Management of SAM in the Philippines: from emergency-focused modelling to national policy and government scale-up
What we know: Access to essential health and nutrition services by the poor and marginalised in the Philippines is low, exacerbated by recurrent disasters and conflict. Malnutrition persists as an alarming concern in the country.
What this article adds: The emergency response to super-typhoon Haiyan in 2013 included successful, cluster-led programmes for treatment of severe acute malnutrition (SAM), but highlighted significant shortfalls in national policies, protocols, health system capacity, supplies and government buy-in.
Subsequently, national guidelines for the management of SAM were developed and adopted by the Philippine Government in a participatory, consultative process led by the Department of Health, with UNICEF technical support, expert and partners’ consultation, and SUN stakeholder involvement (under the auspices of the national CMAM working group). MAM guidelines are also in development, but issues around commodity supply costs at scale and competing agency mandates have hampered integration with SAM guidance and finalisation. A detailed scale-up plan for integrated SAM treatment is now in development for 16 priority provinces; supplies are one hundred per cent funded by the Department of Health’s 2016 Annual Investment Plan.
The Philippines is a middle-income country that has enjoyed reasonable economic growth in recent years. Progressive Gross Domestic Product (GDP) growth is projected for 2016, with a 6.3% increase from a 6.1% increase in 2014 (Asian Development Bank, 2015), positioning the Philippines among countries with the highest economic growth in Southeast Asia. However, compared to other countries in the Association of Southeast Asian Nations, the country’s nutrition indicators are still lagging. While the 2015 Global Nutrition Report shows the Philippines to be “on course” towards achieving the stunting target, (although more recently released 2015 National Nutrition Survey data show an increase from 30% to 33.4% in 2015), the country is “off course” in progress towards the targets for wasting in children under five years old and anaemia among women of reproductive age by 2025.
The country showcases glaring, income-based inequities and its health systems are regularly challenged by natural disasters and armed conflict. Political factors, weak policies and decentralisation resulting in muddled accountabilities at local and national levels have resulted in low access to essential nutrition and health services in remote, poor and minority communities. Political patronage and the lack of “voice” of the poor mean that health and nutrition expenditures are often skewed in favour of the rich. Research from the World Bank finds that the Philippines is one of only 20 countries in the world (among 69 assessed) where government expenditure on health is “significantly pro-rich” (Wagstaff, Bilger, Buisman et al, 2014). Being affected by more than 20 typhoons each year, the environmental context of the Philippines makes disaster preparedness and resilience particularly critical. It is the third-most disaster-prone country in the world, with high vulnerability not only to typhoons but also to flash flooding, volcano eruptions and earthquakes.
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The Emergency Nutrition Network (ENN) and support to the SUN Movement
ENN is a UK registered charity which was set up to improve practice and strengthen the institutional memory of agencies involved in the emergency food and nutrition sectors. ENN focuses on communities in crisis, typically humanitarian emergencies. ENN enables nutrition networking and learning to build the evidence base for nutrition programming in three ways:
- Field Exchange (FEX), an online and print publication on nutrition and food security in emergencies and high burden contexts. Field Exchange is printed three times per year.
- Nutrition Exchange (NEX), is an online publication of short, easy to read articles on nutrition programme experiences and learning. Nutrition is summarised information from the flagship publication, Field Exchange.
- en-net, a free and open resource that helps practitioners access technical advice for operational challenges through the online forum. A specific area for SUN en-net was launched in 2015. Visit SUN en-net ►
ENN is part of the DFID funded Technical Assistance for Nutrition (TAN) programme under which ENN is providing knowledge management services to the SUN Movement in Phase Two (2016-2020). ENN is focused on capturing, curating and disseminating knowledge and learning about nutrition scale up with a focus on high burden and fragile and conflict affected states. Three regional specialists and a Knowledge Management Coordinator are working with country level SUN actors (government, UN, donors, civil society, business and academia) to capture what is being learnt about the scale up of nutrition specific and sensitive activities.