrition response and ensuring the strengthening of government capacities and that of other cluster partners. NCCs enable the cluster to identify and raise specific concerns and challenges in order to pursue strategic decisions and actions. NCCs must also ensure cluster representation at the Humanitarian Country Team level. Upon completion of service, NCCs should ensure proper endorsement of responsibilities and any pending actions for a systematic turnover and continuity of service. During extreme emergencies, the cluster may decide to call on external surge support to act as NCCs at the regional or provincial level.

Information Management Officer (IMO)

Information Management (IM) responsibilities at the national level are handled by the NNC. IM officers do not only facilitate and oversee the collection of data but also analyze and transform the data into useful information and feedback for the cluster. In past large-scale emergencies, an external consultant was brought in to handle the IM role for the Nutrition Cluster, but information management capacities were not turned over to government players for a sustainable IM system. As such, the cluster has prioritized as an objective that IMOs deployed for the initial phase of nutrition response should work from the very beginning towards building the government system’s capacities and skills on information management to sustain and adapt the good practices. For this reason, following Typhoon Yolanda, IM responsibilities have been transferred to the NNC. At present, there is one IMO from the national government, and 2 IMOs at regional cluster level (One from NNC for Region VII and from ACF for region VIII respectively). IMOs from the government still need to be capacitated on information management.

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Table 3. Responsibilities of Information Management Officer

Planning, policy/guidelines, and strategy developmentSharing of information among cluster partners and inclusion of new humanitarian partnersAppropriate coordination mechanisms and coordination with national authorities, local civil societyResource mapping (3Ws/4Ws, registry of nutrition responders, NGOs and their capacities, available logistics/supplies, facilities trained in CMAM)Training and capacity-building in IM/knowledge managementTool standardizationMonitoring and EvaluationRNA, needs assessment and survey (MIRA, SMART, PDNA, IYCF counselling, MUAC) including analysis

Currently, IM roles and responsibilities are divided between the Nutrition Policy and Planning Division (NPPD) and Nutrition Surveillance Division (NSD) based on their respective mandates. The IMO is a technical staff from NPPD and is supported by a technical staff from NSD. The IMO also acts as secretariat of the National Nutrition Cluster, SCG, and TWGs.

Similar to Nutrition Cluster Coordinators, surge support may be called upon to act as Information Management Officers when needed during extreme emergencies. Upon completion of service, IMOs should ensure proper endorsement of responsibilities and any pending actions for a systematic turnover and continuity of service.

Core Groups and Working Groups

In the aftermath of Typhoon Yolanda, a Strategic Core Group (SCG) under the National Nutrition Cluster was formed to develop the Strategic Response Plan (SRP) for Nutrition response for November 2013- 2014. Four technical working groups (TWG) were also organized across four thematic areas, namely Philippine Integrated Management of Acute Malnutrition (CMAM WG), Infant and Young Child Feeding (IYCF WG), Assessment and Monitoring (AM WG), and the Advocacy and Communications (AdComm WG). These groups were organized with specific Terms of Reference (ToR) to support the planning, service delivery, monitoring and advocacy for influencing decision making of the National Nutrition Cluster in these four key areas. At present, the technical working groups and SCG remain active to address concerns and issues even beyond Typhoon Yolanda.

Strategic Core Group (SCG)

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The SCG is responsible for decision-making on behalf of the larger group through representation of stakeholder groups. Members of the SCG are the chairpersons of the different TWGs, and UNICEF as cluster co-lead. The roles and responsibilities of the SCG are as follows:

1. On behalf of the cluster partners, advise the Nutrition Cluster Coordinator during the formulation of the National Nutrition Cluster response strategy and action plan, including the advocacy strategy and ensure its routine monitoring and update;

2. Provide strategic oversight of implementation of the National Nutrition Cluster work plan;

3. Establish, oversee, and close TWGs as needed;4. Provide strategic oversight to resource mobilization and allocation;5. Provide strategic oversight to incorporation of cross-cutting issues in

National Nutrition Cluster action6. Inform the NNC Technical Committee and NNC Governing Board on the

progress of nutrition preparedness and response. 7. Take necessary program decisions on behalf of the cluster partners when

urgent action is required.8. Ensure that program objectives and deliverables are achieved.9. Coordinate with the Health Emergency Management Bureau on the

progress of nutrition preparedness and response

Technical Working Groups

Assessment and Monitoring Working Group Working Group (AM WG)

The AM WG, currently led by NNC-Nutrition Surveillance Division (NSD), is responsible for providing technical guidance to the National Nutrition Cluster with regard to assessments and monitoring related to nutrition, as well as in providing support to the sub-national level and linking technical guidance to program implementation.

The AM WG led the SMART Survey in providing technical inputs and formulating initial questionnaires that were used in the first SMART Survey for Typhoon Yolanda-affected which was conducted on 03 February – 14 March 2014. The second SMART Survey is currently being conducted. Another survey guided by the AM WG is the Nutrition and IYCF Survey in internally displaced households with children under five in the transitory sites and evacuation centers which was conducted in Zamboanga City on August 2014. Results of the said surveys facilitated a planning workshop for refocusing of nutrition interventions in line with the needs of the affected areas.

The cluster has identified strengthening the reporting system as one of the cluster’s priority, guided by existing reporting policies and guidelines for disasters and emergencies. The AM WG is currently developing cluster guidelines on intra-cluster reporting mechanisms, including

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finalization of key indicators to report and also for inclusion of nutrition indicators in the national reporting structures such as HEARS, SPEED, and FHSIS.

Community-based Management of Acute Malnutrition Working Group (CMAM WG)

The CMAM WG is primarily responsible for providing operational guidance to National Nutrition Cluster partners and to sub-national level in the implementation of CMAM. This covers both the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The Department of Health-Family Health Office (DOH-FHO) acts as chair of the CMAM WG.

In March 2015, the cluster held a workshop leading to the development of the National Guidelines for the Management of SAM for Children under 5. This breakthrough document is currently being endorsed for adoption into policy especially concerning development of a scale-up plan and procurement for supplies and commodities. The CMAM AO covers both SAM and MAM even as the MAM guidelines are still being finalized.

Infant and Young Child Feeding Working Group (IYCF WG)

The IYCF WG, under the leadership of DOH-FHO, is tasked to examine and deliberate on specific policy and guidelines on IYCF to be adopted for emergency operation. The WG’s roles also includes providing supportive supervision to regional clusters and sub-clusters, ensuring compliance with the Milk Code, National Guidelines on Donations, International Code and subsequent relevant World Health Assembly Resolutions.

The IYCF WG is guided by the Philippine National IYCF Policy (A0-2005-0014) and the IYCF Strategic Plan of Action 2011-2016 (DC-2011-0278) that aim to improve the nutritional status and health of children and especially the under three years old and consequently reduce infant and under 5 mortality.

IYCF-E Operational Guidelines have been developed by the IYCF WG and are currently awaiting approval and signature from the Department of Health. The guidelines serve to provide guidance to health, nutrition, and social service providers, including government partners, organizations, and donors involved in the protection, promotion and support of optimal and appropriate Infant and Young Child Feeding in Emergencies (IYCF-E).

Advocacy and Communications Working Group (AdComm WG)

The AdComm WG, chaired by PHILCAN (Philippine Coalition of Advocates for Nutrition), is responsible for developing and recommending key messages, and IEC materials to strengthen preparedness and emergency response. The WG is also tasked to come up with standard operating procedures for releasing advisories when there is an alert and to consider working with media networks.

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The AdComm WG developed a minimum IEC materials package based from the available IEC materials from cluster partners, and the requested IEC materials by the Typhoon Yolanda-affected regions were distributed to them. The TWG is also tasked to come up with standard operating procedures (SOPs) for releasing advisories when there is an alert and to consider working with media networks.

As part of its efforts to improve service delivery, the AdComm WG is finalizing its Advocacy and Communications Plan to guide partners in how to disseminate and promote communication and advocacy tools for nutrition. The AdComm WG has also identified the need to consolidate key messages and conduct an inventory of existing IEC material.

G. Coordination Mechanisms (intra-cluster, inter-cluster)

The Philippines formally adopted the cluster system in the country as part of national DRRM efforts in 2007. The Nutrition Cluster remains operational throughout the year and is never formally activated or deactivated. Keeping the nutrition cluster active across all phases of Disaster Risk Reduction and Management (DRRM) will contribute towards better prepared nutrition systems and more resilient communities.

1. Intra-cluster coordination

The National Nutrition Cluster convenes each month during the non-emergency phase, but may have more meetings as needed during the emergency phase. NNC presides over the meeting which is usually held at the NNC conference room. The regular attendance by many cluster partners in these meetings helps in addressing the bottlenecks in service delivery through consensus building and follow-up on the agreed actions. However, it was observed that there is poor attendance in cluster meetings of some partners especially from the government. NNC will appoint a liaison officer for outreach work to the non-participating INGOs and national government agencies.

The four TWGs meet as required both for emergency and non-emergency phase. The meeting venue is held at different offices of the members of the TWGs. NNC acts as the secretariat for the TWGs.

All meetings of the National Nutrition Cluster, SCG, and TWGs are documented and circulated to all members via email and uploaded to the Nutrition Cluster Dropbox. During the Typhoon Yolanda response, the meeting minutes were uploaded to the Philippine Humanitarian Response website.

During emergencies, the Regional Nutrition Cluster of affected regions may be invited to participate in the National Cluster meetings. The concerned Regional Nutrition Program Coordinator may join the National Nutrition Cluster meeting through teleconference to provide updates and share concerns that need to be addressed immediately at the national level. Likewise, the National Nutrition Cluster has to work more closely with sub-national (regional) clusters especially with focus on operationalization of strategic approach (i.e. beyond just

22

information sharing). Hence, NNC will ensure representation and participation of regional cluster focal points in planning meetings of the National Nutrition Cluster. In cases where attendance is unlikely, regional focal points should be consulted prior to such meeting.

2. Inter-cluster coordination

The National Nutrition Cluster recognizes that nutrition services during emergencies must be integrated with services provided by other response clusters. The Nutrition Cluster participates in quad cluster meetings led by Department of Health both during emergency and non-emergency situations. The Cluster has also attended meetings with the Food and Non-Food Item Cluster, but linkages with other clusters like WASH, Camp Management, and Food Security have still to be strengthened.

The cluster has also prioritized coordination with Office for the Coordination of Humanitarian Affairs (OCHA) for better representation of the cluster in the Humanitarian Country Team – Inter Cluster Coordination (HCT – ICC) in order to have parallel structures between HCT and government. NNC is planning to meet with NDRRMC to discuss organization and recognition of local nutrition clusters which was noted to be one of their main concerns, as well as better understanding of the possible inter-cluster linkages with the above mentioned clusters.

H. Information Management

The IMO is responsible for close coordination with all cluster partners to promote timely and effective information management and information sharing. Information such as meeting minutes, schedules, and technical updates are circulated online via the Nutrition Cluster mailing list. Mailchimp is also utilized in information sharing. The primary IM products maintained are shown below and are uploaded in the Nutrition Cluster Dropbox.

Table 4. Information Management Products

Product FrequencyContact lists As requiredMeeting minutes Monthly and as required 3Ws/4Ws matrix 2x a year and as requiredAssessments and surveys As requiredCluster website Monthly and as required

The AM WG is developing guidelines on reporting mechanisms. This includes identification of emergency nutrition indicators to be reported and also the flow of reports between the National Cluster and partners at the regional/provincial/municipal level.

UNICEF has started to develop IM toolkit for uniformity across the Nutrition Cluster.

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I. Nutrition Assessments

Rapid Assessments

Information from nutrition assessments are essential in identifying and prioritizing key actions that the nutrition cluster should take in the aftermath of a disaster. The Nutrition Cluster has participated in assessments at the regional level and also in inter-cluster assessments such as the MIRA. The Multi-Cluster/Sector Initial Rapid Assessment (MIRA) is designed to identify strategic humanitarian priorities during the first weeks following an emergency. The main benefit of the MIRA is the elaboration, from the onset of the crisis, of a concerted operational picture based on the best information available from primary and secondary sources. (IASC, MIRA Provisional Version 2012, UN OCHA).

The Cluster has proposed the development of a Rapid Assessment Tool. Most recently, a rapid assessment tool was made by Regions VII and VIII during the response to Typhoon Ruby. This will serve as the template for subsequent Rapid Assessment Tools. An important update has been the inclusion of taking MUAC measurements in the rapid assessments. However, a standardized nutrition cluster rapid assessment tool is still to be finalized.

After the impact of disaster, the regional nutrition cluster concerned, government, UN agencies, and I/NGOs are requested to share assessment results and submit 3Ws in their respective areas. The Information Management Officer consolidates these submissions in situation updates to be presented during cluster meetings and disseminated through the Nutrition Cluster mailing list. Identified gaps are discussed and addressed during the cluster meetings. Secondary information from annual Operation Timbang (OPT), Demographic and Health Survey (DHS), National Nutrition Survey (NNS), Integrated Food Security Phase Classification (IPC) analysis, Family Health Survey, Field Health Survey Information System (FHSIS), and Multi Cluster Initial Rapid Assessment like (MIRA) can be considered to identify initial response priorities.

Detailed Nutrition Assessments

For detailed nutrition assessments, the National Nutrition Cluster adopts the Standardized Monitoring, and Assessment of Relief and Transitions (SMART) survey methodology. SMART is a global survey method for the assessment of severity of a humanitarian crisis based on the nutritional status of children of children and mortality rate of the population. The survey can be expanded to provide information on key indicators such as CMAM, IYCF, as well as maternal

24

nutrition indicators as carried out during the SMART survey for Typhoon Yolanda-affected areas. ACF and Save the Children have been doing SMART surveys. In the event that a detailed nutrition assessment is required, the AM WG finalizes the plans and presents these to the National Nutrition Cluster for approval. Partners are also tapped to provide resources and technical assistance.

J. Reporting

After the impact of disaster, NNC coordinates with the Regional Nutrition Cluster concerned through the Nutrition Program Coordinator for updates. Updates are received via SMS, email, or fax, and these reports are consolidated at the national level. Although there is a flow for reporting, improvement on the system has still to be strengthened. The AM WG will develop guidelines on reporting to guide sub-national cluster as well as link to DOH-HEMB. The TWG is also tasked to look into the assessment tools from other agencies in order to develop a protocol on when to conduct rapid nutrition assessment and to standardize reporting forms. It is an urgent priority for the TWG to set and agree on minimum set of indicators to be collected.

During quad cluster meetings, the National Nutrition Cluster presents updates based from the consolidated reports from the sub-national level and cluster partners. In the event of a disaster that affects multiple regions, the National Cluster is responsible for consolidating this information and sharing this with government and OCHA for situation reports. For disasters that affect only one region, the Nutrition Cluster inputs will be sent by the Regional Nutrition Program Coordinator with support from the National Cluster as required.

Aside from submitting situation reports to the National Nutrition Cluster, the Regional Nutrition Clusters are always reminded to coordinate with the regional Health Emergency Management Bureau for nutrition reports for inclusion in the Health Emergency Alert Reporting System (HEARS) report of HEMB-DOH. HEARS report is circulated daily to selected agencies.

K. Capacity Mapping

Capacity Mapping is an essential preparedness activity as it allows the cluster to take stock of its available resources both in terms of personnel and supplies. Having an updated database of existing capacities enables the cluster to identify which areas may be in need of nutrition services and also allows for the cluster to position and allocate its services better. In October 2014, the cluster conducted its first capacity mapping exercise during the CMAM/IYCF workshop, focusing on Haiyan-response areas, with another update in January 2015. It has been suggested to update the capacity map twice a year (January and July) and as needed during emergencies, using the existing form to be circulated among cluster partners. The information will be submitted to the Information Management Officer who will compile the data and translate it into a map.

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Capacity mapping as of January 2015 can be seen in Annex 2.

[L.] Supplies

The cluster must also ensure that there are sufficient supplies and resources that have been prepositioned in case of emergency. The cluster should be able to coordinate for smooth and efficient movement of supplies and identify sites for warehousing.

The needed supplies can be estimated based on anticipated targets.

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III. List of Preparedness Activities (Minimum Preparedness Actions)

The Nutrition Cluster has identified minimum preparedness actions which are a set of activities that the cluster will implement in order to establish a minimum level of emergency preparedness within the country. These activities are not risk or scenario-specific and usually do not require additional resources to accomplish. MPAs are centered on actions involving risk monitoring, coordination and management arrangements, needs assessments and information management, and operational capacity and arrangements to deliver relief and protection. These actions will ensure readiness and flexibility to respond to different types of emergencies as they arise.

Due to frequency and magnitude of disasters in Philippines, there is a need to invest in strengthening preparedness efforts, on disaster preparedness and disaster mitigation, to lessen impact of disaster on the affected community. Identified preparedness actions prioritized by the cluster include the following:

Table 5. List of Preparedness Activities

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Preparation of Nutrition Cluster Strategic Plan for Preparedness and Response

1. Capacity Mappinga. Mapping of:

i. Partners’ activities

ii. Technical

NNC, all cluster partners

Updated Capacity Maps

Capacity Map

(table and map)

Jan. and July

Jan. and July

Jan. and July

Jan. and July

Jan. and July

Jan. and July

Jan. and July

27

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

capacitiesiii. Human resourcesiv. Supplies

b. Development of Capacity Mapping Tool/Form

c. Development of Capacity Mapping Mechanisms (who updates, frequency of updates, what channels to use)

d. Geographic representation of Capacity Map

e. Risk Mapping

Geographic Capacity Map

Useful maps for Nutrition Cluster integrating wasting rates, disaster

28

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

prone areas, ASAPP, etc.

2. Cluster Management and Coordination

a. Revisiting and finalization of TORs (National Nutrition Cluster and TWGs, cluster coordinator and IM)

NNC, all cluster partners

Meetings with TWGs

Clear membership guidelines for Nutrition Cluster

Revised TORs

Updated cluster membership/directory

Nov.

3. Rollout of Preparedness Planning for Regional Clusters

a. Dissemination of Strategic Plan for Preparedness and Response

NNC Orientation sessions on Strategic Plan for Preparedness and Response

Development of sub-national Strategic Plans for Preparedness and Response

Jan.-June

29

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

b. Support development of sub-national Strategic Plans for Preparedness and Response

Contingency Stocks/Supplies

1. Contingency stocks be made available for identified priority areas (for easy mobilization)

a. Updating of Supplies/Inventory

b. Prepositioning of supplies

NNC, agencies with supplies (DOH, UNICEF, WFP, PhilCAN)

Identified list of warehouses for prepositioning

Inventory list

Supply Map (Capacity Map)

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Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Capacity Building of Government and Cluster Partners

1. Develop Training Needs Assessment Tool to determine current capacity levels of partners and stakeholders

NNC, NiED

Meetings and consultations to develop Training Needs Assessment Tool

Pretesting of tool

Training Needs Assessment Tool

Q2

2. Develop Training Plan and Modules for essential emergency nutrition capacities

a. Nutrition in

NNC, CMAM, IYCF AM WGs

Review of existing modules

Updating of modules

Training modules developed for:

a. Nutrition in

Jan.-June

31

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Emergenciesb. CMAMc. Blanket

Supplementary Feeding

d. IYCFe. Cluster Coordinationf. Information

Managementg. Assessments (rapid

assessments, SMART Survey)

Emergencies

b. CMAMc. IYCFd. Cluster

Coordination

e. Information Management

f. Assessments (rapid assessments, SMART Survey)

3. Implement capacity building for essential skills in

NNC, DOH,

Database of trained

Conduct of TOT for

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Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Emergency Nutrition Response

a. Nutrition in Emergencies

b. CMAMc. Blanket

Supplementary Feeding

d. IYCFe. Cluster Coordinationf. Information

Managementg. Assessments (rapid

assessments, SMART Survey)

UNICEF, WFP, FDA

personnel/TOT database

Emergency Nutrition Response

Inter-cluster Coordination

1. Strengthen inter-cluster linkages with other clusters (Health, WASH, Food and

NNC Meetings with other Clusters

Established links with WASH

Jan.-Dec.

33

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Non-Food Items)a. Examine existing

partnerships/points of collaboration

b. Establish communication with clusters

c. Attend external cluster meetings and invite other clusters to attend Nutrition Cluster meetings when relevant issues are discussed

Attendance and Participation in other cluster meetings

(coordination during emergencies)

Established links with Camp Coordination and Camp Management (concerns on mother-baby friendly space)

Established links with Health

Establish link with Food and

34

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Non Food Item (food for elderly and children, issues on infant formula)

Nutrition Assessment, Monitoring, and Information Management

1. Support to development of Philippine Food and Nutrition Surveillance System (compilation and updating of fundamental operational datasets such as demographic data, malnutrition prevalence disaggregated to regional/provincial/municipal level, recent nutrition

NNC (AM WG)

Functional and updated nutrition database

Philippine Food and Nutrition Surveillance System

35

Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

survey findings/SMART)a. Reporting Guidelinesb. Monitoring and

Evaluation

Advocacy

1. Development of Advocacy and Communications Plan

AdComm WG

Workshop to develop Advocacy and Communications Plan

Cluster Advocacy and Communications Plan

Oct.

2. Develop Advocacy Packages for:

a. NIEmb. CMAMc. Blanket

Supplementary Feeding

d. IYCF/

AdComm WG

TWG Consultations

Advocacy packages

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Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

Complementary feeding

e. MSf. EO 51

Operational Guidelines and Policies

1. CMAMa. Finalization of SAM

guidelinesb. AO

CMAM WG

TWG Consultation Meetings

Final guidelines

AO

completed

2. Develop and finalize IYCFE guidelines

a. Finalization of IYCFE guidelines

b. AO

IYCF WG

TWG Consultation Meetings

Final guidelines

AO

Dec.

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Preparedness Activity Agencies

Involved

Indicators Output Timeline

2015 2016 2017

2018 2019 2020 2021

2022

3. Review and finalize NiEm guidelines

a. Revision of policy guide on NiEm

NNC TWG Consultation Meetings

Revised policy guide

Q1

4. Advocacya. Develop Advocacy

and Communication Plan

NNC, AdComm WG, DOH

TWG Consultation Meetings

Advocacy and Communications Plan

Oct.

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IV. Response Plan

Adapted from the Minimum Service Package for Nutrition, this aims to guide the Nutrition Cluster on immediate actions to take during emergencies and to prevent worsening of nutrition status and deaths. Implementation of nutrition services will focus on the following activities:

A. CMAMB. Blanket Supplementary Feeding ProgramC. IYCFD. MSE. Ensuring functional referral systemsF. Nutrition IM and SurveillanceG. Advocacy and Communication

Population statistics are essential in determining the extent of an intervention. In situations where demographic characteristics may be unavailable, targets can be approximated based on caseload estimates as in Annex 3.

The coordination during emergencies is based on the provisions of RA 10121, Section 15, which is as follows:

Barangay Disaster Committee 1 barangay affectedCity/Municipal DRRMC 2 or more barangays affected Provincial DRRMC 2 or more cities/municipalities affectedRegional DRRMC 2 or more provinces affectedNDRRMC 2 or more regions affected

In relation to the above mentioned, there are two approaches to consider for the type of response based from the National Disaster Response Plan: 1) for augmentation to the operations of the affected LGUs and, 2) for assumption of functions of the LGUs in providing response assistance to their affected population. Both approaches take into consideration the level of capacity and capability of the affected LGU to determine the amount of assistance that will be released and deployed.

Thus, actions of the Nutrition Cluster at the national level will depend on the extent of the disaster, and the capacity of the Regional/LGU cluster to respond. This section proposes actions that must be taken by the National Nutrition Cluster for 3 scenarios:

A. National Cluster Actions for functional LGU Nutrition Cluster B. National Cluster Level Actions augmenting Functional Regional/LGU Nutrition ClusterC. National Cluster Level Actions taking over for non-functional Regional/LGU Nutrition

Cluster

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Table 6. Response Actions of National Nutrition Cluster (adapted from Minimum Service Package)

A. National Cluster Actions for functional LGU Nutrition Cluster

Timeline Nutrition1. Pre-Emptive

Evacuation Phase

1.1. Update resource inventory/mapping of micronutrients

1.1.1. Tents1.1.2. Vitamin A capsules1.1.3. Multiple micronutrient powders1.1.4. Multiple Micronutrient supplements for pregnant women1.1.5. IECs for Nutrition1.1.6. MUAC Tapes1.1.7. Weighing scale1.1.8. Weight for height reference table1.1.9. Height Board1.1.10. Ready-to-Use Therapeutic Food (RUTF)1.1.11. Ready-to-Use Supplementary Food (RUSF)1.1.12. Lipid-based Nutrition Supplements (LNS)1.1.13. Antibiotics, deworming tablets (for routine acute malnutrition

management, to be coordinated with the health office/centers)1.1.14. Human milk banks (inform them ahead for proper coordination)1.1.15. Breastfeeding Kit (container/katsa, feeding cup with cover, food

container with spoon and fork, 1 liter glass tumbler with cover, IEC materials, birth registration form)

1.2. Mapping of partners (4Ws- Who, what, when, where)

1.3. Coordination with partners on the following:

1.3.1 Conduct of general and blanket supplementary feeding for 6 to 59 months old children, and pregnant and lactating women

1.3.2 Setting-up of mother-baby friendly areas in evacuation center for IYCF counseling and complementary feeding

1.4 Alert notification to health facilities with capacities for SAM (severe acute malnutrition “severe wasting” management), ensure functional referral systems

1.5 Activation

1.5.1 Joint Rapid Nutrition Assessment Teams, if necessary1.5.2 Infant feeding/ Breastfeeding Support Groups, if necessary

1.6 Intra/InterCluster Coordination Meetings

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Timeline Nutrition2 Within First

24 hours of Impact

2.1 Coordinate/Facilitate team deployment by LGU

2.2 Assist LGU in establishing contacts, gathering critical information (baseline) and identifying immediate priorities to include areas that situation may worsen, especially regarding support for IYCF and EO 51 monitoring.

2.3 Support LGU in the conduct of gap analysis and in the prioritization and planning/ scheduling of nutrition interventions

2.4 Facilitate and coordinate the preparation and submission of daily situation report

25 to 71 hours

3 More than 72 hours

1.1 Provision of technical assistance on the following:

1.1.1 Implementation of nutrition interventions1.1.2 Information management (e.g. 4Ws, use of data tracking matrix of

DSWD, situation reports)1.1.3 Monitoring and evaluation1.1.4 Documentation

1.2 Support LGU in policy monitoring of EO51 and reporting of violations

1.3 Lead/facilitate cluster coordination initiatives

1.4 Assist LGU in the advocacy for nutrition services related to mental health and psychosocial care, water, sanitation and hygiene, health, and others

1.5 Activation of 4Ws

1.6 Technical assistance for “exit” strategy

B. National Cluster Level Actions augmenting Functional Regional/LGU Nutrition Cluster

Timeline Nutrition2. Pre-Emptive

Evacuation Phase

2.1. Update resource inventory/mapping of micronutrients by Nutrition Clusters at all levels

2.1.1. Vitamin A capsules2.1.2. Multiple micronutrient powders2.1.3. Ferrous sulfate and iron with folic acid2.1.4. IECs for Nutrition2.1.5. MUAC Tapes2.1.6. Weighing scale2.1.7. Weight for height reference table2.1.8. Height Board2.1.9. Ready-to-Use Therapeutic Food (RUTF)

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Timeline Nutrition2.1.10. Ready-to-Use Supplementary Food (RUSF)2.1.11. Lipid-based Nutrition Supplements (LNS)2.1.12. Antibiotics, deworming tablets (for routine acute malnutrition

management, to be coordinated with the health office/centers)2.1.13. Human milk banks (inform them ahead for proper coordination)2.1.14. Breastfeeding Kit (container/katsa, feeding cup with cover, food

container with spoon and fork, 1 liter glass tumbler with cover, IEC materials, birth registration form)

2.2. Mapping of partners (4Ws- Who, what, when, where) by Nutrition Clusters at all levels

2.3. National/Regional Nutrition Clusters providing augmentation to LGU Nutrition Clusters on the following:

1.5.1 Conduct of general and blanket supplementary feeding for 6 to 59 months old children, and pregnant and lactating women

1.5.2 Setting-up of mother-baby friendly areas in evacuation centers for IYCF counseling and complementary feeding

1.6 Support LGU in giving alert notification to health facilities with capacities for SAM (severe acute malnutrition “severe wasting” management)

1.7 Augment activation of the following:

2.5.1 Joint Rapid Nutrition Assessment Teams, if necessary2.5.2 Infant feeding/ Breastfeeding Support Groups, if necessary

2.6 Support LGU in the conduct of Intra/InterCluster Coordination Meetings

3 Within First 24 hours of Impact

2.2 Augment team deployment by LGU

2.2 Assist LGU in establishing contacts, gathering critical information (baseline) and identifying immediate priorities to include areas that situation may worsen.

3.3 Support LGU in the conduct of gap analysis and in the prioritization and planning/ scheduling of nutrition interventions

3.4 Support LGU in the preparation and submission of daily situation report

25 to 71 hours

4 More than 72 hours

1.7 Augment LGU’s logistics on the following:

1.7.1 Implementation of nutrition interventions1.7.2 Information management (e.g. 4Ws, use of data tracking matrix of

DSWD)1.7.3 Monitoring and evaluation

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Timeline Nutrition1.7.4 Documentation

1.8 Support LGU in policy monitoring of EO51 and reporting of violations

1.9 Support LGU in the conduct of Intra/Inter-Cluster Coordination Meetings

1.10 Assist LGU in the advocacy for services related to mental health and psychosocial care, water, sanitation and hygiene, health, and others

1.11 Technical assistance for “exit” strategy

C. National Cluster Level Actions taking over for non-functional Regional/LGU Nutrition Cluster

Timeline Nutrition1. Pre-Emptive

Evacuation phase

1.1 Updating of inventory of resources and mobilization/mapping of micronutrients

1.1.1 Vitamin A capsules1.1.2 Multiple micronutrient powders1.1.3 Ferrous sulfate and iron with folic acid1.1.4 IECs for Nutrition1.1.5 MUAC Tapes1.1.6 Weighing scale1.1.7 Weight for height reference table1.1.8 Height Board1.1.9 Ready-to-Use Therapeutic Food (RUTF)1.1.10 Ready-to-Use Supplementary Food (RUSF)1.1.11 Lipid-based Nutrition Supplements (LNS)1.1.12 Antibiotics, deworming tablets (for routine acute malnutrition management,

to be coordinated with the health office/centers)

1.2 Coordinate the conduct of general/blanket supplementary feeding

1.3 Conduct of targeted supplementary feeding for 6 to 59 old months children, and pregnant and lactating mothers

1.4 Distribute Vitamin A to RHUs for 6 to 59 months children

1.5 Coordinate the setting up of mother-baby friendly areas in evacuation centers for IYCF counseling and complementary feeding

1.6 Team Activation1.6.1 Joint Rapid Nutrition Assessment Teams 1.6.2 Infant feeding/ Breastfeeding Support Groups

1.7 Referral of SAM (Severe Acute Malnutrition “severe wasting”) with complications to Integrated Management of Acute Malnutrition (IMAM) referral hospitals

43

Timeline Nutrition1.8 Cluster Coordination Meeting

2. Within First 24 hours of Impact

2.1 Assessment Team Deployment

2.2 Rapid nutrition assessment

2.3 Infant feeding in emergencies assessment

2.4 Cluster coordination

2.5 Planning for Intervention

25 to 71 hours

* the following activities will not only be delivered in the evacuation center

3. More than 72 hours

3.1 Implementation of the following nutrition interventions:

3.1.1 Rapid screening for acute malnutrition using mid-upper arm circumference (MUAC) tape

3.1.2 Blanket and targeted supplementary feeding

3.1.3 Integrated Management of Acute Malnutrition (IMAM) activity components

3.1.3.1 Screening and identification of severe acute malnutrition (SAM or “severe wasting”) and moderate acute malnutrition (MAM or “wasting”) using MUAC (or weight-for-height if capacity exists) as basis and checking of bilateral pitting edema

3.1.3.2 Enrolment/admission3.1.3.3 Growth monitoring and promotion3.1.3.4 Standard case management3.1.3.5 Case referral3.1.3.6 IMAM crash course for health staff and volunteers

3.1.4 Promotion, protection, and support of infant and young child feeding in emergencies

3.1.4.1 Policy (Milk Code) active monitoring and advocacy3.1.4.2 Establishment/setting up of breastfeeding

areas/corners/tents in evacuation centers/camps/temporary shelters

3.1.4.3 Organization and orientation of breastfeeding support groups

3.1.4.4 Infant feeding in emergencies assessment and counseling3.1.4.5 Provision of breastfeeding support services

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Timeline Nutrition

3.1.4.5.1. Transport and storage of pasteurized human breastmilk in coordination with human milk bank

3.1.4.5.2. Identification of wet nurses3.1.4.5.3. Organization of relactation sessions3.1.4.5.4. Distribution of breastfeeding kits

3.1.5 Micronutrient Intervention

3.1.5.1 Provision of vitamin A capsules (VAC)3.1.5.2 Iron and folic acid supplementation3.1.5.3 Multiple micronutrient powder (MNP) supplementation3.1.5.4 Supplementary Feeding

3.2 Information Management

3.2.1 Monitoring, supervision and evaluation:

3.2.1.1 Service delivery 3.2.1.2 Resource mobilization and use3.2.1.3 Emerging needs, e.g. need for “Diskwento” caravan3.2.1.4 Anthropometric survey/surveillance

3.2.2 Documentation and information sharing

3.2.2.1 from the LGU to the National office (DOH) 3.2.2.2 within LGUs3.2.2.3 between and among partners3.2.2.4 clusters3.2.2.5 others

3.3 Referral of psychosocial high-risk or positive cases to mental health and psychosocial support (MHPSS) interventions and activities

3.4 Referral to WASH, Health Clusters, and other interventions

3.5 Cluster coordination

3.6 Policy monitoring of EO51 and reporting of violations

3.7 Develop “exit” strategy

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Table 7. Key Indicators

Indicators

Number of Children < 5 years screened for acute malnutrition

Number of SAM admitted into therapeutic feeding programs (at OTP/SC)

Number of MAM provided targeted supplementary feeding

Number of SAM cured/defaulted/died

Number of MAM cured/defaulted/died

Number of children given blanket supplementary feeding

Number of Mother-baby friendly areas established

Number of PLWs with supplementary feeding

Number of PLWs with counselling support for breastfeeding and care practices

Number of children under 23 months who are continuing breastfeeding

Number of Nutrition surveys/assessments conducted

Number of participants trained in NiEm

Number of participants trained in CMAM

Number of participants trained in IYCF counselling

Number of children given vitamin A capsules

Number of children given MNPs

V. Proposed Annexes Nutrition Cluster Contact List Capacity Map (Table and Map) Estimated Caseload

[Documents still under development or being updated]

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Annex 1. Sample Nutrition Cluster Contact List (as of October 2015)

Organization Name Position/Job Title Primary email Phone

ACF Oscar V. Fudalan Jr. Health-Nutrition Coordinator ofudalan@ph.acfspain.org 09277479492ACF Dyan Aimee M. Rodriquez Advocacy and Good Governance

Referentdrodriguez@ph.acfspain.org 09173260319

ACF Rosa May Maitem Communications Manager rmaitem@ph.acfspain.org 09989885461Arugaan Ines A. Fernandez innes.sea@gmail.com 09088888153Arugaan Velvet Roxas velvethere@yahoo.com 09157741614CWC Ruth L. Marayag ruthlimson_marayag@yahoo.com 09258095750DOH Rosalie P. Paje Division Chief, Child Health

Development Divisionrosaliepaje231@yahoo.com 09175075733

DOH-FHO Anthony Calibo National Program Manager - Integrated Management of Childhood Illness

acalibomd@yahoo.com 09178434525

DOH-FHO Luz B. TagunicarSupervising Health Program Officer, Program Manager for Nutrition

luztagunicar@yahoo.com 09155433237, 651-7800 loc.

1729DOH-HEMB Ronald P. Law ronlaw_md@yahoo.com 09225205676DOH-HEMB Marilyn V. Go Chief, Preparedness Division mvgomd@gmail.com (02)7430568DOH-HEMB Janice P. Feliciano Nutritionist-Dietitian V janicepaladfeliciano@gmail.com 09228587290DOH-HFDB Josephine Guiao Development Management Officer IV

(Dietary Adviser), HFEP Coordinator/ Evaluator for Region 2 and 3

josieguiao@yahoo.com 09053125800

DOH-HFDB Cynthia Fabregas cynthiasuarez_6@yahoo.com 09228436034DReAMB Braddy Agarma bmagarma@e-dswd.net 09217191331DTI Josephine Palima btrcp_pmu@yahoo.com 09175439678FNRI Marilou Galang Senior Science Research Specialist mrg4157@yahoo.com 09192068683HKI Dolly R. Rearrio Monitoring & Evaluation Officer drearrio@hki.org 09189136125IMC Kathryn Anne M. Zamora National Health Services Officer manila.health@caremin.com 09228369811IMC Elviro Firmalino Jr. National Health Services Officer manila.health2@caremin.com 09234512810IMC Orly De Ocampo orly.deocampo@caremin.com 09155107287IMC Lincoln Lau Director of Research lincoln.lau@caremin.com

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Organization Name Position/Job Title Primary email Phone

IMC Milton B. Amayun Senior Advisor, Public Sector Funding milton.amayun@caremin.com 09433030624KMI Maria Asuncion Silvestre President miannesilvestre@gmail.com 09175352438KMI Romelei Alfonso rcalfonsomd@gmail.com 09175104705KMI Ria Verdolaga riaverdolaga@gmail.com NNC Maria-Bernardita T. Flores Assistant Secretary of Health and

Executive Director IV bernie.flores@nnc.gov.ph 09189121686

NNC-NIED Melody N. Melo-Rijk Nutrition Officer III mnmrijk@yahoo.com 09162820287NNC-NIED Ma. Katrina A. Demetrio Nutrition Officer II mkademetrio@yahoo.com 09258868653NNC-NIED Jovita B. Raval Division Chief jovie_raval@yahoo.com NNC-NPPD Dianne Kristine P. Cornejo Nutrition Officer III diannecornejo30@gmail.com 09163482429NNC-NPPD Margarita DC. Enriquez Nutrition Officer II may_nrikz@yahoo.com 09331674199NNC-NPPD Maria Lourdes A. Vega Division Chief dd_vega23@yahoo.com 09189111023NNC-NSD Frederich Christian S. Tan Nutrition Officer II derich2287@yahoo.com 09255133265NNC-NSD Hygeia Ceres Catalina B. Gawe Division Chief jigay.gawe@gmail.com 09189215166UP-Philippine General Hospital

Juliet Sio-AguilarProfessor and Chair, Department of Pediatrics

julietsioaguilar79@gmail.com 09175307611

Rappler Mara Cepeda Junior Researcher mara.cepeda@rappler.com 9178989392Red Cross Mark Alvin Abrigo markalvin.abrigo@redcross.org.ph 09285915077Save the Children

Amado R. Parawan Health and Nutrition Adviser amado.parawan@savethechildren.org

09178953070

Save the Children

April Sumaylo Media april.sumaylo@savethechildren.org

09173011240

UNICEF Aashima Garg Nutrition Manager agarg@unicef.org 09064193810UNICEF

Rene Andrew A. BucuNutrition Consultant for CMAM and Preparedness rabucu.md@gmail.com

09989983781

UNICEF Rene Gerard Galera Nutrition in Emergencies Officer rggalera@unicef.org 09175021657UNICEF Maria Evelyn Carpio Nutrition Specialist mecarpio@unicef.org 09178868673WFP Martin R. Parreno Program Officer for Nutrition martin.parreno@wfp.org 09175713154WFP Corazon VC. Barba Consultant coravcbarba@yahoo.com 09178464644WFP Faizza Farinna T. Tanggol Communications Officer faizzafarinna.tanggol@wfp.org 09178809368

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Organization Name Position/Job Title Primary email Phone

World Vision Gem Macanan Advocacy Research Specialist gem_macanan@wvi.org 09176219650World Vision Filomena M. Portales AdComms Director minnieportales@wvi.org 09175342165World Vision Kathrine Yee Advocacy Manager kathrine_yee@wvi.org 09173128508World Vision Sherlane Bongalos Health and Nutrition Technical

Managersherlane_bongalos@wvi.org 09173261641

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Annex 2. Geographical Capacity Map (sample only)

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Annex 3. Caseload Estimates

Age Groups Average % in Population

(DOH Pocket Emergency Tool July 2011)

Estimated Targets for Small-scale Disaster

Estimated Targets for Medium-scale Disaster

Estimated Targets for Large-scale Disaster

Estimated Population Population estimates: 1000

Population estimates: 10000

Population estimates: 100000

Infants below 6 months 1.35 1350 13500 135000

6-11 months 1.35 1350 13500 135000

6-23 months 4.05 4050 40500 405000

24-59 months 8.10 8100 81000 810000

12-59 months 10.8 10800 108000 1080000

5-9 years 11.7 11700 117000 1170000

10-14 years 10.5 10500 105000 1050000

15-19 years 9.5 9500 95000 950000

20-59 years 48.6 48600 486000 4860000

Pregnant Women 3.5 3500 35000 350000

Lactating Women 3.0 3000 30000 300000

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Age Groups Average % in Population

(DOH Pocket Emergency Tool July 2011)

Estimated Targets for Small-scale Disaster

Estimated Targets for Medium-scale Disaster

Estimated Targets for Large-scale Disaster

Estimated Population Population estimates: 1000

Population estimates: 10000

Population estimates: 100000

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