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					Early Childhood Care
and Development
Policy Review
in the Philippines




FINAL REPORT



Prudenciano U. Gordoncillo
Merlyne M. Paunlagui
Ma. Theresa Talavera
Resa J. de Jesus
Deanie Lyn Ocampo
Nelly C. Miranda




January 2009
                                                                             Final Report


                                 EXECUTIVE SUMMARY


1.0    Introduction

The United Nations Education, Scientific and Cultural Organization (UNESCO) and the
United Nations International Children‘s Education Fund (UNICEF) aim to support Asia-
Pacific countries in meeting the first goal of Education for All (EFA) through an
assessment of the state of policy and implementation of early childhood development.
Hence, said organizations launched, in September 2006, the Regional Early Childhood
Care and Development (ECCD) Policy Review Project across eight countries including
the Philippines.

This policy review is in light with the ECCD Act, a national law on early childhood care
and development that defines ECCD as the full range of health, nutrition, early education
and social services that provide for the holistic needs of 0-6 year old children. It will take
on a broader perspective and will go beyond the goal of ECCD and address the issue of
expanding and improving access to early childhood care and development.

In general, the review process aimed to support and assist the Philippine Government in
meeting the goals of the ECCD Program by identifying, documenting, and sharing good
practices as well as constraints in the policy development and implementation of early
childhood care and development, which are aligned with other national sectoral plans as
well as with the international commitments to the Millennium Development Goals (MDG),
World Fit for Children (WFC), and Education for All.

Specifically, the objectives of the review included the following: 1) to determine the level
of access to the basic ECCD services; 2) to identify the factors affecting the level of
access; 3) to assess the quality of the ECCD services; 4) to characterize the nature of
integration and convergence of ECCD services; and 5) to assess the feedback
mechanisms and structure established for the program.

The conceptual framework for this Program review was drawn from the original ECCD
framework adapted from Brofenbrenner (1988) in the baseline survey as well as in the
evaluation study.

To establish the review in proper perspective, it is necessary to understand the
interaction among the stakeholders of the ECCD Program across various levels – from
an individual perspective, household, community, local government unit (LGU) level,
and up to the national level. These interactions that influence the overall
development of the child involves resources, events, values, and communications.
The review will also be guided by the principle that intervention in early childhood
development should be holistic and that the critical role of the primary care givers and
the parents should be considered. Further, ECCD interventions should provide for the
inclusion of vulnerable children, smooth transition from home-to-center-to-school, and
gender sensitivity.

The specific areas of concerns or themes that the review process focused on include
access, quality and the level of integration, and convergence of ECCD services. In terms
of access, the following specific questions were addressed: What were the causes of low
participation? Was it a problem of availability, accessibility, affordability, awareness, or
attitudinal?; and Who were the disadvantaged and the advantaged and how were the
gaps generated?




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The process of assessing the quality of service focused on the appropriateness of the
intervention, content, standards, the mode of delivery, and the capacity and level of
commitment among the service providers. Similarly, the review looked at the adequacy
and appropriateness of ECCD infrastructures, facilities, and material support. It also
assessed the sensitivity of the services to the cultural and social character of the
communities.

One of the guiding principles advocated for an ECCD intervention is that the approach
should be holistic and integrated. Hence, the fundamental question addressed in the
review process was in terms of the mode and extent of integration of the various ECCD
services.

There were also cross-cutting issues that the review dealt with, particularly in terms of
resources, governance and effectiveness of the delivery system. Source and mode of
financing were also critical. In most developing countries, allocations of resources are
often guided by political interest. Thus, there is a need to address the issues concerning
the mechanisms instituted to insulate the program from political interventions as well as
the structures established to define and delineate accountabilities. At the current phase
of ECCD implementation in the Philippines, effectiveness was assessed through
established mechanisms to operationalize the monitoring and evaluation component of
the program.

To assess the mode and extent of integration of ECCD services, one needs to look at
the household as the basic and focal unit. In a status quo, the state of the child
development is determined primarily by the resources available at the household level.
However, attitudes and values also play a critical role in the physiological and psycho-
social development of the child. It is the interplay of these factors that basically
determines the development of the child.

Therefore, any attempt to intervene towards the development of children in terms of
health and nutrition, psycho-social and early education as well as social protection in an
integrative manner will have to be focused at the household level, in general, and to the
child, in particular.


2.0   Methodology

The cases were conducted in five provinces where the ECCD were already
implemented. Two study sites each were selected from Luzon and Mindanao and one
from the Visayas. The provinces of Cagayan and Zambales represented the island of
Luzon; Leyte for Visayas; and Davao Oriental and Misamis Occidental for Mindanao.

The review used both qualitative and quantitative data. The process included three
phases, namely: secondary data review, primary data collection, and analysis.

The secondary data included existing policies promulgated to effect child development,
and a situational analysis based on published reports and statistical bulletins. The
analysis situated the country‘s current ECCD status in relation to the regional patterns
and in relation to the country‘s commitment to the MDG, WFC and EFA.

Primary data were collected through participatory rapid appraisal (PRA). This technique
of data collection required the establishment of experts from various disciplines who
conducted field visits within a period of four to five days. The team was composed of
experts from the fields of health, nutrition, child development/early childhood education,
development economics, sociology and social protection.


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In every field visit, courtesy calls were made with the Provincial Social Welfare Office,
Office of the Governor, and Office of the Mayor. Focus group discussions (FGDs) were
conducted with the Provincial Early Childhood Care and Development Committee
(PECCDC), Municipal Early Childhood Care and Development Committee (MECCDC),
and the Barangay Early Childhood Care and Development Committee (BECCDC). In
addition, the Provincial and Municipal ECCD Action Officer, Municipal Nutrition Action
Officer, Social Development Worker, Rural Health Midwife, Grade 1 teacher, Kinder/Pre-
elementary Teacher, and Day Care Worker served as key informants.

Secondary data were collected from the Provincial and Municipal Planning Development
Office (P/MPDO), Provincial and Municipal Nutrition Office (P/MNO), Provincial/Municipal
Social Welfare and Development Office (P/MSWDO) and Barangay. The secondary
data provided relevant information about the province, municipality, and barangay.

3.0   Access to Early Childhood Care and Development Services

While efforts have been made, malnutrition remains to be a problem in the country.
Malnutrition exists primarily because it is highly linked with economic development.
Developing countries like the Philippines have low income capacity which is a major
cause for the inability to secure food. At present, the identified nutritional problems
among preschool children are: 1) protein-energy malnutrition, 2) obesity, and 3)
micronutrient deficiencies, i.e. vitamin A, iron, iodine and zinc.

There are, however, some encouraging signs of improvement. Given the declining trends
in the prevalence of undernutrition in both preschool and school children, the
interventions as embodied in the MTPPAN are apparently effective. Notable among
these interventions are supplementary feeding; nutrition education including the
promotion of breastfeeding and infant young child feeding; and essential child care
services which includes immunization, growth monitoring, micronutrient supplementation,
and integrated management of childhood illnesses. A major boost in the implementation
of interventions is the Accelerated Hunger Mitigation Program (AHMP).

The general health status of Filipino children zero to six years old has been improving for
the past decade. However, there is an apparent disparity in the health status of children
among the different regions in the Philippines. This is demonstrated by the infant
mortality rate wherein the national infant mortality rate has declined rapidly in the past
eight years while a wide range of values was observed among regions. Furthermore,
efforts to improve the health status do not seem to be sustained as evidenced in the
decrease in the rate of decline in the maternal mortality rate in recent years. The same
observations were noted in service delivery. For instance, there is disparity in the rate of
fully immunized children and in NBS coverage among regions. Immunization rates for
individual vaccines have not consistently improved through the years. Thus, there is a
need for an integrative approach that will provide a more sustained improvement in
health status and a more equitable delivery of services nationwide.

The preschool education services in the country are primarily provided by the
government. As of December 2007, if the benchmark is one day care center per
barangay, then the country has more day care centers than the number of barangays.
However, the issue is that there are barangays with more than one day care center while
there are barangays without a day care center. Per region, the most disadvantaged is
Region IV-B where only 51 percent of the barangays have a day care center (DSWD
2007). Moreover, there are DCCs which do not have a Day Care Worker. Some of the
studies conducted on the subject found that the participation rate of children aged zero to
six in preschool services has been relatively low because of the economic cost.


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The statistics indicate that there is an urgent need to address child protection issues. It
was estimated that there are about 50,000 street children and based on a sample, about
eight percent were between two to five years old. Moreover, one of five children
between zero to six has some form of disability (DLSU 2002). This would have
significant implications to the Education for All goals.

4.0    Enabling Environment as Contributory Factor to the Delivery of Early
       Childhood Care and Development Services

The review has established that there are more than enough legislations designed to
promote early childhood care and development. Before the year 2000, various statutes
were promulgated to cater to sectoral concerns including nutrition, health early
education, and child protection.

For instance, policies emanating from the legislative and executive branches of
government were passed to address the malnutrition problem including the rooming and
breastfeeding act, salt iodization act, establishment of the Philippine Food Fortification
Program and the milk code. For health, similar legal instruments also exist such as full
immunization of children below eight years old, compulsory immunization against
hepatitis B for infants and children below 18 years old and newborn screening. To
improve access and quality of early education, several laws and executive issuances
were passed including the barangay day care law, and barangay-level total development
and protection of children act. In addition, several issuances were issued by the
Department of Education on early childhood education. For social protection, there are
also a number of laws and executive orders that were passed such as those concerning
protection of children against abuse, domestic and inter-country adoption, and juvenile
and justice welfare. It should be noted that many of the social protection laws cover
children and not just specifically children aged 0-6 years old. There were other laws
passed which significantly influenced the delivery of services to children, e.g., the Local
Government Code of 1992 which transferred the provision of services to the local
government units.

Given the importance of the total development of the child and the existing fragmented
approach to their development, a landmark act integrating the services for children was
passed. The ECCD Law (RA 8980), is comprehensive, integrative and sustainable, that
involves multi-sectoral and interagency collaboration at the national and local levels
among government; among service providers, families and communities; and among the
public and private sectors, non-government organizations; professional associations, and
academic institutions. This is a very significant positive step towards achieving the ideal
mechanisms for early childhood development. However, there is an apparent need to
reconcile some of conceptual basis of the previous laws in relation to the provisions of
the ECCD Law and to the visions of early child development.

5.0    Quality of services, Integration and Convergence and Monitoring

The manner by which ECCD was implemented which in turn affect the quality of services
reflects the extent by which the Governor has participated in the program. At one end,
the Governor‘s participation is in approving the work and financial plan jointly prepared
by the technical working group at the municipality and the province while at the other end
is the case where the Governor had a direct hand in determining the number of
barangays as beneficiaries. As a result, there are cases where the municipalities in a
province are all beneficiaries while there were only few municipalities chosen for the
ECCD in other provinces.



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Financial management also differs across the sites. There are cases where funds are
transferred from the province to the municipality but there are also cases where funds
are transferred directly to the barangay. Another variation is that the municipal
government covers the rehabilitation of the barangay and health centers while the fund
from the CWC was spent primarily on supplemental feeding.

The main ECCD interventions that were seen in the field across the study sites were
reflections of the usual programs implemented under the various statutes promulgated
before the ECCD Law. The fact that there is a prospect of funding support from ECCD
generated the enthusiasm and commitment from various stakeholders at the field level.
In spite of the difficulties encountered, the commitment of the members of the
coordinating committees and service providers to provide service kept them going. The
implementation of the ECCD program made them realize the importance of their role in
caring for children 0 to 6 years old. The support of the local government also helped
them in the implementation of the ECCD program. As a result of the ECCD
implementation, there had been some expansion of the regular ECCD services,
rehabilitation of existing facilities, upgrading of ECE materials and capacity building
among the various service providers and stakeholders of the ECCD program.

Access to basic ECCD services is limited mainly due to inadequate resources including
manpower and delayed release of ECCD funds. Moreover, the location of the health
center or the day care center to some of the households in the barangay may prohibit
their access to the ECCD services.

There is a need to improve the quality of services at the level of inputs (manpower and
resources), process, and results. Manpower was found to be insufficient in terms of
number (MNAO, BNS, and midwife) and capacity to perform the tasks expected of them
due to inadequate training. Moreover, the materials and facilities were found to be limited
mainly due to the delay in the release of funds. In terms of process, there is a need to
strictly follow the protocol and guidelines issued for the implementation of some ECCD
services, e.g. conducting a supplementary feeding activity should be 90-120 days; use of
the eight-week curriculum for the new Grade 1 pupils so as to uphold the standards in all
ECCD areas and for the full realization of the effect of the services. As to the quality of
results, evaluation of the ECCD services is needed to be able to determine their
effectiveness.

Integration and convergence are concepts that are not yet internalized at all levels
including the household. In fact, the implementation of ECCD services as one integrated
program needs to be promoted at the barangay and household levels. Thus, there is a
need for new strategies and activities to which these concepts can be elevated from
awareness to understanding level at household, barangay, municipal, and provincial
levels. Moreover, there is a need to improve the feedback mechanism from the
household up to the national level.

The critical challenge of the ECCD implementation is the operationalization of the
mandate to provide a system based on multi-sectoral and inter-agency collaboration in
the delivery of a comprehensive, integrative, and sustainable ECCD services at various
levels from the national to the local levels of implementation.




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6.0   ISSUES

While significant and notable improvements were observed across the various case
study sites, there is a need to input the insights generated in the review process to allow
for the modification of existing policies and processes in order to promote a more
efficient implementation, enhance, and sustain the gains as a result of program
interventions.

6.1   Harmonization of Children-Related Laws on Children with RA 8980

      While the ECCD Law is a very significant positive step to provide the mechanisms
      to integrate and harmonize prior ECCD initiatives, there are apparent issues
      relating to the consistency and alignment of previous laws with the ECCD Law.
      Most previous laws have mandates covering a broader age group of children aged
      less than 18 years old compared to the ECCD law which was very specific in its
      intention to cover only children between zero to six years old. This would have
      very critical implications, particularly in terms of coordination, jurisdiction and
      monitoring. For instance, in most child protection laws, the scope covers children
      beyond six years old.

6.2 Less Emphasis on Child Protection

      In the declaration of policy, the ECCD Law was very explicit in saying that
      ―…promote the rights of children to survival, development and special protection
      with full recognition of the nature of childhood and its special needs….Section 2‖.
      Further, in the identification of the duties of the Barangay Council for the Protection
      of Children, child protection was explicitly mentioned. Except for the provision of
      day care service which can be considered as a form of child protection; most of the
      services provided for under ECCD were mainstream ECCD programs such as
      nutrition and health.        Protection and special needs issues are not often
      incorporated. In one of the study sites, under the protection component are the
      rehabilitation of day center and the corresponding education materials only.
      Moreover, the team has never encountered special learning sessions for disabled
      children.

      Further, the notion of ―Protection‖ as operationalized by BCPC under P.D. 603 has
      assumed a legalistic character and practice. Children are generally being provided
      services by government institutions/agencies, when such children become victims
      of abuse, neglect, and abandonment by parents or guardians. This unbalanced
      emphasis on the legalistic practice appears rather reactive rather than proactive, in
      the sense that there are inadequate strategies to counter the rising incidence of
      children in need of special protection. Or if there are available programs, these are
      not widely advocated; thus not known to majority of the service providers.


6.3   Cost-Sharing (Equity) Scheme

      As a matter of policy, funding for ECCD interventions is supposed to be done under
      a cost-sharing scheme. Feedback from the focus group discussions indicated that
      the sharing was about 70:30, that is, 70 percent of the cost will be funded under the
      program while the remaining 30 percent will be funded as equity by the LGU.
      Some local government executives forwarded the argument that the 30 percent
      equity is very high, particularly for the 5th and 6th class barangays which contributed
      to as much as 10 percent of the 30 percent equity. In fact, one of the barangay



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      officials indicated that the barangay may only be able to raise the required equity
      for a specific ECCD project in three years time.

6.4   Sustainability of ECCD-Hired PECCD Coordinator

      In Cagayan Valley, the provincial ECCD coordinating officer was directly hired for
      the ECCD program management. As a result of the financial incentive, the level of
      effort of the hired ECCD officer was relatively high. The coordination effort was
      very good which resulted in the substantive participation of the various agencies
      involved in ECCD implementation, particularly in the planning stage at the
      provincial level. However, the sustainability of a directly hired officer under the
      ECCD framework may be put into the test as soon as funding for the program is
      terminated.

6.5   Inadequately Informed BCPC

      The Barangay Council for the Protection of Children was organized as the
      implementing body at the local level as provided for in P.D. 603. This council is
      basically composed of the Barangay Captain, Elementary School Principal,
      Barangay Midwife, BHW, BNS, DCW, Sangguniang Kabataan Chairman, and a
      representative from the NGO.

      Most of these personalities also constitute the Barangay Agrarian Reform
      Committee, which is also the implementing arm of one the most significant and
      controversial rural development programs in the country - the Comprehensive
      Agrarian Reform Program (CARP).        The BCPC was also tasked as the
      implementer of the programs under RA 9344 or the Comprehensive Juvenile
      Justice and Welfare Act of 2006.

      And now, with ECCD, the same personalities are again tasked with the
      implementation of yet again another significant development intervention of the
      government. It is agued here that these personalities are now tasked with the
      responsibilities of implementing these various significant development programs of
      the government. Further, the BCPC was conceptualized to operate under the
      concept of voluntarism; hence, it has been difficult to recruit more competent
      members to the committee.

       Furthermore, at the national, provincial, and municipal levels, the ECCD
       coordinating committees are supported by an ECCD secretariat. This was not
       made explicit under the law in the case of the barangay. Hence, at the Barangay
       level, there is a coordinating committee but without an ECCD secretariat.

6.6   ECCD Monitoring System

      One of the key elements to an effective delivery of ECCD services is an efficient
      monitoring system. During the field visits, effective monitoring system seemed
      absent particularly at the barangay level.

      To dramatize the point, in one of the sites visited, there was very minimal nutrition
      intervention because the Barangay Nutrition Scholar declared that the incidence of
      malnutrition was insignificant. However, the extent of malnutrition among new
      school entrants in the same community was relatively high. In fact, the incidence
      was about 33 percent. This is an anomaly because malnutrition can not just
      happen overnight. If the extent of malnutrition among zero to six children was



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      practically insignificant, where would the malnourished children among the new
      Grade 1 entrants be coming from?

      The passage of the local government code also has significant implications to the
      implementation of ECCD. Under the devolution, the provision of basic services
      was delegated down to the smallest political administrative unit of the government:
      the Barangay. As a consequence, data on early childhood development had been
      scanty at the provincial, regional and national levels. This is partly due to the fact
      that LGUs do not see either the need or the obligation to provide information
      beyond their immediate level of jurisdiction and mainly due to lack of mechanism to
      integrate the information beyond the municipal level. Hence, in terms of
      monitoring, the current system does not allow for an easy decomposition of the
      target beneficiaries and their needs because available data are in five-year age-
      grouping.

6.7 ECCD Visibility and Advocacy

      While ECCD has been going on for quite sometime in most of the study sites, the
      household level discussions revealed that the extent of awareness about ECCD as
      a Program has been very low suggesting that ECCD awareness campaigns are
      insufficient. In fact, some of the mothers interviewed never heard of ECCD. In one
      of the study sites visited, there was not even a single signage that would show the
      presence of the ECCD program in the community.

      This lack of visibility and limited advocacy my have contributed to the lack of sense
      of project ownership at the community (barangay) level.

6.8   Sense of Project Ownership at the Community (Barangay) Level

      One of the key informants in the study mentioned that while it would have been
      preferred that the level of authority be lowered down to the Barangay level, the
      fact that project disbursements are done at the municipal was accepted as a
      convenient excuse to avoid the accountability associated with fund disbursement.
      As a consequence, there was a feeling of alienation on the part of the local
      government unit.

6.9   Misconceptions on ECCD Integration

      In the true sense of the word, the ECCD services at the time of this review are not
      yet integrated. The providers and stakeholders view that the services are already
      integrated because the centers are offering the various ECCD services and that,
      the process entailed the participation of various agencies of government and
      NGOs. However, it is argued here that the true essence of an integrated ECCD
      services can be characterized by convergence. For ECCD services to be more
      meaningful and effective, such interventions must converge to a specific household
      which covers both the parents and the children. An ECCD facility can readily
      report excellent statistics of increased level of reach in PES, IMCI, EPI, OPT, and
      feeding, among others. But it is not very effective if PES goes to one of the parents
      in one household, IMCI goes to the first child in another household, feeding to the
      third child in yet another household, and so on.




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6.10 The Role of Parents in the Day Care Center Sessions

    During the site visits, it was observed that majority of the parents stayed with their
    children at the premises of the day-care centers during session hours. In a school
    in Cagayan Valley, about five mothers were with their children inside the day care
    centers to monitor their children; while the majority of the parents were just outside
    waiting for the session to end. The fact the parents stayed with their children
    during the entire course of the day care center sessions defeats the very purpose
    of the center, which was intended to cater to the need of the working parents. The
    fact since most of the enrollees now of the day care centers are non-working
    parents (by virtue of their willingness to stay with the child in the center) may
    indicate the real targets of the centers, which are the working parents, may have
    been disenfranchised by the non-working parents.

    The other relevant issue associated with the role of the parents in the day care
    centers was the interest of the parents for their children to acquire added skills that
    would prepare their children for the formal elementary education. This attitude is
    not consistent with the intent of the law.

6.11 Separation Anxiety in the Transition from DCCs to Grade One

    In the preceding section, it was noted that parents stayed with their children during
    the sessions at the day care centers. As a consequence, children were unable to
    get used to being independent in the class.

    The field visits revealed that many parents stayed within the school premises to
    wait for their new Grade 1 children. This issue was highlighted in one case where
    a child cried and refused to enter the Grade 1 classroom fearing that her mother
    would eventually leave her behind as soon as she enters the class room.

6.12 Inappropriateness and Inadequacy of Instruction Materials for the Eight-
     Week Curriculum

    Grade 1 teachers (GOT) are required to attend the training for the implementation
    of the eight-week curriculum for GOTs. However, the provisions for instruction
    materials was very limited at best. Thus, GOTs e.g., in the Cagayan Valley and
    Misamis Occidental either prepare or buy visual aids which may not conform to the
    prescribed ones. This was observed in one of the field visits where the Grade 1
    teacher used materials with inappropriate examples and quite small that could be
    hardly seen at the back of the classroom. The situation is more problematic for
    GOTs who have not attended the eight-week curriculum training but tasked to
    teach Grade One students. These teachers rely on the learnings of other teachers
    as well as borrowing or making their own visual materials. Further, while the ECCD
    law was explicit in the promotion of location-specific learning materials, this has not
    been operationalized in all barangays.

6.13 Multi-Tiered Schemes (ToTs)

    To deliver the human resource development (HRD) component through training
    activities, the implementation strategy was to employ the Training of Trainors (ToT)
    concept. Feedback from the field visits indicated that there has been a significant
    departure from the standards of the acquired knowledge and skill by the local
    stakeholders through the ToT concept.




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6.14     Sectioning of the School-Ready and Not School Ready Pupils

       In some instances, the number of identified non school-ready pupils was
       considerably low. To mitigate this situation, the non-ready pupils were separated
       into another section which was to be handled by another teacher. However, there
       is no curriculum for the non-school ready pupils. As such, the head teacher simply
       made the instruction to the teacher-in-charge of the non-school ready to tone down
       the level of treatment. This was compounded by the fact that the teacher-in-charge
       of the non-school ready did not attend the training program for the eight-week
       curriculum. The problem became more complex in cases where there is only one
       classroom for the new Grade 1 entrants, which would be expected in most of the
       communities under the ECCD program.


7.0    RECOMMENDATIONS

7.1    Harmonization of the Existing Statutes with ECCD

       Prior to the ECCD Law, there were various statutes promulgated to effect the
       delivery of ECCD services. The problem is, such laws had scopes much broader
       than ECCD, which mainly focused on children zero to six years old. It is suggested
       that explicit policies should be promulgated to develop a framework within those
       respective laws so that the implementation can be structured based on the specific
       needs of children stratified according to a rational age grouping. For instance, the
       law providing for the protection of children is concerned with child labor. For all
       practical purposes and intent, this concern may not be very relevant to ECCD.
       Also, the child-centered development mechanism envisioned for LCPCs and local
       ECCDCCs is lacking. As a consequence, there was no comprehensive set of data
       regarding the situation of children aged 0-6 years and their families in Calamba.
       Whatever available data were not presented according to age ranges and
       developmental stages so it was not clear which pertained to ECCD and non-ECCD.

       To operationalize this, the existing ECD programs under various existing laws can
       be structured by concerns according to age categories. It should not be very
       difficult to embrace the idea that there could be health, nutrition, education and
       social protection concerns according to various life stages from early childhood to
       young adulthood. For instance, the Child 21 framework for child development
       should be emphasized to LGUs. This framework uses a life cycle approach in
       planning, thus, stratifying needs, programs/services, outputs according to age
       groups—Mother and the unborn child; infancy (0-less than 1); early childhood (1-6);
       middle childhood (7-11); and adolescence (12-17).

7.2    Flexible Equity Policy

       As with the other programs of the government, the equity of the LGU should be
       based on its capacity to pay. Most often, high incidence of malnutrition and infant
       and under-five mortality is high in municipalities belonging to 5th and 6th class
       municipalities, thus, these are the ones in need of assistance but do not have the
       capacity to cover its equity. For them to be able to participate, there is a need to
       either waive or adjust the equity requirement.




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7.3   Proper orientation of the members of the BCPC on ECCD

      As argued earlier, the BCPC is also involved in most of the major development
      programs in the barangay, wherein the scopes are much broader than that of the
      ECCD. To avoid the problem of delineating the ECCD concerns within the
      mandate of the previous statutes where the BCPC is also involved, there is need to
      ensure that the BCPC members are properly oriented and clearly informed of their
      role in the implementation of ECCD and that the Committee on Early Childhood
      Care and Development must be created as specified in the guidelines.

      To run parallel with the structures from the national down to the municipal level, a
      secretariat at the barangay level must also be created. This can be headed by the
      DCW. The other members could be the parent representative and the NGO
      representative. Two other members of the secretariat can be drawn from the
      community at large chosen by the BCPC sub-committee on ECCD upon
      endorsement of the parent representative.

      Finally, there is the need to reconsider the concept of voluntarism in the
      implementation of ECCD programs at the barangay level. It is suggested here that
      an explicit policy on incentive schemes should be provided in order to enhance the
      level of effort and commitment among the service providers.

7.4   Advocacy program for ECCD

      There is a need to enhance the information, communication and education
      activities of the ECCD. This can be done through posting of signage in strategic
      areas in ECCD communities; development of IEC materials; and holding of slogan,
      logo, and essay writing contests.

7.5   Tapping Alternative Fund Conduits at the Community Level

      To instill a sense of ownership to the program by the local stakeholders, there is a
      need to engage the community in the identification and implementation of ECCD
      including the ―power of the purse‖. However, this has to be done in a way so as not
      to allow for the political factors to dominate in the decision making process. The
      ―KALAHI‖ experience can be replicated under ECCD where                      peoples‘
      organizations were established and were utilized as conduits of the interventions
      under the program. In this manner, the final decision in the type of interventions to
      be funded and how it will be managed are seen to contribute to efficient
      management of the project and ownership.

7.6   Technologically Appropriate Monitoring System

      For a monitoring system to work efficiently for ECCD, there are three basic
      elements to be considered: the data requirements; the repository; and the system
      of processing and retrieval.

      For the data requirements, it is critical to structure the data set by the critical age
      group. Again, the nutrition case can be cited to drive the point. It was established
      that the initial report of low malnutrition was based on a statistical report of all
      children between zero to six. It is argued here that aggregating children from zero
      to six years old would distort that true picture of the children‘s nutritional status.
      The incidence of malnutrition among infants would be very low. This, in effect


                                                                                        xii
                                                                            Final Report


      distorts the true picture by pulling the central tendency measures downwards. This
      is the reason why the report indicated a low incidence of malnutrition.       It is
      suggested here that the data system should be stratified according to a more
      reasonable age grouping so as not to distort the general character of the
      population.

      The other is the repository of the data. Since the crucial integration and
      convergence of ECCD services is at the barangay level, then the barangay ECCD
      committee should have a handle of the data sets at their level. Hence, a system
      must be instituted at the barangay level which could be designed for aggregation at
      the municipal, provincial, and national level.

      However, an ECCD implementer must know that a typical rural barangay would be
      at least five years away from maintaining a computer that could be host to an
      ECCD monitoring system on a day-to-day basis. Further, the system would need
      the presence of a qualified staff with functional knowledge on basic database
      computer applications. A barangay should have the internal capacity to maintain a
      computer system. Computers made available to remote barangays would have a
      life-span of about six months. Hence, it is suggested that at an early stage, it may
      not be necessary or appropriate for a barangay to set up an electronic data system.
      At the barangay level, an index card system could work. The level of aggregation
      in electronic form can be done at the municipal level.

      Furthermore a monitoring system should encompass indicators to measure both
      performance and impact. For the former, the data capture instruments should be
      simple enough to allow for easy and systematic encoding, storage, processing and
      analysis. For the latter, the system should built-in benchmark indicators that are
      generated on a longitudinal perspective.

7.7   Convergence of ECCD Services

      One of the critical added values of ECCD relative to the prior ECCD laws is its
      mandate to affect the convergence of ECCD services. However, at this point, the
      concept of convergence is still not internalized. Hence, there is no convergence in
      the implementation of the services.

      It is suggested that in the short run, there is a need for a massive reorientation of
      the service providers and stakeholders on the concept of convergence particularly
      in relation to and its difference from an integrated ECCD services. There is also a
      need, in the short run, to organize a referral system so that the ECCD services can
      converge to a certain child or better still to a specific household. In the long run, a
      better approach to allow for the convergence of ECCD services is to have an
      inventory and needs assessment at the household level so that ECCD services can
      be tailored to fit and converge to a specific household.              Also, in facility
      development, convergence of services can be enhanced if a one-stop ECCD shop
      can be the basis for the development of ECCD facilities

7.8   School Readiness at Entry to Grade One

      The high dropout rate prevalent in Grades 1-2 in our country (Heaver and Hunt,
      1995), plus the very low national achievement results of children in the early grades
      prompted the Bureau of Elementary Education to explore various ways to better
      prepare children for school. This has also been cause for the emphasis on school
      readiness, transition from home to school, and keeping children in school. Initially,
      there was the Summer Preschool Program, which aimed to develop the


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                                                                             Final Report


       socialization and ―readiness‖ skills of children aged 6.5 to 7 years entering Grade 1
       in the coming school year. The entry age requirement then was 7 years. Overall,
       this pilot program met with mixed success. However, the drop out rate in the early
       grades of children who were preschoolers in the program was only one percent
       compared to the 15 percent for children who did not have the summer preschool
       experience. Complementarily, in 1994-1995, the official age for entry into primary
       school was dropped to 6 years of age. DepEd justified this policy through a
       research that showed there was hardly any difference in the competencies of the 6-
       and 7-year-olds.

       Furthermore, majority of children entered school then ―at a definite disadvantage‖
       because they have not had the opportunity to go to preschools or avail of the DCS
       at the least). So in a typical Grade 1 class in the public schools, majority of the
       students did not have prior ECE experiences and were, thus, unprepared for formal
       education. Hence, in order to mitigate the problem of school readiness upon entry
       to Grade 1, the following measures are suggested: Continuing education of DepEd
       teachers on ECCD, preschool education/teaching strategies and production of
       teaching devices are called for. District supervisors and coordinators of specialized
       areas reiterate the same need; Develop and implement developmentally-
       appropriate curriculum, learning materials and creative activities for Grade 1; The
       development of Standards for Learning Competencies in ECCD must consider that
       majority of our children do not access ECE programs prior to entering primary
       school (despite the availability of DCS and in spite of the new National Preschool
       Education program). Therefore, the learning competencies of the national
       ECCDCC sets for the 6 year olds must provide more time for them to acquire such
       in Grade 1. Many Grade 1 teachers are still apprehensive that the 8-week
       curriculum would infringe on their budget of time to work on the present Grade 1
       curriculum. They often mention the ―No read, no move‖ policy for Grade 1 children;
       and the total development of children, not preparation for elementary schooling
       alone, is the imperative of all early education programs, including Early Childhood
       Experiences in Grade 1.

7.9 Promote a Policy of Child Weaning at the ECE Stage

       Field observations revealed that most of the parents stayed with their children
       during the entire session of the DCCs. As a consequence, children are unable to
       develop the sense on independence and confidence to do the ECE activities
       without the presence of their parents. This attitude hampers the smooth transition
       of the children‘s learning process from ECE to Grade 1. It is suggested here that
       parent should be discouraged from staying within the premises of the Day Care
       Centers during session hours. However, to be consistent with the concept of
       developing an independent child, the parents can be involved in specific tasks in
       the day care sessions on a staggered schedule so that only about two to three
       parents can be involved in any given day care activities. Further, this arrangement
       eases the workload of day care workers.

7.10     Apply a Modified ToT

       The ToT concept can be best utilized when the trainees themselves are already
       capable trainors. The essence is to orient the trainor-trainees the perspective on
       the new subject matter. If the ToT concept is applied to stakeholders who were
       never trainors themselves, then there are many avenues for knowledge gaps and
       effectivity of knowledge transmission. It is recommended that the training should
       be made directly to the local stakeholders at the Barangay level. If there are
       logistical constraints, then capable trainors from locally based (Regional/Provincial)


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                                                                          Final Report


    academic institutions and NGOs can be tapped as the direct trainors for the local
    service providers. If necessary, then the trainors from locally based institutions can
    be the recipient of a ToT for ECCD in their respective areas and must be tasked to
    train the ECCD service providers.

7.11 Research Agenda

    One of the most fundamental issues that was abstracted in the review was the
    apparent tension between the original guiding principle of the Day Care Center,
    which was to cater to the needs of the working parents vis a vis the trend in the
    demand of the non-working parents of day care children to use the center as the
    transition towards elementary education. This must be investigated systematically
    in order to draw more precise policy prescriptions.




                                                                                     xv
                                                                 Final Report




                             TABLE OF CONTENTS


                                                                                Page

1.0 INTRODUCTION                                                                  1
1.1    Objectives                                                                 1

2.0 METHODOLOGY                                                                   1
2.1   Conceptual Framework                                                        1
2.2   Analytical Framework                                                        2
2.3   The Case Study Sites                                                        3
2.4   Data Collection and Analytical Techniques                                   4

3.0 Access to Health, Nutrition, Early Childhood Education, and Social
    Protection Services                                                           5
3.1    Nutrition                                                                  5
3.2    Health                                                                     9
3.3    Early Childhood Education (ECE)                                            13
3.4    Social Protection                                                          18

4.0 Enabling Environment as Contributory Factor to the Delivery of Early
    Childhood Care and Development Services                                       20
4.1   Nutrition Policies                                                          21
4.2   Health Policies                                                             22
4.3   Early Childhood Education Policies                                          25
4.4   Social Protection Policies                                                  30
4.5   The ECCD Law (RA 8980)                                                      30

5.0 Quality of Early Childhood Care and Development Services                      31

6.0 Integration and Convergence                                                   32

7.0 Feedback Mechanism and Structure Established for the ECCD System              33
7.1   Monitoring                                                                  33
7.2   ECCD Structure and Management                                               33

8.0 CONCLUSIONS                                                                   34
9.0 ISSUES                                                                        36

10.0 RECOMMENDATIONS                                                              40

     Annex 1: Case Studies                                                        45




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                                                                    Final Report




                              LIST OF TABLES


Number                                  Title                               Page
      3.1 Population of preschool children by single age group,
          Philippines: 2000-2007 (in millions)                                5
    3.1.1 Percent distribution of preschool children (0 to 5 years) by
          nutritional status, Philippines: 1989-2005                          6
    3.1.2 Proportion of 0-5 year old children by nutritional status and
          by age                                                              6
          Prevalence of anemia among preschool children by age
    3.1.3 group                                                               7
    3.1.4 Prevalence of deficient and low levels of vitamin A among
          preschool children                                                  7
    3.1.5 Zinc deficiency by age and by gender (in percent                    8
    3.2.1 Selected health indicators, 1993 to 2006                            9
    3.2.2 Ten leading causes of child mortality (1-4 years old),             10
          number and rate/100,000 population Philippines, 2000
    3.2.3 Maternal mortality rate, Philippines: 1993 to 2006 (per
          100,000 live births)                                               10
    3.2.4 Maternal mortality by main cause, number rate per 1000
          livebirths and percentage distribution, Philippines, 2003          11
    3.2.5 Number of deaths <5 and total deaths                               11
    3.2.6 Reported cases of vaccine preventable diseases,
          Philippines: 2000                                                  11
    3.2.7 Vaccination rate by type of vaccine, Philippines: 2005 &
          2006                                                               12

      3.3.1 Distribution of day care center by region, 2007.                 14
      3.3.2 Percentage of barangays with day care centers, Regions VI,       14
            VII and XII, Philippines: 2000-2006.
      3.3.3 Participation rate of children aged 36-71, Regions VI, VII       14
            and XII, Philippines: 2000-2004
      3.3.4 Typical expenditure items for one day care center (in pesos)     17
      3.3.5 Costs paid by a family with one child in public day care         17
      3.3.6 Participation rate of children aged 0-71 months in               18
            Supervised Neighborhood Play, Regions VI, VII and XII,
            Philippines: 2000-2004
      3.3.7 Participation rate of children aged 0-71 months in preschool     18
            services (DepEd and Private), Regions VI, VII and XII,
            Philippines: 2000-2004
        4.1 Nutrition and Related Laws, Philippines                          21
        4.2 Health Laws, Philippines                                         22
        4.3 Early Education Laws, Philippines.                               26
        4.4 Legislations Related to Child Protection                         31




                                                                                  xvii
                                                         Final Report




                       LIST OF FIGURES



Number                            Title                         Page

       2.1 The child‘s environment                                2
       2.2 Schematic diagram indicating the link between ECCD
           services and child development.                       3
       2.3 Case study sites                                      4
     3.2.1 Number of newborns screened, 1996-2006                12




                                                                      xviii
                                                                    Final Report




                          LIST OF ANNEX TABLES


Number                                    Title                                Page

     2.3.1 Summary of accomplishments in the two pilot areas as of 2007            60
     2.3.2 Summary of activities included in the ECCD plan in Sta. Fe              60
     2.3.3 OPT among preschool children and weighing results among                 64
           Grade 1 pupils, Milagrosa
     2.3.4 List of responsibilities of mother and father                           67
   3.3.3.1 Components of system establishment and institutionalization,
           Gov. Generoso, Davao Oriental                                           72
   3.3.3.2 Capability building for service providers and provision of
           livelihood activities to beneficiaries                                  72
     3.3.3 Programs for day care centers                                           73
     3.3.4 Planning and management programs                                        74
   3.3.6.1 Rehabilitation of rural health station by municipality, Davao
           Oriental                                                                74
   3.3.6.2 Comparison between hot meal and choco milk                              76
   3.3.6.3 Percent change in the nutritional status of children by age,            77
           Barangay Nangan: First quarter 2005 and 2006 (in mos.)
   3.3.6.4 List of rehabilitated day care centers , Municipality of Governor       78
           Generoso. 2006
     3.4.1 Demographic profile of service providers, Barangay Nangan,              79
           Governor Generoso: 2007
     3.4.2 Knowledge, attitude and perceptions of service providers,
           Barangay Nangan, Governor Generoso: 2007.                               79
    3.5.1 Service providers and those providing assistance in the delivery
          of services for children: Barangay Nangan, Governor
          Generoso: 2007                                                           80
    3.5.2 Service providers and those providing assistance in the delivery
          of services for children: Barangay Nangan, Governor
          Generoso: 2007                                                           81
    4.3.1 Remuneration by type of service provider, Barangay Capatan,              90
          Tuguegarao City
    4.3.2 Knowledge and attitudes of service providers                             90
      4.5 Report submitted by type, whom submitted and frequency by                92
          the Barangay Nutrition Scholar, Barangay Capatan, Tuguegarao
          City
    5.2.2 ECCP funds released to pilot municipalities.                             94
      5.3 Activities performed by the six committees of the BCPC, Siloy,
          Calamba, Misamis Occidental                                              96
    5.4.1 Status of the health-related service provided by the RHM, Siloy,
          Calamba, Misamis Occidental                                              97
    5.4.2 DCW‘s tasks, Siloy, Calamba, Misamis Occidental                          98
    5.4.3 Training activities attended by the DCW‘s, Siloy, Calamba,               99
          Misamis Occidental
    5.4.4 ECCD projects in Calamba                                                 99


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                                                            Final Report



5.4.5 Services provided by the Grade 1 teacher, Siloy, Calamba,        100
      Misamis Occidental
5.5.1 Reports prepared by the Grade 1 teacher                          101
5.5.2 ECCD services available in Siloy                                 103




                                                                       xx
                                                                  Final Report




                        LIST OF Annex Figures


Number                                 Title                             Page

    3.2.3.2 Provincial ECCD Coordinating Committee                        71
    3.3.6.1 Nutritional Status of pre-school children, Barangay           76
            Nangan: 2005 and 2006
         3.5 KAP on children‘s rights, maternal and child health and      82
             cognitive development of mother, Barangay Nangan,
             Governor Generoso: 2007




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                                              Final Report




          LIST OF ACRONYMS

AHMP      Accelerated Hunger Mitigation Program
APECCDO   Assistant Provincial ECCD Officer
BC        Barangay Captain
BECCDIT   Barangay ECCD Implementing Team
BHW       Barangay Health Worker
BNAP      Barangay Nutrition Action Plan
BNL       Below normal low
BNS       Barangay Nutrition Scholar
BNVL      Below normal very low
CARP      Comprehensive Agrarian Reform Program
COA       Commission on Audit
CSEZFP    Cagayan Special Economic Zone and Free Port
CSWO      City Social Welfare Office
CWC       Council for the Welfare of Children
DA        Department of Agriculture
DCC       Day Care Center
DCS       Day Care Services
DCW       Day Care Worker
DepEd     Department of Education
DILG      Department of Interior and Local Government
DOH       Department of Health
DOST      Department of Science and Technology
DSWD      Department of Social and Welfare Development
ECD       Early childhood development
ECE       Early childhood education
ECEP      Early Childhood Enrichment Project
EFA       Education for All
EPI       Expanded Program of Immunization
FGD       Focus Group Discussion
FHSIS     Field Health Service Information System
FNRI      Food and Nutrition Institute
GOT       Grade One Teacher
HRD       Human Resource Development
IDD       Iodine Deficiency Disorder
IEC       Information, Communication and Education
ILO       International Labor Organization
IMCI      Integrated Management of Childhood Illnesses
IP        Indigenous People
IRA       Internal Revenue Allocation
IRR       Implementing Rules and Regulations
IRS       International Reference Standard
IUD       Intrauterine Device
KAMPI     Kapisanan Ng May Kapansanan, Inc.
KAP       Knowledge, Attitude and Perception



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                                                      Final Report




               Local/Provincial/City/Municipal/Barangay Council for
L/P/C/M/BCPC   the Protection of Children
LCE            Local Chief Executives
LDPC           Local Development Plan for Children
LGC            Local Government Code
LGU            Local Government Unit
M/BECCDCC      Municipal ECCD Coordinating Council
MBN            Minimum Basic Needs
MCPC           Municipal Council for the Protection of Children
MDG            Millennium Development Goals
MIS            Management Information System
MOA            Memorandum of Agreement
MPDC           Municipal Planning and Development Council
NBS            Newborn Screening
NDHS           National Demographic and Health Survey
NEDA           National Economic and Development Authority
NGA            National Government Agencies
NGO            Non-Government Organization
NNC            National Nutrition Council
NNS            National Nutrition Survey
NSCB           National Statistical Coordination Board
NSO            National Statistics Office
OSY            Out-Of-School Youth
P/M/B/ECCDC    Provincial/Municipal/Barangay Early Childhood Care
               and Development Committee
P/M/BHO        Provincial/Municipal/Barangay Health Office
P/MNAO         Provincial/Municipal Nutrition Action Office
P/MNO          Provincial and Municipal Nutrition Office
P/MPDO         Provincial and Municipal Planning Development
               Office
P/MSWDO        Provincial/Municipal Social Welfare and
               Development Office
PD             Presidential Decree
PECCDO         Provincial ECCD Officer
PES            Parent Effectiveness Services
PhilHealth     Philippine Health Insurance
PHO            Provincial Health Office
PHS            Philippine Health Statistics
PNP            Philippine National Police
PPAN           Philippine Plan of Action on Nutrition
PRA            Participatory Rapid Appraisal
PTCA           Parent-Teacher Community Association
PTWG           Provincial Technical Working Group
R/PSCWC        Regional/Provincial Sub-committee for the Welfare of
               Children
RA             Republic Act
RHMW           Rural Health Midwife



                                                                 xxiii
                                                Final Report


RHU      Regional Health Unit
SK       Sangguniang Kabataan
SNP      Supervised Neighborhood Play
SRA      School Readiness Assessment
SRAT     School Readiness Assessment Test
SSS      Social Security System
STAC     Stimulation and Therapeutic Activity Center
SWOC     Strengths, Weaknesses, Opportunities, And
         Constraints
ToT      Training of Trainors
TRICAP   Tribal Community Association of the Philippines
TWG      Technical Working Group
UNCRC    United Nation‘s Convention on the Rights of the Child
UNESCO   United Nations Education, Scientific and Cultural
         Organization
UNICEF   United Nations International Children‘s Education
         Fund
VAD      Vitamin A deficient
VAWC     Violence Against Women and Children
WFC      World Fit for Children
WFP      Work and Financial Plan
WHO      World Health Organization




                                                            xxiv
                 EARLY CHILDHOOD CARE AND DEVELOPMENT (ECCD)
                        POLICY REVIEW IN THE PHILIPPINES


1.0 INTRODUCTION

The United Nations Education, Scientific and Cultural Organization (UNESCO) and the
United Nations International Children‘s Education Fund (UNICEF) aim to support Asia-
Pacific countries in meeting the first goal of Education for All (EFA) through an
assessment of the state of policy and implementation of early childhood development.
Hence, said organizations launched, in September 2006, the Regional Early Childhood
Care and Development (ECCD) Policy Review Project across nine countries including
the Philippines.

This policy review is in light with the ECCD Act, a national law on early childhood care
and development that defines ECCD as the full range of health, nutrition, early education
and social services that provide for the holistic needs of 0-6 year old children. It will take
on a broader perspective and will go beyond the goal of ECCD and address the issue of
expanding and improving access to early childhood care and development.


1.1 Objectives

In general, the review process aimed to support and assist the Philippine Government in
meeting the goals of the ECCD Program by identifying, documenting, and sharing good
practices as well as constraints in the policy development and implementation of early
childhood care and development, which are aligned with other national sectoral plans as
well as with the international commitments to the Millennium Development Goals (MDG),
World Fit for Children (WFC), and Education for All.

Specifically, the objectives of the review included the following:

          to determine the level of access to the basic ECCD services;
          to identify the factors affecting the level of access;
          to assess the quality of the ECCD services;
          to characterize the nature of integration and convergence of ECCD services;
           and
          to assess the feedback mechanisms and structure established for the
           program.


2.0 METHODOLOGY

2.1 Conceptual Framework

The conceptual framework for this Program review was drawn from the original ECCD
framework adapted from Brofenbrenner (1988) in the baseline survey as well as in the
evaluation study as outlined in Figure 2.1.

To establish the review in proper perspective, it is necessary to understand the
interaction among the stakeholders of the ECCD Program across various levels –
from an individual perspective, household, community, local government unit (LGU)
level, and up to the national level. These interactions that influence the overall
development of the child involves resources, events, values, and communications.
                                                                                            Final Report


The review will also be guided by the principle that intervention in early childhood
development should be holistic and that the critical role of the primary care givers and
the parents should be considered. Further, ECCD interventions should provide for the
inclusion of vulnerable children, smooth transition from home-to-center-to-school, and
gender sensitivity.

     Figure 2.1 The child‘s environment


                                                            National Institutions

                  Interaction                                                         Communication
                                                        Church, School, Health Care


                                                                Community

                                                                   Family



              Value System                                                                  People
                                                                    Child



                                                                 Household

                                                           Immediate Community

                                                          Institutional community
                Physical                                                               Activites
                (Space, Ameneties)                                                     (Events,Routine
                                                         Socio-Political Framework
                                                                                       Cycles)
                    Figure 1. The Child’s Environment




  Source: International Development Research Center, 1988.




2.2 Analytical Framework

The specific areas of concerns or themes that the review process focused on include
access, quality and the level of integration, and convergence of ECCD services. In terms
of access, the following specific questions were addressed: What were the causes of low
participation?; Was it a problem of availability, accessibility, affordability, awareness, or
attitudinal?; and Who were the disadvantaged and the advantaged and how were the
gaps generated?

The process of assessing the quality of service focused on the appropriateness of the
intervention, content, standards, the mode of delivery, and the capacity and level of
commitment among the service providers. Similarly, the review looked at the adequacy
and appropriateness of ECCD infrastructures, facilities, and material support. It also
assessed the sensitivity of the services to the cultural and social character of the
communities.

One of the guiding principles advocated for an ECCD intervention is that the approach
should be holistic and integrated. Hence, the fundamental question addressed in the
review process was in terms of the mode and extent of integration of the various ECCD
services.




                                                                                                         2
                                                                            Final Report


There were also cross-cutting issues that the review dealt with, particularly in terms of
resources, governance and effectiveness of the delivery system. Source and mode of
financing were also critical. In most developing countries, allocations of resources are
often guided by political interest. Thus, there is a need to address the issues concerning
the mechanisms instituted to insulate the program from political interventions as well as
the structures established to define and delineate accountabilities. At the current phase
of ECCD implementation in the Philippines, effectiveness was assessed through
established mechanisms to operationalize the monitoring and evaluation component of
the program.

The review was guided by a framework of analysis as shown in the schematic diagram
Figure 2.2. It is argued here that to assess the mode and extent of integration of ECCD
services, one need to look at the household as the basic and focal unit. In a status quo,
the state of the child development is determined primarily by the resources available at
the household level. However, attitudes and values also play a critical role in the It is the
interplay of these factors that basically determine the development of the child.



    Government
                                         Health/Nutrition
                      ECCD                Interventions
                     Services

             Household                                              Child Survival,
              Resources                   Psycho-Social               Growth and
                                                                   Child Development
               Attitudes                  Early Education            Development
                Values


                                          Social Services
                                            Protection




 Figure 2.2 Schematic diagram indicating the link between ECCD services and child
            development.


Therefore, any attempt to intervene towards the development of children in terms of
health and nutrition, psycho-social and early education as well as social protection in an
integrative manner will have to be focused at the household level, in general, and to the
child, in particular.

2.3 The Case Study Sites

The cases were conducted in five provinces where the ECCD were already
implemented. Two study sites each were selected from Luzon and Mindanao and one
from the Visayas (Figure 2.3). The provinces of Cagayan and Zambales represented the
island of Luzon; Leyte for Visayas; and Davao Oriental and Misamis Occidental for
Mindanao.




                                                                                        3
                                                                            Final Report




                                                                     Bgy. Capatan,
                                                                     Tuguegarao City,
                                                                     Cagayan Valley
            Bgy. Porac,
            Botolan.
            Zambales




                                                                        Bgy. Milagrosa,
                                                                        Sta. Fe,
                                                                        Leyte




          Bgy. Siloy,
          Calamba,
          Misamis
          Occidental
                                                                          Nangan,
                                                                          Governor
                                                                          Generoso,
                                                                          Davao
                                                                          Oriental




         Figure 2.3 Case study sites


2.4 Data Collection and Analytical Techniques

The review used both qualitative and quantitative data. The process included three
phases, namely: secondary data review, primary data collection, and analysis.
                                  Figure 2.3. Case Study Sites
The secondary data included existing policies promulgated to effect child development,
and a situational analysis based on published reports and statistical bulletins. The
analysis situated the country‘s current ECCD status in relation to the regional patterns
and in relation to the country‘s commitment to the MDG, WFC and EFA.

Primary data were collected through participatory rapid appraisal (PRA). This technique
of data collection required the establishment of experts from various disciplines who
conducted field visits within a period of four to five days. The team was composed of
experts from the fields of health, nutrition, child development/early childhood education,
development economics, sociology and social protection.

In every field visit, courtesy calls were made with the Provincial Social Welfare Office,
Office of the Governor, and Office of the Mayor. Focus group discussions (FGDs) were
conducted with the Provincial Early Childhood Care and Development Committee
(PECCDC), Municipal Early Childhood Care and Development Committee (MECCDC),
and the Barangay Early Childhood Care and Development Committee (BECCDC). In
addition, key informants including the Provincial ECCD Officer, Municipal ECCD Action
Officer, Municipal Nutrition Action Officer, Social Development Worker, Rural Health


                                                                                          4
                                                                            Final Report


Midwife (RHMW) stationed/assigned in Barangay, Grade One Teacher (GOT),
Kinder/Pre-elementary Teacher, and Day Care Worker (DCW)

Secondary data were collected from the Provincial and Municipal Planning Development
Office (P/MPDO), Provincial and Municipal Nutrition Office (P/MNO), Provincial/Municipal
Social Welfare and Development Office (P/MSWDO) and Barangay. The secondary
data provided relevant information about the province, municipality, and barangay.


3.0     Access to Nutrition, Health, Early Childhood Education and Social Protection
        Services

In 2000, the population of preschool children numbered 13,557,000, representing 18
percent of the total population of the Philippines. It was estimated that in 2007, the
number rose to 16,052,000 or 2,495,000 preschool children more than in 2000 (Table
3.1).

       Table 3.0. Population of preschool children by single age group, Philippines:
                 2000-2007 (in millions)
        Age      2000     2001      2002     2003     2004      2005     2006      2007
         0       1,876    1,927    1,972     2,018    2,066    2,114     2,163    2,214
         1       1,876    1,969    2,015     2,062    2,110    2,159     2,210    2,262
         2       1,944    1,998    2,045     2,092    2,141    2,192     2,243    2,295
         3       1,962    2,016    2,063     2,112    2,161    2,212     2,263    2,316
         4       1,970    2,024    2,072     2,120    2,170    2,221     2,273    2,326
         5       1,969    2,023    2,071     2,119    2,169    2,219     2,271    2,325
         6       1,960    2,014    2,061     2,109    2,159    2,209     2,261    2,314
        Total   13,557   13,971   14,299    14,632   14,976   15,326    15,684   16,052
      Source: NSO



3.1      Nutrition

Protein-energy Malnutrition

The average prevalence of underweight, under height, and thin in the eight surveys
conducted were 30.4 percent, 33.4 percent and 5.7 percent, respectively. The incidence
of underweight and under height preschool children showed a declining trend (Table
3.1.1). The percent of underweight increased from 1993 to 1996 by 0.9 percentage
points; and from 1996 to 1998 by 1.2 percentage points. However, the figure for
underweights consistently decreased. The prevalence for stunting showed a more
consistent declining trend except in years 1993 and 1996 when a very small increase
was noted.

The study of Pedro et al. (2006) estimated that reducing the proportion of underweight
children to 17.25 percent by 2015 is difficult to achieve given that the average annual
reduction was only 0.58 percent. However, the trends are expected to improve when
there would be improvements in food intake, health, and water and sanitation. The
prevalence of wasting is also expected to decrease but not stunting. In fact, the
incidence of underweight will tend to decrease at a faster rate than that of stunting
(Kennedy et al. 2006).



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                                                                                     Final Report



    Table 3.1.1 Percent distribution of preschool children (0 to 5 years) by nutritional
                  status, Philippines: 1989-2005

                    1989-   1992    1993    1996   1998      2001    2003   2005          Remarks
                     90
    Underweight     34.5    34.0    29.9    30.8    32.0      30.6   26.9   24.6    High

    Stunting        39.9    36.8    34.3    34.5    34.0      31.4   29.9   26.3    High except in
                                                                                    2003 & 2005
    Wasting          5.0     6.6     6.7     5.2    6.0       6.3    5.3    4.8     Low
   Sources: DOST-FNRI NNS, 1993; 1998; 2003; Regional Updating of the Nutritional Status of
            Children, 1989/1990; 1992; 1996; 2001; 2005

Table 3.1.2 shows the decreasing trend in the occurrence of underweight, under height,
and thinness by age group from 1998 to 2005 for all indicators in all age groups.
However, as the children grew older, the prevalence of underweight, under height, and
wasting more than doubled. For instance, the incidence of underweight among infants
increased from 10.2 percent to 28.9 percent; under height from 5.4 percent to 25.4
percent; and wasting from 4.5 percent to 12.0 percent. This suggests that the period
between zero to one year of age is the critical period, a phase where under nutrition and
growth faltering occur. Then, as the children grow older, a large number of them continue
to suffer from under nutrition.

  Table 3.1.2. Proportion of 0-5 year old children by nutritional status and by age
       Index/Year                                         Age in years
                              0             1             2            3            4           5
  Underweight
  1998                       12.9          38.6        37.2          34.1          34.6        32.6
  2003                       11.7          31.2        31.7          29.6          27.3        29.9
  2005                       10.2          28.9        24.7          25.6          27.7        26.3
  Underheight
  1998                       8.7           33.0        31.5          40.0          43.6        42.7
  2003                       8.2           25.4        31.8          37.9          36.4        38.2
  2005                       5.4           23.5        25.5          30.0          34.6        36.2
  Wasting
  1998                       5.7           14.9        5.8            2.5          3.5        3.5
  2003                        -             -           -              -            -          -
  2005                       4.5           12.0        4.0            4.3          2.7        2.1
 Sources: DOST-FNRI NNS, 1998; 2003; Regional Updating of the Nutritional Status of Children 2005



Iron Deficiency Anemia

There was an increasing trend in the prevalence of iron deficiency anemia among six
months to less than one-year old children and one year to five years old from 1993 to
2003 (Table 3.1.3). On a per age group basis, the incidence was highest among one-
year old children in both nutrition surveys at 53.2 percent and 53 percent, respectively.
Moreover, the decrease in the prevalence was very low at 0.02 percent from 1998 to
2003. As the children grew older, the frequency of anemia decreased because the
children were now able to eat a wider variety of iron-rich foods. The problem on anemia
was attributed primarily to inadequate iron intakes (Pedro et al. 2006). Other factors
included poor child feeding and weaning practices and poor compliance with iron
supplementation programs (Kennedy et al. 2006).


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                                                                         Final Report



    Table 3.1.3. Prevalence of anemia among preschool children by age group
                  Age                                 Prevalence/year
                                               1993      1998             2003
      6 mos to < 1 year                        49.2      56.6             65.9
      1 year – 5 years                         25.7      29.6             29.1
      1 year                                     -       53.2             53.0
      2 years                                    -       36.9             34.8
      3 years                                    -       23.4             24.8
      4 years                                    -       20.0             18.8
      5 years                                    -       18.2             14.7
   Sources: FNRI-DOST. NNS, 1993; 1998; 2003


Vitamin A deficiency

Vitamin A deficient (VAD), which has been defined as serum retinol <20 ug/dl, is
considered a public health problem if it affects 15 percent of children aged six to 59
months. The prevalence of VAD had been increasing among preschool children,
particularly among infants (Table 3.1.4). The incidence of VAD also increased by 10
percentage points from 1993 to 2003. The high prevalence of VAD among preschool
children was attributed partly to the poor micronutrient status of pregnant and lactating
women (Pedro et al. 2006).

Iodine Deficiency Disorders

Data on the incidence of
iodine deficiency disorder        Table 3.1.4. Prevalence of deficient and low levels
(IDD)      among    preschool                    of vitamin A among preschool children
                                           Age                    Prevalence (%)
children is not available.
                                                           1993       1998       2003
However, goiter prevalence
(national) had been studied       6 mos to > 1 year        37.5       42.2       47.0
in 1993 and was found to be       1 year – 5 years         35.6       37.6       39.3
6.7 percent among subjects
7 years old and above with        6 mos – 5 years          35.3       38.0       40.1
                                 Source: DOST-FNRI. NNS, 1993, 1998, 2003
the     highest    occurrence
among pregnant females
between ages 13 to 20 years
old (Tuazon and Habito nd). Another parameter was used later on, which was urinary
iodine excretion. The 2003 national nutrition survey (NNS) of the Food and Nutrition
Institute (FNRI) reported a decline in the prevalence of IDD from 36 percent in 1998 to
11 percent among children 6 to 12 years. A similar trend was noted among pregnant
women from 28.4 percent moderate to severe in 1998 to 18 percent in 2003.

Zinc and Other Micronutrient Deficiencies

The problem of zinc deficiency is considered as moderate given that the overall
prevalence was 9.8 percent (10.6% and 9.1% for the males and females, respectively)
(Table 3.1.5). The 4-year old children had the highest incidence of deficiency at 13.7
percent which was also considered moderately high.
.
Deficiencies in other micronutrients were included in the fourth NNS (FNRI, 2003). The
results showed that zero to six year-old children were found to manifest clinical signs
suggestive of deficiencies in riboflavin, thiamin, and vitamin C. Less than 1 percent of
children were found to suffer from angular stomatitis (0.7%), cheilosis (0.4%), magenta
tongue (0.2%), spongy bleeding gums (2.3%) and pale conjunctiva (19.2%). Angular


                                                                                    7
                                                                           Final Report


stomatitis, cheilosis, and magenta tongue are signs associated with riboflavin deficiency;
pale conjunctiva for iron deficiency anemia, and spongy bleeding gums for vitamin C.
Riboflavin deficiency was not considered prevalent because of the low percentage
(Tuazon et al. 1997). In contrast, thiamin deficiency was a nutritional problem based on
the erythrocyte transkelolase activity where 34.4 percent of infants and preschoolers
were found to be deficient.


        Table 3.1.5. Zinc deficiency by age and by gender (in percent
                 Age group/sex              Male        Female       % deficiency
        6-11 months                          8.7           9.7            9.1
        1 year                              11.1           8.4           19.1
        2 years                              8.6           7.8            8.2
        3 years                             11.3           6.9            9.1
        4 years                             13.4          13.9           13.7
        5 years                              9.3           7.9            8.5
        All children                        10.6           9.1            9.8
       Sources: DOST-FNRI NNS, 2003



Overweight/Obesity

The rate of recurrence of obesity remains to be significantly less than under nutrition but
still needs to be addressed. While a small proportion of children are obese, the
increasing trend in the rates of obesity is alarming since half of the children who are
obese at six years of age are more likely to become obese in their adulthood (Pedro et
al. 2006). Moreover, obesity is a risk factor for several diseases such as type 2 diabetes,
coronary heart disease, hypertension and some types of cancers (WHO 1997 as cited in
Kennedy et al. 2006).


Breastfeeding and Young Child Feeding Practices

Based on the results of the 2005 NNS of the DOST-FNRI, about 89 percent of mothers
practiced exclusive breastfeeding with a mean duration of three months. This falls below
the recommended exclusive breastfeeding for six months. On the other hand, 87 percent
of children were breastfed for a mean duration of almost six months.


Food Intake and Nutrient Adequacy

The food intake and nutrient adequacy can partly explain the current poor nutritional
status of preschool children. Inadequate food intake is a direct or primary cause of under
nutrition. As children grow older, the amount consumed per food group increases except
for milk. The mean intake of rice increases from 116 grams to 202 grams from infancy to
five years old. In contrast, the mean intake of milk decreases from 726 to 59 grams. The
decrease is also more significant after infancy from 726 grams among 6 to11-month old
children to 355 grams among one-year old children. Starting at two years old, children
are not able to consume the recommended one glass (240 grams) of milk a day.

In general, the food intake of preschool children was found to have increased from 1978
to 2003. However, in terms of adequacy, the preschool children were found to be
inadequate in energy and other nutrients (iron, vitamin A and calcium) except protein.


                                                                                      8
                                                                                Final Report


Rice, milk and milk products, fish, meat and poultry, and fruits were the major
contributors to the children‘s diet. The inadequate food intake contributed to the
children‘s poor nutritional status.

3.2    Health

Among all children, the under five-year old population has been recognized as most
vulnerable to health problems. Healthy children become healthy adults: people who
create better lives for themselves, their communities and their countries (UNICEF nd).
Knowing that health status would have an impact on children‘s growth and development,
child health is an important public health concern.

Infant Mortality

Infant mortality was not only declining but declining faster in the more recent years.
Between 1993 and 1998, infant mortality only decreased at an average of 1.58 percent
per annum compared to the 6.29 percent annual reduction between 1998 and 2006. As
such, there is a very high probability of meeting the infant mortality rate of 19 per
thousand live births in 2015 as specified in the MDG.


      Table 3.2.1. Selected health indicators, 1993 to 2006
      Indicator                1993       1998        2006           Percent Change
                                                              1993-1998        1998-2006
      Infant mortality rate      38         35         24          -1.58            -6.29
       Sources of Raw Data: 1998, 2003 –NDHS; 1993 – National Demographic Survey;
                            2006 – Family Planning Survey


In the 2003 Philippine Health Statistics (PHS), eight of the 10 leading causes of infant
mortality were conditions affecting neonates or infants one month old or younger. These
included neonatal infections, congenital malformations, and conditions related to events
surrounding the child‘s birth such as pregnancy complications and difficult deliveries.
These causes accounted for 64.8 percent of the total infant deaths. This indicates that
majority of deaths occur in the newborn period, emphasizing the importance of
interventions and programs that address these problems. Also noteworthy was that four
out of the 10 leading causes of infant mortality were infectious in nature, namely:
pneumonia, neonatal sepsis, congenital pneumonia and infectious diarrhea. In spite of
preventive measures and advances in medical care, infections remained to be significant
contributors to infant mortality.


Under-five Mortality

UNICEF data ranked the Philippine under-five mortality rate at 86th in the world. In the
National Demographic and Health Survey (NDHS) (2003), it was estimated at 42/1000
live births. Mortality rate was higher in rural (52/1000) compared to urban (30/1000)
areas.

Under-five mortality rate in the Philippines declined from 90 per 1000 live births in 1970
down to 62 in 1990 and to 33 in 2005. The rate of reduction was higher from 1990-2005
with an average annual rate of 4.2 percent compared to the period 1970-1990 with an
average annual rate of 1.9. Nonetheless, the MDG of 26.7 per 1000 livebirths in 2015 is
highly attainable (Canlas nd).


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                                                                                Final Report



In 2000, about 70 percent of deaths in one to four-year age group were due to
pneumonia, diarrhea, measles, meningitis, and malnutrition (Table 3.2.2).


Maternal Health Indicators

One indicator that is used to reflect the health of pregnant women is the maternal
mortality     rate.    Table 3.2.2 Ten leading causes of child mortality (1-4 years old),
Maternal                                number and rate/100,000 population Philippines,
mortality      was                      2000
declining, from                                                                  Both
209 per 100,000                       Cause                     Male Female           Rate*
                                                                                Sexes
live births in         1. Pneumonia                            1,540 1,341 2,881       37.76
1993 to 162 in
                       2. Accidents                              839     506 1,345     17.63
2006.          The
                       3. Diarrheas and gastroenteritis
decline,                                                         685     546 1,231     16.14
                          of presumed infectious origin
however, was
                       4. Measles                                452     425      877  11.50
sharper
between 1993           5. Congenital anomalies                   350     337      687   9.01
and 1998 than          6. Malignant Neoplasm                     219     153      372   4.88
between 1998           7. Meningitis                             201     155      356   4.67
and 2006 (Table        8. Septicemia                             173     173      346   4.54
3.2.3). In fact,
                       9. Chronic obstructive pulmonary
the        slowing                                               174     164      338   4.43
                          disease and allied conditions
down in the            10. Other protein-calorie
reduction        of                                              175     159      334   4.38
                           malnutrition
maternal                      *rate per 100,000 population of corresponding age-group
mortality     cast            Source: PHS 2000, DOH
doubt on the
ability of the government to meet the MDG of reducing maternal mortality rate to 52 per
100,000 live births in 2015.


     Table 3.2.3       Maternal mortality rate, Philippines: 1993 to 2006 (per 100,000
                         live births)
                                                                   Percent Change
     Indicator               1993       1998         2006
                                                              1993-1998     1998-
                                                                            2006
     Maternal                209         172          162        -3.54         -1.16
     Mortality Ratio
     Sources of Raw Data: 1998, 2003- NDHS; 1993 – NDHS; 2006 – Family Planning Survey


The most common causes of maternal death were hypertensive complications and
hemorrhage accounting for 43.7 percent of all maternal deaths (Table 3.2.4). The causes
of maternal deaths remained almost the same through the years.


Expanded Program of Immunization

Infections are significant contributors to the morbidity and mortality in children.
Fortunately, vaccines have been developed to protect individuals against these
infections. However, in spite of the availability of this preventive measure, significant
numbers of vaccine preventable diseases are still being reported (Table 3.2.5).



                                                                                           10
                                                                                    Final Report




  Table 3.2.4 Maternal mortality by main cause, number rate per 1000
              livebirths and percentage distribution, Philippines, 2003
                             Cause                            Number       Rate          Percent
   Other Complications related to pregnancy during
                                                                811        0.5             45.1
        labor, delivery and puerperium
   Hypertension complicating pregnancy,
                                                                479        0.3             26.6
        childbirth and puerperium
   Postpartum hemorrhage                                        319        0.2             17.7
   Pregnancy with abortive outcome                              189        0.1             10.5
  *Percent share to total number of maternal death
   Source: www.doh.gov.ph/kp/statistics/maternal_deaths



In the Philippines, the incidence of
diseases for which vaccines were             Table 3.2.5 Number of deaths <5 and total
part of the routine immunization                        deaths
schedule decreased remarkably                Diseases                       Deaths       Total
(Table 3.2.6). The reported cases                                           <5 years     deaths
                                                                            old          (000)
of preventable diseases were all                                            (000)
below 50 except for tetanus with             Vaccination for which vaccination is part of most
reported cases of 161 in 2006. In            national immunization schedule
fact, there were no reported cases
                                             Measles                               540        610
of neonatal tetanus in 2006 and
only nine cases for pertussis.               HiB                                   386        386
                                             Pertussis                             294        294
Remarkably, most cases for most              Tetanus                               198        213
diseases were reduced in 1995,               Yellow fever                           15         30
particularly for pertussis and polio         Diptheria                               4          5
whose number of reported cases               Polio                                  <1         <1
dropped by around 90 percent
                                             Hepatitis B                            <1        600
between 1990 and 1995.
                                             Vaccine for which a licensed vaccine is available
Great efforts have been made to              Japanese encephalitis                 5            14
increase the immunization rate. A            Meningoccocal                        10            26
child is said to be fully immunized          Rotavirus                           402           449
if he or she has received BCG,               Pneumococcal                        716         1,612
three doses of polio and DPT, and
                                             Total                            10,468        57,029
measles vaccinations. In the 2003
demographic         survey,     the
completion rate was only 70 percent       with higher completion rate in urban areas (74%)
than in rural areas (65%).

Table 3.2.6.      Reported cases of vaccine preventable diseases, Philippines: 2000
    Diseases           1980        1985         1990        1995      2000        2005        2006
Measles                 1,910       1,669          921         173       88         118           47
Pertussis              26,765      62,959       42,938       3,913    7,120         118            9
Polio *                19,844      19,628        4,135          22       23          20           41
Tetanus                   432         557           85          40        0            0           0
(neonatal)
Tetanus (total)         1,506        1,244         291         288      281         177            161




                                                                                                   11
                                                                                            Final Report


Nationwide coverage with individual vaccines was around 80 percent in 2005 and 2006.
However, there was a slight decrease in nearly all types of vaccine from 2005 to 2006.
For instance, immunization rate for BCG slightly went down from 82.4 percent in 2005
to 81.70 percent in 2006. By contrast, the immunization rate for Hepatitis B almost
doubled during the same period (Table 3.2.7).


Newborn Screening
                                     Table 3.2.7 Vaccination rate by type of vaccine,
                                                 Philippines: 2005 & 2006
Newborn screening in
                                    Diseases              2005            2006
the         Philippines
started through the          BCG                           82.4            81.7
initiative    of    two      DPT1                          83.3            81.9
pediatricians:       Dr.     DPT2                          81.6            80.7
Carmelita Domingo,           DPT3                          81.0            80.0
an       endocrinologist     OPV1                          83.6            81.8
and Dr. Carmencita           OPV2                          82.5            80.6
Padilla, a geneticist.       OPV3                          81.9            79.9
In       1991,     they      Hepa B1                       48.9            78.8
requested            the     Hepa B2                       45.1            74.0
Department of Health         Hepa B3                       42.9            72.9
(DOH) to include NBS         Measles                       84.1            83.2
in routine newborn
care. They headed
the lobby in the congress and senate for the approval of the NBS bill. It was only in 2004
that the NBS Act was passed. Since then, there was a dramatic increase in the number
of NBS facility nationwide.

The number of newborns screened increased steadily from 11,992 during the initial
introduction of NBS to 66,784 in 2003 (Figure 3.2.1). It increased exponentially when the
NBS Act was passed from 88,938 in 2004 to 175,694 in 2006. However, this staggering
number only corresponds to 10.5 percent of all newborns.
                                       Number of New borns Screened


200,000                                                                                                175,694

150,000                                                                                      126,815

100,000                                                                            88,938
                                                                 60,269   66,784
                                               40,888   46,535
 50,000            32,301   33,432
                                      24,572
          11,992
     0
          1996     1997     1998       1999    2000     2001     2002     2003     2004       2005      2006

Figure 3.2.1. Number of newborns screened, 1996-2006.




                                                                                                          12
                                                                        Final Report


3.3    Early Childhood Education (ECE)

Day Care Program

A country case study by the Department of Education (DepEd) and Department of Social
and Welfare Development (DSWD) in 2002 cited by UNESCO (2004) reported three
types of early childhood education program: day care center (DCC), preschool (public
and private), and ECE for Grade 1. The most numerous are the DCCs with 32,787
(Table 3.3.1). The number of public preschool was four times less than the number of
DCC while the private DCC was even lower at a little over 5,000.

The ECE was largely provided by the government. In terms of enrolment, the ECE for
Grade 1 had the most number of enrollees at 2,474,009 which was almost twice the
number of day care pupils at 1,526,023. The share of the private ECE providers was a
mere 8 percent of the total enrolment.

In terms of the target group, the DepEd public preschool was the only ECE which
attended to single year age group. On the other hand, the other ECE programs were for
three to five years and six to seven years old.

On one hand, the total number of DCCs, 45,732, is 6,208 more than the total number of
barangays estimated at 39,524, meaning that there are barangays with more than one
day care center (DSWD 2008). On the other hand, analysis by per barangay reveals
that 14% or 5,696 barangays are still without DCCs. Moreover, the deficit in day care
center was very pronounced in Region IV-B where only 51 percent of the barangays had
a day care center (Table 3.3.1). By contrast and interestingly, the ratio of DCC and
barangay reveals that in Regions XI and XII there are about two day care center for
every barangay with a ratio of 1.93 and 1.99, respectively.

The percentage of barangays without DCCS was two percentage lower than in the study
areas covered under the early childhood development (ECD) study (ECDP 2005)
wherein 88 percent of the 7,491 barangays had DCCs. The study of Gordoncillo et al.
further noted variations in the presence of DCCs among the three regions (Table 3.3.2).
Among the regions, Region VI had the highest percentage of barangays with DCC from
2001 to 2006. On the other hand, Region XII had consistently been at the bottom of the
list since 2000. However, it is worth noting the increase in the number of barangays
having DCC in Region XII. From a little over half (53.6%) in 2000, the proportion of
barangays with day care had consistently increased to about three-fourths in 2004.

Another observation was the ability of Region VI to be at par with Region VII in 2004
despite the fact that the former had slightly lower percentage of barangays with DCCs in
2000. By 2004, both regions had 91 percent of the barangays in both regions had
DCCs.

The ECD study found that at best, participation rate of children aged 36 to 71 months
was less than half (48%) in 2004 for all the three regions (ECDP 2005) (Table 3.3.3).
When disaggregated by region, participation rate appeared to keep on increasing for the
three regions but the increase was faster in Regions VI and XII. For instance,
participation rate in Region VI increased from 32.4 percent in 2000 to 52.6 percent in
2004. Surprisingly, the participation rate in Region VII also increased, but very slow
when compared with the progress of the other two regions, (from 35.7 in 2000 to 38.4
percent in 2004).




                                                                                    13
                                                                                  Final Report


        Table 3.3.1 Distribution of day care center by region, 2007.
             Region        No of           Total DCCs           Percent of     Ratio of DCC
                         Barangays                             barangay with        and
                                                                   DCC          barangay
         NCR               1,695          1,722                         0.55           1.02
         CAR               1,176          1,860                         0.95           1.58
         I                 3,265          2,939                         0.90           0.90
         II                2,311          2,495                         0.94           1.08
         III               3,102          3,725                         0.95           1.20
         IV-A              4,011          3,904                         0.75           0.97
         IV-B              1,458          1,245                         0.51           0.85
         V                 3,471          3,998                         0.90           1.15
         VI                4,050          5,044                         0.87           1.25
         VII               3,003          3,868                         0.97           1.29
         VIII              4,390          3,557                         0.81           0.81
         IX                1,904          2,083                         0.88           1.09
         X                 2,022          2,882                         0.86           1.43
         XI                1,162          2,241                         0.98           1.93
         XII               1,194          2,378                         0.91           1.99
         CARAGA            1,310          1,791                         0.95           1.37
         Total            39,524          45,732                        0.86           1.16
        Source: 2007. Policy Development and Planning Bureau. Department of Social
                Welfare and Development.

Table 3.3.2. Percentage of barangays with day care centers, Regions VI, VII and
                XII, Philippines: 2000-2006
     Region            2000            2001          2002               2003          2004
       VI              77.8            82.8             84.1            86.6          90.9
       VII             84.1            91.1             90.9            90.6          90.9
       XII             53.6            61.9             68.6            72.4          73.6
      Total            76.0            82.6             83.8            85.6          88.1
Source: Early Childhood Development Project. 2005.



Table 3.3.3. Participation rate of children aged 36-71 months, Regions VI, VII
                and XII, Philippines: 2000-2004
     Region            2000            2001          2002               2003          2004
       VI              32.4            42.2             46.9            48.9          52.6
       VII             35.7            35.6             35.3            36.1          38.4
       XII             37.6            41.9             44.6            44.0          51.4
      Total            34.4            40.0             42.8            43.8          48.0
Source: Early Childhood Development Project. 2005



The ECDP study also reported that the 48 percent attendance for the three regions was
4.20 percentage points higher than the 2003 attendance. The ECDP study attributed the
increase in participation rate to: 1) trained DCWs in 41 percent of the LGUs in the three
regions, 2) upgraded DCCs, 3) construction of new DCCs, 4) additional DCWs, and 5)
support extended by the LGUs and non-government organizations (NGOs). The
achievements could be further enhanced by addressing the following concerns: 1)


                                                                                              14
                                                                            Final Report


attitudinal problems of parents such as children being too young to attend day care, and
2) pre-occupied parents with livelihood activities who are constrained to bring their
children to day care.

The study of Gordoncillo et al. (2006) included access to early education among
indigenous people (IP) children. The predominant trend in enrollment among them was
lower when compared with the national average, although there were some noticeable
improvements. In Regions VI, VII and XII, participation rates were found to be 29.8
percent, 11.1 percent and 16.9 percent, respectively in 2001-2002. In 2004-2005, such
values increased to 34.5 percent, 33.0 percent, and 31.6 percent, respectively.
However, these figures were still way below the national level.

The low level of enrollment in a learning center for children zero to six years old was
further compounded by cases of dropping out, which even escalated for all the regions in
2005. Before 2001, incidences of dropping out for Regions VI, VII and XII were 6.3
percent, 1.1 percent, and 2.5 percent, respectively (Gordoncillo et al. 2006). In 2005,
these values swelled to 21.8 percent, 5.5 percent, and 8.4 percent for Regions VI, VII
and XII, respectively.

A summary of the UNESCO report reveals the following characteristics of the day care
program in the Philippines: 1) there are more community-based day care programs in the
urban than in the rural areas; 2) the existing day care centers are insufficient to
accommodate the large number of three to five years old children, particularly in the
urban areas where the number of preschoolers ranged from 35 to 60 per class. The
average class day care class is 46. This can be reduced to 23 if there will be two shifts:
one in the morning and one in the afternoon. This number is close to 27, the average
number of children found in a study evaluating the impact of the early childhood
development in Regions VI, VII and XII and VIII (Gordoncillo et al. 2006); and 3) Day
care class is usually smaller in rural areas than in the urban areas for several reasons
including lack of awareness and appreciation among parents of the importance of ECE,
limited finances for the tuition, and location of the day care center.


Day Care Services (DCS)

The main task of day care workers is to provide psycho-social development and early
education services like supervised play and group activities (arts and crafts, music and
movement, story telling), childcare for personal hygiene, supplemental feeding, health
and nutrition education, learning experiences for early literacy and mathematics, and
socialization experiences to support social and emotional development. As a result, more
than half of the time of the DCW is spent with students. The DCW is also tasked to
conduct routine growth monitoring, and health protection for enrolled children and for
their parents like immunization and feeding programs. The DCW is also required to
submit monthly and quarterly reports.

The study of Gordoncillo et al. (2006) found that a DCW works for an average of five
hours and a half per day, three hours of which were spent with the students. Thus, there
still remained two hours for other activities like talking to parents, preparing reports, and
conducting home visits for children enrolled in the day care center. The DCW also
conducts classes for parents. There was a marked increase in the proportion of DCWs
holding classes for parents between 2001 and 2005, after the implementation of the ECD
program.




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                                                                           Final Report


Day Care Workers

There is no national data on the number and profile of day care workers. Thus, only
research studies are the main sources of information for the DCWs. Again, using the
UNESCO study, the service providers: 1) are mostly recruited from the community to
conform with the provision of the law that these providers should live near the center, (2)
majority are between the ages of 30 to 40 years, (3) mostly are over qualified, (4) have
no work experience, and (5) are committed public servants.

Based on the special ECCD projects and surveys, it was found that majority (44%) of
DCWs were between the ages of 30 to 40; 38 percent were between 20 to 30 years old;
and 8 percent were between the age 40 to 50 years. A similar finding was presented in
an ECD study (2004) where the average age of a DCW was computed at 39 years old.

Majority (62.5%) of the day care workers were college undergraduates, college
graduates (16%) and high school graduates (22%) – the educational requirement for
DCWs. Gordoncillo et. al (2005) reported, however that there were DCWs who have not
completed their secondary education.

In terms of experience, only eight percent had some experience of working with children
while 30 percent had some form of work experience but not related to children. Less
than 30 percent had participated in some of form of in-service training meaning that they
learned to work with children on the job. Referring to the study of Gordoncillo et al.,
(2005), the percentage of day care workers in the non-ECD areas who had attended
training related to their work was 35 percent compared to the 88 percent of those
residing in the ECD areas.

The length of service of DCWs ranged from less than a year to more than10 years.
Twenty-six percent had experience working with children for six to 10 years; 19.7 percent
for two to three years; 13 percent for more than 10 years; and 9 percent for only one
year.

On the average, a DCW receives a monthly salary of PhP3,000.00. This is much higher
than the average honorarium received by a DCW in a non-ECD area while it was almost
at par with those in the ECD barangays. However, there are LGUs which tried to
increase their honorarium as in Naga and Zamboanga where a resolution was passed to
cover the premiums for the Social Security System (SSS) and Philippine Health
Insurance (PhilHealth) (City of Naga 2005, Zamboanga City 2007).

As discussed ealier, there are barangays without a DCC. Perhaps the explanation could
be in the cost involved in operating a DCC. For instance, when conducting a feeding
program, the cost is very high but in most cases, feeding is only served once or twice a
year. If that is the case, the payment of honorarium of about PhP36,000 makes the
most expense (Table 3.3.4).




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                                                                                    Final Report



 Table 3.3.4 Typical expenditure items for one day care center (in pesos)
                          Item                                  Monthly                  Annual
 Honorarium of day care worker                                     3,000                     36,000
 Repair and maintenance                                            2,000                     20,000
 Supplies and materials                                            1,000                     10,000
 Feeding (PhP5/child/20 days)                                      6,000                     50,000
 X 60 children (average number of children at center)             12,000                    126,000
 Cost per child                                                        200                    2,000
 Source: Department of Education and Culture, DSWD. 2002. ECCD Indicators: A country case study,
         Consultative Group on ECCD as cited in UNESCO 2004.



One reason for smaller class size in the rural area is the cost of attending a day care.
UNESCO estimated that a family spends an average of PhP365 per month or a total of
PhP2,850 pesos (Table 3.3.5).

 Table 3.3.5. Costs paid by a family with one child in public day care
                          Item                                Monthly              Annual
 Registration fee                                                  5                    50
 Participation fee                                                50                   500
 Daily allowance (PhP10/child/day)                               200                 2,000
 Clothing (uniform)                                              100                   300
 Total*                                                          355                 2,850
 *At an average of PhP200 daily wage or an annual income of PhP48,000, the total cost per child
  roughly represents 6 percent of the total household family income.
 Source: Department of Education and Culture, Department of Social Development. 2002. ECCD
          Indicators: A country case study, Consultative Group on ECCD as cited in UNESCO 2004.



Supervised Neighborhood Play

Delos Angeles-Bautista (2004) considered Supervised Neighborhood Play (SNP) as a
less widespread but very promising form of ECE which was introduced under the ECCD.
SNP is a component of the Parent Effectiveness Services (PES) where play groups are
convened in a designated home from one to five times a week. It was organized as a
way of building on informal peer groups to develop stimulating settings for socialization
and early learning.

The participation rate of children aged 0 to 71 months in SNP for Regions VI, VII and XII
was also covered in the report of the ECD Project (2005). The participation rates of
these children in the SNP were all lower for the three regions when compared with the
participation rates in the day care center despite the increasing pattern between 2000 to
2004 (Table 3.3.6). Among the regions, Region XII had the lowest participation rate of 5
percent in SNP while Region VI had the highest participation rate of 28.2 percent in
2004.




                                                                                                  17
                                                                            Final Report


Table 3.3.6. Participation rate of children aged 0-71 months in supervised
             neighborhood play, Regions VI, VII and XII, Philippines: 2000-2004
      Region            2000       2001           2002           2003           2004
        VI               2.0        6.4            8.2           17.7           28.2
       VII               0.9        1.8            7.9            6.9           14.1
       XII               0.6        0.7            0.5            2.8            6.0
      Total              1.2        3.2            5.0            9.9           16.7
Source: Gordoncillo et al., 2005



Preschools, Kindergartens and Nursery Classes

Generally, participation in preschool was lower than the participation rate in day care in
the three regions (Table 3.3.7). Regions VI had the highest participation rate among the
three regions, although it is lower when compared with the day care participation rate as
presented in the earlier section. This is mainly due to the higher tuition rate for preschool
services. For instance, in Bucao, Botolan, Zambales, the tuition for pre-elementary
school was PhP150 per month compared to PhP50 for the day care tuition. Despite, the
offer of reducing the tuition fee to PhP100 per month, parents opted to enroll their
children in the day care. As such, there is competition between pre-elementary and day
care services in Barangay Bucao.

Table 3.3.7. Participation rate of children aged 0-71 months in preschool services
              (DepEd and Private), Regions VI, VII and XII, Philippines: 2000-2004
      Region            2000        2001          2002           2003           2004
        VI               39.8       39.9           37.1           37.6          37.4
        VII              19.5       18.9           20.3           22.3          25.9
        XII              20.4       19.5           22.9           26.2          27.1
       Total             25.4       24.9           26.4           28.6          29.8
Source: ECDP, 2005



Data on early childhood education experience is not as readily available as with the
health and nutrition status of children. Data were sourced from research studies, thus
national estimates are rarely available. As noted earlier, provision of DCS was devolved
to the LGUs with the DSWD providing technical assistance. It was not clear if there is
any monitoring mechanism. Thus, data on the number of DCC and DCWs and
participation rate of children are not as available as with the other indicators for children
aged zero to six years.


3.4     Social Protection

Street Children

These are highly visible children, spending more than four hours on the streets. A
UNICEF study (2002) of highly visible children in 22 cities nationwide covering 8,513
sample children showed that 46.5 percent of the street children were 6 to12 years old,
31.5 percent were 13 to 15 years old, and 8 percent were 2 to 5 years old.




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                                                                             Final Report


The reasons cited for not going home were: (1) to earn money (3.2%); (2) did not like
home chaotic home/afraid of parents (21%); (3) physical/verbal abuse from
parents/siblings (21.4%); (4) separated parents with step parents (5.9%); (5) accessibility
to distance from home (7.4%); (6) abandoned/do not know where parents were (14.7%);
(7) poor living conditions/ basic needs not provided (2.1%); (8) like to be with
friends/peers (2.7%); (9) stow away (8.3%) no house prefer to stay in the center (13.3%);
(10) they have used prohibited drugs the past six months (15.4%); and (11) they are into
rugby sniffing (81.9%), shabu (19.7%), syrup (2.4%), and marijuana (17.8%).


Child Labor

Child labor as defined by International Labor Organization (ILO) as forced labor in
hazardous and exploitative conditions and deprivation of education opportunities. In the
Philippines, child labor is defined as the illegal employment of children below the age of
15 who are not directly under the sole responsibility of their parents or guardian or whose
works do not impair their normal development. Child labor also includes children below
the age of 18 who are employed in hazardous situations (KC Link 2003). There were four
million child laborers age 5 to17 years who were predominantly from rural households
(67.1%) in Regions IV, VI and XI. A total of 65 percent were boys, 59 percent were
exposed to hazards, six out of 10 were unpaid, 64 percent were in agriculture, 16.4
percent were in sales, 9.2 percent in production work, and 8.8 percent in services/trade.
Thirty-seven percent of working children did not go to school (NSO 2001).

As indicated earlier, child labor is a serious problem in the Philippines, particularly in the
rural areas where the age requirement for schooling and work is not enforced. Children
work for long hours with minimal pay in farms or factories. Their work conditions are
devoid of stimulation for physical and mental development.


Children with Disability

This category of children in need of special protection has more boys than girls. One of
five children in zero to six age bracket has some form of disability, with those in the 10 to
14 age groups having the highest prevalence rate. The most common form of
impairment is hearing and visual disorder. More than half are acquired and can be
prevented (NSO 2000 census). Only two percent of persons with disabilities of school
age are enrolled in formal educational institution (UNESCAP 2006).

This situation exists despite international and local mandates declaring that education is
a basic right for all children and calling for the inclusion of all children in primary
education. Infants and children with disabilities require access to early intervention
services, including early detection and identification (birth to four years old) with support
and training to parents and families to facilitate the maximum development of the full
potential of their disabled children. Failure to provide early detection, identification, and
intervention to infants and young children with disabilities and failure to support their
parents and caregivers results in secondary disabling conditions which further limit their
capacity to benefit from educational opportunities. Provision of early intervention should
be a combined effort of education, health, and social service (UNESCAP 2003).

According to the Philippine definition, disability means a physical or mental impairment
that substantially limits one or more psychological or anatomical functions of an
individual. It further defines persons with disability as those suffering from restriction of
different abilities as a result of mental, physical or sensory impairment in performing an
activity in the manner or within the range considered normal for a human being.


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                                                                            Final Report



As cited in the PES module for parents, one out of five children aged zero to six years
suffers physical and mental disabilities. Fifty percent of these are acquired disabilities in
hearing, vision, and movement. Majority of these children come from poor families who
are unable to provide even the basic needs of their ―normal‖ or able-bodied children. It
was also pointed out that the government has not been able to provide adequate special
education for these children. These children‘s situation in the rural areas is more serious
because they have not received even basic education. These children are also
confronted with other problems, ranging from discrimination to lack of access to
adequate social services. Globally, less than 10 percent of the world‘s disabled children
attend school.

Children in Other Difficult Circumstances

There are other situations wherein children are in disadvantaged positions. However,
due to lack of information, it is very difficult to determine whether children aged zero to
six years old are involved or not and the extent and nature by which the preschool
children are affected. These are the children in ethnic/cultural communities,
undocumented immigrants, victims of commercial sexual exploitation, sexual abuse,
without primary caregivers, affected by HIV/AIDS, and victims of armed conflict.


4.0    Enabling Environment as Contributory Factor to the Delivery of Early
       Childhood Care and Development Services

The level of access to nutrition, health, early education and health services has
increased through the years, as shown in the earlier discussion. This achievement was
largely due to laws and regulations originating from the legislative and executive
branches of the government.

4.1    Nutrition Policies

As early as 1974, nutrition was already considered an important concern of the
government. The first law that was enacted and declared nutrition as a priority was
Presidential Decree (PD) 491 (Nutrition Act of the Philippines). It also mandated the
creation of the National Nutrition Council (NNC) which is the highest policy making body
on nutrition. The chairmanship of the NNC has been changed from time to time, e.g.
Department of Agriculture (DA) to DSWD then to DA and now to DOH. The possible
effect of this change could be in the focus or perspective of program implementation.
With DA, the program included food and nutrition; with DOH, the focus was nutrition and
health services. Nevertheless, the preschool children are still included as target groups.

The other laws that were passed related to or have an impact on nutrition can be
grouped into three categories (Table 4.1), namely: 1) laws providing legal framework and
budget for specific interventions to be implemented; 2) laws related to the organization
and structure of NNC; and 3) laws identifying and deploying nutrition workers at the local
levels.

Salt Iodization Law, classified under the laws providing legal framework and budget for
specific interventions, was considered instrumental in the reduction of under-five
mortality (Pedro et al. 2006). The other factor was the increasing availability and
consumption of fortified processed foods (Philippine Food Fortification Program nd).

In the third category, PD 1569 mandates the implementation of a Barangay Nutrition
Scholar (BNS) program and that one BNS per barangay should be identified and


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                                                                                   Final Report


appointed. However, some barangays do not have a BNS. RA 7883 provides for the
training and deployment of Barangay Health Workers (BHWs). The BHWs would be
responsible for providing primary health care services in the community after having
been accredited properly by the DOH. Unlike the BNS, they are entitled to hazard
allowance, subsistence allowance, free legal services, and preferential access to loans.
The ideal ratio of BHW to households is determined by DOH. PD 1286 was signed in
1978 and it provides for the regulation of the practice of the Nutrition and Dietetics
profession. The law also states (among others) that there should be at least one
nutritionist-dietitian for each province, city, municipality, and rural health unit. However,
this law has not been fully enforced as it is not considered a priority position in the Local
Government Code (LGC).


   Table 4.1. Nutrition and related laws, Philippines.

   Category 1-Legal Framework
     RA 7600        The Rooming-in and Breastfeeding Act (1992)
     RA 8172        Act of Salt Iodization Nationwide (1995)
     RA 8976        An Act Establishing the Philippine Food Fortification Program and for
                    Other Purposes
     EO 51          Milk Code (1986)


   Category 2 – Organization and Structure
     PD 491         Nutrition Act of the Philippines
     LOI 441        Specified the functions of the different members
     EO 234         Reorganization of NNC (1987) which called for the expansion of the
                    membership of NNC to include the Departments of Labor and
                    Employment, Trade and Industry, Budget and Management and the
                    National Economic Authority (NEDA)


   Category 3-Nutrition Workers at the Local Level
     P.D. 1569      Strengthening the Barangay Nutrition Program by Providing for a
                    Barangay Nutrition Scholar in Every Barangay, Providing Funds
                    Therefore, and For Other Purposes
     RA 7883        An Act Granting Benefits and Incentives to Accredit Barangay Health
                    Workers and for Other Purposes
     P.D. 1286      Practice of Nutrition and Dietetics in the Philippine, and for Other
                    Purposes

Worthwhile to be mentioned as well is the LGC which was enacted in 1991. The law
mandated the transfer of powers from the national government agencies (NGAs) to the
LGUs to plan, implement, monitor, supervise, and improve basic services including
health and nutrition. The law facilitated the implementation of various programs in an
integrated manner under the leadership of the local chief executives (LCEs). It also
opened new doors for NNC to explore coordinative strategies. The chair of the local
nutrition committee is the mayor or governor. The members of the committee are the
heads of agencies that implement nutrition and related interventions.




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                                                                            Final Report


4.2     Health Policies

A number of national policies, plans and frameworks, and programs are already in place,
targeting various aspects that impact on newborn and child health, implementation, and
monitoring and evaluation (Table 4.2).

Under P.D. 996, all children below eight years old must receive vaccinations against
tuberculosis, diphtheria, tetanus, pertussis, polio, measles, rubella, and other basic
immunization which the Council for the Welfare of Children (CWC) will recommend to the
DOH. The Expanded Program of Immunization (EPI) is a program of the DOH that
implements this decree. In practice, rubella is not included in the EPI schedule of
immunization. Although rubella is not usually accompanied by complications in young
children, rubella in pregnant women particularly in the first trimester can lead to
debilitating and disabling conditions in the infant such as deafness, cataracts, and
congenital heart disease.

EPI schedules the above immunizations during the first year of life. Newborns and
infants less than one year old are followed up by the BHW to encourage immunization.
However, there is a need for greater surveillance of children more than one year old who
have not completed the above immunizations as the decree provides for immunization of
children below eight years old. Even the EPI TCL in the ECCD areas included only
infants immunized. The reporting for full immunization covers infants less than 11
months only. Immunization services have been extended to children one to eight years
old mostly during nationwide immunization campaigns. There have been campaigns
against measles and polio which have included children less than eight years old
regardless of vaccination status.

The EPI must have provisions for the immunization schedule of children beyond the first
year of life and health care providers must be correspondingly trained. Section 6 of the
decree provides for immunization of school entrants who have not received the
immunization. According to of one the DCW interviewed, the immunization status of their
students is obtained during enrollment. Those who have not completed the immunization
are advised to go to the health center. There must be coordination between the DCW
and health centers to ensure that preschool entrants get immunized. There must be a
surveillance system of to ensure that both private and public schools follow the PD. The
current recommendation of most pediatric specialist organizations is to give a booster of
DPT and polio at 18 months and at four years old. The EPI may be extended to give
compulsory DPT/polio immunizations upon entry to the day care.


   Table 4.2. Health Laws, Philippines.
      PD 996        Full immunization of children below 8
      RA 7846       Compulsory immunization against Hepatitis B for infants and children
                    below eight years old
      RA 7600       The Rooming-in and Breastfeeding Act of 1992
      RA 9288       Newborn Screening Act of 2004

Compulsory immunization against Hepatitis B for infants and children below eight years
old was articulated under RA 7846. Among the immunizations offered in the EPI,
Hepatitis B vaccination has the lowest reported coverage mainly because of inadequate
supply of the vaccine. If there is not enough supply of this vaccine for infants, more so for
children ages one to eight years old.



                                                                                        22
                                                                            Final Report


There is a need to emphasize the importance of Hepatitis B vaccination among the
community residents, health providers, and local governments. Hepatitis B infection
increases the risk of cancers of the liver; this form of cancer thus may be preventable. If
there is increased awareness of the importance of the vaccination, then there may be
corresponding increase in government commitment and support. One way of increasing,
awareness is to include Hepatitis B vaccination in the reporting of a fully immunized
child.

The specific population of persons at risk of Hepatitis B infection are infants born to
mothers who are carriers of the infection. Special attention to this group was provided in
Section 2 of the decree. It states that infants of women with Hepatitis B shall be given the
vaccine within 24 hours after birth. Therefore, to control the spread of the infection, there
must be an accompanying policy for compulsory screening of all pregnant women for
Hepatitis B or compulsory immunization within 24 hours of birth for all infants regardless
of the Hepatitis B status of the mother.

The Rooming-in and Breastfeeding Act (RA 7600) of 1992 provides incentives to all
government and private health institutions with rooming in and breastfeeding practices.
The policy states that the Senate adopts rooming in as a national policy to encourage,
protect, and support breastfeeding practices. The benefit of breastfeeding has long been
established. However, breastfeeding rate has declined probably because of a number of
factors such as increasing number of working mothers, mothers not well-informed about
the benefits of breastfeeding, and marketing strategies of formula milk manufacturers.
This Act imposes breastfeeding practices in government and private hospitals by giving
incentives to those that adopt the policy and by giving sanctions to those that violate the
Act.

One of the incentives listed in Section 13 is tax deduction of expenses incurred by
private hospitals in complying with the Act provided that the hospitals comply within six
months after the approval of the Act. For government institutions, they shall receive an
additional appropriation equivalent to the savings derived as a result of adopting the
rooming in and breastfeeding policy. There is no detail given as to the nature of the
savings. Perhaps the only tangible and direct saving from breastfeeding is the cost of
milk formula which is purchased by the parents. It is very difficult to quantify the savings
from decreased infections, decreased hospitalizations, or decreased staff and utility
requirements in nurseries. Sanctions were clearer, ranging from reprimand or censure to
suspension of the license to operate in case of repeated and willful violations. There
appears to be less commitment to giving incentives compared to giving sanctions in the
implementation of the Act.

Integrated Management of Childhood Illnesses

The under-five year old mortality rate in developing countries has remained to be high.
According to World Health Organization, seven out of the 10 under-five deaths are due
to five preventable and treatable diseases, namely: pneumonia, diarrhea, measles,
malaria, and malnutrition. Inadequate diagnostic services, equipment and drugs are
among the factors identified to have contributed to these deaths. The UNICEF has
addressed this problem by developing the Integrated Management of Childhood
Illnesses (IMCI) strategy. The Philippines, together with Vietnam, were the first countries
in the Western Pacific to adopt IMCI.

IMCI is an integrated approach that focuses on the well-being of the child. It includes
both preventive and curative elements that are implemented by health facilities with the
participation of families and communities. Instead of the conventional single disease
approach to diagnosis, IMCI combines the factors that contribute to increased risk in


                                                                                        23
                                                                            Final Report


children. This approach ensures that all conditions present in the child will be diagnosed
and correspondingly treated. The IMCI guideline provides a stepwise approach to the
management of childhood illnesses. It also emphasizes preventive measures and good
nutrition.

Integrated in the IMCI approach are the protocols for control of diarrheal diseases and
acute respiratory infection. Nationwide, 14 percent of diarrhea cases in children aged 0
to 59 months were given oral rehydrating solution (ORS).

Safe Motherhood

Safe motherhood is a program that aims to address the causes of maternal mortality. As
most of these causes overlap with the causes of stillbirths, neonatal mortality, and
neonatal morbidity, a reduction in these health indicators can also be expected. There
are four basic components to a Safe Motherhood Program, namely: family planning,
antenatal care, clean and safe delivery, and essential obstetric care.

Family planning ensures that parents have the information and services to plan the
timing, spacing, and number of pregnancies. In the 2006, Field Health Service
Information System (FHSIS) report, there were 4.7 million current users of family
planning method. The most common method used was the pills (39.0%) followed by
injectables (14.6%), and IUD (13.1%). Among the new acceptors of the family planning,
the most common methods used were the LAM (51.8%), pills (21.1%), and injectables
(12.9%).

Antenatal care by early identification and appropriate treatment is important to prevent
complications of pregnancy. Pregnant mothers are also advised about breastfeeding and
tetanus toxoid injection. In 2003, among the surveyed women who had a live birth in the
five-year period before the survey, 62 percent of pregnant women had three or more
prenatal visits while 6 percent had no prenatal check up. Thirty-seven percent received
two or more doses of tetanus toxoid. In the 2006 FHSIS Report, the percentage of
pregnant women who had three or more prenatal check up was slightly lower at 59.1
percent. On the other hand, the vaccination rate with two or more doses of tetanus toxoid
increased to 59 percent in 2006. Clean and safe delivery component of safe motherhood
ensures that birth attendants have the knowledge, skills, and equipment needed for safe
and clean delivery. It also includes the provision of post-partum care to mothers. In the
2003 survey, only 38 percent delivered in a health facility while the rest delivered at
home. A total of 60 percent were assisted by a trained professional, doctor, nurse, or
midwife. Meanwhile, 69 percent had at least one postpartum follow-up.

Republic Act (RA) No. 9288 or the Newborn Screening Act of 2004 promulgates a
comprehensive policy and a national system for ensuring newborn screening. The act
ensures that every baby born in the Philippines is offered the opportunity to undergo
newborn screening (NBS). The screening system in the country offers early detection of
five diseases, namely: G6PD deficiency, congenital hypothyroidism, phenylketonuria,
galactosemia, and congenital adrenal hyperplasia. When left untreated, these conditions
may lead to mental retardation and even death. However, early detection and treatment
can save the infant from these complications.

One of the provisions of this policy is the responsibility of the health provider who attends
or assists in the delivery of an infant. The Act provides that the DOH must inform and
educate the health providers about this responsibility. Since many pregnant women
deliver at home attended by midwives and trained hilot (traditional midwife), there must
be an extra effort to educate health providers who engage in private practice and are not



                                                                                        24
                                                                             Final Report


connected with any agency. Different agencies also need to collaborate more in
promoting newborn screening.

NBS is one ECCD program that has not been implemented by the municipality of
Botolan. The members of the council have not attended any training on NBS at the time
of interview. However, NBS facility was already available

The provision on the establishment of newborn screening centers is not so clear on
whether private laboratories can offer newborn screening tests as testing kits are
commercially available. Rather than preventing them, there must be a provision for
accreditation, quality control, monitoring and evaluation of existing laboratories who
would want to offer newborn screening test apart from that offered in the NIH. Private
laboratories and paying patients may have the resources for more diseases to be
screened. This would mean more benefit to those newborns that have access to such
tests. Accreditation will also ensure that the tests being offered are of good quality. If
these private laboratories are not accredited and they still offer the tests, then there
would be a group of newborns who will not be included in the national database for NBS.

Newborn screening rate is quite low for a number of reasons. In fact, statistics on live
births screened are only available from 2004 up 2006. Moreover, the screening rate was
very low at 4, 7 and 11 percent in 2004, 2005 and 2006, respectively. The main reason is
that the service is quite new, thus it is not as widely known to health providers in the rural
areas and available in the health facilities compared with the other health services for
children. The other reason is the cost, about PhP600, which is not affordable for many
couples. Though PhilHealth offers a discount of PhP100 for its members, it is still costly
for them more so for the many non-members.


4.3    Early Childhood Education Policies

Twenty-five years ago, the first law promoting early childhood education in the
Philippines was passed. PD1567 or the Barangay Daycare Law provided that at least
day care center in every barangay with at least 100 households must be built in order to
run early childhood socialization activities for neglected preschool age children. The day
cay center shall ―look after the nutritional needs and social and mental development of all
children from ages 2 to 5 when their parents are unable to do so.‖ It was the first act of
government to provide state funded early childhood education.

Meanwhile, laws which are broad in scope have also provided the legal basis for the
development and implementation of Early Childhood Enrichment Project. This refers to
PD 603 or the Child and Youth Welfare Code of 1978. PD 603 clarifies the
responsibilities and obligations of the state and its citizens in relation to children as well
as the duties and responsibilities of children and youth themselves (UNESCO 2004).
The Early Childhood Enrichment Project (ECEP) from 1978 up to the mid-80s gave the
day care program a much needed-boost in the 1980s.

Then in 1990, Republic Act 6972 or the Barangay-Level Total Development and
Protection of Children Act. RA 6972 mandates the establishment of a day care center in
every barangay with a total development and protection of children program. The first
law centers on socialization activities while the latter emphasizes the total development
of children. RA6972 included programs 1) monitoring the registration of births and the
completion of the immunization series for prevention of tuberculosis, diphtheria,
pertussis, tetanus, measles, poliomyelitis and such other diseases for which vaccines
have been developed for administration to children up to six (6) years of age; 2) growth
and nutritional monitoring, with supplementary nutritional feeding and supervision of


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nutritional intake at home; and care for children of working mothers during the day and,
where feasible, care for children up to six (6) years of age when mothers are working at
night. Further, RA6972 also emphasized that children are the community‘s collected
responsibility and that the barangay must ensure a safe environment that promotes that
total development.


   Table 4.3. Early Education Laws, Philippines.
     PD 1567        Barangay Day Care Law
     RA 6972        Barangay-Level Total Development and Protection of Children Act
     R.A. 9155      Governance of Basic Education Act reiterates that early education is part
                    of basic education which is the foundation for subsequent learning
     EO No. 340     Provision of day care services for employees' children under five years of
                    age in government and corporate establishment



The provision of DCS has been extended to places outside the barangays. Executive
Order No. 340 (1997) directs national government agencies and government-owned and
-controlled corporations to provide day care services for their employees' children under
five years of age. These services shall include proper care and nutrition; development of
social and intellectual skills, spiritual, socio-cultural and nationalistic values; substitute
parenting and protection from neglect, abuse and exploitation.

All these years, the Department of Social Welfare and Development (DSWD) was
mandated to manage the day care program of the government. Then in 1992 when the
Local Government Code of 1992 was passed, the DSWD together with the Department
of Health and Department of Agriculture transferred their political and administrative
authority, functions and responsibilities to the local government units. For the day care
program, this meant that only the policy and program development and technical
assistance was retained with the DSWD. The supervision of the provincial and municipal
welfare and development officers and the allocation of funds for early childhood
education rest with the local government executive. Similarly, the health and nutrition
functions and responsibilities of the other departments where decentralized. The quality
and access to the provision of early childhood education depend largely on the priority of
the local government units. The allocation of funds for training over other competing
requirements like infrastructure could mean a lot to the total development of children. As
it is, there is so much to be done to improve the quality and access of children to early
childhood education (UNESCO 2004).

Despite the passage of RA6972 some barangays do not have day care center. At the
same time, the status, wages and working conditions of day care workers which form
critical aspect of early childhood education remained unchanged through the years.
According to UNESCO (2004), a day care workers is one of the most underpaid,
overworked and inadequately supported public servants.

As early as 1971, the Bureau of Public Schools encouraged the public sector to organize
pre-school classes through their parent-teacher associations (Memo no. 25, s. 1971).
The Education Act of 1982, or Batas Pambansa Blg. 232, provides for compulsory basic
formal education corresponding to six or seven grades, including preschool programs. In
2001, the Governance of Basic Education Act (R.A. 9155) reiterates that early education
is part of basic education which is the foundation for subsequent learning.




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The goals of ECE, as stipulated in MECS Order no. 8, s. 1986, are to prepare children
for elementary schooling and to improve pupils‘ achievement at the elementary level.
These goals seemed to have shifted in the 1990s. The Master Plan for Basic Education
1996-2005 articulated that the aim of ECE is to provide children with ECCD, thus, the
focus became the total development of children.

Standards for the organization and operation of nursery classes (for children aged three
to four years old) were developed in the 1970s (Department Order no. 60, s. 1975 and
MECS Order No. 24, s. 1978).

In 1987, the Coordinating Council for Pre-school Education in the Philippines (CONCEP)
was established. CONCEP is a body of pre-school specialists from the private and public
sector tasked to coordinate pre-schools all over the country. It articulated guidelines for
the regulation, licensing, organization, management and supervision of private and
public pre-schools (MECS Order no. 60, s. 1975; DECS Order no. 41, s. 1985; DECS
Order No. 107, s. 1989; DECS Memo no. 100, s. 1997).

The effect of the decentralization and the concern for the integration and convergence of
services for the total development of children aged 0-6 years old have provided the
impetus for the passage of the Early Childhood Care and Development Act in 2002.
Among others, the ECCD Act provided for the institutionalization of a National System for
Early Childhood Care and Development that is comprehensive, integrative and
sustainable involving multi-sectoral and inter-agency collaboration at the national and
local levels among government; among service providers, families and communities; and
among the public and private sectors, non-government organizations, and academic
institutions. Of special mention are children with special needs and advocate respect for
cultural diversity.

As mandated by R.A. 8980, the DSWD is responsible for regulating the quality of ECCD
programs for children, including those provided through various centers. Thus, in 2004,
the DSWD developed accreditation standards and indicators to ensure effective and
quality delivery of the Day Care Service and other ECE-ECCD programs for children
below six years old through various centers and its service providers (A.O. no. 29, s.
2004; E.O. 221).

However, functions of standard setting and issuance of permits are assigned to the
DepEd. Because of the overlap, the National ECCD Coordinating Council defined and
delineated the roles and functions of the DSWD and DepEd on the accreditation and
licensing of center-based ECCD programs in 2004 (Council resolution no. 1; DepEd joint
memorandum circular no. 001-12-04).

The Medium-Term Philippine Development Plan 2005-2010 include among others the
following policies on education:
         pre-school as a prerequisite to Grade 1 and part of the education ladder;
         the present barangay DCCs to provide ECE services following a standardized
           ECE curriculum for five-year olds;
         the present coverage of organized ECCD programs to expand to reach all
           five-year-old children, with priority to children of poorest households;
         DepEd to adopt the Standard SRAT; and
         DepEd, in coordination with DOH and LGUs, to expand health and nutrition
           programs in public DCCs and preschools

UNESCO (2004) believes that the integration of ECCD services happen at the
household level and not at the day care centre or any service delivery point. Thus, it is a
challenge for the ECCD implementers to center all its efforts on the family unit.


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Moreover, there are a number of activities that the ECCD needs to address, including the
following:

       Activating and strengthening of the multiple layers of co-ordination;
       Intensify the efforts to secure the necessary resources for programming and to
        explore more and better ways to work with children and families; and
       Develop more opportunities for the interaction of various stakeholders for
        developing program features or processes for the full realization of the ECCD
        objectives.

Another pre-school initiative of the DECs is the pre-school Service Contracting This Pre-
school Service Contracting Scheme as an alternative delivery system was launched in
1997 when pre-school classes were organized in the 5th and 6th class municipalities,
urban poor and resettlement areas (for those affected by natural calamities and armed
conflict). Service providers are NGOs, private schools, LGUs and PTCAs. The general
arrangement is that DECS will pay P250 per child per month for 6 months while the
service providers will organize classes with 20-25 pupils per class as well as provide the
salary of qualified teachers, school/classroom facilities, adequate instructional materials
and basic school supplies. Funding comes from the DECS regular budget supplemented
by the Bases Conversion Development Authority (BCDA) from funds raised through the
sale of military camps (UNESCO nd). As of 2007, there were 714 permanent pre-school
teachers under DepEd. This number will increase to 835 in 2008 as additional 121 new
items have been approved.

In 2005, the DepEd launched the National Pre-school Education Program in line with
Pres. Arroyo‘s Ten-Point Pro-Poor Legacy Agenda for 2005-2010, her 2004 SONA to
―standardize what is taught in barangay day care centers,‖ and Executive Order No. 349
(2004) which provides that ―the government will incorporate pre-school in the education
ladder to encourage early childhood development.‖ This program aims to achieve
universal coverage of all five-year-olds for pre-school by 2010.

To determine the school readiness of all incoming Grade One pupils, the School
Readiness Assessment Tool (SRAT) is now administered twice in a school year in public
schools (DepEd Order no. 13, s. 2006; DepEd Order no. 25, s. 2007). The assessment
includes the different developmental domains, the results of which are used as bases for
providing interventions in school and in homes.

The conceptual framework and structure of the SRAT is similar to the Revised ECCD
Checklist which was designed in 2002 ―to objectively monitor a child‘s development‖ in
seven developmental domains. It is to be administered to children from aged 0 months to
5 years 11 months. This is presently used in the DCCs as assessment tool in order to
identify children at risk for developmental delays and to input for curriculum
development.

Further, despite the passage of laws from both the legislative and executive branches,
there are still issues which have to be responded to by the government. These are as
follows:

   While the roles and responsibilities of the DSWD and DepEd in the registration,
    licensing and accreditation of center-based ECCD programs have been delineated,
    there is still no policy recommendation or joint circular for the adoption of DSWD‘s
    ―Standards for Day Care, Other ECCD Centers and Service Providers‖ by the DepEd
    for public and private pre-schools; and the Curriculum Framework (Early Learning
    Standards for 0-6), which has not yet been developed, must ensure that foundational
    principles, curriculum, teaching-learning experiences and materials, and evaluation/


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    assessment processes and procedures are developmentally-appropriate for ECCD
    children and that smooth transition and continuity across age groups and settings is
    established, regardless of which operating ECE programs are under the jurisdiction
    of DSWD and DepEd. Note for example that the use of workbooks in the DCS is not
    an indicator of service quality in the Standards.

   Pres. Gloria Macapagal-Arroyo‘s 2005 SONA commitment to make pre-school
    education a prerequisite to Grade 1 and part of the education ladder shall be able to
    meet its goals efficiently and effectively only if home-, community-, and center-based
    early education programs for children below 6 years old (under DSWD) are
    strengthened and expanded in terms of service quality and availability in barangays
    and other settings; and the total development of children, not preparation for
    elementary schooling alone, remains the imperative of all early education programs,
    including Early Childhood Experiences in Grade 1.

       o   Parallel to this, creative and dynamic mechanisms for the professionalization
           of the said programs‘ service providers are to be developed and
           implemented. R.A. 6972 treats day care workers as ―private volunteers, who
           are responsible members of the community‖ and enjoins the Sangguniang
           barangay to tap them to provide ―consultative services for medical,
           educational and other needs of children.‖ While this long history of barangay-
           level volunteerism has become the backbone of ECCD service delivery, it has
           likewise exploit the service providers because they are in reality extending
           full-time work.

       o   Moreover, early education programs for children aged 0 to 3 years old have to
           be given more legislative, programmatic, and financial support. This age
           group belongs to an even more critical stage in children‘s development and
           early stimulation and interventions produce significant positive outputs in
           learning.

   There is a need to intensify the training and monitoring of service providers on the
    utilization of assessment results—from the Revised ECCD Checklist or the SRAT—
    for curriculum planning so that children‘s early education experiences are
    appropriate, stimulating and challenging.

   Orientation and capacity-building programs must be conducted directly with the
    service providers and not through various levels. Training design and methodologies
    need to be evaluated at the LGU level in order to improve ways of building
    competencies of the service providers according to standards and other benchmarks.

   Policy guidelines and implementation need to be set on long-standing conflict points
    between the DCS and public school-based ECE programs like the PTCA-initiated
    kindergarten classes competition in terms of serving the same clientele (mostly the
    four- and five-year-olds) since the monthly honorarium of DCWs and kinder teachers
    largely come from the monthly contributions of the enrollees; and preference of public
    schools for Grade 1 entrants who enrolled in the PTCA-initiated kindergarten class
    the previous year; school heads reason that ―it is easier to teach such children in
    Grade 1 than children who come from DCCs‖.

   Because PD 1567 mandates that a DCC must be established in every barangay with
    at least 100 households and R.A. 6972 states that ―a DCC is to be established in
    every barangay,‖ some LGUs limit the number of DCCs to only one in each
    barangay. Factors such as population of target clientele, non-maximized facilities
    (such as unused classrooms in DepEd schools), conduct of DCS sessions in the


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      afternoon can justify the construction of new DCCs or expansion of the DCS in the
      community.

4.4      Social Protection Policies

In 1989, the Philippines became a signatory to the United Nation‘s Convention on the
Rights of the Child (UNCRC), which was ratified in July 1990. Through this international
commitment, both government and NGOs were provided a meaningful shift in the
framework for program development, policy formulation, and intervention strategies for
children. This new direction brought about legislations embodying the rights of children
broadly categorized as rights to: survival, development, protection, and participation.
However, long before the advent of the Convention on the Rights of the Child in l989, the
Philippines had already formulated a landmark legislation for children as early as June
l975, with the passage of PD 603, otherwise known as the Child and Youth Welfare
Code. The Code recognizes that the child is one of the most important assets of the
nation and it upheld the ―natural right and duty of parents in rearing of the child for civic
efficiency‖. The code explicitly detailed 12 rights of the child, two of which (Nos. 8 and 10
of Art. 3) were specific to their ―rights to protection against exploitation, improper
influences, hazards and other conditions or circumstances prejudicial to his physical,
mental, emotional, social and moral development.‖ Further it states, that ―every child has
the right to the care, assistance and protection of the state particularly when his parents
or guardians fail or are unable to provide him with his fundamental needs for growth,
development and improvement‖. ―Moreover, special categories of children, such as the
dependent, neglected and abandoned, the physically and mentally disabled, and youth
offenders below 21 years old are protected by the State under the doctrine of parens
patriae.‖ Also, this decree created The Council for the Welfare of Children in August
1975.

In addition to PDs 1567 and 603 and RA 6872 which also have provisions on the
protection of children, other legislations which focus on child protection are enumerated
in Table 4.4. These legislations are translated into programs and projects to address
issues and concerns on children. Examples of these projects are the Early Detection,
Prevention and Intervention of Disability (EDPID) and TAWAG of the Department of
Social Welfare and Development. The DSWD has developed a tool called EDPID tool
which is used to determine signs and symptoms of disability or those with apparent
disability. On the other hand, Tuloy Aral Walang Sagabal for children with Disability
(TAWAG) was developed to enhance the physical, social, mental and psychological
functions of children and out-of-school youth with disabilities through their integration into
day care services or special and regular schools.


4.5      The ECCD Law (RA 8980)

Given the legal framework through which ECCD interventions were initiated under
various statutes covering nutrition, health, early education, and child protection, a
landmark legislation, Republic Act 8980 otherwise known as the Early Childhood Care
and Development Law was passed in 2000. The basic element of the law was to provide
a system based on multi-sectoral and inter-agency collaboration in the delivery of a
comprehensive, integrative, and sustainable ECCD services at various levels from the
national to the local levels of implementation. However, it must be noted that, while the
existing statues have broader scopes, ECCD is focused on the welfare of children from
zero to six years old.




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Table 4.4 Legislations related to child protection
Republic Act
 RA 7610
                    Otherwise known as an act providing for stronger deterrence and Special
                    Protection against child abuse, exploitation and discrimination (1992)
    RA 7727         Magna Carta for Disabled Persons (1992)
    RA 8369
                    Family Courts Act of 1997
    RA 8552
                    Domestic Adoption Act of 1998
    RA 8043         Inter-Country Adoption Act of 1995
    RA 8980         The Early Childhood Care and Development Act of 2000
    RA 9344
                    The Comprehensive Juvenile and Justice Welfare Act of 2006

    Executive Order (EO)
    EO 275 S        Creating a Committee for the Special Protection of Children from all forms of
    1995            neglect abuse, cruelty, exploitation, and discrimination to their development
    EO 184 S        Establishing the Presidential award for the Child Friendly Municipalities and Cities
    1999
    EO 310 S        Authorizing the adaptation and implementation of the Phil. National Strategic
    2000            Framework for Plan Development for Children 2000- 2025 or child 21 and its
                    Accompanying Medium-Term Plan and Framework

EO 56 series of     Adapting the Comprehensive Framework for Children in Armed Conflicts and
2001                Directing National Government Agencies and LGUs to Implement the Same


To achieve the goals outlined in the Law, the following components were identified: (1)
early childhood care and development curriculum, (2) parent education and involvement,
(3) human resource development program, (4) ECCD management, and (5) quality
standards and accreditation.

In terms of Program implementation, the law provides for the creation of ECCD
Coordinating Committees from the national down to the provincial, municipal, and
barangay levels. It must be noted that at the barangay level, the Barangay Council for
the Protection of Children (BCPC) was also designated as the Barangay ECCD
Coordinating Committee. The Barangay ECCD Coordinating Committee as provided for
under P.D. 603 (for the BCPC) is composed of the Barangay Captain, School Head,
BHW, BNS, DCW, Sangguniang Kabataan (SK) Chairman, parents, and NGO
representatives.


5.0      Quality of Early Childhood Care and Development Services1

Among the ECCD components, the renovation of Day Care Center and Rural Health
Unit/Station, capacity-building and supplemental feeding were mostly implemented in the
covered barangays. However, it should be noted that supplemental feeding varies by
location. Others have 120 day supplemental feeding while others have shorter periods.


1
  The discussion on the quality of services, integration and convergence, feedback mechanisms and
structure established for the ECCD implementation were solely based on the case studies conducted for the
study.


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The Rural Health Centers included in the study provides immunization, prenatal and
postnatal care, family planning and other health related services as indicated in the
ECCD Law. In most cases, the Barangay Health Workers and Barangay Nutrition
Scholar take turns in manning the Barangay Rural Health Center as the Rural Health
Midwife (RHM) comes once a month, except for the Province of Leyte where the RHM
visits the barangay once a month. Money from the ECCD project was used in the
renovation and upgrading of health units and procurement of pre-determined equipment
with the exception of Zambales where the Office of the Governor volunteered to finance
the upgrading and renovation of health and day care centers.

Under the early childhood education, is the renovation and upgrading of the Day Care
Center, provision of materials and the implementation of the eight week curriculum. SRA
is administered to determine the readiness of children to attend formal schooling. In the
barangay visited by the team, the SRA results of Grade 1 pupils in Siloy elementary
school indicated that 95 percent of them were ―not ready‖ for the Grade 1 learning
competencies. The GOT explained that children might not have been able to
comprehend the SRA instructions which were administered in English as he was
instructed to do. It was not clear how the GOT used the eight-week ECD curriculum to
help children develop the readiness skills that were lacking. As of data-gathering time,
the second SRA consolidated report for the second administration, i.e. after the eight
weeks, was not yet available. (The District Reading Coordinator (DRC) of Calamba
refuted the GOT‘s explanation: the SRA Test (SRAT) Manual states ―use the first
language/ mother tongue/dialect that is familiar to the child.‖)

The livelihood component of the ECCD was not implemented in all the five case study
sites. It was implemented in Davao Oriental where goats were distributed to the selected
beneficiaries while cash for entrepreneurial activities was awarded to the Day Care
Workers as additional funds.


6.0    Integration and Convergence

Ideally, convergence occurs at the household level which makes the decision to avail or
not the health, nutrition, education and social protection services. The concept of
integration is not uniformly understood and/or its being a component of the ECCD
program is not known to all. In one study site, integration is explained differently by
those involved in the program. For instance, the members of the PCPC refer to
integration as the implementation of services relevant and specific to children that
maximizes resources and prevents overlapping of services. On the other hand, the
members of the MCPC explained integrated ECCD services‖ as ―wholesome‖; ―more on
the enhancement of children‖ and ―similar to coordination where each agency
implements its ECCD related activities.‖ For the services providers, integration means
that all the services needed for ECCD are available at the barangay level and data are
shared among the agencies. Meanwhile, among the mothers interviewed, availment of
services varied, although the most common was immunization and pre-and post-natal
services. In one study site, a BNS considers integration as coordinative in nature, i.e., it
refers to the coordination between the BNS and MNAO. Meanwhile, the MNAO believes
that integration refers to being integrated in other programs implemented by the LGU to
the different sectors or services rendered are not on health alone.

Convergence seems to be even less understood, particularly among the service
providers. At best, they equate convergence with integration.




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7.0    Feedback Mechanism and Structure Established for the ECCD System

7.1    Monitoring

In all study sites, monthly accomplishment report is submitted by the municipality to the
province. In addition, monitoring is undertaken in the study sites as they deemed
appropriate. In Misamis Occidental, the PTWG monitors the ECCD implementation in the
pilot municipalities every quarter to verify the project status, identify hindering factors,
and assess the functionality of ECCD organizational structures at the municipal and
barangay levels. In the case of Davao Oriental, a staff was hired at the municipal level
and at the barangay to consolidate the report from the barangay to the municipal level,
particularly on supplemental feeding. In Cagayan Valley, the provincial ECCD program
came up with a single monitoring form to reflect all the concerns of the units involved in
ECCD.

7.2   ECCD Structure and Management

In all the cases, the Governor chairs the Provincial Early Childhood Care and
Development Committee (PECCDC). In two provinces, the Provincial Council for the
Protection of Children (PCPC) serves as the PECCDC while in others, other existing
committees like the Sub-committee for the Welfare of Children in the province of
Zambales served as PECCDC.

In support of the PECCDC, a technical working group headed by the Provincial ECCD
Officer, is organized to coordinate and monitor the effective implementation of ECCD. Of
the four provinces, only the Cagayan Valley ECCD Officer was hired while the rest were
designated by the Governor. For the designated ECCD Officers, they were either from
the Provincial Social Welfare and Development Office, Provincial Health Office and
Provincial Planning Development Office (PPDO) depending on the desire of the
Governor. In the Province of Davao Oriental, the technical working group which is
directly under the Board Member who is the Chairperson on Women and Children was
composed of only four members representing from the Provincial Health Office (PHO),
Municipal Nutrition Action Officer (MNAO), Department of Interior and Local Government
(DILG), and PPDO. In lieu of hired ECCD Officer, Assistant ECCD Officers were hired in
Bataan and Davao Oriental.

In Davao Oriental, then Governor Maria Elena Palma Gil created an office for ECCD with
several support staff. The province is also unique because municipal and barangay
ECCD coordinators were hired to monitor the supplemental feeding. Correspondingly,
the Council for the protection of Children at the municipal and barangay level serves as
the Municipal Early Childhood Care and Development and Barangay Early Childhood
Care and Development Committees, respectively.

In general, the PECCDC or PCPC integrates the work and financial plan from the
municipality planning takes place at the municipal level, although in one province the
PECCDC prepares the investment and work and financial plan based on the plan of the
municipalities.

The province plays a major role in determining the number of municipalities and
barangays to be included, although the final selection of barangays as beneficiaries of
ECCD is determined at the municipal level. In the Province of Cagayan, there were only
five municipalities that were originally selected based on infant mortality, under-five
mortality and nutritional status. However, then Governor Lara negotiated with CWC to
implement ECCD in the 29 municipalities and in turn selected 82 barangays.


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For the Province of Zambales, only three municipalities including Botolan, Olongapo City
and Masinloc were selected with each of the municipalities having different strategies in
implementing ECCD.      For instance in Olangapo City, only the 13 barangays largely
populated by Muslims were selected while in Masinloc all barangays were ECCD
beneficiaries. The Municipality of Botolan poured ECCD resources in the top 10
barangays. On the other hand, all municipalities and barangays were the beneficiaries of
ECCD in Davao Oriental.

The equity ratio ranged from 70:30 to 80-20 as in the case of Misamis Occidental and
Leyte. In the 70:30 ratio, 70 percent of the funds came from the CWC while 30 percent
came from the LGU. The 20 percent to 30 percent share of the LGU is further
subdivided between the province and the municipality and the barangays. For instance,
in Cagayan Valley, 90 percent of the 30 percent equity was provided by the City of
Tuguegarao while the remaining 10 percent was shouldered by the barangay. In
Zambales, the barangay was asked to provide an equity for the supplemental feeding
program. By contrast, the Province of Davao Oriental shouldered all the 30 percent
equity for the implementation of ECCD.

From CWC, ECCD fund is transferred to the trust account of the province which in turn
deposit the money to the trust account of the municipality. Except for the Province of
Davao Oriental, procurement of equipment and supplies and disbursements are done at
the municipality. In Davao Oriental, planning and disbursement of funds were done at
the province, except for the renovation fund of day care and health centers which was
directly released to the barangay council. The other extreme is the case of Sta. Fe
where the fund for the supplemental feeding was released directly to the Day Care
Worker and not to the municipality.

There are also variations as how funds are utilized.             In some provinces and
municipalities, cash advance is allowed while it is not possible for other areas. The most
common problem is that municipalities have different fund utilization rate; thus, it was
difficult at the provincial level to liquidate the funds earlier released by the CWC to
replenish the project funds. The municipalities have encountered difficulties in following
the government‘s system of procurement, particularly for supplemental feeding.


8.0   CONCLUSIONS

While efforts have been made, malnutrition remains to be a problem in the country.
Malnutrition exists primarily because it is highly linked with economic development.
Developing countries like the Philippines have low income capacity which is a major
cause for the inability to secure food. At present, the identified nutritional problems
among preschool children are: 1) protein-energy malnutrition, 2) obesity, and 3)
micronutrient deficiencies, i.e. vitamin A, iron, iodine and zinc.

There are, however, some encouraging signs of improvement. Given the declining trends
in the prevalence of undernutrition in both preschool and school children, the
interventions as embodied in the MTPPAN are apparently effective. Notable among
these interventions are supplementary feeding; nutrition education including the
promotion of breastfeeding and infant young child feeding; and essential child care
services which includes immunization, growth monitoring, micronutrient supplementation,
and integrated management of childhood illnesses. A major boost in the implementation
of interventions is the Accelerated Hunger Mitigation Program (AHMP).




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                                                                            Final Report


The general health status of Filipino children zero to six years old has been improving for
the past decade. However, there is an apparent disparity in the health status of children
among the different regions in the Philippines. This is demonstrated by the infant
mortality rate wherein the national infant mortality rate has declined rapidly in the past
eight years while a wide range of values was observed among regions. Furthermore,
efforts to improve the health status do not seem to be sustained as evidenced in the
decrease in the rate of decline in the maternal mortality rate in recent years. The same
observations were noted in service delivery. For instance, there is disparity in the rate of
fully immunized children and in NBS coverage among regions. Immunization rates for
individual vaccines have not consistently improved through the years. Thus, there is a
need for an integrative approach that will provide a more sustained improvement in
health status and a more equitable delivery of services nationwide.

The preschool education services in the country are primarily provided by the
government. As of December 2006, if the benchmark is one day care center per
Barangay, then the country still needs about 9,208 centers nationwide. Moreover, about
10 percent of the DCCs do not have a Day Care Worker. Because of the limited
availability of data for the preschoolers, the review focused on some of the studies
conducted on the subject, which has established that the participation rate of children
aged zero to six in preschool services has been relatively low because of the economic
cost.

The statistics indicated that there is an urgent need to address child protection issues. It
was estimated that there are about 50,000 street children and based on a sample, about
eight percent were between two to five years old. Moreover, one of five children
between zero to six have some form of disability. This would have significant
implications to the Education for All goals.

The main ECCD interventions that were seen in the field across the study sites were
reflections of the usual programs implemented under the various statutes promulgated
before the ECCD Law. The fact that there is a prospect of funding support from ECCD
generated the enthusiasm and commitment from various stakeholders at the field level.
In spite of the difficulties encountered, the commitment of the members of the
coordinating committees and service providers to provide service kept them going. The
implementation of the ECCD program made them realize the importance of their role in
caring for children 0 to 6 years old. The support of the local government also helped
them in the implementation of the ECCD program. As a result of the ECCD
implementation, there had been some expansion of the regular ECCD services,
rehabilitation of existing facilities, upgrading of ECE materials and capacity building
among the various service providers and stakeholders of the ECCD program.

Access to basic ECCD services is limited mainly due to inadequate resources including
manpower and delayed release of ECCD funds. Moreover, the location of the health
center or the day care center to some of the households in the barangay may prohibit
their access to the ECCD services.

In terms of the quality of ECCD services, there is a need to improve them at the level of
inputs (manpower and resources), process, and results. Manpower was found to be
insufficient in terms of number (MNAO, BNS, midwife) and capacity to perform the tasks
expected of them due to inadequate training. Moreover, the materials and facilities were
found to be limited mainly due to the delay in the release of funds. In terms of process,
there is a need to strictly follow the protocol and guidelines issued for the implementation
of some ECCD services, e.g. conducting a supplementary feeding activity should be 90-
120 days; use of the eight-week curriculum for the new Grade 1 pupils so as to uphold
the standards in all ECCD areas and for the full realization of the effect of the services.


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As to the quality of results, evaluation of the ECCD services is needed to be able to
determine their effectiveness.

Integration and convergence are concepts that are not yet internalized at all levels
including the household. In fact, the implementation of ECCD services as one integrated
program needs to be promoted at the barangay and household levels. Thus, there is a
need for new strategies and activities to which these concepts can be elevated from
awareness to understanding level at household, barangay, municipal, and provincial
levels. Moreover, there is a need to improve the feedback mechanism from the
household up to the national level.

The critical challenge of the ECCD implementation is the operationalization of the
mandate to provide a system based on multi-sectoral and inter-agency collaboration in
the delivery of a comprehensive, integrative, and sustainable ECCD services at various
levels from the national to the local levels of implementation.


9.0   ISSUES

While significant and notable improvements were observed across the various case
study sites, there is a need to input the insights generated in the review process to allow
for the modification of existing policies and processes in order to promote a more
efficient implementation, enhance, and sustain the gains as a result of program
interventions.

9.1   Harmonization of Children-Related Laws on Children with RA 8980

      While the ECCD Law is a very significant positive step to provide the mechanisms
      to integrate and harmonize prior ECCD initiatives, there are apparent issues
      relating to the consistency and alignment of previous laws with the ECCD Law.
      Most previous laws have mandates covering a broader age group of children aged
      less than 18 years old compared to the ECCD law which was very specific in its
      intention to cover only children between zero to six years old. This would have
      very critical implications, particularly in terms of coordination, jurisdiction and
      monitoring. For instance, in most child protection laws, the scope covers children
      beyond six years old.

9.2 Less Emphasis on Child Protection

      In the declaration of policy, the ECCD Law was very explicit in saying that
      ―…promote the rights of children to survival, development and special protection
      with full recognition of the nature of childhood and its special needs….Section 2‖.
      Further, in the identification of the duties of the Barangay Council for the Protection
      of Children, child protection was explicitly mentioned. Except for the provision of
      day care service which can be considered as a form of child protection; most of the
      services provided for under ECCD were mainstream ECCD programs such as
      nutrition and health.        Protection and special needs issues are not often
      incorporated. In one of the study sites, under the protection component are the
      rehabilitation of day center and the corresponding education materials only.
      Moreover, the team has never encountered special learning sessions for disabled
      children.

      Further, the notion of ―Protection‖ as operationalized by BCPC under P.D. 603 has
      assumed a legalistic character and practice. Children are generally being provided
      services by government institutions/agencies, when such children become victims


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      of abuse, neglect, and abandonment by parents or guardians. This unbalanced
      emphasis on the legalistic practice appears rather reactive rather than proactive, in
      the sense that there are inadequate strategies to counter the rising incidence of
      children in need of special protection. Or if there are available programs, these are
      not widely advocated; thus not known to majority of the service providers.

9.3    Cost-Sharing (Equity) Scheme

      As a matter of policy, funding for ECCD interventions is supposed to be done under
      a cost-sharing scheme. Feedback from the focus group discussions indicated that
      the sharing was about 70:30, that is, 70 percent of the cost will be funded under the
      program while the remaining 30 percent will be funded as equity by the LGU.
      Some local government executives forwarded the argument that the 30 percent
      equity is very high, particularly for the 5th and 6th class barangays which contributed
      to as much as 10 percent of the 30 percent equity. In fact, one of the barangay
      officials indicated that the barangay may only be able to raise the required equity
      for a specific ECCD project in three years time.

9.4   Sustainability of ECCD-Hired PECCD Coordinator

      In Cagayan Valley, the provincial ECCD coordinating officer was directly hired for
      the ECCD program management. As a result of the financial incentive, the level of
      effort of the hired ECCD officer was relatively high. The coordination effort was
      very good which resulted in the substantive participation of the various agencies
      involved in ECCD implementation, particularly in the planning stage at the
      provincial level. However, the sustainability of a directly hired officer under the
      ECCD framework may be put into the test as soon as funding for the program is
      terminated.

9.5   Inadequately Informed BCPC

      The Barangay Council for the Protection of Children was organized as the
      implementing body at the local level as provided for in P.D. 603. This council is
      basically composed of the BC, School Head, Barangay Midwife, BHW, BNS, DCW,
      SK Chairman, and a representative from the NGO.

      Most of these personalities also constitute the Barangay Agrarian Reform
      Committee, which is also the implementing arm of one the most significant and
      controversial rural development programs in the country - the Comprehensive
      Agrarian Reform Program (CARP).        The BCPC was also tasked as the
      implementer of the programs under RA 9344 or the Comprehensive Juvenile
      Justice and Welfare Act of 2006.

      And now, with ECCD, the same personalities are again tasked with the
      implementation of yet again another significant development intervention of the
      government. It is agued here that these personalities are now tasked with the
      responsibilities of implementing these various significant development programs of
      the government. Further, the BCPC was conceptualized to operate under the
      concept of voluntarism; hence, it has been difficult to recruit more competent
      members to the committee.

      Furthermore, at the national, provincial, and municipal levels, the ECCD
      coordinating committees are supported by an ECCD secretariat. This was not
      made explicit under the law in the case of the barangay. Hence, at the Barangay
      level, there is a coordinating committee but without an ECCD secretariat.


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9.6   ECCD Monitoring System

      One of the key elements to an effective delivery of ECCD services is an efficient
      monitoring system. During the field visits, effective monitoring system seemed
      absent particularly at the barangay level.

      To dramatize the point, in one of the sites visited, there was very minimal nutrition
      intervention because the Barangay Nutrition Scholar declared that the incidence of
      malnutrition was insignificant. However, the extent of malnutrition among new
      school entrants in the same community was relatively high. In fact, the incidence
      was about 33 percent. This is an anomaly because malnutrition can not just
      happen overnight. If the extent of malnutrition among zero to six children was
      practically insignificant, where would the malnourished children among the new
      Grade 1 entrants be coming from?

      The passage of the local government code also has significant implications to the
      implementation of ECCD. Under the devolution, the provision of basic services
      was delegated down to the smallest political administrative unit of the government:
      the Barangay. As a consequence, data on early childhood development had been
      scanty at the provincial, regional and national levels. This is partly due to the fact
      that LGUs do not see either the need or the obligation to provide information
      beyond their immediate level of jurisdiction and mainly due to lack of mechanism to
      integrate the information beyond the municipal level. Hence, in terms of
      monitoring, the current system does not allow for an easy decomposition of the
      target beneficiaries and their needs because available data are in five-year age-
      grouping.

9.7 ECCD Visibility and Advocacy

      While ECCD has been going on for quite sometime in most of the study sites, the
      household level discussions revealed that the extent of awareness about ECCD as
      a Program has been very low suggesting that ECCD awareness campaigns are
      insufficient. In fact, some of the mothers interviewed never heard of ECCD. In one
      of the study sites visited, there was not even a single signage that would show the
      presence of the ECCD program in the community.

      This lack of visibility and limited advocacy my have contributed to the lack of sense
      of project ownership at the community (barangay) level.

9.8    Sense of Project Ownership at the Community (Barangay) Level

      One of the key informants in the study mentioned that while it would have been
      preferred that the level of authority be lowered down to the Barangay level, the
      fact that project disbursements are done at the municipal was accepted as a
      convenient excuse to avoid the accountability associated with fund disbursement.
      As a consequence, there was a feeling of alienation on the part of the local
      government unit.

9.9   Misconceptions on ECCD Integration

      In the true sense of the word, the ECCD services at the time of this review are not
      yet integrated. The providers and stakeholders view that the services are already
      integrated because the centers are offering the various ECCD services and that,
      the process entailed the participation of various agencies of government and



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    NGOs. However, it is argued here that the true essence of an integrated ECCD
    services can be characterized by convergence. For ECCD services to be more
    meaningful and effective, such interventions must converge to a specific household
    which covers both the parents and the children. An ECCD facility can readily
    report excellent statistics of increased level of reach in PES, IMCI, EPI, OPT, and
    feeding, among others. But it is not very effective if PES goes to one of the parents
    in one household, IMCI goes to the first child in another household, feeding to the
    third child in yet another household, and so on.

9.10 The Role of Parents in the Day Care Center Sessions

    During the site visits, it was observed that majority of the parents stayed with their
    children at the premises of the day-care centers during session hours. In a school
    in Cagayan Valley, about five mothers were with their children inside the day care
    centers to monitor their children; while the majority of the parents were just outside
    waiting for the session to end. The fact the parents stayed with their children
    during the entire course of the day care center sessions defeats the very purpose
    of the center, which was intended to cater to the need of the working parents. The
    fact since most of the enrollees now of the day care centers are non-working
    parents (by virtue of their willingness to stay with the child in the center) may
    indicate the real targets of the centers, which are the working parents, may have
    been disenfranchised by the non-working parents.

    The other relevant issue associated with the role of the parents in the day care
    centers was the interest of the parents for their children to acquire added skills that
    would prepare their children for the formal elementary education. This attitude is
    not consistent with the intent of the law.

9.11 Separation Anxiety in the Transition from DCCs to Grade One

    In the preceding section, it was noted that parents stayed with their children during
    the sessions at the day care centers. As a consequence, children were unable to
    get used to being independent in the class.

    The field visits revealed that many parents stayed within the school premises to
    wait for their new Grade 1 children. This issue was highlighted in one case where
    a child cried and refused to enter the Grade 1 classroom fearing that her mother
    would eventually leave her behind as soon as she enters the class room.

9.12 Inappropriateness and Inadequacy of Instruction Materials for the Eight-
     Week Curriculum

    Grade 1 teachers (GOT) are required to attend the training for the implementation
    of the eight-week curriculum for GOTs. However, the provisions for instruction
    materials was very limited at best. Thus, GOTs e.g., in the Cagayan Valley and
    Misamis Occidental either prepare or buy visual aids which may not conform to the
    prescribed ones. This was observed in one of the field visits where the Grade 1
    teacher used materials with inappropriate examples and quite small that could be
    hardly seen at the back of the classroom. The situation is more problematic for
    GOTs who have not attended the eight-week curriculum training but tasked to
    teach Grade One students. These teachers rely on the learnings of other teachers
    as well as borrowing or making their own visual materials. Further, while the ECCD
    law was explicit in the promotion of location-specific learning materials, this has not
    been operationalized in all barangays.



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9.13 Multi-Tiered Schemes (ToTs)

       To deliver the human resource development (HRD) component through training
       activities, the implementation strategy was to employ the Training of Trainors (ToT)
       concept. Feedback from the field visits indicated that there has been a significant
       departure from the standards of the acquired knowledge and skill by the local
       stakeholders through the ToT concept.

9.14     Sectioning of the School-Ready and Not School Ready Pupils

       In some instances, the number of identified non school-ready pupils was
       considerably low. To mitigate this situation, the non-ready pupils were separated
       into another section which was to be handled by another teacher. However, there
       is no curriculum for the non-school ready pupils. As such, the head teacher simply
       made the instruction to the teacher-in-charge of the non-school ready to tone down
       the level of treatment. This was compounded by the fact that the teacher-in-charge
       of the non-school ready did not attend the training program for the eight-week
       curriculum. The problem became more complex in cases where there is only one
       classroom for the new Grade 1 entrants, which would be expected in most of the
       communities under the ECCD program.


10.0     RECOMMENDATIONS

10.1    Harmonization of the Existing Statutes with ECCD

       Prior to the ECCD Law, there were various statutes promulgated to effect the
       delivery of ECCD services. The problem is, such laws had scopes much broader
       than ECCD, which mainly focused on children zero to six years old. It is suggested
       that explicit policies should be promulgated to develop a framework within those
       respective laws so that the implementation can be structured based on the specific
       needs of children stratified according to a rational age grouping. For instance, the
       law providing for the protection of children is concerned with child labor. For all
       practical purposes and intent, this concern may not be very relevant to ECCD.
       Also, the child-centered development mechanism envisioned for LCPCs and local
       ECCDCCs is lacking. As a consequence, there was no comprehensive set of data
       regarding the situation of children aged 0-6 years and their families in Calamba.
       Whatever available data were not presented according to age ranges and
       developmental stages so it was not clear which pertained to ECCD and non-ECCD.

       To operationalize this, the existing ECD programs under various existing laws can
       be structured by concerns according to age categories. It should not be very
       difficult to embrace the idea that there could be health, nutrition, education and
       social protection concerns according to various life stages from early childhood to
       young adulthood. For instance, the Child 21 framework for child development
       should be emphasized to LGUs. This framework uses a life cycle approach in
       planning, thus, stratifying needs, programs/services, outputs according to age
       groups—Mother and the unborn child; infancy (0-less than 1); early childhood (1-6);
       middle childhood (7-11); and adolescence (12-17).

10.2 Flexible Equity Policy

       As with the other programs of the government, the equity of the LGU should be
       based on its capacity to pay. Most often, high incidence of malnutrition and infant
       and under-five mortality is high in municipalities belonging to 5th and 6th class


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                                                                             Final Report


       municipalities, thus, these are the ones in need of assistance but do not have the
       capacity to cover its equity. For them to be able to participate, there is a need to
       either waive or adjust the equity requirement.

10.3    Proper orientation of the members of the BCPC on ECCD

       As argued earlier, the BCPC is also involved in most of the major development
       programs in the barangay, wherein the scopes are much broader than that of the
       ECCD. To avoid the problem of delineating the ECCD concerns within the
       mandate of the previous statutes where the BCPC is also involved, there is need to
       ensure that the BCPC members are properly oriented and clearly informed of their
       role in the implementation of ECCD and that the Committee on Early Childhood
       Care and Development must be created as specified in the guidelines.

       To run parallel with the structures from the national down to the municipal level, a
       secretariat at the barangay level must also be created. This can be headed by the
       DCW. The other members could be the parent representative and the NGO
       representative. Two other members of the secretariat can be drawn from the
       community at large chosen by the BCPC sub-committee on ECCD upon
       endorsement of the parent representative.

       Finally, there is the need to reconsider the concept of voluntarism in the
       implementation of ECCD programs at the barangay level. It is suggested here that
       an explicit policy on incentive schemes should be provided in order to enhance the
       level of effort and commitment among the service providers.

10.4 Advocacy program for ECCD

       There is a need to enhance the information, communication and education
       activities of the ECCD. This can be done through posting of signage in strategic
       areas in ECCD communities; development of IEC materials; and holding of slogan,
       logo, and essay writing contests.

10.5 Tapping Alternative Fund Conduits at the Community Level

       To instill a sense of ownership to the program by the local stakeholders, there is a
       need to engage the community in the identification and implementation of ECCD
       including the ―power of the purse‖. However, this has to be done in a way so as not
       to allow for the political factors to dominate in the decision making process. The
       ―KALAHI‖ experience can be replicated under ECCD where                      peoples‘
       organizations were established and were utilized as conduits of the interventions
       under the program. In this manner, the final decision in the type of interventions to
       be funded and how it will be managed are seen to contribute to efficient
       management of the project and ownership.

10.6 Technologically Appropriate Monitoring System

       For a monitoring system to work efficiently for ECCD, there are three basic
       elements to be considered: the data requirements; the repository; and the system
       of processing and retrieval.

       For the data requirements, it is critical to structure the data set by the critical age
       group. Again, the nutrition case can be cited to drive the point. It was established
       that the initial report of low malnutrition was based on a statistical report of all
       children between zero to six. It is argued here that aggregating children from zero


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       to six years old would distort that true picture of the children‘s nutritional status.
       The incidence of malnutrition among infants would be very low. This, in effect
       distorts the true picture by pulling the central tendency measures downwards. This
       is the reason why the report indicated a low incidence of malnutrition.           It is
       suggested here that the data system should be stratified according to a more
       reasonable age grouping so as not to distort the general character of the
       population.

       The other is the repository of the data. Since the crucial integration and
       convergence of ECCD services is at the barangay level, then the barangay ECCD
       committee should have a handle of the data sets at their level. Hence, a system
       must be instituted at the barangay level which could be designed for aggregation at
       the municipal, provincial, and national level.

       However, an ECCD implementer must know that a typical rural barangay would be
       at least five years away from maintaining a computer that could be host to an
       ECCD monitoring system on a day-to-day basis. Further, the system would need
       the presence of a qualified staff with functional knowledge on basic database
       computer applications. A barangay should have the internal capacity to maintain a
       computer system. Computers made available to remote barangays would have a
       life-span of about six months. Hence, it is suggested that at an early stage, it may
       not be necessary or appropriate for a barangay to set up an electronic data system.
       At the barangay level, an index card system could work. The level of aggregation
       in electronic form can be done at the municipal level.

       Furthermore a monitoring system should encompass indicators to measure both
       performance and impact. For the former, the data capture instruments should be
       simple enough to allow for easy and systematic encoding, storage, processing and
       analysis. For the latter, the system should built-in benchmark indicators that are
       generated on a longitudinal perspective.

10.7 Convergence of ECCD Services

       One of the critical added values of ECCD relative to the prior ECCD laws is its
       mandate to affect the convergence of ECCD services. However, at this point, the
       concept of convergence is still not internalized. Hence, there is no convergence in
       the implementation of the services.

       It is suggested that in the short run, there is a need for a massive reorientation of
       the service providers and stakeholders on the concept of convergence particularly
       in relation to and its difference from an integrated ECCD services. There is also a
       need, in the short run, to organize a referral system so that the ECCD services can
       converge to a certain child or better still to a specific household. In the long run, a
       better approach to allow for the convergence of ECCD services is to have an
       inventory and needs assessment at the household level so that ECCD services can
       be tailored to fit and converge to a specific household.              Also, in facility
       development, convergence of services can be enhanced if a one-stop ECCD shop
       can be the basis for the development of ECCD facilities

10.8    School Readiness at Entry to Grade One

       The high dropout rate prevalent in Grades 1-2 in our country (Heaver and Hunt,
       1995), plus the very low national achievement results of children in the early grades
       prompted the Bureau of Elementary Education to explore various ways to better
       prepare children for school. This has also been cause for the emphasis on school


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    readiness, transition from home to school, and keeping children in school. Initially,
    there was the Summer Preschool Program, which aimed to develop the
    socialization and ―readiness‖ skills of children aged 6.5 to 7 years entering Grade 1
    in the coming school year. The entry age requirement then was 7 years. Overall,
    this pilot program met with mixed success. However, the drop out rate in the early
    grades of children who were preschoolers in the program was only one percent
    compared to the 15 percent for children who did not have the summer preschool
    experience. Complementarily, in 1994-1995, the official age for entry into primary
    school was dropped to 6 years of age. DepEd justified this policy through a
    research that showed there was hardly any difference in the competencies of the 6-
    and 7-year-olds.

    Furthermore, majority of children entered school then ―at a definite disadvantage‖
    because they have not had the opportunity to go to preschools or avail of the DCS
    at the least). So in a typical Grade 1 class in the public schools, majority of the
    students did not have prior ECE experiences and were, thus, unprepared for formal
    education. Hence, in order to mitigate the problem of school readiness upon entry
    to Grade 1, the following measures are suggested: Continuing education of DepEd
    teachers on ECCD, preschool education/teaching strategies and production of
    teaching devices are called for. District supervisors and coordinators of specialized
    areas reiterate the same need; Develop and implement developmentally-
    appropriate curriculum, learning materials and creative activities for Grade 1; The
    development of Standards for Learning Competencies in ECCD must consider that
    majority of our children do not access ECE programs prior to entering primary
    school (despite the availability of DCS and in spite of the new National Preschool
    Education program). Therefore, the learning competencies of the national
    ECCDCC sets for the 6 year olds must provide more time for them to acquire such
    in Grade 1. Many Grade 1 teachers are still apprehensive that the 8-week
    curriculum would infringe on their budget of time to work on the present Grade 1
    curriculum. They often mention the ―No read, no move‖ policy for Grade 1 children;
    and the total development of children, not preparation for elementary schooling
    alone, is the imperative of all early education programs, including Early Childhood
    Experiences in Grade 1.

10.9 Promote a Policy of Child Weaning at the ECE Stage

    Field observations revealed that most of the parents stayed with their children
    during the entire session of the DCCs. As a consequence, children are unable to
    develop the sense on independence and confidence to do the ECE activities
    without the presence of their parents. This attitude hampers the smooth transition
    of the children‘s learning process from ECE to Grade 1. It is suggested here that
    parent should be discouraged from staying within the premises of the Day Care
    Centers during session hours. However, to be consistent with the concept of
    developing an independent child, the parents can be involved in specific tasks in
    the day care sessions on a staggered schedule so that only about two to three
    parents can be involved in any given day care activities. Further, this arrangement
    eases the workload of day care workers.

10.10   Apply a Modified ToT

    The ToT concept can be best utilized when the trainees themselves are already
    capable trainors. The essence is to orient the trainor-trainees the perspective on
    the new subject matter. If the ToT concept is applied to stakeholders who were
    never trainors themselves, then there are many avenues for knowledge gaps and
    effectivity of knowledge transmission. It is recommended that the training should


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    be made directly to the local stakeholders at the Barangay level. If there are
    logistical constraints, then capable trainors from locally based (Regional/Provincial)
    academic institutions and NGOs can be tapped as the direct trainors for the local
    service providers. If necessary, then the trainors from locally based institutions can
    be the recipient of a ToT for ECCD in their respective areas and must be tasked to
    train the ECCD service providers.

10.11 Research Agenda

    One of the most fundamental issues that was abstracted in the review was the
    apparent tension between the original guiding principle of the Day Care Center,
    which was to cater to the needs of the working parents vis a vis the trend in the
    demand of the non-working parents of day care children to use the center as the
    transition towards elementary education. This must be investigated systematically
    in order to draw more precise policy prescriptions.




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Annex 1: Case Studies

1.0   Province of Zambales

1.1   Profile

Zambales is located along the western coast of Central Luzon. It is bounded on the north
by the province of Pangasinan; on the east by Tarlac and Pampanga; on the south by
Bataan; and on the west by China Sea. The topography of the province is generally
irregular, with the coastal plains and valleys stretching from Lingayen Gulf down south
towards Subic Bay along the western coast and further towards a 17 kilometers (km.)
stretch of shoreline.

Zambales has a total land area of 3,714.4 square kilometers (sq. km). Botolan and
Masinloc have the largest land area with 613.7 sq. km. and 440.9 sq. km., respectively.
These are the towns where the mountain ranges of Zambales are found. Sixty-nine
percent of the land area is classified as timber land.

As of 2000, the province has a total population of 627,802. Olongapo City had the
highest number of population at 194,260 followed by Subic with 63,019 and Sta. Cruz
with 49,269. The Municipality of Botolan where Barangay Porac is located ranked fourth
with 46,602 total population.

While the number of infant deaths decreased from 2000 to 2003, there was a notable
increase from 2001 to 2002. This was in contrast to the country‘s pattern where there
was a decrease in infant deaths from 99 or 11.4 per 1000 live births reported (FSHS
2006). Infant deaths were a lot higher compared to deaths in the one to four years and
in the 5 to14-year age groups. The high incidence of under-five mortality was attributed
to the group‘s inherent low resistance to diseases aggravated by the inadequate supply
of essential drugs especially to the underserved population.

The most common causes of infant mortality had not changed from 1998 to 2003.
Pneumonia remained to be the most common cause. Five out of the 10 leading causes
were conditions present during the newborn period such as prematurely, congenital
anomaly, sepsis neonatorum, ARDS, and asphyxia neonatorum. In the 2006 FHSIS
data, Zambales had eight deaths from neonatal tetanus equivalent to a rate of 0.9 per
1000 live births.

The following are the health services offered in the province:

Expanded program of immunization. There was no common trend for all the
municipalities in the province on this aspect. Only San Antonio had a steadily increasing
trend during the four-year period while the rest of the municipalities showed fluctuating
rates. However, full immunization rates were higher in 2003 compared to 2002 in
Palauig, Botolan, Cabangan, San Antonio, San Marcelino, Castillejos and Subic. The
total full immunization rate for the entire province did not vary greatly but the rate in 2003
was lower than the rate in 2000.

Hepatitis B vaccination has been included in the EPI but has not been widely
implemented yet. The provincial accomplishment for Hepatitis B immunization from years
2000 to 2003 was low because of the irregularity and inadequacy in the delivery of
vaccines. In 2003, the rate was lowest in Masinloc (20.4%), Palauig (21.3%), and
Botolan (32.5%), while the highest was in San Felipe (72.8%).




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                                                                            Final Report


Prenatal and postnatal care. The percentage of pregnant women who received tetanus
immunization during prenatal checkup was 43 percent in 2003. This was higher than the
2000 value at 38.6 percent. Pregnant women were also informed about the benefits of
breastfeeding. Regional Health Unit (RHU) personnel and BHWs conducted health
education to motivate them to breastfeed exclusively.

After the delivery of the infant, the personnel visit post-partum mothers at least twice
before the cord stump falls off. Post-partum mothers go to the clinic for at least one post-
partum check-up. The percentage of mothers who had at least one post-partum check-
up declined steadily from 61 percent in 2000 to 49.3 in 2003. In 2003, it was lowest in
Subic at 22.9 percent and highest in Castillejos at 87.9 percent.

Moreover, malnutrition remains to be a problem of Zambales, affecting particularly young
children. From 2003, the province started to use the International Reference Standard
(IRS) for classifying the nutrition status of children. Based on the IRS, the prevalence of
below normal (low and very low) weights among preschool children declined steadily
from 2003 to 2005. However, the prevalence increased from 9.79 percent in 2005 to
11.37 percent in 2006.

Examining the occurrence of underweight according to age group in 2004 and 2005, it is
apparent that the prevalence is lowest at 0 to 11 months old (0.69 %) compared to any
age group between 12 and 71 months (1.86-2.31%). However, 2005 data showed an
increased frequency in the 0 to 11 months old to 0.82 percent while there was a decline
in the prevalence in age groups 12 to 71 months.

The incidence of below normal weight was higher among school children (age 6 to12
years old) compared to preschool children in all years studied. However, the increasing
trend from 2005 to 2006 was also noted in the school-age children.

Micronutrient deficiency is another public health concern in Zambales. According to the
FNRI data in 1998, 13.4 percent of children six months to five years old in Zambales had
vitamin A deficiency. This was higher than the prevalence in Region III (6.8%) and in the
Philippines (8.2%). The same observation was noted in iron deficiency anemia wherein
the prevalence in children six months to five years old in Zambales was higher than the
regional and national values. Iron deficiency anemia was highest in children six months
to one year old at 68.6 percent and lactating mothers at 60.5 percent. Anemia in
pregnant women was 38.9 percent, which was lower than the regional and national
values.


1.2    ECCD Structure and Management

The Governor is the over-all chairman of the ECCD system and the PECCDCC is the
managing team. The provincial government has an existing Sub-committee for the
Welfare of Children (PSCWC) which also serves as the PECCDCC. The chair of
PECCDCC is the Provincial Social Welfare and Development Officer while the School
Division Superintendent acts as the Vice-Chair. The members are composed of the
representatives from the Provincial Health Office (PHO), PPDO, Provincial Population
Social Services Division, Provincial Nutrition Action Office (PNAO), Department of
Interior and Local Government (DILG), Provincial Finance Committee, Philippine
National Police or PNP-Women‘s Desk Officer, Chairman, Provincial Council Committee
on Social Services, PSWDO, NGO (Hiyas ng Pagasa), PO (ABSNET) and DSWD-SWO
II.




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The provincial government hired an Assistant Provincial ECCD Officer (APECCDO) in
accordance with the guidelines set by the CWC. CWC guidelines allow the LGU to hire
either a PECCDO or an APECCDO. However, the province of Zambales has opted to
hire an APECCDO for reasons that an outside person lacks the connections with the
agencies involved. While the other members of the PECCDCC have other
responsibilities outside of ECCD, the APECCDO‘s responsibility is solely on ECCD, and
s/he acted as the over-all coordinator of the program.

Every ECCD municipality has its own management team referred to as the MECCDCC.
In Botolan, the Municipal Council for the Protection of Children (MCPC) also serves as
the Municipal ECCD Coordinating Council (MECCDCC). ECCD matters are discussed as
part of the agenda in MCPC meetings. In the barangay level, the BCPC functions as the
Barangay ECCD Coordinating Council (BECCDCC). No additional staff was hired in
Botolan and Porac for ECCD implementation.

1.2.1 Planning
ECCD implementation in Zambales started in June 2006. But even prior to the passing of
the ECCD law, the provincial government had already prepared a strategic plan to
address the needs of children in their Local Development Plan for Children (LDPC) for
year 2000. The detailed plan was sponsored by Vice-Governor Cheryl Deloso.
Unfortunately, it was not implemented because of the lack of funding and change in
administration after the elections. When the ECCD law was passed, the said LDPC was
revived and was used as the basis for the ECCD implementation in the province.

In 2003, the province started compiling data from the component municipalities on the 10
indicators set by CWC as the basis for the selection of program areas. These 10
indicators are: 1) population of zero to six children; 2) maternal mortality rate; 3) infant
mortality rate; 4) participation on ECCD programs; 5) drop-out rate in Grade 1; 6)
prevalence of underweight; 7) prevalence of stunting; 8) prevalence of wasting; 9) under-
five mortality rate; and 10) poverty incidence. Among these indicators, data available
were only on the first six, which became the basis in ranking the municipalities. The
ranking was utilized in the ECCD planning workshop to identify program areas. To
concentrate the ECCD funds and to make a considerable impact, the top 3
municipalities, namely: Masinloc, Botolan, and Subic were chosen.

On March 23, 2005, the provincial council passed Resolution No. 2005-120 authorizing
then Governor Vicente P. Magsaysay to enter into a Memorandum of Agreement (MOA)
with CWC National Executive Director Lina B. Laigo and DSWD Regional Director
Margarita B. Sampang. The MOA was finally executed on December 28, 2005.

During the planning stage, the municipalities attended an orientation and workshop on
ECCD. They were also required to submit an investment plan and work and financial
plan (WFP). After the approval of the said plans, Resolution No. 2006-54 was passed by
the Provincial Council adopting the said ECCD investment plan and WFP on March 6,
2006. The province was then required to raise an equity equivalent to 30 percent of the
total investment plan for three years. Each municipality, on the other hand, needed to put
up an equity of 10 percent. All of the required equities were met by the LGUs.

The municipalities used different bases for choosing the barangay to be included in the
implementation of ECCD. In Masinloc, all 13 barangays were said to be included to avoid
complaints from any barangay that would not be chosen. Five out of 13 barangays in
Subic were included in the ECCD implementation; most of these barangays have
significant numbers of Muslim communities.



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In Botolan, 10 out of 31 barangays were included in the ECCD implementation. The
selection was based on six criteria set by the CWC for which data were available. The 31
barangays were ranked according to the indicators. The ECCD team in Botolan together
with the mayor decided to get the top 10 neediest barangays to be included in the
program to concentrate the funds in priority areas. The MECCDCC recognized the
commitment of the Mayor to the ECCD program; he has volunteered to shoulder the
construction and upgrading of the health centers and DCCs so that the CWC fund could
be devoted solely to the actual implementation of the ECCD programs.


1.2.2 Financial Management

The PECCDCC prepares a budget based on the investment plan and WFP submitted by
the ECCD municipalities. Once approved by the CWC, arrangements are made for the
transfer of the funds. The provincial government is required to put up a counterpart
equivalent to 30 percent of the total budget before the release of the funds. The total
ECCD budget for 2006 was PhP7,852,476.20. Eighty percent of the total budget was
allotted for the ECCD implementation in the three selected municipalities. The 20 percent
remained in the province for administrative and training expenditures under the Centrally
Managed Fund.

ECCD implementation in Zambales started on the third quarter of 2006. PECCDCC
released the budget to the three ECCD municipalities in two installments, each to finance
the programs for two quarters of the year. Each municipality was required to put up 10
percent equity for the program implementation. After almost a year of implementation,
utilization of the first half of the budget was 86.8 percent. The remaining funds were
added to the budget for the second half of the year. The release of the second half of the
fund was delayed because of the delay in the liquidation in some municipalities.

Botolan received a total of PhP2,095,238 for the first year of implementation. In addition
to this, they put up an equity of PhP259,000.00. Only 46.5 percent of the total ECCD
fund has been utilized after a year of implementation. The MECCDCC is the main
administrating body of ECCD funds. It makes the purchases and distributes them to the
10 ECCD barangays in Botolan. MECCDCC also required equity from each barangay.
The BECCDCC in Barangay Porac was not aware of how much fund was allocated to
their barangay. However, they were asked to give PhP10,000.00 as equity for the
feeding program.


1.2.3 Delivery System

The PECCDCC gave the municipalities the CWC guidelines on what programs may be
funded by the ECCD. The MECCDCC then decided what programs they would spend
the fund on. All the implemented programs in Botolan were included in the
recommended programs by CWC. They have not implemented programs outside of the
CWC recommendations because of the limitations set by the latter. The implemented
programs in Botolan were supplemental feeding, day care service,           eight-week
curriculum, family planning, PES/ERPAT, micronutrient supplementation, nutrition
education through PABASA, home and community food production, and maternal and
child health care including prenatal and postnatal care, immunizations, and family
planning. These services are administered and monitored by the respective agencies as
it was before the ECCD implementation. Accomplishments are then reported to the
MECCDCC.




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At the barangay level, the barangay officials of Barangay Porac had their first meeting
regarding the ECCD program in November 2005. According to them, they were included
in the program because they had a high number of malnourished children in their
barangay. In the implementation of the ECCD program, they have concentrated their
efforts and resources on Sitio Bucao. This part of the barangay has a high number of
Aetas that migrated from Mt. Pinatubo when it erupted in 1991. According to the reports
of the BHW and BNS, there are many malnourished children among this subpopulation.

The barangay officials are the implementing team of ECCD in the barangay. There are
no additional personnel hired for ECCD implementation. They attend regular meetings at
the municipal level to discuss ECCD. However, there is no regular meeting for ECCD in
the barangay level; ECCD matters are discussed during the BCPC meetings.

The MECCDCC is the main administrating body of the ECCD funds. The barangay
council is not aware of how much fund is allocated to their barangay. But the barangay
officials appreciate the presence of funding from the ECCD program. Because of ECCD,
they have funding for their feeding programs. The MECCDCC has also distributed
supplies for the DCC as well as medicines and some equipment for the health center.
The barangays do not request for particular supplies; all supplies are purchased and
distributed by the MECCDCC.

Although the provincial and municipal ECCD teams understand the ECCD programs,
some of the barangay councils have no concrete understanding of what ECCD is all
about. Some believe that all children under 18 years old are covered by the program.


1.3   Accessibility/Quality of ECCD Services

1.3.1 Health Services

The Bucao Health Center is located on a hill, about 30 meters climb from the main road.
It is estimated to be two kilometers away from the farthest household. Walking through
rocky trails is the only means for residents to go to these centers. Sitio Bucao has four
BHWs assigned to a specific area to ensure that the residents are informed about health
services. They usually go from house to house to inform residents of health programs or
even to deliver health services.

The basic ECCD services are offered in the Bucao Health Center. These are
immunization, prenatal and postnatal care, family planning, and primary health care.
Most of the services are scheduled on the day that the rural health midwife (RHMW) is
present in the center. She is present in the center once a week only and the task of
carrying out unscheduled services lies on the BHW.

The Bucao RHMW said that majority of the population avail of all the services provided.
In 2006, they have attained 100 percent full immunization rate in Bucao. Not all pregnant
women go to the health center for prenatal and postnatal care. Some of them go to other
service providers. In 2006, 29 pregnant women were seen in the Bucao Health Center.
Thirteen were referred to other service providers for management of high-risk
pregnancies. Eleven delivered in the hospital while 18 delivered at home. Only one of the
home deliveries was attended by the RHMW. The rest were assisted by a trained hilot
(traditional birth attendant).

The RHMW estimated that about 10 percent do not avail of services. Possible reasons
given were 1) distance from the health center, 2) the children work with their parents in
the fields, and 3) the parents fear that the children might get sick after immunization.


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                                                                          Final Report




1.3.2 Nutrition Program

Barangay Porac has invested on the feeding program because of its high malnutrition
rate. According to the PNAO, an effective feeding program must be conducted for 120
days. In this program, the children are fed once a day either around noon or three o‘clock
in the afternoon. The budget is PhP12 per child. In Bucao, they were able to conduct a
feeding program for 67 underweight children in 2006. The feeding program lasted for two
months only. There was good participation with only one dropping out because the family
transferred residence. However, out of the 67 participants only three gained weight and
only one had a sustained weight gain even after the feeding program.

Another feeding program has been started in July 2007 with 48 participants. There has
been an interruption to the feeding schedule because no food has been delivered from
the MECCDCC. One reason for the delay in the delivery of goods is the procurement
procedure as set by Commission on Audit (COA). No cash advances are allowed. No
new funds are released if the liquidation of the previous disbursement has not been
completed yet. This becomes a problem particularly in the feeding programs because the
feeding should be conducted daily but the organizers should make requests and do
canvassing every week to comply with COA procedures.

The BNS of Bucao also conducts the PABASA which is a mother‘s class program about
nutrition. The 10 modules for the program have been compressed so that the program
can be finished in seven days. Upon completion, the participants are given an
examination regarding nutrition. The BNS also encourages the families to plant
vegetables to augment their food source.


1.3.3 Health and Nutrition: Quality

The health center in Bucao was observed to be used for only a week during the interview
conducted. The RHMW and BHW were still organizing the center. The previous site of
the health center was a corner of the multi-purpose hall. There was no distinct room for
the health services. When the municipal office built a new building for the DCC, the old
DCC was converted into a health center. There were no room divisions yet, as it used to
be a classroom. There is, however, a curtained corner which would serve as the
examination room. It has provisions for a toilet with plans to have water connection
underway. The center has on its walls different information posters on immunization,
family planning, and IMCI treatment protocol. Some are old but most are new and
recently put up.

The Bucao Health Center has the necessary equipment for the delivery of services.
From the ECCD fund, they have acquired a new Salter scale to measure weight more
accurately than the commercially available scales. The center also has enough supplies
of gloves and syringes though it doesn‘t have medicines.

The Health Center is open eight hours a day from Monday to Friday. However, the
RHMW is available only on Thursdays because she goes on duty in other health centers
on the other days. Regular services such as immunizations and prenatal check-up are
scheduled on a Thursday. Consultations or concerns from the neighborhood that arise
on other days are initially attended to by the BHW. There are four other BHWs that rotate
on duty at the health center so that at least one BHW is present. The BHW comes from
different areas in Bucao and they have been assigned to promote the services to their
respective areas.


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                                                                            Final Report



In terms of competencies, the RHMW is a registered midwife. She has been in the
service for six years. She has attended training seminars on IMCI, EPI and MCH. The
BHW interviewed finished 3rd year high school. Before ECCD implementation, she has
already attended trainings on tuberculosis, healthy lifestyle, and birth control. However,
she has not yet attended any training on ECCD or health protocols.

The BNS, who also functions as a BHW, has completed a two-year secretarial course.
She has attended a training to become a BNS. She was also able to attend the ECCD
orientation in December 2006 together with the RHMW and was involved in the planning
of ECCD activities. She goes on duty as a BHW at the health center every Thursday.
She supervises the feeding program daily at 3 pm. There was good participation in the
feeding program in 2006 with only three children unable to finish because they needed to
transfer residence. There were instances when they brought the food to the house of the
child who was not in the site of the feeding program. In some areas, there were
complaints about the same type of food being given daily.

1.3.4 Early Childhood Education

The day care center is beside the health center and children who attend the service must
walk through the same rocky path. To get to the DCC, one must pass across a one-foot
wide and two-foot deep canal. The DCW says she has not heard any concern or
complaint about the safety of the surroundings and that the children are used to it. Some
of them are not even accompanied by their parents or relatives in going to school.

The day care service is under the direct supervision by the DSWD. It is offered to
children three to five years old for a fee of PhP50 monthly. Teaching sessions are
conducted daily from Monday to Friday. Each session usually lasts three to four hours. In
2006 only 30 out of 80 children ages three to five years old were able to attend the day
care. The DCW related that the IPs do not have good attendance in school for reasons
similar to those given for not availing of health services. For those who live in the
mountains, the day care may be as far as a half day walk from their residence. Some
also cited financial reasons for not sending their children to the DCC.

Three out of the 30 children enrolled failed to finish the school year. Ten students were
transferred to pre-elementary education in the middle of the school year because they
were already five years old and were therefore eligible for pre-elementary.

The pre-elementary is under the supervision of DepEd. The pre-elementary teacher‘s
compensation comes from the monthly student fees of PhP150 per student.
Furthermore, the five-year old children from the DCC were transferred to pre-elementary
to meet a total of 25 students in the latter. (The DepEd has promised to give an item to
the pre-elementary teacher if there are at least 25 students). According to the DCW,
there was coordination between the MSWDO and DepEd regarding this matter.

The pre-elementary classes are held from Monday to Friday with each session lasting for
two to three hours. The teacher follows the eight-week curriculum in the pre-elementary
classes. The entire school year is divided into two semesters. A child may choose to
start in any semester or start from the first semester and finish the entire school year. In
the latter case, the student would have gone through the eight-week curriculum twice. In
Grade 1, the child is again taught the eight-week curriculum at the beginning of the
school year.




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                                                                          Final Report


The eight-week curriculum has been designed for Grade 1 students at the beginning of
the school year. The Grade 1 teacher interviewed said that the children who benefited
most from the curriculum were those who have not gone through the day care or pre-
elementary.

1.3.5 Early Childhood Education: Quality

The DCC is a new building constructed from the municipal budget outside of the ECCD
fund. During the visit, the center has not yet been used. It still lacks furniture and
classroom décor. However, some of the teaching materials from the old center have
been transferred. There were educational charts on topics such as days of the week,
weather, months of the year, national symbols, family life, and rights of the child. There
were books provided by the ECCD program. The available compact discs were a mixture
of English nursery rhymes and Filipino children‘s songs. There were a variety of hand-
made children‘s educational toys such as picture puzzles, memory game, picture lotto,
among others, made by the DCW themselves. The DCW complained that learning
materials are not enough that she sometimes had to borrow from other teachers. Each
child also has on file an accomplished ECCD checklist. This is routinely done for every
child in the day care.

The DCW is a college graduate and she has been in the service for the past four years.
She replaced the previous Grade 1 teacher who has retired. She has attended on-the-
job training on the Day Care Manual in 2004 and training on the new ECCD Revised Day
Care Manual in June 2007. The Grade 1 teacher finished Bachelor in Science in
Industrial Engineering with 18 units of Elementary Education. She has been an
elementary school teacher for 19 years but year 2007 is her first time to handle Grade 1
students and to implement the eight-week curriculum while she did not receive formal
training on the curriculum, she gained on the topic from her colleagues and supervisor.

1.4 Integration and Convergence

The most common understanding of integration is the collaboration of different agencies
in implementing of a certain goal such as the ECCD program. They say this integration is
evident in the ECCD program because different agencies are involved. However, the
actual conduct of specific programs has not changed after the implementation of ECCD.
One difference is that the different agencies have become aware of the activities of the
others. This decreases the chance of duplication of services. There is also sharing of
data between agencies as exemplified by the weight and height measurements data by
the Municipal Nutrition Action Office (MNAO) being utilized by an NGO to determine the
target population. Perhaps the greatest impact of ECCD is the provision of funding for
services that benefit children aged zero to six years. Such investment by ECCD to this
age group has increased the awareness of different agencies and service providers on
the importance of the normal growth and development of children if they are to become
productive individuals.

This idea of integration in ECCD was shared by the members of the PECCDCC and
MECCDCC. However, majority of the ECCD council and the service providers in the
barangay do not have an idea of what integration is. Some do not even know what
ECCD is about; some heard of ECCD only during the interview. Although some of them
have attended an ECCD orientation, the information has not been shared with the rest of
the persons involved.




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                                                                            Final Report


The household interviewed has seven members. Three are children aged six months old,
one year old, and four years old. Other members living in the household are the
children‘s parents, grandfather, and uncle. The mother was the informant during the
interview. She has had prenatal check-up and vaccination against tetanus during her
pregnancies. All children were registered at birth. All of them were breastfed exclusively
for about one to two months. All of them were also fully immunized under the EPI
program. However, the father has not participated in any ECCD program. The parents
have not attended any PES or ERPAT. The mother has expressed the need for advice
on family planning, education on how to take care of children, and knowledge on tending
to a sick child.


1.5 Monitoring System

The PECCDCC conducts a monthly monitoring of the ECCD programs in the province.
They visit the ECCD areas and interview beneficiaries to evaluate the programs. Data
are also validated to assess the program based on the approved project proposal. The
individual agencies are responsible for evaluating their respective ECCD activities. Each
agency has its own monitoring instrument for the purpose. At the time of the interview,
the MECCDCC was still in the process of designing a common tool for monitoring and
evaluation of the implementation of ECCD programs. Until such tool is designed, the
individual agencies continue to utilize their respective reporting and monitoring forms.


2.0    The ECCD in Leyte

2.1    Profile

Leyte is one of the six provinces in Region VIII and it is classified as a first class
province. It has a total land area of 5,712.80 square miles divided into five congressional
districts. It has 2 cities, 41 municipalities, and 1,641 barangays (76.5% rural and 23.3%
urban). It is bounded by Carigara Bay in the north; San Juanico Strait and the Leyte Gulf
in the east; Southern Leyte in the south; and Camotes Sea in the west. The province is
mainly agricultural with some manufacturing industries.

Sta. Fe is one of the 41 municipalities in the province with a land area of 81.90 sq. km. It
is composed of 20 barangays and is classified as a 5th class municipality. It is bounded in
the north by Tacloban City; on the south by the municipality of Pastrana; on the west by
the municipality of Alangalang; and on the east by the municipality of Palo. The
municipality is located along the highway. Thus, it is quite accessible from Tacloban City.
However, it has far-flung barangays which can be reached by a single motorcycle.

The major source of income of households is farming with rice and coconut as main
crops. As of 2005, the total population was 15,384 which increased from 13,695 in 1995.
With an annual growth rate of 2.32 percent, the population is expected to increase to
20,301 by 2009. The population density is also expected to increase from 167 persons
per square km. to 247 persons per square km.

There is no hospital in Sta. Fe but it has one municipal health unit which is run by one
doctor, one nurse, three midwives each one assigned to cover seven barangays, one
dentist, one sanitary inspector, and two medical technologists. There are 42 BHWs who
are considered as the frontliners in the delivery of health services. In Barangay
Milagrosa, there is only one BNS. It was also reported that there is a disproportionate
number of health workers vis-à-vis the population. At present, each midwife is covering
more than 5,000 individuals spread over six to seven barangays.


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Based on the 2007 Annual Operations Plan of the Municipal Health Office (MHO), about
87 percent of mothers had prenatal check-up. Only 88 percent of the children were
immunized because the mothers failed to bring their children to the health center due to
work, fear of side effects/reactions of children, shortage of syringes, and no master list of
children and log book for missed children, and failure to follow-up. The municipality also
reported a high prevalence of malnutrition at 25 percent with an OPT coverage of about
86 percent.

2.2     ECCD Structure and Management

2.2.1    Planning

The implementation of the ECCD in Leyte started with the conduct of two workshops
(September 1-2, 2004 and November 4-9, 2004) initiated by the regional office of the
DSWD/CWC. The PSWDO selected two municipalities while priority barangays in each
municipality were selected by the MCPC. The province had no participation in the
selection and prioritization of the barangays. For a municipality to be involved in the
ECCD program, the following requirements had to be complied with: 1) Memorandum of
Agreement, 2) investment plan adopted by the Sangguniang Panlalawigan, 3) approved
WFP, 4) bank certificate as proof of the deposited counterpart, 5) appointment or
designation of an ECCD officer, 6) EO reorganizing and strengthening Local Council for
the Protection of Children (LCPC), and 7) letter of request. At the preparatory stage, one
of the target municipalities failed to submit the required counterpart on time which
affected the other municipality that was able to remit on time. The PSDWO wrote a letter
to the mayor to inform him that non-compliance could lead to giving the slot to the next
municipality in line.

The two municipalities, Sta. Fe and Matag-ob, were selected by the PCPC using three
criteria: 1) incidence of malnutrition, 2) non-participation in elementary school, and 3)
non-completion in elementary school. The PCPC used the 2002 OPT and National
Statistical Coordination Board (NSCB) data as basis. Sta. Fe ranked 2nd in criteria 1 and
ranked 1st in the other two. On the other hand, Matag-ob ranked 7th, 2nd, and 8th in the
three criteria, respectively. The ECCD plans prepared by the two municipalities were
consolidated by the PCPC into a provincial ECCD plan with additional activities
necessary for the management, i.e. communication, monitoring, advocacy, training,
among others. On the other hand, the barangays were selected by the MCPC together
with the PCPC.

Planning at the provincial level was done through the conduct of workshops. The
Regional Sub-committee for the Welfare of Children (RSCWC) organized the ECCD
planning workshop which was held in Villa Hotel, Ormoc City. Selected members of the
PCPC, MCPC, and BCPC were invited to attend. The workshop included several
sessions on 1) Framework of Child-Friendly Local Governance and Situating Child
Rights in Local Development Planning, 2) Situation Analysis, 3) Defining Strategic
Directions Until 2025: Vision, Mission, and Goals, 4) Defining Medium-Term Strategies,
Directions, and Actions; 5) Monitoring and Evaluation, and 6) Action Planning. The
RSCWC organized the workshop in coordination with the provincial government headed
by Governor Carlos Petilla.

The total budget needed to implement the plan for three years is PhP21,986,100. The
funds would come from the LGU (PhP4,125,000), CWC (PhP16,500,000) and
municipal/barangay funds (PhP1,361,100). For 2006, the approved WFP showed a
budget of PhP7,311,890; 80 percent of which came from CWC (PhP4,724,632) and 20
percent from the LGU (PhP1,181,158). For 2007, the budget amounted to a total of


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PhP4,400,000; 30 percent          (PhP1,300,000)      from    the   LGU    and    70   percent
(PhP3,100,000) from CWC.

Assessment was done at all levels using secondary data, i.e. prevalence of
undernutrition. The goals/objectives were also set by the PCPC, MCPC, and BCPC
during the planning workshops. No additional goals were added or deleted from the
national goals. The assessment stage is an important element in the whole planning
process. Thus, while using secondary data is practical, these may need to be
complemented with other assessment procedures, e.g. FGDs, conduct of strengths,
weaknesses, opportunities, and constraints (SWOC). Assessment can be given more
time and its own funding. Doing so could reduced disapproved proposals as well as
increase confidence in the plans to be submitted as these would reflect the true
picture/situation of the area.

At the provincial level, the provincial governor issued EO No. 085 which called for the
reorganization and strengthening of the Leyte Council for the Protection of Children.
Moreover, the Sangguniang Panlalawigan of Leyte authorized the governor to enter into
an agreement with CWC through a resolution (05-282) entitled ―A resolution authorizing
the Hon. Carlos Jericho L. Petilla, Provincial Governor, to enter into a MOA with the
CWC relative to the implementation of the ECCD program in the province of Leyte‖.
Another resolution was passed, Resolution No. 06-190, adopting and implementing the
ECCD investment plan for the Province of Leyte for CY 2006-2008 in the municipalities
of Matag-ob and Sta. Fe with a total project cost of PhP20,625,000.

At the municipal level, the MSWDO/ECCD coordinator requested for a meeting of the
MCPC and requested proposals per department. Then selected members, i.e. MHO,
MBO, Municipal Planning and Development Council (MPDC), engineer, DepEd, and
MSWDO attended the workshop held in Ormoc City. The accounting officer was included
in the planning but not in the workshop.

At the barangay level, the members of the BCPC responded to the invitation of the
municipality to be part of the ECCD program. They said that the municipality identified
and prioritized their barangay to be included in the ECCD program. During the FGD, the
BCPC members said that while they were able to attend and participate in the planning
workshop, they were not informed which of the proposed activities were approved or
disapproved. Moreover, at the time of the visit, the BCPC did not have a copy of the plan
that was submitted to the municipality and province. Thus, majority of the BCPC
members did not know the status of the ECCD program implementation in their
barangay.

The BCPC enumerated the needs of the barangay, i.e. renovation of the day care fence,
presence of underweight children; renovation of the old barangay hall to become the
barangay health station/center (which can be equipped with prenatal equipment,
supplies, and information materials); renovation of the day care center since it has no
playground (which limits the children‘s activities); no electricity, kitchen, water, and lights;
and no supply of medicines for simple ailments such as headache and iron supplements.
The BCPC conducted meetings to prioritize the identified needs of the barangay; these,
in turn, were submitted to the municipal level.

The BCPC was also able to comply with all the requirements including the counterpart of
PhP11,200 per year or a total of PhP33,000 for three years. The BCPC during the FGD
said that they were willing to give the amount from their Internal Revenue Allocation
(IRA) since the barangay would receive more than what they have invested in return.




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2.2.2 Financial management

According to the ECCD coordinator, the work and financial plan is prepared at the
municipal level with technical assistance from the ECCD coordinator and assistant
ECCD coordinator and consolidated by the ECCD provincial secretariat. Each LGU is
required to provide a yearly counterpart. It takes two months to prepare and process
project proposals but the release of funds takes longer.

The funds are disbursed by the Provincial Treasurer to the Municipal Treasurer as cash
advance depending on the total amount of proposals submitted and approved at the
provincial level following the ―no liquidation, no succeeding release policy‖. The supply
unit of the municipality is responsible for buying the equipment and supplies. But the
amount and type of supplies and materials to be procured are based on the approved
budgetary requirements specified and requested by the LGU. The equipment, supplies
and materials are procured locally when the proposal is approved.

The procurement process includes: 1) proposal prepared and submitted for approval of
the LCE, 2) supply unit prepares the purchase request with attached approved proposal,
3) delivery of supplies, 4) inspection, 5) prepare and processing of voucher for payment.

The barangay captain said that he liked the present set-up wherein the ECCD money is
not released to the barangay for disbursement. This way, he said, there will no questions
on how the ECCD money is being used. However, in this set-up, the BCPC will become
―powerless‖, e.g. they will not know how much money had been utilized and how much
money is left. Consequently, they will not be able to determine/assess if there is a need
to realign the budget. For instance, the money for supplementary feeding is released
from the municipality every week. When the treasurer is out of office, the activity stops
due to the non-release of funds which, in turn, results to the unscheduled stoppage of
the feeding program.


2.2.3 Delivery system

At the provincial level, the PCPC is responsible for the implementation and supervision
of the ECCD program in the municipal and barangay levels. On top of the province is the
RSCWC, which reports to the CWC at the national level. The CWC is responsible for the
development of overall policy and program, setting and dissemination of guidelines and
standards, and providing of technical assistance to the LGUs. One of the technical
assistance needed at the municipal and barangay levels is the issuance of
guidelines/standards on the different services. It is possible that all the
guidelines/standards, e.g. building code for DCC, standards for program delivery, can be
compiled and issued in the ECCD areas.

While the orientations/planning workshops were held in 2004 and the ECCD plan was
formulated in 2005, the implementation started in the fourth quarter of 2006 (October)
upon the release of funds. If the plan was implemented on time, the original schedule of
implementation was February 2006. With the delay in the release of funds, the activities
that are being implemented in 2007 are still using funds from the 2006 release. The
delay was due to the revisions in the ECCD plan as well as the need to resolve the issue
on cost sharing.




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Between the two pilot areas, Matag-ob is implementing the identified activities much
faster than Sta. Fe. As of April 2007, more than PhP1M have been released to Matag-
ob. In Sta. Fe, implementation has been delayed because of various unexpected
problems such as recent death of the municipal nutrition action officer and inability of the
municipal ECCD coordinator/social welfare officer to work due to the sickness and death
of a son.


2.2.4 Service Providers

The service providers are present at the provincial down to the barangay levels. At the
provincial level, the ECCD coordinator (designated by the PSWDO) and assistant ECCD
coordinator are the prime movers. The members of the PCPC are involved in the
assessment, planning, and monitoring of the ECCD program. At the municipal level, the
municipal ECCD coordinator (who is also the MSWDO) coordinates the implementation
of the ECCD program. The ECCD program frontliners (direct contact with households
and children) are the Grade 1 teacher, midwife, BHW, BNS, and DCW. These separate
workers provide services on health, nutrition, and preschool education, respectively.

Social Welfare Officer

The social welfare officer finds the ECCD goals as realistic and relevant ―if given full
government support‖. She said that the goal is ―to ensure that children from birth to six
years old receive consistently high-quality care and education so that they can develop
their fullest potential‖. She is also aware of the legal basis for ECCD as well as the target
participants (0 to 6 years old) and gives her full support and commitment. As a result of
the implementation of the ECCD program, her work load and responsibilities have
increased. At present, she is directly involved with the supplementary feeding which she
finds relevant, appropriate, and socially acceptable. Supplementary food is given to
underweight children (0 to 6 years old) in barangay Milagrosa, Sta. Fe once a week. She
always follows the protocol because ―we are subordinates‖ even though she had not
received training for implementing supplementary feeding. Interventions are promoted by
conducting meetings with parents and community. She also said that participation in
interventions is 100 percent.

The social welfare officer was not involved in the planning and decision-making process
of the ECCD program. She does understand that integration is ―immersion and
oneness‖. The nature and extent of participation is ―satisfactory‖ at the community level
but there is no collaboration with other private agencies or NGOs. The ECCD has
improved the delivery of services by improving the nutritional status of the children.

Barangay Nutrition Scholar and Barangay Health Worker

The BNS conducts OPT together with the BHW and midwife and assists the DCW in the
implementation of the supplementary feeding. The BNS has been working as such for
only six months. Thus, she is not able to fully perform the tasks expected of her, i.e.
conduct nutrition education which is quite a critical function. She needs training as well
as logistical support.

The BHW assists the midwife in providing health care services to a group of 20 to 30
households in a barangay. A law (RA 7883 enacted in 1995) has granted the BHWs
hazard and subsistence allowances, educational programs, civil service eligibility, and
preferential access to loans (Solon 2006). There are more BHWs (200,000) than BNSs
(22,000) in the country. In Sta. Fe, there are 45 BHWs spread over 20 barangays. They
conduct yearly OPT, assist the midwife, and follow up clients for immunization, family


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planning, among others. The BHW is given PhP900 per month honorarium by the
barangay.

Rural Health Midwife

The midwife provides the health care services, e.g. immunization, prenatal care which
she believes are relevant, appropriate, and socially acceptable. She provides these
services to mothers and children every month when she visits the barangay. She said
that only about 4 percent of children and mothers are able to avail of the services due to
insufficient funds to fully implement the different health programs. She finds the paper
work, e.g. FHSIS and immunization reports difficult. She submits these reports to the
nurse every month who is also her direct supervisor and the latter gives her feedback.
The midwife is assisted by the BHW in measuring blood pressure and weighing. She has
not attended training related to ECCD.

Day Care Worker

The DCW teaches the preschool children enrolled in the DCC and assists in information
campaign for immunization and dental services. She also weighs children enrolled in the
day care. However she does not compute the age in months, determines the nutritional
status, and implements and coordinates the supplementary feeding program (with 12
enrollees). The DCW is not using the ECCD curriculum and not yet conducting an
assessment using the ECCD checklist.

The DCW has been involved in the planning/decision-making because she attended the
planning workshop. Based on her estimate, about 90 percent of the population avails of
the services offered by the DCC while the rest cannot do so due to their distance from
the DCC. On some occasions, some children do not attend class for one week when
there is heavy rainfall or when they do not have money for transportation. Information
campaign about the day care service might not be as needed as the health services
since mothers would enroll their children based on their initiative.

The DCW finds teaching children as the easiest work because it is her main task; while
the hardest thing is working with the parents. The parents are difficult to organize and
are also busy with work in or out of the house to be involved in the activities of the DCC.
The DCW attends meetings at the MSWDO. However, she did not receive training on
weighing of children, using the IRS to determine the nutritional status of children, and the
conduct of supplementary feeding. She did receive verbal instructions but no handouts
or manuals. She was also able to attend a seminar on using the revised manual and on
using the new session plan for ECCD. The DCW also have other responsibilities such as
being a member of the barangay council. Sometimes, she has a hard time dividing her
time because meetings are called when she is teaching.

The DCW is using the integrated curriculum which she learned from the training on the
revised manual held last 6-10 August 2007 in Ormoc City. Her travel expenses were
shouldered by the barangay. During the training, she received a notebook, ballpen,
Manila paper, cartolina, and pentel pen. She also said that she further simplified the
curriculum and the activities since there were no materials or books that could be used
by the children. Further, she also organized meetings with parents, i.e. twice in 2006.
However, very few parents attended the meeting. She would also like to learn more
about guiding children‘s behavior, children‘s development, and use of Internet/computer.

The DWC is supervised by the MSWDO who visits the DCC monthly to look at her work
during sessions. She likes being ―monitored‖ and ―supervised‖ since she can receive
advice. She also submits quarterly report (number of children, drop outs, enrollees,


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transferees, among others), but she seldom receives feedback. There is perception that
discussions are done but no actions are implemented. With regards to ECCD, there is
no ECCD form or checklist that is being used.

The current DCW is qualified since she was able to meet the qualifications which are as
follows: female, between 18 and 45 years of age; high school graduate; physically
healthy; of good moral character; preferably with prior work experience with preschool
children; willing to undergo training and accept technical supervision from the MSWDO;
must render full-time service for a minimum of two years (UNESCO 2006).

With regards to the need to coordinate with the Grade 1 teacher, the DCW said that
DepEd offers pre-elementary education from October to May. The children eligible for
Grade 1 in the following school year transferred to the pre-elementary because free
notebooks are provided. Consequently, the number of children enrolled in DCC
decreases by October.

Grade One Teacher

The Grade 1 teacher handles two classes in one classroom. She has 22 and 18 pupils in
Grades 1 and 2, respectively. She has attended the training on eight-week curriculum
and has started to use it. She said that she needs support in developing teaching
materials to be used for teaching the pre-elementary class. She also stated that it is quite
difficult to teach two classes at the same time but she has to abide by the rule is that one
section should be composed of at least 35 students.

The DepEd prescribes the following qualifications and profile for teachers (Education
Order 107s, 1989) in preschools: 1) a Bachelor of Science degree with specialization in
Early Childhood or Kindergarten Education, Family Life and Child Development or
Elementary Education with at least 18 units in ECCD; an allied non-education college
degree with at least 18 units of ECCD; 2) male or female, between the ages of 21 to 35
years; 3) training, experience, and interest in working with young children; and 4)
certified physically and emotionally fit (UNESCO 2006).

The Grade 1 teacher also implements the Food for School Program implemented last
September 2006 which involves giving of 1 kilo rice everyday to Grade 1 pupils. The
teacher was of the opinion that the service was appropriate and relevant and all Grade 1
pupils were reached/covered. The direct supervisor is the principal-in-charge. The
teachers report their accomplishments every month using Form 2 (Attendance); Lesson
Plan/Daily Activity; and Exam (includes the result). The attendance and lesson plan are
submitted to the principal. Attendance is submitted monthly while the lesson plan
depends on the need. Feedback is usually received through an acknowledgement of the
submitted reports/form. The teacher was able to attend the planning workshops and from
there received handouts. The three topics that the teacher would want to learn more are
on 1) investment programming for children; 2) implementation process and financial
management; and 3) action planning.

In general, the various service providers have knowledge on children‘s rights, maternal
and child health and nutrition, and cognitive development even though they had no
training. Among the service providers, the DCW got a perfect score on children‘s rights
and on children‘s cognitive development. The score of the other service providers are.
This could mean that they have other sources of information other than from training,
e.g., printed materials. All service providers need more information on maternal and
children health and nutrition
.



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2.3 ECCD Accessibility/Quality of Services Delivered

The implementation of the ECCD programs/services is being coordinated by the ECCD
coordinator and assistant ECCD coordinator at the provincial level. At the time of the
field visit, the assistant ECCD coordinator has not been paid her salary for two months
already. Some activities proposed by the LCPCs were disapproved by CWC. For
example, as part of its advocacy program, the PCPC has requested for an LCD to be
used during trainings and workshops but this was disapproved by CWC. The BCPC said
that their request to fence the playground was likewise disapproved.

The ECCD plan includes several program/projects/activities as shown in Annex Table
2.3.1.The plan does reflect the need of the two pilot municipalities in health, nutrition,
and day care services. Some of the identified areas were similar but others were
different particularly for the maternal and child care package. The supplies and
equipment identified by the Sta. Fe group included: 1) examining table, 2) weighing
scale, 3) stethoscope, 4) sphygmomanometer, 5) scissors, and 6) umbilical cord clamp,
among others. This was because the barangay does not have a barangay health station.
The midwife assigned to the barangay holds clinic at the barangay hall which also needs
improvement. Moreover, the barangay hall is not suitable for prenatal care because of
the absence of the necessary supplies and equipment.

 Annex Table 2.3.1 Summary of accomplishments in the two pilot areas as of 2007,
                   Sta. Fe, Leyte
                     Sta. Fe                               Accomplishment indicator
    Orientation of BCPC on ECCD                   Conducted; 85% functionality attained
    Procurement of computer table                 Part of computer set requested
    Supplemental feeding                          Ongoing; 85% of beneficiaries increased
    Treatment of infectious and other              in nutritional status
     diseases                                      Ongoing; 100% of children and mothers
                                                    treated from infectious diseases

The barangay captain, as chair of the BCPC, leads the implementation of the ECCD
plan. He also coordinates the implementation of the plan and conducts informal
monitoring visits together with some of the councilors. Moreover, the BCPC said that
they depend on the ―say so‖ of the MCPC, e.g. what the MCPC gives, they accept, and
they wait for the next one. For example, the municipal engineer told them that the
construction of the health center will start in September 2007 so they are waiting for it to
be implemented. This situation, in addition to the fact that the BCPC did not have a copy
of the ECCD plan, shows that the barangay may not be proactive in implementation.

As of the first quarter of 2007, the activities listed in Annex Table 2.3.2 were reported to
have been accomplished and/or the implementation is ongoing at the municipal and
barangay level.

The MCPC FGD participants said that the ECCD helps the LGU in providing services to
children. The indigent families in the barangays will be given assistance in terms of
medicines and immunization, and supplementary feeding. They expect that the children
in the day care centers would have improved nutritional status, increased attendance,
and increased number of available learning materials.

Annex Table 2.3.2 Summary of activities included in the ECCD plan in Sta. Fe
     Programs                               Projects/Activities                     Sta. Fe
 ECCD advocacy      Involves the provision and installation of materials such as       /
                    signboards, etc.
 Social services    Capacity building: orientation of BCPCs on ECCD, training          /
                    on the revised DCWs manual, parent effectiveness service,


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     Programs                               Projects/Activities                      Sta. Fe
                    basic business management skills training, and skills
                    enhancement
                    Accessing social services: improvement of day care centers,         /
                    procurement of day care learning materials, provision of
                    honorarium to DCWs, livelihood assistance,
                    upgrading/procurement of day care facilities and structures,
                    installation of day care recreational/play ground facilities
 Health/nutrition   Treatment of infectious and other diseases (ARI, CCD,               /
 services           nutrition, PTB, dengue, measles, deworming)
                    Treatment of PTB on children
                    Maternal and child health care (pre-natal, natal, post-natal)       /
                    Immunization                                                        /
                    Procurement of dental health facilities and equipment (e.g.         /
                    dental chair, anesthesia for children)
                    Health education focused on proper dental care
                    Improvement of the Barangay Health Station to the standard          /
                    of Sentrong Sigla, e.g. installation of comfort room, lavatory
                    Women‘s reproductive health, e.g. pap smear, breast and             /
                    pelvic exam
                    Family planning and health education                                /
 Organization/      CPC/BCPC meeting                                                    /
 Management


The MCPC FGD participants also reported that the funds being used in 2007 are still
from the 2006 release. The day care center in barangay Milagrosa has not been
renovated. But materials are being procured; canvassing was already done. Except for
supplementary feeding, nothing much was done due to the election and to the delay in
the release of funds.

At the barangay level, the only program being implemented was supplementary feeding.
The DCW is given PhP700 to be used to buy foods and this is released and liquidated
every week. The allowance for each child is PhP12 per day for five days a week. There
were 12 preschool children included in the feeding program. The problem with the
weekly release of funds is that when the Municipal Treasurer is out of the office, there is
no money to buy food. Consequently, the supplementary feeding stops and resumes
when the Municipal Treasurer is present to release funds again. The children suffer from
this kind of arrangement because they are supposed to get the food for 90-120 days as
scheduled. Another issue is that some of the parents were too busy to do the tasks
assigned to them. Thus, the DCW either would do the work for them or find other
mothers to act as substitutes. This condition means additional work for the DCW. It could
also indicate that mothers are not fully supportive of the program or that other strategies
are needed to account for mothers who cannot do their assigned tasks due to work
inside or outside the home.

No innovative strategies or interventions or activities were identified and/or included in
the ECCD plans at the provincial, municipal, and barangay levels. It is possible that the
LCPCs are constrained from being creative and resourceful because of the requirements
and because funding is comes from the CWC. Probably a budget ceiling has been set or
a set of services has already been identified and enumerated in the guidelines.

Moreover, plans or programs for promoting ECCD were not in place. The P/M/BCPCs
had included advocacy activities in the plans, but these were not yet implemented
pending release of funds. Moreover, only activities were identified/listed with
corresponding budget; these were not really an ―advocacy or social marketing plan‖ with
its own set of objectives, strategies, and implementing guidelines.


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The family that was interviewed had not heard about the ECCD program and was found
to have limited access to health services (midwife goes to the barangay hall once a
month); DCSs; and to nutrition programs such as food, seeds for planting, information,
communication and education (IEC) materials, and counseling (BNS is newly appointed
and had not received training yet). This is a reflection of the access to ECCD services by
other households in Barangay Milagrosa which could also be described as limited. For
instance, there is no barangay health station; the midwife holds office in the barangay
hall which does not have the necessary facilities such as water, toilet, electricity, and
room for consultation. The midwife‘s visit is limited since she is covering seven
barangays. Further, the newly appointed BNS is not performing the expected tasks
except OPT. Lastly, Barangay Milagrosa also has no nutrition action plan, indicating that
there is no comprehensive action addressing malnutrition problem in the barangay. At
the moment, target households have access to supplementary feeding, immunization,
day care service, and growth monitoring through OPT. There are some areas in the
barangay which are quite far from the barangay hall thus, making access to health
services more difficult.

Though limited, the respondent was able to avail of prenatal care services including
tetanus toxoid immunization only. Four of her children were provided with medical
examination, birth registration, full immunization; two of her children were exclusively
breastfed and were able to enjoy extended breastfeeding and complementary feeding.
Her children were also able to attend the DCC which she thought should take in children
aged four years so that they would learn at an earlier age. She also said that children
were not accepted in Grade 1 if they were not able to attend day care.

The ECCD services are primarily being delivered through DCCs, elementary school
(Grade 1 entrants), and health centers/barangay health stations. The MSWDO has been
responsible for the implementation of the day care system since 1991 when the DSWD
was devolved after the enactment of the LGC. It is considered the largest provider of
ECE and education services for three- to four-year old children (UNESCO 2006). The
operation of the DCC is actually part of the National Preschool Education Program which
aims (among others) to upgrade the quality of preschool education to ensure that the
children would be ready to enter elementary school. As of 2000, there were 32,787 day-
care centers (out of 41,924). In 1998, 26.7 percent of the barangays was found to have
access to this program.

Likewise, the MHO is responsible for providing health and nutrition services through the
municipal health centers and barangay health stations. These are considered to be the
―main service delivery points for decentralized maternal and child health services that
complement the group experiences in day care centers‖ (UNESCO 2006). The municipal
health centers are manned by doctors, nurses and midwives. The barangay health
stations are staffed by midwives, BHWs, and in some areas, including BNSs.

There is a need to determine the reasons for not accessing health services. Based on
the DOH‘s Health Sector Development Project, only 70 percent of the poor used health
facilities, lower than the middle-income (75%) and the rich (82%) despite a corollary
survey showing that 32 percent of poor adults were sick compared to only 19 percent of
rich adults. Same report showed that the poorest 30 percent turned to traditional healers
40 percent of the time.

On the other hand, the DepEd (not a devolved department) implements the eight-week
curriculum to entrants to Grade 1 who have either graduated from public and/or private
preschools or have not attended preschool.



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Based on observation, there is a need to establish the links between services and/or to
make known the links from one service to another. For instance, the preschool child who
is expected to graduate from the DCC should be referred/linked to the Grade 1 teacher
(either in the private or public elementary school present in the area). There should also
be a referral system between the day care center, barangay health station, Barangay
Health Office (BHO), and police, among others. The types of links would probably vary
depending on the extent of present or future use of services. As of now, establishing the
linkages, especially at the barangay level, is quite feasible since the physical facilities are
located near one another. This strategy would probably help concretize the concept of
convergence and integration of services at the household level.

The quality of the ECCD services provided in Barangay Milagrosa was assessed in
terms of inputs (qualifications of personnel, availability of materials, and facilities) and
process (meeting the standards of what and how interventions should be done). The
barangay has a total population of 550 with 106 households; 19 pregnant women; 19
lactating women; and 16 children aged 0 to 16 years old.


2.3.1 Day care service/preschool education

The quality of day care service/preschool education needs to be improved. The day care
center needs to be renovated to include electricity, kitchen, playground (outside), play or
activity corners inside the classroom, and additional learning materials. The DCC
operates five days a week but with half-day sessions only. Each session would be
comprised of supervised play and group activities (arts and crafts, music and movement,
storytelling), childcare for personal hygiene, supplemental feeding, learning experiences
for early literacy and mathematics, and socialization experiences to support social and
emotional development. The day care worker needs to be trained on the new ECCD
curriculum. There is also a need for the DCW to implement the assessment of the
preschool children‘s developmental status using the Child Development Checklist and to
start using the new ECCD curriculum. In the supplementary feeding program, some
parents were not participating because of the cropping season. It was also observed that
feeding for some children has become a substitute for lunch or dinner. The protocol for
supplementary feeding is not being followed.

According to the mother/respondent, her children like to attend day care because they
like the teacher and they receive allowance everyday. The children like best the drawing
activity. However, the mother does not know of other activities done in the day care, of
any assessment made on the children, and how the assessment is done. However, she
knows that a child is given one star if she/he needs practice, two stars for ‗good‘ rating,
and three stars for ‗very well‘ rating. She is also not aware or has not been informed of
her children‘s progress in attending the day care.


2.3.2 Health services

The quality of health services is relatively poor. There is also low quality of BHS and
DCC infrastructures which affects the quality of services delivered to the children, i.e.
inadequate materials and facilities. Ideally, a barangay should have a barangay health
station with one midwife to provide services. In reality, the absence of a health facility
can be a major impediment to the delivery of services, i.e. pre and postnatal care, dental
services. Coverage of immunization and OPT were found to be both less than 100
percent. There is also a need to train the health personnel (midwives, BHWs) to become
more capable on managing childhood diseases. Moreover, health facilities/infrastructure



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should be improved and medical supplies should be provided as scheduled. Between a
BHW or BNS and DCW, there were more DCW noted than health volunteers.

The midwife holds consultation and provides health services at the barangay hall
(located within a compound which includes the day care center that serves as the
barangay health station) once a month. The barangay hall has a floor area of 4 x 5
meters and has been used as BHS for 10 years. The barangay hall is described as
―bungalow type‖ with jalousy windows, roof made up of galvanized iron sheets, with
concrete walls, and cemented floor. In front of the barangay hall is the highway and in its
back is a rice field. Beside the barangay hall is a free space which serves as a waiting
area or a playground. The source of water is a deep well. The barangay looks unclean
and untidy; it has no provision for garbage, but it has a small toilet. It has one table at the
center of the room, one filing cabinet, and one typewriter. A number of clients are served
per visit, e.g. 8 to 10 pregnant mothers and 20 lactating women; six children aged one to
three years old; five children aged four to six years old; and two children four to six years
old; and five adults. There is no annual plan and no budget for its operation as well.
Records that were available were target client list (updated); record of live births
(updated); family record (not updated); and daily service log. There are no equipment
and facilities in the barangay hall, e.g. stethoscope, thermometer, among others.
Syringes and sterile needles are brought by the midwife during her scheduled visit once
a month.

2.3.3 Nutrition service

The barangay nutrition committee has not been organized and no barangay nutrition
action plan has been developed. The BNS is newly appointed and has not attended any
training yet. She conducts OPT together with the midwife and BHWs and assists the
DCW in the implementation of the supplementary feeding. The OPT is a nationwide
program aimed at determining the nutritional status (using weight-for-age index) of
preschool children so that immediate nutrition assistance could be given to those
identified as underweight. The results of the OPT is also used in identifying and planning
nutrition programs.

Ideally, nutrition services for children refer to those covered by ―PPAN impact programs‖
such as nutrition education or promotion of exclusive breastfeeding for six months;
adequate complementary feeding starting at six months with continued breastfeeding for
two years; appropriate nutritional care of sick and malnourished children; adequate
intake of vitamin A, iron, and iodine; and food production, among others. Some of these
services are probably not being provided given the lack of training of the BNS and the
absence of a BNAP. The PNO prepares a nutrition plan funded by the provincial
government but this is not being submitted to the Regional Office of NNC.

The results of OPT among preschool children and weighing among Grade 1 pupils in
barangay Milagrosa in 2007 are shown in Annex Table 2.3.3.

 Annex Table 2.3.3. OPT among preschool children and weighing results among
             Grade 1 pupils, Barangay Milagrosa
              OPT results (2007)                    Result of underweight among Grade 1
                                                       students (as of January 2007)

 Total number of preschool children: 126        Below normal: 4
 Number normal nutritional status: 91           Normal: 11
 Number of below normal (BN): 18                Above normal: 0
 Number below normal very low (BNVL): 2
 Number of overweight (OW): 0
 Total weighed: 111
 Incomplete immunization: 20

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2.3.4 Pre-elementary education/eight-week curriculum

The quality (in terms of time and attention to pupils) of the teaching of Grade 1 pupils is
constrained by having just one teacher handling two classes (Grades 1 and 2) at the
same time. The two classes cannot be separated because of the DepEd rule that each
section/class should have at least 35 students. While the teacher is already using the
eight-week ECCD curriculum in Grade 1, there is a need for supplies to prepare
learning/educational materials.

The Grade 1 teacher should also continue to administer the school readiness test. This
test is given to all Grade 1 entrants in public elementary schools to determine children's
readiness of four developmental domains: (1) gross motor; (2) fine motor; (3) cognitive;
and (4) language. The children are then classified into those that are ―school ready‖ and
―not ready‖. Students who are "not ready" are made to undergo the eight-week
curriculum. Those who are "school ready" are expected to use the Grade 1 curriculum
right at the start. This classification and arrangement cannot be implemented in the
class observed since the teacher does not have enough time and space to separate
sessions for the ―not ready‖ and ―ready‖ children. Both Grades 1 and 2 classes as said
earlier are held in the same room. Moreover, the teacher bears the cost of photocopying
the school readiness form. The Grade 1 teacher is also burdened with measuring the
weight and height of pupils because she does not have the necessary equipment and
the training for nutritional assessment.


2.3.5 Integration and Convergence

The ECCD program framework puts importance on the concepts of coordination,
integration and convergence of services. In general, these concepts are not fully
operational at the local level.

Coordination is important in implementing the ECCD program. It could improve program
efficiency, reduce duplication, and maximize the use of resources. Coordination can be
done horizontally and vertically. Coordination exists at various levels, i.e. between the
chair and members of the LCPCs; among members of the PCPC, MCPC, and BCPC;
and from PCPC to MCPC to BCPC. This activity needs funding for activities such as
meetings, communication, visits, among others. The strategies used in coordination
should also be identified, i.e. meetings, communication through different channels.

Coordination is mostly done through meetings of the LCPCs. Relations of the members
of the LCPCs with the chairs (governor, mayors, barangay captains) was described as
‗satisfactory‘. The linkage from PCPC to MCPC to BCPC was also described as ‗well
established‘. However, coordination among members of the PCPC, MCPC and BCPC
particularly with the DepEd needs to be further defined and strengthened. At the
provincial level, the representative from DepEd does not regularly attend the PCPC
meetings. At the municipal level, the new district needs to be oriented on his/her role in
the ECCD program. At the barangay level, the Grade 1 teacher has to coordinate with
the DCW (e.g., more than half of the enrollees to the DCC are abruptly ―transferred‖ to
attend the pre-elementary curriculum).

During the meetings, issues on implementation of projects/activities are discussed (e.g.,
reasons why supplementary feeding was stopped, actions to be taken to improve the
construction of the BHS, etc.) However, it is the BC who coordinates with the MCPC and
the DCW with the MSWDO.


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The concept of integration (―joining up‖) of services must be understood by service
providers and the households since it helps improve access to, awareness of, and
confidence in delivering/availing of ECCD services. By providing the counterpart, the
LCE/LGU has shown its commitment to the ECCD program. However, this commitment
should be translated into more concrete terms (e.g., the target priority families should be
able to receive or access the services that they need at the time that the need these).
Moreover, for this to work, there is a need to identify the services that are already being
provided and the gap in each service that should be responded to accordingly.

The concept of integration is not uniformly understood and/or its being a component of
the ECCD program is not known to all. The PCPC refers to integration as the
implementation of services relevant and specific to children that maximizes resources
and prevents overlapping of services. The MCPC participants refer to ―integrated ECCD
services‖ as ―wholesome‖; ―more on the enhancement of children‖; and ―similar to
coordination where each agency implements its own ECCD related activities.‖

There is a need to have one definition of integration (formal and informal) and to explain
the where and what (levels) of integration. The approaches of integration being used
should also be identified, whether community-based (recognition of the family and
community as the natural context of the child), holistic (integrates, promotes and
provides for the child‘s needs through cluster of services, e.g. health services, nutrition
services), or rights-based (rights of the child). Further, there is a need to identify the
integrating mechanism, e.g. center-based delivery of services or joint planning,
assessment, and implementation.

One possible strategy of addressing this issue is to explain what approach/es are being
used to deliver ECCD integrated services, i.e. use of information or referral system,
placement of services near one another (barangay hall, barangay health station, day
care center are located in one area in the barangay), and pointing out the link between
the services provided from the barangay health station to day care center to elementary
school.

A consolidated review at the household level shows that the family was able to receive
routine services (not funded by ECCD), such as preschool education from the day care
center, and immunization, vitamin A capsule, and prenatal care from the health center.
The family also received supplementary feeding from the ECCD program funded by the
ECCD.

The family is composed of the father, mother and five children; two of whom are aged 4
years old and 10 months. The father works irregularly as a “mason” and occasionally
sells coconut salad while the mother tends to the sari-sari (variety) store. The mother has
more responsibilities than the father (Annex Table 2.3.4). Some responsibilities are also
shared by the father and mother but nobody waits for the children while the latter are in
school. Either the parents lacked time and would rather use the waiting time for more
productive activities or they really felt no need for waiting. The shared responsibilities of
the parents, however, showed the importance of education in their family life as they
spent time teaching and helping the children with their lessons.

In terms of parenting, time is spent with the children in doing some activities together
such as: 1) preparing the children‘s meal, 2) playing with the children, 3) taking children
to and from school, 4) helping the children with their homework, 5) exchanging/telling
stories with the children, and 6) sleeping. Activities which are not done together with the
children are 1) feeding the children, 2) taking the children for strolls or outings, 3)
working for pay, and 4) participation in community organizations.


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Annex Table 2.3.4 List of responsibilities of mother and father
 Responsibility of               Responsibility of mother                     Shared
      father                                                              responsibilities
 teaching              laundrying/ironing of clothes                    teaching children
   children their       bringing kids to school                           homework
   homework             teaching homework                                helping children
 helping               preparing meals for children                      with their
   children with        feeding the children                              homework
   their                buying food                                      buying food
   homework             taking care of children
 putting               getting health services for children, e.g.
   children to           immunization, VAC capsule, iron
   sleep                 supplements
 buying food           bathing children
                        helping children with their homework


The respondent believes that it is better and easier to discipline the children when they
are at the right age of 8 to 10 years old. When children behave, they reward them with
food (fruits), praises, and hugs/kisses. These are done so that the child would persevere
and get inspired to behave well. However, they do hit their children when they
misbehave especially when they don‘t listen to advices. Parents teach the values of
being God-fearing, helpful unselfish, and respectful to elders by frequently reminding
their children of these values. They would like to see their children finish their education,
learn how to socialize with people, and praise God.

The respondent tries to protect her children by selecting their printed reading materials
and by minimizing the exposure of children when they (couple) have
arguments/confrontations. The family does not engage in neighborhood activities
because they do not know how to play bingo and other forms of gambling. Rather, they
encourage their children to attend religious activities and engage in worthwhile
undertakings like playing musical instruments and joining in sports.

The mother had six pregnancies but one child died at birth. In all her pregnancies, she
availed of prenatal care from the BHW. She also breastfed two of her five living children
for four months. She decided to breastfed her children because of limited money to buy
milk formula. She started complementary feeding with foods like vegetable soup or fish,
cereal (e.g., Ceralac) when her children were eight months old. The frequency of feeding
was eight times a day, which is relatively high. To prevent the children from getting sick,
the mother 1) gives them a bath (about five minutes spent with child), 2) sterilizes
feeding bottles, 3) buys water for drinking (PhP2/container), and 4) ensures having a
toilet inside the house. She also feeds her children with mango, biscuit and soft drink
(e.g., Royal) when they are sick.

Parents especially the primary care giver should be taught how to prepare food since
they are the ones who purchase and provides food to the preschool children. They make
decisions in behalf of the children. Thus, poor parenting skills related to nutrition (e.g.
poor weaning practices) could exacerbate the problem on nutrition among preschool
children. Studies have shown that children under five years have a greater demand for
nutrients and energy to support the body's requirements for growth and development
than at any other time throughout their life cycle (Taylor et al. 2004).




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2.3.5 Monitoring System

At the provincial level, the PCPC included a mid-term review and monitoring visits in the
place. The provincial ECCD coordinator and one technical staff conduct the monitoring
visits. The ECCD provincial team also conducts monitoring visits accompanied by the
RSCWC focal person and/or ECCD regional coordinator. They provide verbal feedback
to the mayor and to the municipal ECCD coordinator as well as to the regional office and
PCCD team. Because of the feedback during the monitoring visits, concerns are
immediately acted upon. The ECCD coordinator has devised a monitoring tool to
facilitate the recording of the results. However, no management information system has
been established at all levels. No prescribed monitoring tool has also been prescribed for
the barangay, municipal, or provincial levels.

At the municipal level, the MCPC conducts monthly monitoring. Funds for these visits
have been included in the plan. During the monitoring, the MCPC learns of issues on
implementation at the barangay level. For instance, some mothers are not able to buy
the food to be used in the feeding program (their assigned tasks) since they do not have
money for fare going to the market. Some mothers do not cook the food to be served to
the children because they are either busy or they feel that they are always the ones
cooking. The MCPC inform the chair of the MCPC and BCPC on such issues.

At the barangay level, the BCPC chair and councilor monitors the implementation of
ECCD activities, e.g. supplementary feeding done in the DCC. However, this is done
informally (i.e. mainly observation, doing unplanned visits) and no monitoring tool is
used. The DCW also submits reports on the supplementary feeding activities to the
MSWDO and the MNAO, and gives a file copy to the barangay. The DCW contends that
the BCPC knows the status of the supplementary feeding‘s implementation since the
child of one of the councilors is among the beneficiaries.



3.0   Province of Davao Oriental

3.1     Profile

Davao Oriental lies on the Southern section of Mindanao. It is bound by the Pacific
Ocean in the east; by Agusan del Sur and Surigao del Sur in the north; by Davao
Province in the west; and the Davao Gulf and the Celebes Sea in the south. Its
geographic location follows the highly irregular southeastern coast of Mindanao facing
the Pacific Ocean from Cateel Bay down to Cape San Agustin. The topography is
characterized by extensive swamps and lowlands.

The province has a total land area of 516,446 hectares representing 16.26 percent of the
total land area of Region XI. It has 11 municipalities divided into two districts. District 1
comprises Baganga, Boston, Caraga, Cateel, Manay, and Tarragona. District 2 includes
Mati, Banaybanay, San Isidro, Lupon, and Governor Generoso.

The Municipality of Governor Generoso is located in the southernmost tip of the
Philippine archipelago. It is bound in the north by the Municipality of San Isidro; in the
west by Davao Gulf; and in the east by the City of Mati, about 75 kilometers away from
Governor Generoso. The terrain of the municipality is characterized by tapering of rolling
hills and green plains. With 30,295 hectares of land, the municipality ranks ninth of the
11 municipalities comprising the province of Davao Oriental.



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The municipality is shaped like the body of a shrimp. It is composed of 20 barangays, 14
of which are coastal barangays. Barangay Nangan, the barangay chosen for this study,
is a costal barangay.

Barangay Nangan is located 27 kilometers from the town proper of Governor Generoso.
Barangay Nangan is an agricultural barangay (70% of its land is devoted to agricultural
production) wherein coconut is the major crop. Other crops grown include banana,
corn, mango, coffee, root crops, cacao, and other fruit trees.

3.2   ECCD Structure and Management

3.2.1 Planning

Orientation on ECCD took place on July 21, 2004 when the UNICEF and CWC
representatives visited the province of Davao Oriental. Highlights of the orientation
included the introduction, presentation of the goal, vision and mission, interventions,
funding scheme, monitoring and evaluation of ECCD, and points to consider in the
preparation of the plan. The pointers highlighted the need to: 1) prioritize the
implementation of activities based on urgency and long-term impact, 2) pool activities
where resources are limited, 3) ensure that people involved in the implementation are
fully aware of the objectives of ECCD, 4) make action steps (what to do, who to do and
when to do) for big activities, and 5) take care on over committing resources.

After the orientation, the technical working group prepared the investment plan on
August 11, 2004 at the PSWDO in the province. Based on the plan, ECCD will be
implemented in all municipalities and their corresponding barangays in three phases.
The prioritization was based on the level of malnutrition and suggestion from the
Governor and the consultant of the Provincial Committee on Women and Children. The
priority municipalities for the first year of implementation included Boston, Governor
Generoso and Baganga; the three municipalities of Lupon, Caraga, and Manay and the
City of Mati for the second year; and the remaining four municipalities of Banaybanay,
San Isidro, Tarragona and Cateel for the last year.

As an ECCD recipient, the province prepared several documents which were required by
the CWC. The first document passed was the EO which enabled the creation of the
PCPC. Others included the Provincial Development Plan for Children, Resolution of the
Sangguniang Panlalawigan allowing the provincial government to enter into a
Memorandum of Agreement with the CWC, ECCD WFP, investment plan, and the MOA.
For its financial contribution, the province provided the 30 percent equity.

3.2.2 Financial management

The provincial government handled the disbursement of the ECCD funds. Only the
money allocated to the rehabilitation of DCCs and RHUs were directly issued to the
Barangay Captain. Moreover, there were claims that government rules and regulations
in the disbursement of fund were not followed. The bidding for supplies and materials
were not conducted; instead, cash advances were requested.

3.2.3 Delivery system

The PECCDCC, headed by the Governor, is responsible for the implementation of the
ECCD programs and projects. The technical working group, directly under the Board
Member who is the chairperson on Women and Children, is currently coordinated by the
ECCD Officer who is the Assistant Provincial Health Officer.



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When the PECCDC was formed, it, in turn, created a technical working committee. The
technical working committee is composed of members designated by the members of
the PECCDC to carry out their functions. It has only four members despite efforts to
include other concerned units of the province. Specifically, the four members came from
the MHO, Nutrition Action Center, DILG, and PPDO. The representative from the PPDO
was designated as the Provincial ECCD Coordinator by then Governor Maria Elena
Palma-Gil.

A Provincial Office for ECCD was created under the Office of the Governor. The ECCD
Assistant Coordinator mans the Office as the ECCD Coordinator is based at the PPDO.
There are currently five staff stationed at the ECCD Office. There are other positions
created when ECCD started in the province but are still vacant. These include roving
bookkeeper, encoder, draftsman and engineer.

The provincial government hired municipal and barangay ECCD coordinators
(MECCDC/BECCDC) while supplemental feeding was ongoing. For its first year of
implementation, every barangay had BECCDC, which was reduced to one barangay
coordinator for every five barangays during the second year. The salary of all the ECCD
staff, excluding the ECCD Assistant Coordinator, was charged to the budget of the
province outside of ECCD equity.

The MECCDC is mainly responsible for monitoring the feeding and weighing activities in
the barangays. The consolidated report of these activities is forwarded to the Provincial
ECCD Office for submission to CWC. A copy of the report is also submitted to the
MCPC. The MECCDC receives the supplies and materials for the feeding program. For
their part, the BECCDCs are hired to monitor the supplemental feeding program in the
barangay. Both MECCDC and BECCDC are hired for six months while supplemental
feeding is ongoing. The MECCDC can be rehired in the other municipalities scheduled
for the second and third years of implementation.

At present and with the new Governor, the ECCD Provincial Office has four support staff;
three were hired after the recent election while another clerk was on detail from the
Office of the Provincial Veterinary Office. There is uncertainty whether MECCDC and
BECCDC will be hired.

The ECCD organizational structure in Davao Oriental is quite different from the other
provinces included in the study. As noted earlier, planning was highly centralized, thus
all the activities are being coordinated at the top. An advantage of this set-up is the well-
organized documentation, particularly of the feeding and weighing program. The
BECCDC keeps the record of all the supplemental feeding which is then forwarded to the
MECCDC for consolidation at the municipal level, then forwarded to the PECCD Office.

Corresponding MCPC was organized at the Municipal and Barangay levels despite the
fact that planning and implementation was done at the province. The Municipality of
Governor Generoso passed Executive Order 09-2004 Series of 2004 merging the MCPC
and the ECCD Coordinating Council. This was done to avoid confusion and duplication
of similar council/committee in the LGU with the MCPC as the umbrella organization for
all programs for children. The MCPC is headed by the Mayor with the Sangguniang
Bayan members who chair the Committee on Social Welfare and Development and
Committee on Women Affairs. The other members are the SK Chairperson; Municipal
Local Government Operation Officer; Municipal Planning and Development Officer:
Municipal Social Welfare and Development Officer; Municipal Treasurer; Chief of Police;
Municipal Nutrition Aid; DepEd North and South District Supervisors and an NGO
representative as member (Annex Figure 3.2.3.2).


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                                                           Corazon N. Malanyawon
                                                            Governor-Chairperson


                                                        Delfin B. Miones, Board Member
                                                                Vice-Chairperson



                                                           Technical Working Group




           PNO                           PHO                    Provincial ECCD                  PSWDO                             DILG
                                    Luz P. Salvacion               Coordinator
     Roseny N. Casicnan           Ma. Cerenia Sunggay           Dr. Joy S. Sanico               Cora P. Son



                                                           Assistant ECCD Coordinator
                                                            Myla Villa M. Aquino, RSW




      Roving Bookeeper                 Encoder                       Clerk                      Draftsman                      Engineer
                                                                Glenn B. Morales              Salvador Bijis II




                          Municipal ECCD            Municipal ECCD                  Municipal ECCD                Municipal ECCD
                           Coordinator               Coordinator                     Coordinator                   Coordinator
                              Lupon                      Mati                           Manay                        Caraga



 Annex Figure 3.2.3.2 Provincial ECCD Coordinating Committee



Despite the many members, the Committee was reported not functional for several
reasons. Only one or two members of the committee are actively participating and there
has never been a regular meeting of the committee. Furthermore, the province-hired
MECCDC coordinated and monitored the ECCD activities in the barangays and prepared
the needed reports which are then certified by the Mayor before these were forwarded to
the PECCD Office.

The BCPC is in charge of the ECCD in the barangay. The BCPC was headed by the BC
with the Barangay Councilor on Family and Children, DCW, BHW, Chief of Tanod, SK
Chair, and PTCA as members.

The absence of committees is another demonstration of the inconsistent implementation
of ECCD in the province. Committees for ECCD implementation from the province to
the municipality to the barangay were not created.

As noted earlier, to officially signify the start of the program, a MOA was signed between
CWC and the Province. In turn, a MOA was drawn between the province and the
municipalities covered in the first and second years.


3.3 Accessibility/Quality of ECCD Services

The interventions followed the programs indicated in the ECCD Act with supplemental
feeding as its banner activity. Other interventions included provision of health and
nutrition supplies and materials, deworming, livelihood program, livestock program,
renovations of day care centers/rural health units, capital assistance to day care parents


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and provision of day care center leaning materials.           Specifically, the interventions are
grouped as follow (Table 4.3.3.1):

3.3.1 Support service delivery

Included in the group of programs/projects are nutrition education; upgrading of
barangay health service and barangay health center for primary health care; growth and
monitoring and promotion; deworming; micronutrient supplementation; and supplemental
feeding.

The Technical Working Group (TWG) decided that three barangay health stations for
every municipality would be renovated. Thus, 33 were indicated in the investment plan.

3.3.2 Establishing and institutionalizing the system

This component deals with activities on the briefing of the organization of the LCPCs in
all levels and provision of advocacy sessions on ECCD to Sangguniang Panlalawigan
/Sangguniang Bayan/BC/LCPC (Annex Table 3.3.2.1).

3.3.3    Capability Building

Training of service providers and provision of livelihood activities to beneficiaries are
enumerated under this group of intervention. Examples of training programs are: training
of Grade 1 teachers on the eight-week curriculum; training of health personnel on IMCI,
IRS; upgrading of DCW on the new manual and ECCD checklist; and upgrading of
parents and service providers on PES incorporating VAWC and ERPAT (Annex Table
3.3.2.2). Under the livelihood component are skills training of parents on backyard
gardening, poultry, piggery, and goat raising. Provision of capital assistance to parents
engaged in food processing for livelihood is also included.

Annex Table 3.3.3.1. Components of system establishment and institutionalization, Gov.
               Generoso, Davao Oriental
Program/Project      Brief Description                   Beneficiary               Lead Office
Briefing the         Strengthen the operation of the     11 municipalities         DILG/
organization of      LCPCs in all levels
                                                         183 barangays             PSWDO/
the LCPCs in all
levels                                                                             LGU

Provision of         Improvement and well-informed       100% of SP/SB/Brgy        DILG
advocacy session     officials                           officials and LGU
on ECCD to                                               improved KAS
SP/SB/BC/LCPCs


Annex Table 3.3.3.2. Capability building for service providers and provision of livelihood
                     activities to beneficiaries.
Program/Project       Brief Description                      Beneficiary               Lead Office
Training of Gr I      Teaching Staff and Production of       Grade 1 Teachers          DepEd
Teachers on eight-    Teaching Materials
week curriculum
                                          st
Training of Health    Training in IMCI (1 Yr only)           MHO, PHN, RHMW            PHO
Personnel




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Program/Project          Brief Description                        Beneficiary                    Lead Office
Upgrading of DCC         Enhance RS Day Care Worker               Day Care                       PSWDO
Workers                  Manual/ECCD Checklist                    Officers/Accreditors and Day
                                                                  Care Workers

Upgrading of DCC         PES Training Incorporating VAWC          MSWDO and DCWs                 PSWDO
Parents and Service      and ERPAT
Providers
Enhancing Livelihood     Parents‘ Skills training on Livelihood   Parents with below normal      OPAG/PNO
Skills for Parents                                                PS
Livelihood Faith         Backyard
Programs                 Vegetable/Poultry/Piggery/Goat
                         Raising
                         Provision of capital assistance to       Organized Day Care Parents     PSWDO
                         parents engaged in food processing
                         for livelihood



3.3.4 Protection

There are only two activities under this intervention: the upgrading of day care centers
and the provision of learning materials. Similar with the plan for the rehabilitation of
BHS, only three DCCs for every municipality will be allowed for renovation (Annex Table
3.3.4).

Planning and Management

This last component covers the setting up of database and management information
system (MIS); meetings at the provincial, municipal and barangay levels regarding
ECCD, such as monitoring evaluation, PIR; and acquisition of computer set for
documentation purposes (Annex Table 3.3.5).

Financing for all the activities was estimated at PhP23,570. The national ECCDCC will
shoulder 70 percent of the total budget while the remaining 30 percent will be the share
of the LGU. As indicated in the provincial investment plan, the total amount was almost
equally divided into three years of implementation.


Annex Table 3.3.3. Programs for day care centers
Program/Project        Brief Description                      Beneficiary                  Lead Office
Upgrading of           Rehab of Day Care Centers              Pre-schoolers in 326         PSWDO
Day Care               and Parent-Child Development           DCCs
Centers (DCCs)         Programs


Provision of                                                  326 DCCs
DCC Learning
Materials




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                                                                             Final Report


Annex Table 3.3.4 Planning and management programs
Program/Project           Brief Description             Beneficiary             Lead Office
MIS/Documentation/Data    Monthly updated and           ECCD Council/Pilot      PPDO &
Banking                   accurate information          Municipalities          ECCD
                                                                                Council
Computer set              Equipment/facility for data   ECCD Personnel          ECCD
                          encoding                                              Council
PCPC meeting              Quarterly                     Council Member          PPDO &
                                                                                ECCD
                                                                                Council
MCPC Meetings             Quarterly


TWG Meeting               Monthly                       TWG                     ECCD
                                                                                Council
                           nd   th
Monitoring Evaluation     2 /4 quarter                  Gov Gen. Boston, and
PIR                                                     Baganga



3.3.6 Accomplishments

The accomplishment is divided into first and second years. Nearly all the activities listed
in the work and financial plan for the first year were implemented, although there was a
big lag between the ECCD‘s introduction and implementation in the province. The lag
delayed the project‘s implementation for the second years, and this was further held
back by the holding of election in 2001. The 2007 barangay election will also affect the
implementation of the ECCD. The third year of implementation should have been
started, but as of September 2007, the project has not started yet. The new Governor
was asking for a complete audit of the first two years of the ECCD project before
approving its continued implementation.


Health component

For the initial year, all the nine rural health units in the identified barangays have been
renovated (Annex Table 3.3.6.1).
These health centers were also
                                               Annex Table 3.3.6.1. Rehabilitation rural
provided     with    equipment/materials,
                                                   health station by municipality, Davao
including: refrigerator, mechanical bed,
                                                   Oriental
steel filing cabinet, office table, office
chair, sphygmomanometer, white board,           Municipality/          Barangay
and stand fan. All barangay rural health        Baganga
stations information, communication and                                Batawan
education of the three municipalities                                  Baculin
included     in   the      first year     of                           Kinablangan
implementation were also provided with                                 Sibahay
                                                Boston
sphygmomanometer, Salter weighing                                      Cauwayanan
scale, bathroom weighing scale, ECCD                                   Cantilan
health growth cards, vitamin A, iron, and                              Nangan
deworming pills.                                Governor
                                                                       Tamban
                                                 Generoso
                                                                      Tandang Sora
Albeit small, the renovated RHU is well
ventilated and well lit because of the big


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                                                                         Final Report


windows. It has a consultation room and a waiting area for the patients. The RHU is
generally clean including the surroundings. However, the room which functions as
kitchen a and the room for ligation and vasectomy were quite crowded. The RHU has
piped water and electricity and filled with equipment and materials purchased under the
ECCD project.

As mentioned earlier, the identification of the RHUs for renovation was identified at the
provincial level in consultation with the barangay officials and rural RHMWs, BNSs, and
BHWs. For Barangay Nangan, the check amounting to PhP63,000 was issued directly
to the Barangay Captain. The monitoring of the renovation was done by the Provincial
ECCD-based engineer. As such, the municipality did not have any participation which
was in opposition to what was being espoused by the ECCD project. This is the
downside of the project implementation. Nevertheless, the barangay council headed by
the barangay captain has taken the challenge and proven its capability to supervise well
the rehabilitation (Box 1).

Supplemental Feeding

The 120-day supplemental feeding for six months officially started in November 2005
and ended in May 2006. Children younger than two years old were supplied with
Nestogen mild while children two to six years old were fed with a hot meal. As planned,
the supplemental feeding for all the barangays of the three municipalities of Baganga,
Boston, and Governor Generoso was implemented simultaneously. A total of 3,008
children coming from 49 barangays were fed. Originally, hot meal was provided for the
supplemental feeding with ingredients such as chicken, rice, and egg. These ingredients
were procured in bulk in the province by the Provincial Nutrition Officer and then
distributed to the different municipalities, also in bulk. The MECCDCs, in turn, accept
these supplies at the municipality with the understanding that the BHW would pick them
up for the scheduled feeding. Because of the lack of freezer, there was an occasion
when chicken were spoiled while eggs were broken due to bad roads. To solve the
problem, the province provided a chest freezer.



                    Renovation of Barangay Nangan Rural Health Unit

       Barangay Nangan is one of the six barangays identified by the Provincial
       Technical Working Committee whose Rural Health Unit has to be
       renovated/rehabilitated under the ECCD.        The cost of repair was
       PhP63,000 which was directly transferred and to be managed by the
       Barangay, particularly the Barangay Treasurer. The Barangay Captain
       supervised the construction. From time to time, the engineer from the
       ECCD Provincial Office monitored the construction.

       To save money for the building materials, the Barangay Treasurer and
       concerned members of the Barangay Council canvassed the construction
       materials in Davao City and had them transported to Barangay Nangan.
       They also accrued savings from buying trees within the barangay and had
       them sawed into lumber. Their savings amounted to PhP16,000 which they
       have requested to be used in buying the motor for the water pump and
       curtains for the RHU.




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During the third month of
the supplemental feeding,         Table 3.3.6.2 Comparison between hot meal and choco milk
the meal was changed to           Menu          Advantages                    Disadvantages
                                  Hotmeal        Heavy in weight Different    Food storage
choco milk feeding. The                            menu everyday               Far distance
daily appropriation per child                    Easy to conduct mother‘s         from the feeding
was composed of rice,                              class during the feeding        center
choco quick, and B-sugar                         Most mothers were            Tiresome
which was then cooked                              interested                  Not easy to
similar to “champorado‖. It                      Easy for rehabilitation of       prepare
                                                   malnourished children       Delivery of food
is estimated that the value                                                        supplies to
of meal per child was about                                                        barangay in
PhP12. In one report of the                                                        terms of
MECCDC, there was a                                                                transportation
comparison between the            Chocomilk      Easy to prepare              Some of the
                                  feeding       Division of labor to service      parents want to
hot meal and the choco                          providers (clustering)            get their share
milk      feeding     (Table                                                      during weekend
3.3.6.2).       Choco milk                                                        in order to feed
feeding was easier to                                                             all their children
prepare;     however,    the                                                      at home
recovery from malnutrition                                                     Spoilage
was longer when compared                                                       Not easy for
with the hot meal feeding.                                                        recovery


Parents participated in the feeding program by bringing firewood, dishes, and other
utensils as well as in the actual cooking. It was also reported that mothers of 18-month
old children were provided with Nestle powdered milk. This was not included in the
ECCD work and financial plan.

To monitor the effect of the supplemental feeding, weighing of children were weighed
every three months. A comparison of the nutritional status of children during the first
quarter of 2005 and 2006
revealed      an    interesting Annex Figure 3.3.6.1 Nutritional Status of pre-school
pattern. Overall, there was               children, Barangay Nangan: 2005 and 2006
an improvement in the               90.00
nutritional status of children,     80.00
particularly those in the           70.00
below      normal     category      60.00
where the reduction was             50.00
most     noticeable     (Annex                                 2005
                                    40.00
                                                               2006
Figure 3.3.6.1). There was          30.00
also a reduction in the             20.00
percentage of children in the       10.00
below normal very low                0.00
category but not as much as                Below Normal Below Normal         Normal     Above Normal
                                             Very Low
that of the below normal low                                         Nutritional Status
category.

Examining the change in nutritional status by age group also revealed an interesting
pattern. The highest improvement in malnutrition occurred among babies where below
normal very low nutritional status was completely eliminated in 2006 (Annex Table
3.3.6.3). This was followed by improvement in the nutritional status among children
aged 48-59 months in the below normal very low with 89 percent reduction.




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Meanwhile, in the below normal low      Annex Table 3.3.6.3. Percent change in the
(BNL) status, the highest reduction          nutritional status of children by age,
occurred among children aged 36 to           Barangay Nangan: First quarter 2005 and
47 months. What is bothersome is             2006 (in months)
the persistence of the high                                  Below
percentage of below normal very low                         Normal      Below
(BNVL) children aged 60 to 71           Age (in               Very      Normal
months. Another observation was         months)               Low        Low        Normal
that across age groups, the             0-11                -100.00        7.32         0.77
reduction in the below normal very      12-23                -25.84      -48.66        14.20
low was less when compared with         23-35                -31.40      -24.53         7.38
the children in the below normal low    36-47                 14.42      -74.91        23.30
category. These findings highlight      48-59                -88.64      -65.91        29.02
the need for longer supplemental        60-71                 96.60      -41.02         4.46
feeding for those children in the BNL
category and that hot meal feeding should be preferred over the choco milk feeding. Or
perhaps a different menu should be tried specifically for children suffering from BNVL.

The supplemental feeding time also gave opportunity for the service providers to conduct
mothers‘ classes. They have conducted two sessions of mothers‘ class during the six
months that supplemental feeding was ongoing. The topics discussed were on
immunization, deworming, and family planning.

Livelihood Component

The livelihood component was composed of two projects: goat dispersal and provision of
capital assistance. For the goat dispersal, a household was given a head of goat. Once
the goat gives birth, one kid is given to another beneficiary while the mother and the
other kids are kept by the original beneficiary. As planned, 92 households were
recipients of the goat dispersal project. The accomplishment report mentioned only the
dispersal but not the status of the project, although during the most recent monthly
reports of the MECCDC, there were reported cases of goats which died due to
miscarriage or were just found dead under a coconut tree. Since the appointment of the
MECCDCC co-terminates with the feeding program, there is the question of who will
monitor the progress of the goat dispersal program. Monitoring is important to ensure
that the kid is transferred to the deserving household.

For the capital assistance program, the target beneficiaries were day care parents. The
representative from the PSWDO visited the municipalities to consult the Municipal Social
Welfare Development Office and the DCW Officer to identify the barangays for the cash
assistance project. In Governor Generoso, they decided to award 10 and 12 Day Care
Parents of Barangay Sergio Osmeña and Barangay Montserrat, respectively. Also being
referred to as ECCD Self-Employment Assistance, a capital of PhP3,000 was given to
start a small business. As reported, the economic activity where the capital was used
included banana production, sari-sari store, hog raising, fish vending, snack/food
vending, and buy and sell of dry goods. There were no updated reports of whether the
capital was used in these entrepreneurial activities.

For the first year of implementation, there were nine day care centers for repair and
improvement which were identified and eventually completed (Annex Table 3.3.6.4).
These were also provided with materials of cobble hole and big black board. Meanwhile,
all the 79 DCCs in the three municipalities were provided with learning materials, kiddie
tables, kiddie chairs, and play mat.




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                                                                               Final Report


Capacity-building

Several training activities have already
been delivered in its first year of        Annex Table 3.3.6.4 List of Rehabilitated Day
implementation. These included the                Care     Centers,     Municipality of
following: training of Trainors (ToT)             Governor Generoso, 2006
on the revised day care manual and
ECCD checklist; seminar on ERPAT           Municipality/Barangay   Day Care Center
and PES, eight-week curriculum;            Baganga                 Dapnan Hi-way
orientation to vita meal feeding; and                              Macopa, Mahan-ub
                                                                   Tagumay, Saoquigue
training on IMCI and project                                       San Jose
implementation review.                     Boston                  Panaohan, Cabasagan
                                                                   Carmen
There were also activities which were                              Cagamisan, Surop
                                       Governor Generoso           Anitap
not included in the ECCD but were                                  Sitio Pasto, Crispin Dela
implemented       in   the   province.                             Cruz
Specifically, the province has created
an office under the governor which
housed the PECCDC and took charge of the hiring of municipal and barangay ECCD
coordinators. The payment of salary for the ECCD municipal coordinators and the
honorarium of barangay ECCD coordinators came from the province outside of its equity.

During the second year of implementation which started in October 2006, the project
covered three municipalities: Lupon, Caraga and Manay, and the City of Mati covering
81 barangays. While most of the activities were implemented in the first and the second
year witnessed fewer activities and these could be further affected by the new
administration and the forthcoming barangay election. The project distributed health
equipment like sphygmomanometer, Salter weighing scale, bathroom weighing scale,
and ECCD growth cards. Learning materials for the DCCs have also been distributed.

The DCCs and RHUs for rehabilitation have already been identified and the budget for
these have been allocated. Only 12 percent of the targeted DCCs and RHUs have been
rehabilitated.

For 2007, it was noted that supplemental feeding, milk feeding, distribution of one kilo
rice, and holding of a mother‘s class were reported by the Provincial Nutrition Committee
for all the barangays and not limited to the targeted barangays under the ECCD. the
ECCD was claimed to be a continuation of the earlier supplemental feeding. However,
this is unlikely because supplemental feeding was done for all and not to the targeted
children BNL and BNVL aged 0 to 6 years old and it was only done for a day. The
distribution of one-kilo rice was also not part of the ECCD project.

3.4 ECCD Partner

For its second year, the supplemental feeding is done in partnership with the Pondo ng
Pinoy (Filipino Fund) of Archbishop Gaudencio Rosales. Filipino Fund implemented an
Integrated Nutrition Program for the poor and malnourished children nationwide called
HAPAG-ASA feeding the future. The menu for supplemental feeding consisted of vita-
meal mixed with rice, choco quick and brown sugar. A total of 5,000 children were
targeted for the second year of implementation.     It was reported that 99 percent of
supplemental feeding have been accomplished.

In Barangay Nangan, the service providers are composed of the RHMW, barangay
health workers, barangay nutrition scholar, day care teacher, kindergarten teacher, and


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                                                                               Final Report


Grade 1 teacher. Except for the Grade 1 teacher, all the service providers are under the
supervision of the LGU while the Grade 1 teacher is under the Principal.

Available demographic data reveal that the service providers from the barangay are 50
years old on the average, and had provided service to preschool and Grade 1 students
for an average of 21
years (Annex Table         Annex Table 3.4.1 Demographic profile of service providers,
                                      Barangay Nangan, Governor Generosos: 2007
4.3.4.1). The RHMW
                               Service Provider      Age     Educational        Length of
had been in service for                                        Attainment        Service
28 years, the longest      Rural Health Midwife       52    Midwifery                28
among the service          Day Care Teacher           58    High School              22
providers interviewed.     Kindergarten Teacher       46
                                                              rd
                                                            3 Yr College             13
                             Grade 1 Teacher                44   BEED                     22
Most of the service
providers worked for 40 hours a week, that is, eight hours a day from Monday to Friday.
The kindergarten teacher had the least number of hours with only three hours a day for
five days. Meanwhile, the day care teacher had the longest number of hours with nine
hours a day for five days due to handling of three sessions of day care class with a total
enrolment of 71. The kindergarten teacher had the least number of students (32). There
is an overlap in the age group of pupils enrolled in day care and kindergarten. In the day
care center, the ages of pupils ranged from three to six years old while the kindergarten
class catered to five to six years old only. Meanwhile, the age of Grade 1 pupils ranged
from 6 to 13 years old suggesting older children entering elementary education.

The salary/honorarium of the service providers came from the LGU budget with the
exception of the kindergarten teacher. The salary of the kindergarten teacher comes
from the monthly tuition of PhP50 per student. Among the service providers interviewed,
the Grade 1 teacher had the highest salary of PhP13,000 per month while the
kindergarten teacher had PhP2,400 per month and sometimes even less depending on
the number of students who could pay the monthly tuition.

All the service providers have attended training under ECCD which they reported to be
‗very useful‘ in performing their duties and responsibilities. However, they want more
capacity-building activities on the Child Assessment Checklist. According to them, this is
very important in determining what kind of assistance should be given to children based
on the results of the checklist.

In general, the service providers have knowledge about the rights of children, health of
mothers and children, and cognitive development of children. The knowledge, attitude,
and perception (KAP) ratio was computed by dividing the expected answers and the total
number of questions in each category.      Among the service providers, the Grade 1
teacher garnered the highest score of 0.94 closely followed by the RHMW with 0.93.
The kindergarten teacher had the least score of 0.74 (Annex Table 3.4.2).
 Annex Table 3.4.2 . Knowledge, attitude and perceptions of service providers, Barangay
                     Nangan, Governor Generoso: 2007
                                                   Maternal
                                    Children's     and Child      Cognitive
  Service Provider                   Rights         Health       Development      Average

  Rural Health Midwife                 1.00          1.00           0.80            0.93
  Barangay Health Worker               1.00          0.81           0.80            0.87
  Day Care Teacher                     1.00          0.81           0.80            0.87
  Kindergarten Teacher                 0.80          0.63           0.80            0.74
  Grade 1 Teacher                      1.00          0.81           1.00            0.94



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                                                                            Final Report



3.5 Integration and Convergence

Integration of services for children means that all the LGUs and relevant organizations
should be involved in preparing the plan, implementation, and monitoring of interventions
for children zero to six years old. There should be shared ownership of the programs,
and projects for children and the planning process. This would ensure achievement of
the best possible outcomes for children set out in the plan. In short, there must be a
single service system for children.

At the provincial level, integration is very limited. Only four out of the 12 agencies   and
relevant organizations were actively involved in the PECCDC/TWG in the planning          and
implementing ECCD. In general, it was the provincial Local Government Executive          and
the Chair of the Committee on Women and Children who influenced the planning             and
implementation of the ECCD.

At the municipal level, integration is completely absent. They provided the data required
during the initial orientation, submitted a report before the appointment of the MECCD
Coordinator, came up with the required MOA, and formed the LCPC. Specifically, the
MNO merely received the supplies for the supplemental feeding. Moreover, all the
supplies and materials for the DCCs and RHUs and the money for renovation were
directly issued to the concerned service provider/official in the barangay.

Coordination with other government and non-government units as well as with the other
service providers is an avenue for the integration of services for children. When asked
about integration, the response was ‗coordination and unification of the objectives
especially on the delivery system for the children.‘ This was further articulated when
respondents were asked whom they were coordinating with and who were providing
assistance. For instance, the RHMW coordinated with the MSWDO for the feeding
program and with the MHO for the needed logistics. Meanwhile, the Grade 1 teacher
coordinates with DepEd and the LGU (Annex Table 3.5.1) while the kindergarten teacher
coordinates with the parents because her monthly salary comes from the tuition fee of
the students.

Among the service providers, the RHMW received the most assistance while the
barangay officials gave assistance to all the service providers. As shown in Annex Table
3.5.2, the RHMW is supported by the BNS in the Operation Timbang; by the BHW in
preparing the list of patients by sitio; by the barangay officials in providing the needs of
the     RHU;
and by the        Annex Table 3.5.1 Service providers and those providing assistance in
day      care                   the delivery of services for children: Barangay Nangan,
teacher. On                     Governor Generoso: 2007
                  Service Provider                 DepEd         LGU      MSWD       MHO
the     other
hand,     the     Rural Health Midwife                                      X          X
kindergarten
teacher and       Day Care Teacher                                 X
the     BHW       Kindergarten
conduct                                               X
                  Grade 1 Teacher
household
                                                      X            X
surveys.
Day      care
teachers assisted by the parents who helped during the conduct of classes; the RHMW
who provided medical services; and the barangay officials who provided financial support



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                                                                              Final Report


for the day care center maintenance. The value of cooperation is clearly illustrated
during the supplemental feeding. The parents provided firewood, fetched water, and
brought plate, spoon and cup, other households lent the pot and ladle.

    Annex Table 3.5.2 Service providers and those providing assistance in the delivery of
                services for children: Barangay Nangan, Governor Generoso: 2007

    Service Provider          BNS    BHW       Bgy         Day     RHMW     Parents
                                             Officials    Care
                                                         Teacher
                               X       X        X           X
    Rural Health Midwife
    Day Care Teacher
                                                X                    X
    Kindergarten
                                       X        X                                 X
    Grade 1 Teacher
                                       X        X

As conceptualized by the policy review project, convergence of services should be
gauged at the households or through the recipients of the services on health, nutrition,
education, and social protection. Thus, a household with children belonging to zero to
six years old was interviewed.

The household interviewed was composed of the couple and their six-year old son. The
mother works as an employee while the husband is a fisherman. They also had income
from their farm.

The traditional division of labor exists in the family. The mother makes the decision in
reproductive-related tasks. Out of the 12 tasks included in the questionnaire, only two
tasks related to teaching the son in doing his homework were jointly decided by the
couple. The mother, on the other hand, makes the decision on tasks related to cleaning,
buying, and preparing food; immunization and giving of vitamins and iron supplements;
and taking care of children.

The mother also follows practices to ensure the nutritional status of her son especially
during the early years. These included, breastfeeding her son for two years, cleaning
the breast with warm water and massaging around the nipples, starting complementary
feeding when the baby was at his seven months old with mashed vegetables (sayote,
potato and carrots), and observing proper food storage like keeping the left-over food in
the refrigerator. To prevent her child from getting sick, the mother keeps the baby clean
by giving him a bath twice a day and by keeping the playthings and clothes of children
clean. When the baby got sick she gave him food like noodles, milk, and soft boiled egg.
She also spent time playing with her child.

The source of the water for drinking is the deep well; however, it is not clear whether the
water was tested for contamination. The family also has a water- sealed toilet.

According to the mother, she brings her child with her in most activities such as attending
social gatherings, participating in community meetings, and watching movies. The son
also sleeps with the couple.

The mother believes that the child should be rewarded when behaving well or have done
something good, though he also needs to be disciplined. She rewards her son with toys
and hugs or kisses him whenever he behaves well. This incentive will encourage the
child and help him remember to be good always. On the other hand, she disciplined her
son for being too playful and too stubborn by beating him as early as three years old.


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                                                                                             Final Report


The mother wants her son to finish his studies and envisions him to have a wholesome
family of his own in the future. She wants her child to become independent, and she
instills in him the values of being respectful, prayerful, honest, clean, and helpful.

To protect her child from internal and external threats, the mother discourages her son
from seeing pornographic materials and games and vices like bingo, mahjong and other
forms of gambling because she considers them as wasteful activities. As much as
possible, she supports her son to engage in activities that could develop his artistic
talent. She also encourages her son to attend religious services with the family and to
watch wholesome television programs.

The mother claimed that she has not heard of ECCD. However, she had accessed and
availed of some of the services from the health center like prenatal care; vitamin A and
iron supplements; and feeding program. She had even attended seminars on nutrition
and counseling. Currently, her child is enrolled in the day care center.

The mother thinks that a child should start schooling at age four years because at this
stage, children are already eager to attend school. The children are even the ones
convincing their parents to send them to school. Some parents want their children to
experience early education because they want them to become ―early learners‖. On the
other hand, some parents did not want to compel their children to attend school early if
the children were not interested because they might get easily bored of school.

According to the mother, her son was then very eager to attend preschool because he
liked the stories read in the class and the new songs; the writing/drawing activities; and
playing with his classmates. He was also excited to get his allowance every time he goes
to school. The mother had witnessed how her son‘s writing skill has improved. She was
also informed of the progress of her son by the day care teacher whenever she visited
the center.

As a result of sending her son to preschool, the mother said it would not be difficult for
her to teach her son how to write and that he will easily know how to socialize with
people,      thus, she
intends to enroll her      Annex Figure 3.5. KAP on children‘s rights, maternal and
son in Grade 1 the                  child health and cognitive development of mother,
following school year.              Barangay Nangan, Governor Generoso: 2007

Finally, the mother is
slightly             more        0.90
knowledgeable on the             0.80
rights of a child than on        0.70
maternal and child               0.60
health     and      child‘s      0.50
cognitive development            0.40
(Annex Figure 3.5).              0.30
She got the highest              0.20
score2 of 0.90 on the            0.10
rights of the child. Her         0.00
scores on the maternal                          Children's Rights   Maternal and    Cognitive
and child health and                                                Child Health   Development

child‘s          cognitive
development were very
close at 0.81 and 0.80, respectively.

2
    Score is computed as the ratio of the total expected answer over the total number of items.


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                                                                              Final Report



In conclusion, convergence can be seen in the mother having availed of RHU services
before and after becoming pregnant as well as of the day care center where her son is
enrolled. Her responses to the different questions suggest that she is a responsible
parent and that she exerts efforts to make her son a healthy and well-
behaved/responsible adult.

3.6 Monitoring System

Based on the key informant interview, the ECCD Assistant Coordinator reported having
designed four forms for ECCD implementation and monitoring: Form 1: Barangay Profile
contains 15 items characterizing the barangay. Specifically, it contains information on
population size by gender, children‘s population by age group, employment and sources
of income, basic education and health facilities, immunization and nutritional status of
children, mortality, morbidity, child abuse, and domestic violence. Form 2: Child Profile
Consent Form contains demographic information on the child as well as the other
members of the household. More importantly, in this form, the parents allow their
qualified children enrolled in the supplemental feeding; promise to participate in the
feeding program by bringing their children to the feeding center as scheduled, weighing
of children, and bringing their own plate, soon and fork; attend all the mother class
sessions; assist in buying, cooking and feeding; and donating in cash or in kind for the
supplemental feeding program. Form 3: Master list of Children is a compilation of the
children who have participated in the supplemental feeding program.

The hiring/appointment of staff, e.g., engineer at the provincial ECCD Office as well as
MECCDC and BECCDC was claimed to be an innovation and reported as one of the
best practices in the ECCD implementation. Perhaps, it fast tracked the implementation
of the activities during the first year while the presence of MECCDC and BECCDC
facilitated the monitoring of the supplemental feeding. However, it has contributed to the
non-attainment of the goal of ECCD which is convergence of the delivery of services at
the provincial, municipal and barangay levels and sustainability of the interventions. The
disadvantages outweigh the advantages. The hiring of its own staff at the ECCD
Provincial Office curtailed the different provincial and municipal staff from becoming
involved in the ECCD. For instance, instead of the Provincial Engineer doing the
coordination and monitoring with the Municipal Engineer for the civil work in the DCC
and RHU rehabilitation, the hired ECCD engineer coordinated with the barangay officials.
One reason for the non-functioning of the MCPC was that the MECCDC has been
performing the tasks which the former should be doing.

Instead of targeting the beneficiaries of the project as indicated in the Implementing
Rules and Regulations (IRR) of RA 8980, the provincial government has included all the
municipalities and barangays in three batches of implementation. However, this strategy
is unsustainable and costly. After the first year of implementation in the three priority
municipalities, there were no follow-up activities except for the one-day supplemental
feeding. It is very costly in the sense that even the non-targeted beneficiaries in the
supplemental feeding were included.

The innovation introduced in the barangay seems to be better than those being claimed
by the province. For its supplemental feeding, the BHWs and the parents decided to
divide the eight sitios into two clusters to make it easier for parents to bring their children
and at the same time to attend the mothers‘ class.




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4.0    Province of Cagayan Valley

4.1   Profile

Classified as a second class city, Tuguegarao is a peninsula located west of the Sierra
Madre foothills. It is approximately 450 km north of Manila, 45 minutes by plane and 10
hours by land.

Tuguegarao City as the capital of the province of Cagayan and the Regional Center of
the Cagayan Valley Region is the hub of socio-economic growth in the region. The city
serves as backbone support to the Regional Agro-Industrial Center in Isabela and to the
Cagayan Special Economic Zone and Free Port (CSEZFP) in Santa Ana, Cagayan.

Barangay Capatan is one of the barangays in Tuguegarao City, consisting of six puroks.
As of June 2007, it has a total population of 3,148 with 1,734 households. By age
bracket, 9 percent belonged to zero to five years old while 24 percent were under the 6
to 17-year old age group. Meanwhile, adults (18 years old and above) comprised 67
percent of the total population. Of the total number of school-going children (3 to 24
years old), 647 were in school while the remaining one-fourth or 180 were out-of-school
youths (OSYs).


4.2    ECCD Structure and Management

4.2.1 Planning

The ECCD program was introduced in the province of Cagayan in 2004. The Regional
Social Welfare Development Office in Region II briefed the staff of the province on what
is ECCD is all about particularly in choosing the target areas.

Originally, the province of Cagayan has prioritized only five municipalities for the ECCD
based on infant mortality rate, under-five mortality, and nutritional status based on the
results of the Minimum Basic Needs (MBN) survey. These were all covered during the
first year of implementation. Then former Governor Edgardo Lara negotiated with the
Council for the Welfare of Children to cover all the 29 municipalities during the following
year. However, only 82 or 10 percent of the 821 barangays commonly referred to as
―Club 82‖ were the targeted recipients of ECCD. ―Club 82‖ was an initiative of the
Governor to assist the most depressed barangays in terms of high poverty incidence,
malnutrition, and other health problems.

While the province has set the number of target barangays, the technical working group
at the municipalities decided which barangays to include in the ECCD based on the
selected indicators. The municipal technical working group was asked to submit the five
priority barangays but the final number of selected barangays varies depending on the
income class. For instance, four barangays were selected for fifth class municipalities;
three barangays for fourth class municipalities; and two barangays for third, second, and
first class municipalities.

In the City of Tuguegarao, early childhood care and education was organized as early as
when the City Social Welfare Office operating under the Department of Social Welfare
organized its barangay day care program 35 years ago. The early childhood care and
education program was enriched and strengthened when the city joined the search for
the Most Child-Friendly City national contest and has consistently won for three
consecutive years earning itself a Hall of Famer award in the child-friendly movement.
The ECCD system was launched in May 2006.


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At the city level, the ECCD was introduced per agency. For instance, the DepEd staff
was briefed about the program during the training on the eight-week curriculum for
Grade 1 teachers while the Social Workers had it during one of their meetings. The
members of the Council were already aware of the services even before ECCD was
introduced.

The MBN assessment results conducted in 2005 was used to formulate the ECCD
program goals and objectives in the target barangays of Capatan and Linao West. Each
Department head member of the LCPC/ECCDCC prepared his/her respective plans and
targets for these barangays. These plans and targets were consolidated and included in
the city development plan by the City Planning and Development Officer who is also a
council member. The goals set were all in line with the national goals.

LCPC/ECCDCC members participated in a planning workshop facilitated by the
Provincial ECCD Coordinator in coordination with the regional sub-Committee for the
Welfare of Children on July 14-15 2006. The LCPC prepared the work and financial
plans for ECCD based on the MBN assessment and family survey (tool formulated by
the local council) results. The families and barangay council members were consulted on
priority concerns, plans, projects, and programs for children after a thorough discussion
of MBN and family survey results conducted through community assemblies. Facilitating
the preparation of local development plans for children, included the availability of
updated children‘s data; availability of local government and ECCD budget allocation;
availability of technical assistance by provincial and regional ECCD coordinators; the
interest and willingness of leadership to invest in children; good teamwork among
LCPC/ECCDCC members and service providers and presence of enabling law.

The delayed submission of documentary requirements like the WFP was due to their
earlier reluctance to participate in the project. This reluctance was because they
believed that they have already been involved in ECCD as proven by their Hall of Fame
award in the most child friendly city-municipality, a national contest. Officially, ECCD
was implemented in Tuguegarao City when the sub-memorandum of agreement was
signed between the province and the city in September 2006. This is in addition to all
the submitted required documents, e.g., resolution of the Sangguniang Council
authorizing Mayor RS Ting to negotiate and sign for and in behalf of the LGU, approved
Investment Plan for Children by the Sangguniang Council, approved WFP, and Bank
Certification for the initial deposit of the counterpart fund.

In Tuguegarao, the identified barangays for the ECCD implementation were Barangay
Capatan, the barangay site for this study, and Linao West. Selecting these barangays
followed a similar procedure.

The identification of Barangay Capatan as having the highest incidence of malnutrition
was first rejected by the Barangay Captain who requested for another household survey.
When the results of the earlier survey were confirmed in the second round, the barangay
officials accepted their status as one of the most depressed barangays. In response, the
barangay council drafted a resolution promising to work hard to improve the situation,
particularly that of the children. Instead of using ECCD funds, the barangay council
volunteered to have the repair of the day care center be charged to the Barangay IRA. It
should be noted that ECCD is not yet implemented at Barangay Capatan because the
fund was released when the election ban was in effect, although an exemption was
issued by the Commission on Election.




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4.2.2 Financial Management

As provided for in the sub-memorandum of agreement, the LGU provides equity for the
implementation of the ECCD. Further, the LGU will take over the funding requirement
and management of the project after three years. Since the ECCD has been a regular
program of the city government, it has already allocated part of its IRA for the program to
ensure sustainability. Allocation of funds was based on needs, projects and activities
reflected in the WFP of each sector, e.g., health, nutrition, education and protection. The
city/municipal government provided 90 percent of the PhP50,000 counterpart fund while
the rest was put up by the concerned barangays. This was in addition to the 80 percent
of the IRA that the city government allocated for education, welfare and health programs,
the bulk of which are for children.

Municipalities that received ECCD funds followed government auditing and disbursing
procedures. Project proposals were prepared and submitted based on the submitted
WFP for the release of funds deposited in the City Treasurer‘s Office. The ECCD
program funds had a separate account with the Land Bank of the Philippines.

The unit office/department requesting for supplies, equipment or materials needed were
held responsible in preparing for the bidding requirements. The Bids and Awards
Committee undertook the bidding process and later on, supervised deliveries of
materials or supplies requested by the winning bidders. Each department head and staff
in coordination/consultation with the service providers determined the supplies or
materials to be procured. Supplies may be ordered from as far as Metro Manila for
delivery by the supplier as in the case of educational reading materials delivered to the
City Social Welfare Office (CSWO) for the DCC. These were distributed on June 14,
2007 to DCW. The procurement is a long process and becomes longer if there are no
local bidders. It runs from two to three months or even longer.

For the City of Tuguegarao, the ECCD fund from PECCDCC was first received in
December 2006 after the LCPC submitted all the documentary requirements like WFP,
project proposals for the two barangays covered by the ECCD, and MBN results as
bases for planning and targeting. Delay in the submission of some requirements deferred
the release of funds. Implementation was further delayed by the election ban in May
2007 although an exemption was already approved.

At the province, part of the ECCD fund is released at the beginning while later releases
were based on the amount liquidated. This poses a problem because of the uneven
capability of the municipalities to expend their allocation. As a result, the province had to
use provincial funds first.


4.2.3 Delivery System

Club 82, became the conduit to implement ECCD in the province of Cagayan. Club 82
has a provincial management team headed by the governor while all the department
heads are members. In addition, Club 82 has a technical working group, composed of
technical people from different departments as well as different national offices and
NGOs based in the province. This seems ideal as Club 82 facilitated the identification of
the needs of the children and that the mechanism and structure were already in place to
implement the program. Club 82 targets all the households as well as the community and
not just children aged zero to six years old. The functions of the PECCDC were also
assumed by Club 82. Only the Provincial ECCD Coordinator was hired to implement the
program. All the other tasks were assigned to the regular staff of the province.



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In Tuguegarao, the City Council for the Protection of Children also known as LCPC
serves as the City ECCD Coordinating Council (CECCDCC) headed by the City Mayor,
Randolf S. Ting with membership as prescribed by law. The LCPC/ECCDCC follow the
functions as provided for in the law such as to: (1) coordinate and monitor the delivery of
services at the barangay level, (2) ensure reporting and documentation of services
delivered, and (3) support and complement resources available to barangays for ECCD
program improvement like purchasing learning materials and supplies. The city social
welfare office acts as informal secretariat whose tasks are only to remind members the
submission of reports or to notify members of meetings.

Each department head, i.e., Health, Social Welfare, Nutrition, Education, coordinates
and supervises the ECCD programs and services under his/her own department. Each
head submits his/her report to the City Planning Officer who collates and packages work
and financial plans and reports of accomplishments, not only for ECCD but also for all
other programs and services for children beyond six years of age. Reports are prepared
twice a year: mid-year and year end.

At the city social welfare office, the ECCD program is handled by several staff. A welfare
aide is assigned to handle and coordinate the day care; a social welfare assistant
handles children with disabilities of all age groups; and the assistant to the department
head takes charge of adoption, foster care for abandoned, surrendered children, children
in conflict with the law, and children who are victims of abuse and exploitation. The
department heads coordinate all ECCD efforts/programs and services in the department.
Incentives come in the form of capability building and attendance to professional
association conferences and participation in LGU-sponsored “Lakbay Aral” (educational
tours).


4.3    Accessibility/Quality of ECCD Programs/Services

From the province down to the municipal level and based on the WFP of Barangay
Capatan, it appears that the Councils followed the ECCD services recommended in the
CWC guidelines. They did not introduce other services because of their understanding
that only those programs indicated in the CWC guidelines will be funded.

It should be noted that the services reported here referred to the whole province as the
ECCD was not fully implemented in Tuguegarao City because of the delayed release of
funds and the election in May 2007. In Barangay Capatan, services mentioned were
those enumerated in their local development investment plan.

Province-wide, the services which have already been delivered included the following:
1) provision of reading and instructional materials and furniture (kiddie tables and chairs),
stand fan, video cassette device and outdoor facility for the day care center; renovation
of day care centers; 2) supplemental feeding; 3) micronutrient supplementation including
vitamin A, iodine supplementation and iron; 4) provision of deworming tablets for children
aged one to five years old; 5) distribution of ECCD cards; 6) upgrading and provision of
equipment for the rural health center such as weighing scale, sphygmomanometer and
stethoscope, and furniture like monoblock tables and chairs, and medicines (Rifampicin
and INH syrup; and 7) conduct of Reach Every Barangay or REB, a surveillance
program that identifies cases of neonatal tetanus.

The province has also conducted a number of capability building activities for the service
providers. These are as follows: 1) Three-day enhancement training for Grade 1
Teachers on the School Readiness Assessment 2006 and the Implementation of the
Early Childhood Experience; 2) Basic Course on Integrated Management of Childhood


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Illness; 3) Training of Trainors on the Revised Day Care Manual cum Orientation of
ECCD Checklist: Scoring, Analysis and Interpretation; and 4) Training of Trainors on the
PABASA sa Nutrisyon. In addition, several orientation programs on ECCD for the
different service providers were also conducted.

Among the services provided for in the ECCD, the implementation of newborn screening
was limited due to high cost of service. The local government-managed People‘s
Emergency Hospital conducts NBS but the city government only subsidizes PhP100.00
of the PhP600 total cost. Others can also avail of the service at full cost from St. Paul
University Hospital, a private hospital in the city.

Among the services, only the livelihood component of the ECCD has not been
implemented in the province of Cagayan. The livelihood component is intended for
families with below normal low and below normal very low children. The provincial ECCD
is still conducting livelihood trainings.
While the ECCD Program covers children zero to six years old, there were reported
activities which also addressed the concerns of older children and adults. Funds for
these were not drawn from the ECCD. These included the strengthening of the Pagasa
Youth Association of OSYs, orientation on violence against women and children, and
provision of toilet bowl molders.

Although not funded by the ECCD, the City of Tuguegarao has services for children in
need of special protection. The Stimulation and Therapeutic Activity Center (STAC) and
Responsive Shelter of Tuguegarao are innovations by the City. STAC is not specifically
for children aged zero to six years but many of the patients at the time of the field visit
were of these ages. The STAC provides specialized services like occupational and
physical therapy for children with disabilities; referral services for speech and
psychological evaluation; and other needed rehabilitation services for these children.

The government provides yearly allocation of PhP21,000,000 for the People‘s
Emergency Hospital where the STAC is a major hospital program/service for children
with disabilities. The substantial ($300,00) financial assistance of Kapisanan ng may
Kapansanan Inc. (KAMPI) for three years starting July 2007 ensures sustainability of the
STAC until 2010.

In Barangay Capatan with the money being forwarded to the municipality, the services to
be provided under ECCD were similar to those for the province. There were also others
not listed earlier as follows:

      Center-based supplemental feeding for 180 days and for iron syrup for seven
       malnourished children;
      Upgrading of barangay health center in terms of improving the facilities, e.g.,
       mason work of toilet and bath and hanging of curtain and height post, and
       procurement of medicine (ORS, Anti-TB drugs, paracetamol and antibiotics),
       medicine cabinet, and weighing scale;
      Purchase of iron tables for lactating and nourishing mothers;
      Renovation of the day care center through painting of walls and finishing the floor
       tiles and acquisition of instruction materials, e.g., reference books, workbook and
       educational compact disks; and
      Purchase of birth contraceptives like injectables (Depo Provera), oral
       contraceptives, and condoms;




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As reported earlier, the BC of Capatan and the Council has decided to shoulder the cost
of renovating the day care center. The money earmarked for this will be spent on other
activities.

4.3.1   The Service Facilities and Providers

The day care center is located at the ground floor of the barangay hall which is fairly
accessible to all the residents of the barangay. It is open for eight hours a day from
Monday to Friday. Based on the key informant interview, the day care worker was not
knowledgeable on assessing the height and weight of pre-school children. She also did
not know what to do with the underweight pre-school children or how to use the data on
nutritional status.

Meanwhile, the Barangay Health Center is located near the barangay hall. It is open from
8:00 am to 4:00 pm from Monday to Friday and from 8 am to 1 pm during Saturday. The
facility is about 20 square meters which is divided between the consultation room and
the waiting area. It is generally clean and orderly, well-ventilated but poorly lit; it does
not have a lavatory and water supply. The Center has basic functioning equipment like
stethoscope, BP apparatus, thermometer, tape measure, infant and adult weighing
scales, syringes, and nebulizer. However, the patients are asked to buy medicine and
supplies like gloves. Patients are also referred to the municipality for their medicinal
requirement. The Center does not also have a sterilizer for instruments, Maternal and
Child Health Manual and Mother and Child Book. Equipments are brought to the city
hospital for sterilization.

The referral system in the health center requires patients to bring with them their record
to the city hospital where they are being referred for treatment. The records are later
picked up by the midwife during their weekly meeting.

At the barangay level, the ECCD service providers comprised the day care worker, the
BNS, the BHWs, RHMW, and the Grade 1 teachers (Annex Table 4.3.1). Among the
barangay-based service providers, only the midwife has a plantilla position at the
municipality, thus, paid a monthly salary of PhP7,062 pesos and a transportation
allowance of PhP150. The other service providers receive monthly honorarium from the
province, city, and barangay. Meanwhile, the Grade 1 teacher is under the Department
of Education. Among the service providers, the BHW has the lowest honorarium while
the DCW receives the highest honorarium.

The BNS is 55 years old, had completed elementary education and has been servicing
the barangay for 17 years. She is not a member of the BCPC. She reports to the health
center once a week for one hour and a half. Her regular activities are weighing, inviting
mothers for immunization, preparing master list of children 0-24 months, and assisting in
the distribution of vitamins and deworming pills. She also conducts OPT once a year for
all zero to six years old. She is an active member of the women‘s group engaged in
making cacao balls.

Among the service providers, the midwife scored the highest with an average score of
0.89 followed by the BHW and last was the BNS with 0.69. The midwife got the highest
score on children‘s rights and children‘s cognitive development with 0.90 score Annex
(Table 4.3.2). Among the items the midwife missed on maternal and child health were 1)
the possibility for a pregnant woman with goiter to give birth to a mentally retarded child,
and 2) possibility for one to suspect if a person is anemic from the color of his/her palms.
These results were quite unexpected. Albeit, not very different from the other scores, the




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RHMW‘s score was lowest on maternal and child health. In fact, all the three service
providers had the lowest score on maternal and child health.

      Table 4.3.1.     Remuneration by type of service provider, Barangay Capatan,
                       Tuguegarao City
       Number        Service Provider        Salary         Honorarium        Source
                                                              (Peso)
      One (1)    BNS                            -              650         Barangay
                                                               200         City
                                                               100         Province
      Five (5)   BHW                            -              250         Barangay
                                                               200         City
                                                                50         Province
      One (1)    RHMW                        7,062
      One (1)    DCW                            -            1,450         Barangay
                                                               200         Province
      Two (2)    GOT                            -           9,000+         National

     Annex Table 4.3.2. Knowledge and attitudes of service providers
                        Item                          Service Provider
                                              BHW          RHMW             BNS
      On children‘s rights                      0.80         0.90           0.60
      On maternal and child health              0.63         0.88           0.56
      On children‘s cognitive development       0.80         0.90           0.90
      Average                                   0.74         0.89           0.69

Despite attendance to training on ECE, the Grade 1 teacher seemed not properly
equipped to handle the eight-week curriculum. Some of the observations included
insensitiveness of the teacher to the religious affiliation of the students, use of
threatening words and shouting at students, and use of inappropriate instruction
materials. When she was asked if she was aware of the teacher-child-parent friendly
approach and modules in teaching Grade 1, the answer was negative. She also kept the
water jug in the toilet; thus, the students kept on visiting the toilet. It was learned that
she was not provided with instructional materials during the training and that she only
used what was available and other visual aids which she could afford. Thus, not only
were the teaching materials inappropriate for the lesson but also small to be clearly
visible to the students at the back.

4.4. Integration and Convergence

Integration among the service providers involved more of coordination of different
personnel. Some service providers thought of integration as attendance to meetings and
submission of plans and accomplishments to the Club 82 coordinating council.
According to the BNS, she coordinates with the BC and the midwife who sign her report
while the midwife coordinates with her city health supervisors. She did not even
acknowledge the assistance of the BHW and the BNS. On the other hand, another
service provider considered the provision of services to her clients as integration.

At the household level, convergence was lacking based on the response of the mother
interviewed. Most of the services availed of were for the children only. For instance, her
preschool child received vitamin A capsule, was dewormed, and was regularly weighed.
There were no other services availed particularly by the mother. There were no other


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nutrition-related services received like nutrition education, mother‘s class, livelihood
assistance, seeds, and feeding. The lack of access to livelihood assistance was
expected because ECCD was not yet implemented; however, the other services were
already in existence before the ECCD implementation.

In Tuguegarao City, there were partners in the implementation of the ECCD and ECCD-
related activities. There were private institutions like the St. Paul University and St. Louis
University NGOs, parish councils, and evangelical churches. There was also the Plan
International, an international child welfare agency which has been sponsoring formal
education and health and nutrition needs of sponsored children specifically in-school
children. However, this organization will soon end its operation in the province.

4.5. Monitoring System

The yearly search for the most child-friendly city municipality serves as the built-in
monitoring and evaluation mechanism for the ECCD program utilizing the same
assessment tool. Monitored are the programs and services for children, WFP, facilities
for health, education, nutrition and protection of children, law/ordinance for children
passed, actual visit to centers, programs and services, review of records, and reactions
generated through interviews of parents/service providers conducted by the LGU and
Regional Council for the Welfare of Children (RCWC).

Each department head prepares mid-year and year-end reports on the program based
on the achievement of the objectives for the year. The result of the child-friendly
movement evaluation is discussed among LCPC/ECCDCC members, parents, and
service providers. The Child-Friendly Assessment tool has been effectively used since
2001 when the city first joined the contest. These are validated by members of the
regional sub-committee for the welfare of children chaired by the DSWD regional
director, and co-chaired by the DepEd and DOH representatives. Documentation of
service delivery is usually through the mid-year and year-end narrative and statistical
reports prepared by the LCPC members. Result of the child-friendly movement is written
yearly not only for the two ECCD barangays but for 54 barangays with the same
programs and services.

Briefly, each of the agencies involved in the ECCD implementation had its own system of
reporting, e.g., where to submit and frequency of reporting, resulting in the difficulty of
integrating the reports. For instance, the BNS prepares five reports and submits these to
different personalities as shown in Annex Table 4.5. Thus, the province came up with a
single recording process in each barangay and a single monitoring form for all activities,
not only for ECCD but also for all other activities of Club 82. In this manner, everyone
who visits the barangay can monitor the successes as well as the difficulties and
challenges in its implementation.

With a population of more than 3,000, Barangay Capatan must have a nurse and a
midwife; however, the Rural Health Center is only served by a midwife and assisted by
barangay health workers. The midwife is quite young at 24 years old. She has been with
the Barangay Capatan for three years. She has also attended several training programs
on cold chain management, natural family planning method, renal diseases and EPI but
not on IMCI, IMCH, Manual for Midwives, Nutrition and PES. She claimed to have
knowledge of ECCD but does not know when it started in the barangay (This has not
been implemented).

Of the five BHWs, the BHW interviewed was almost twice older than the RHM. She has
been with the barangay for seven years. She reports to the health center once or twice a


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week depending on their activities. The activities of the BHWs included the following up
of patients, home visits, assistance during the annual household surveys, administration
of vitamin A supplementation in the day care center, referral of sick patients to health
center, and helping the midwife in accomplishing reports. The BHW does not know the
ECCD despite the claim of the municipality to have conducted ECCD orientation for all
service providers.

Annex Table 4.5. Report submitted by type, to whom submitted, and frequency by the Barangay
             Nutrition Scholar, Barangay Capatan, Tuguegarao City
         Type              To whom submitted            Frequency            Feedback
Barangay Nutrition        City Nutrition Action   Annual                The reports are
Action Plan (BNAP)        Officer (CNAO)                                checked          for
                                                                        correctness during
Full weighing report      Midwife first then to   Biannual
                                                                        evaluation or upon
                          the CNAO
                                                                        submission.
Monthly weighing report   Midwife first then to   Monthly               Feedback          is
                          the CNAO                                      usually    provided
Quarterly weighing        Midwife first then to   Quarterly             during the monthly
report                    the CNAO                                      meeting of BNS.

BNAP Accomplishment       City Nutrition Action   Annual
Report                    Officer (CNAO)



4.6    Facilitating and hindering factors

Based on the annual report of accomplishments, several factors have positively and
negatively influenced the implementation of ECCD in the province of Cagayan. The
facilitating factors consisted of the support being extended by the local government
executives as well as national agencies; positive attitude of program beneficiaries;
organized and functional PECCDC, MCCDC and BCCDC or the local counterpart of the
Council for the Protection of Children; and timely submission of the required documents,
e.g., local investment plan and work and financial plan. A report ensured timely release
of funds.

By contrast, factors that hindered or slowed down the implementation were as follows:
late submission of the required documents; the long/stringent bidding process which
delayed the purchase of some instructional materials; unavailability of supplies locally;
non-availability of transport which limited the visits to the ECCD barangays, particularly
the far-flung areas; and performance of other duties aside from ECCD.


5.0     Province of Misamis Occidental

5.1.    Profile

Misamis Occidental is located near the narrow strip of land between northwestern
Mindanao and the north central part of the island. It is bounded on the northeast by the
Mindanao Sea; east by the Iligan Bay; southeast by Panguil Bay; and west by the
provinces of Zamboanga del Sur and Norte.

Misamis Occidental is a third-class-income province composed of 14 municipalities, 3
cities (Oroquieta City as the provincial capital), 2 congressional districts, and 492
barangays. It has a total land area of 1,939.32 sq. km and total population of 486,723
people (as of May 2000). There is a high dependency ratio caused by the large


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population of residents aged 0 to 17 years (54%) and the increasing population of 60
year old and above (9.6%).

Calamba, a landlocked fourth-class municipality, is located in the northern part of the
province along the National Highway leading from Ozamis City to Oroquieta City and to
Dipolog City of Zamboanga del Norte. It is one of the smallest municipalities with its
estimated land area of 112.54 sq. km. This land area is distributed to 19 barangays. As
of 2000, Calamba had a total population of 17,594 or a total population density of 156
persons/sq. km.

Agriculture is the main source of livelihood in the municipality that includes coconut, rice
and corn production; vegetable and fruit production; livestock raising (poultry, swine,
cattle, carabao and goat); and fishing (tilapia, hito and carp). Coconut is the
municipality‘s main product. Cassava has been recently introduced to the farmers. Rice
and corn milling, as well as cooperatives, are other income sources.

Barangay Siloy is the second largest barangay of the Municipality of Calamba. It is
accessible by all types of vehicles through the 9-km provincial road from the highway.
Farming is the primary occupation of Siloy residents, majority of whom own the lands
they till. After farming, however, most of the farmers have secondary occupations like
raising livestock, becoming hired labor, or managing sari-sari (variety) stores in the
barangay. There are no big businesses and commercial establishments in Siloy.

There is a small population of Subanens that resides in Barangay. Siloy. About 50
households are members of the Tribal Community Association of the Philippines
(TRICAP) of which the Subanen group was organized in 1996. The TRICAP extends
lending (financial) facilities to its members and assists, together with the provincial LGUs,
in goat dispersal and peanut production projects.

The two cultural traditions that the Subanens of Siloy still celebrate are the Menajak
(Love) Festival and the Halad (Offering). The Menajak Festival features various street
and ritual dances to the rhythm of the drum and agong as participants don colorful
Subanen costumes. This festival is celebrated by Calambahanon every February 14.

Siloy Subanens take part in the halad, an offering of chicken and eggs, usually organized
and celebrated in Barangay. Mamalad where more Subanens reside. (Mamalad
Subanens even give durian seedlings to the Siloy group.)

Many child-rearing practices in Siloy Subanen households are similar with those of the
mainstream. There were suggestions raised to document and utilize Subanen songs,
stories and music but this project was never done.

Since the Siloy TRICAP secretary (a Subanen) became ill and passed away in May
2007, the Siloy group has not been active anymore. The secretary had once been in-
charge on following up on all the TRICAP projects in the past.




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5.2     ECCD Structure and Management

5.2.1     Planning

The formulation of the Provincial Development and Investment Plans for Children (2004-
2008) was based on the survey data presented during the 2004 workshop on ECCD3
and consultations with the municipalities. In these plans, the provincial TWG (PTWG)
identified three major goals--children‘s nutrition, health, and education.       The pilot
municipalities were required to come up with their five-year development and investment
plans for children. Annual work and financial plans are also submitted to the provincial
LGU, which the latter consolidates to an annual provincial work and financial plan.

Aside from supporting the national goals for children, the Development Plan for Children
of Misamis Occidental incorporates the Target 1000 Project of Gov. Loreto S. Ocampos.
Target 1000 is the Short-Term Development Plan of the province covering a three-year
period (2007-2010) or 1,000 working days of the present leadership and administration.
It sets all targets at ―1,000‖ to achieve the province‘s goals for CHAMPS—Competence,
Health, Agriculture, Maintenance of Peace and Order, Preservation of the Environment,
and Social Services. Target 1000 includes targets for health, nutrition and education
interventions directly benefiting infants, children and mothers; targets for the promotion
of quality family life (substantive and relational aspects); and targets for the development
of ECCD support mechanisms. All targets at various system levels (from micro to macro)
affect the development of infants and children.

At the Barangay level, based on the MECCDCC‘s ECCD work and financial plans, the
proposed projects of Siloy are purchase of program materials for the DCC; purchase of
health materials and equipment for the BHC; and supplemental feeding. The LGUs refer
to the CWC checklist of program materials and equipment which are required for the
DCS and health and nutrition programs.

In order to avail of the CWC funds, the BCPC was requested to determine the number of
malnourished children before Siloy could benefit from the supplemental feeding
activities. For the requested civil works, the BCPC needed to submit a program of work,
barangay certification, counterpart manpower or resources (e.g., parents contributed
additional vegetables and firewood for the supplemental feeding), and photos of the
structures for renovation. Ordinances and resolutions had to be passed as well.

5.2.2     Financial Management

Funds are transferred from the CWC to the provincial LGU as stipulated in the Work and
Financial Plan. It is by the same process that funds are transferred from the provincial
LGU to the municipal LGU. The PTWG is responsible for the disbursement of funds
following the procedures set by the COA. No procurement of equipment, supplies and
materials for ECCD programs are made at the provincial level.

ECCD funds amounting to P1,100,000.00 per pilot municipality is obtained from the
CWC (80 percent), provincial LGU (20%), and municipal LGU (10%). To date, there have
been three fund releases and its fund statuses are shown below:

        Annex Table 5.2.2. ECCP funds released to pilot municipalities.
            Budget                  Amount                          Status/Remarks                      Source
                    st
         Total 1                P 1,640,680.00            Fund utilization is 78 percent                 CWC
3        release
   The data usednd the 2004 ECCD workshop seemed to be the preliminary outputs of the medium-term strategic
         Total 2 for            P 2,483,287.20            Released August 2007                           CWC
objectives set till 2005. As conveyed by the Provincial Social Welfare and Development Officer, these data were the bases
         release
for developing the Provincial Development and Investment Plans for Children (2004-2008).
                    rd
         Total 3                P 8,039,673.20            For release: Recently                          CWC
         release                                          conducted orientation for
                                                          expansion phase areas                                      94
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There were time differences between the release and utilization of funds depending on
the capacity or efficiency of the municipal LGUs. Consequently, succeeding releases
were withheld when fund utilization from the previous release has not reached 50
percent.

An annual investment program is submitted to the municipal LGU every year. However,
since 2006, the BCPC has not yet received any CWC-supported ECCD fund for its
planned projects—the repair/rehabilitation of the BHC; purchase of materials and
equipment in the BHC; and purchase of DCS materials.

In 2006, Siloy participated in the six-month supplemental feeding activities initiated by
the MECCDCC. The municipal LGU managed the funds, purchased the necessary
materials, and delivered these monthly to its eight pilot ECCD barangays.

This year, the municipal LGU released funds amounting to PhP33,000.00 to Siloy‘s Day
Care Parents group for another supplemental feeding activity. The funds were used to
pay for the milk and ingredients the group purchased. Rice came from the NFA through
the DSWD and LGUs. After the 42-day feeding activity, the Parents Group submitted a
report to the MSWDO.


5.2.3 Delivery System dating Organization

The full implementation of ECCD with support from the Council for the Welfare of
Children (CWC) began in the third quarter 2005 but the institutionalization of ECCD
system as an initiative of the province commenced as early as 1998. The U.P. Education
Research Program provided technical assistance then.

The PTWG for ECCD4 was formed in 2004 before the ECCD funds were released. In a
workshop, the PTWG and provincial officers selected and prioritized the municipalities
and barangays that would be involved in the CWC-supported ECCD system
implementation. Criteria used were those stated in the ECCD Act, as well as additional
indicators promoted by National Economic and Development Authority (NEDA) and the
Child 21 framework.

Some of these indicators were high incidence of poverty; identified high malnutrition rate,
infant mortality rate, maternal mortality rate and under-five mortality rate; low level of
participation of the three to five years old children in the day care service and preschool
programs; and low participation rate in Grade 1 and high drop-out rate among Grade 1
pupils.

The PTWG recommended seven priority municipalities to the Governor who made the
final decision. The pilot sites are Baliangao, Calamba, Clarin, Don Victoriano, Jimenez,
Lopez Jaena and Tudela.

The Governor heads the management of the ECCD system at the provincial level but the
actual management was assigned to the Provincial Social Welfare and Development
Officer who is the present ECCD Action Officer. The members of the PECCDC are as
follows: Schools Division Superintendent, Provincial Planning and Development
Coordinator, Provincial Budget Officer, Provincial Health Officer, Provincial Director of
DILG, Provincial Social Welfare and Development Officer (ECCD Action Officer),

4
   The PTWG is the same as the Provincial ECCD Coordinating Committee (PECCDCC). The two acronyms are used
interchangeably in this report.



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Provincial Treasurer, Provincial Nutrition Action Officer, President of the Provincial
League of Municipalities, and two representatives from NGOs (Himaya and Paglaum).

5.3.   Accessibility/Quality of ECCD Services Delivered

The ECCD health, nutrition and education interventions in the province are based on the
program designs made by and ―handed down‖ from the NGAs. However, there are
presently four provincial initiatives or thrusts that contribute to or highlight ECCD goals
for education and nutrition.

At the Barangay level, the participation of Siloy in the institutionalization of the ECCD
system in Calamba started in 2006. The BC is the officer-in-charge of the BECCDCC
while all the BCPC members automatically became the BECCDCC members. There is
no additional support staff hired for the ECCD system in Siloy.

The BCPC of Siloy is said to have six committees: education, health, agriculture,
environment, peace and order, and sports. The activities of each committee are
enumerated in the table below:

 Annex Table 5.3. Activities performed by the six committees of the BCPC, Siloy,
            Calamba, Misamis Occidental
   Committee                                           Activities
 Education             Focuses on the school and helps improve the health conditions of the
                        children; its most recent activity was the supplemental feeding
 Health                Conducts survey every quarter, e.g., number of households without
                        toilets
                       Follows up status of residents with illness; convinces them to seek
                        medical advice; gives referrals or recommendations
                       Implements the 4 o‘clock habit for dengue prevention—burn dry leaves
                        to drive away mosquitoes, instructs people to use mosquito nets
 Agriculture           Implements many projects (Siloy is an Agrarian Reform Community)
 Environment           Tree planting as anti-deforestation measure
 Peace and order       Protects or secures the earth dam
                       Monitors residents conducting illegal fishing activities by the river
 Sports                Organizes basketball, boxing games, get-together and parties in the
                        barangay


Since Siloy was identified as an ARC many years ago, a lot of agencies and
organizations have ―come in‖ to assist the barangay. Church groups and the LGU-based
agrarian reform and agriculture offices coordinated with them.

The Siloy Health Center is located beside the DCC (same compound) and across the
abandoned and dilapidated Barangay Hall. It is a permanent structure—roof made of G.I.
sheets, concrete walls and floor – with a waiting area and consultation rooms inside that
are well ventilated, generally clean, and organized. There is no electricity in the center
but it remains properly lit because of the natural light that penetrates the numerous
jalousied windows. The center has no piped water too. Water is sourced instead from the
communal piped water system outside and stored in containers. The surroundings of the
center are also clean.

5.4 Service Providers

For the BHW, ―integration‖ refers to the concern for the needs of children aged zero to
six years and their mothers. ―Extent of integration‖ among the various service providers
refers to the mothers‘ orientation and home visits they are able to conduct. The


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collaboration between the barangay LGU and CARE Philippines or ZPHEP has assisted
her in fulfilling her ECCD responsibilities. The gains of integration have been her monthly
honorarium (total P450.00); and the various materials, supplies and equipment essential
for the health services.

The RHMW finds the health services provided in the barangays ―relevant, appropriate,
and socially acceptable.‖ She was involved in planning and deciding which services
needed to be implemented in the communities.

A list of health-related services had been provided by the RHMW (Annex Table
5.4.1).The commonly utilized services were the vitamin A supplementation, OPT, and
deworming. The least utilized were the family planning services and immunization (due
to few number of children).


 Annex Table 5.4.1 Status of the health-related service provided by the RHM, Siloy,
              Calamba, Misamis Occidental.
           Services             Frequency   Target   Served              Reasons
 Pre-natal care                 Monthly          9    8.3      Target was too high
 Child birth/delivery           As needed       13    9.5      Deliveries mostly handled
                                                               by hilot
 Post-natal care                As needed      13      9.5     Served only those assisted
                                                               by RHMW
 Tetanus toxoid for             Monthly         9      10      Target was too high
 pregnant women                                      percent
 Vit. A supplementation for     2x/year        13      80      Regular monitoring of
 family planning clients                             percent   RHMW
 Iron supplementation for                      13     60%      Inadequate supply of iron
 post partum mothers
 Family planning—new                            4     60%      CDH doing family planning
 acceptors                                                     services
 EPI (fully immunized child)                   32     50%      Target was too high
 Nutrition program with vit.A   Every 6       106     90%      Support from the national
 supplementation for 0-59       months                         level and BHWs‘
 month olds                                                    commitment in doing their
                                                               tasks
 Operation Timbang              1x/year       186    72.2%     Target was too high
 CDD                                            4    100%      Full support of the LGU
 CARI                                           3    100%      Full support of the LGU


There were no innovations introduced in any of the above-mentioned services. Among
these services, the RHMW found the EPI (fully immunized child) program the easiest
task to implement because following up on the children basically entailed the RHMW
coordinating the schedule of services and list of beneficiaries with the BHWs.
Considered the hardest was childbirth and delivery because of the inaccessibility of
transportation to the areas and because of the difficult terrain in the far-flung areas.

The day care service sessions in Siloy are conducted five days weekly, three hours daily.
The DCW renders another three hours for other related DCS tasks everyday. All 28
children enrolled this school year belong to the morning class. Their ages ranged from
four to seven years. The table below enumerates the DCW‘s tasks:

Among the tasks performed by the DCW, meeting with the DC Parents Group was the
easiest for the DCW because the parents were cooperative and supportive—they spend
time in the DCC to help the DCW manage the children; respond positively when asked to



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contribute; and easily understand the DCW‘s needs. Conducting the DC sessions was
the hardest. Because children‘s family life experiences are varied, the DCW found it
difficult to adjust or manage the class effectively (Annex Table 5.4.2).

Moreover, since 1996, the provincial LGU had not purchased new program materials for
the DC children like drawing books and developmentally appropriate reading materials.
The DCW used the curriculum development framework and procedures she was trained
on in the early 2000‘s. The same were contained in the Revised DCW Manual which
provides a step-by-step guide to DCWs on how to develop their DCS curricula. At the
start of the school year, the children‘s health information or records were given to the
DCW so that continued medical assistance (e.g., purgative every two months) can be
extended. Children‘s birth certificates were also shown or submitted to her.


 Annex Table 5.4.2. DCW‘s tasks, Siloy, Calamba, Misamis Occidental
         Tasks            Freq         Innovations    Target         % served and reasons
1. Conduct DCS          Daily       Used pictures,   28          80%--due to sickness,
  sessions                          reading          enrolled    dropped out, under aged;
                                    materials, field children    live far away from the DCC
                                    trip
2. Meets up with DC     Monthly
  Parents Group
3. Conducts             Daily for                    28          90%--absences due to
  supplemental          42 days                      children    illness
  feeding for DC
  children
4. Celebrate Araw ng    Yearly
  Calamba
5. Celebrate Children‘s Yearly
  Month

From 2002 to early 2007, the DCW used the Child Development Checklist (CDC) to
assess children‘s developmental level. Starting July 2007, she had been administering
the ECCD Checklist; the results are to be utilized for curriculum planning. The DCW has
attended numerous training programs since 1997 and found these beneficial in
enhancing her competencies to provide creative activities appropriate for the children.

The MSWDO was involved in planning and deciding on the relevant and appropriate
ECCD interventions in the communities. As the ECCD Action Officer, she directly
coordinates with all agencies concerned through the MECCDCC and BECCDCCs. She
is also involved in planning, implementing, monitoring, evaluating, and reporting the
ECCD projects in Calamba. The target participants are the children, parents, BDCs and
the communities.

As an MSWDO, she is directly involved in supplemental feeding, DCS sessions and
referrals (Annex Table 5.4.3).

The recent training programs included child development, ECCD assessment checklist,
among others (Annex Table 5.4.3).

These services were promoted to the target participants through barangay assemblies,
parents‘ meetings, and PES sessions. Supplies for these services are oftentimes
inadequate because of insufficient funding.




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 Annex Table 5.4.3. Training activities attended by the DCW‘s, Siloy, Calamba, Misamis
                    Occidental
         Training program/ Topic                Dates        Training            Funding to attend
                                                             provider
 Child development                            June 2007    MSWDO              Municipal LGU
 ECCD assessment checklist                    June 2007    MSWDO              Provincial LGU, National
                                                                              agencies
 DCW curriculum and instructional             May 2002     U.P. ERP           Municipal and Provincial
 materials development seminar-                                               LGUs
 workshop
 ECCD Child development monitoring            April 2002   U.P. ERP           Municipal and Provincial
 and    session     planning    seminar-                                      LGUs
 workshop
 Creative teaching for DC children            July 2001    U.P. ERP           Municipal and Provincial
                                                                              LGUs
 Trainers‘ training on creative teaching      May 2001     U.P. ERP           Municipal and Provincial
 for DC children                                                              LGUs

The MSWDO believes that everyone who is concerned with the implementation and
delivery of services should follow procedures or processes (protocol) as prescribed,
recommended or designed depending on the nature of the services. Training programs
are provided anyway. The delivery of ECCD services has improved because of the
―convergence of agencies‖ and the organization of the MECCDCC and BECCDCCs.

The Grade 1 Teacher has been teaching in the Siloy Elementary School for four years
now and in the Grade 1 level for one year only. He is a college graduate and is employed
on a permanent status by the DepEd District of Calamba. His salary is P10, 939.00 per
month.

 Annex Table 5.4.4. ECCD projects in Calamba
      ECCD Interventions                   Target Participants                   Frequency
 Supplemental feeding              malnourished children              6-month duration/ year
 Day Care Service sessions         3-6 year old children              Daily
 Referrals                         3-6 year old children with         As the need arises
                                   needs and their parents


The Grade 1 class is held five days a week from 7:30 am to 2:00 pm. The 26 children in
the GOT‘s class were all required to submit their birth certificates and to take the School
Readiness Assessment (SRA) when they applied to be admitted before the start of S.Y.
2007-2008. Three dropped out from school since then, due to poor nutritional status,
inadequate daily subsistence, and distance from home to school. The table below
enumerates the services he provides (Annex Table 5.4.5).

The GOT considered the supplemental feeding as the easiest task because the children
and assisting adults were all cooperative. The hardest task was managing children‘s
illness because of the lack of paraphernalia and medicines. To illustrate, the GOT had a
Grade 1 pupil who seemed to be hearing-impaired. The GOT found out that the cause
was ear infection. He helped clean the child‘s ears everyday, applied herbs, and finally
referred the child to the BHW. He was disappointed that some of the children‘s families
were ―hard to reach‖ because they prioritized their livelihood/work over meeting their
children‘s immediate needs.



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Before the start of the school year, Grade 1 entrants took the SRA in order for the school
to determine their developmental level in five basic competency areas: Gross and Fine
Motor, Receptive and Expressive Language, and Cognitive domains. These domains are
critical in tracking Grade 1 learning competencies.

 Annex Table 5.4.5. Services provided by the Grade 1 teacher,     Siloy, Calamba, Misamis
                        Occidental
            Services                 Freq     Target  Served               Reasons
 R-BEC curriculum                  Daily    All       70-         Different levels of
                                                      75%         thinking
 Supplemental feeding (Food for Weekly      All       100%        Children loved it
 School program of DepEd)
 Managing children‘s illness       Acquired sick ones 80%         Lack of medicines



The SRA results of Grade 1 pupils in Siloy elementary school indicated that 95 percent
of them were ―not ready‖ for the Grade 1 learning competencies. The GOT explained
that children might not have been able to comprehend the SRA instructions which were
administered in English as he was instructed to do. It was not clear how the GOT used
the eight-week ECD curriculum to help children develop the readiness skills that were
lacking. As of data-gathering time, the second SRA consolidated report for the second
administration, i.e. after the eight weeks, was not yet available. (The District Reading
Coordinator (DRC) of Calamba refuted the GOT‘s explanation: the SRA Test (SRAT)
Manual states ―use the first language/ mother tongue/dialect that is familiar to the child.‖)

Of the 22 Siloy elementary school Grade 1 pupils tabulated in the DRC‘s consolidated
report, 73 percent had ECE experiences under the DCS. The Child Development
Checklists of these children were not forwarded to the Grade 1 teacher or to Siloy
elementary school. The DRC commented that they are not interested in the end-year
assessment results of DC children because according to them there is no link between
the DCS and Grade 1 curricula.

The GOT uses the R-BEC curriculum developed by the DepEd. He modifies this from
time to time to fit with his pupils‘ ―level of thinking.‖ Survey and test measures are the
other assessment techniques used in class.

The School-In-Charge directly supervises the GOT‘s work and extends technical
assistance to teachers particularly in the area of pupils‘ achievement. Consultations may
be done as the need arises; however, the GOT has not received any feedback for
improvement. Table 4.5.4.1.6 shows the list of reports the GOT prepares in order to
document different aspects of teaching the Grade 1 class.


5.5 Integration and Convergence

For the BHW, ―integration‖ refers to the concern for the needs of children aged zero to
six years and their mothers. ―Extent of integration‖ among the various service providers
refers to the mothers‘ orientation and home visits they are able to conduct. The
collaboration between the barangay LGU and CARE Philippines or ZPHEP has assisted
her in fulfilling her ECCD responsibilities. The gains of integration have been her monthly
honorarium (total PhP450.00); and the various materials, supplies and equipment
essential for the health services.




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 Annex Table 5.5.1. Reports prepared by the Grade 1 teacher
                   Report                Submitted to     Freq      Receive feedback?
  Pupils‘ test results or achievement       S-I-C       Quarterly          No
  Reading assessment                        S-I-C       Quarterly          No
  Class attendance                          S-I-C       Monthly            No
  Pupils‘ nutritional status                Nurse       Annually           No

For the BNS, ―integration‖ is coordinative in nature, i.e. it refers to the coordination
between the BNS and MNAO. The BNS has not collaborated with private and non-
government agencies in the conduct of her responsibilities. For the MNAO, ―integration‖
refers to being ―integrated in other programs implemented by the LGU to the different
sectors‖ or ―the services rendered are not on health alone.‖ The MNAO believes that
ECCD has improved service delivery to children aged zero to six years. The DCW joins
the BNS in monitoring the weight and health of children and families through mothers‘
classes and home visits. The MNAO has also collaborated with private doctors and civic
organizations who conducted outreach services on nutrition.

The Siloy Household

The household is a nuclear family composed of five members: the couple and three
children aged eight, six and one year(s) old. The sources of household income are
farming/livestock raising and hired labor.

Care and Nurturance of Children

The mother is the main player when it comes to attending to the children‘s sustenance.
She buys food (ingredients), prepares the meals, and feeds the children. She is also
responsible for bathing the children and putting them to sleep. She helps them with their
homework or teaches/reviews school lessons (on speaking, reading, writing) in their
home. Outside, she accesses services like immunization and vitamin supplementation.
She also performs other household tasks like laundering and ironing. Approximately 12
hours per day are spent on caring for her children. The father is involved in feeding the
children. Meanwhile, the children are involved in all tasks except for meal preparation.

Health and nutrition practices

Upon the advice of her parents, the mother availed of the pre-natal services in the
barangay during the three pregnancies she had. Only one of her three pregnancies was
more difficult because of experienced headaches and dizziness during the first trimester.
She consulted the BHW to determine the cause of her discomfort.

All her children were breastfed for more than 10 months. The mother considers
breastfeeding very important because the colostrum strengthens the children‘s immune
system, it saves on cost and it is easier to do/manage. The BHW encouraged her to
breastfeed. She breastfeeds the youngest about eight to nine times in day; three times
each in the morning, afternoon and evening, with each breastfeeding time lasting about
15 minutes. She cleans her breasts and nipples by washing these gently with soap when
she takes a bath.

This started when the (youngest) child was six months old. Foods regularly given were
vegetables in soup like squash, upo, and papaya. Feeding happens three times daily.
The foods were either prepared in the home or bought and stored in a pot in the kitchen.



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Children take a bath once daily and they are sponge-bathed or cleaned up before they
sleep in the evening. Eating paraphernalia are washed with soap and foods are stored in
pots in kitchen.

When children are ill, the mother feeds them congee, milk and biscuits. It is believed that
Royal Tru-Orange soft drink can bring down fever so she serves this also to a feverish
child.

The household uses water-sealed toilet. The source of water is the spring, which the
mother claims to be safe for drinking.

Early education practices

The mother believes that disciplining children is a must so that children grow up with
good manners, conduct themselves well, and possess values like respect for elders,
helpfulness, honesty, and fear of God.          The positive discipline techniques include
praising the child; hugging, kissing or showing affection; giving gifts like Barbie Doll; or
permitting the child to join the DCC‘s field trip. The ―right ages‖ to discipline children are
between five and ten years when children are ―still obedient‖ and parents are confident
that what they say or teach the children will not fall on deaf ears. On the other hand, the
negative discipline techniques include reprimanding, reminding, scolding, ―lecturing,‖ or
spanking.

While children in the past started schooling at seven years old, children at present are
sent at earlier ages because more adults believe these are the formative years. In fact,
the mother thinks that children as young as three years old can already enroll in the DCS
because the earlier they are exposed to a variety of stimulating learning experiences, the
earlier they will likewise develop.

Generally, parents who send their children to ECE programs like the DCS want their
children to be prepared for Grade 1 schooling. On the other hand, parents who do not
enroll their children reason that the ECE experiences are a waste of time. They are busy
with farm work and there are no additional hands to attend to their children‘s needs in the
DCS or meet the requirements like bringing or fetching them; participating in DCS or
parents‘ activities take up their time.

Without any difficulties or anxieties, the two older children attended the DCS when they
were four to five years of age. Before this, the DCC was already a familiar sight since the
children participated in feeding activities conducted in the same area. They would look
forward to attending the DC sessions everyday and meeting new classmates. They liked
the drawing activities best and the writing activities least.

The mother is not knowledgeable about how the DCW conducted children‘s assessment
but she was informed about the status of her children‘s development (a ―paper‖ was
shown to her). For her, the DCS contributed most especially in her children‘s social
growth—overcoming shyness and gaining confidence. She intends to enroll the
youngest one in the DCS someday so that he can become like his older brother.
To protect their children from some internal and external threats, the mother shared that
they encourage the children and whole family to attend religious activities/services as
these are also practiced in school (―religious hour‖) and to engage in activities like music,
art, sports, and gardening in order to develop or improve their talents and skills; provide
safety measures at home to prevent accidents like turning off the main electrical switch
when the children are left alone in the house; ensure that children do not have
pornographic and violent media materials accessible; do not witness violent conflicts or
confrontations between spouses; and they do not engage in gambling activities in the


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neighborhood. However, the mother allows the children to choose whatever radio
program, television program or printed materials they want to listen to, watch or read.

Aspirations for the children

The mother would like to see her children study and finish school. These would lead
them to work and later on to have families of their own and ―live a good life.‖ The
mother obtained the highest KAP ratio (1.00) on children‘s rights and the lowest KAP
ratio on maternal and child health (0.56). Her KAP ratio on children‘s cognitive
development was satisfactory (0.73) (Table 5.5).

Among the different ECCD services available in Siloy, the household availed of the
following for its members:

   Annex Table 5.5.2. ECCD services available in Siloy
                      Services                     F       M      C1     C2      C3
    Mother and the unborn child:
      Reproductive health and family planning       /      /
      Pre-natal check visits                               /
      Tetanus toxoid immunization                                  /      /       /
      Nutrition education program                          /       /      /

    Infancy:
       Growth monitoring and promotion                             /      /
       Birth registration                                          /      /       /
       Full immunization                                           /      /       /
       Breastfeeding and complementary feeding                     /      /       /
       Micro-nutrient supplementation
       Food supplementation                                        /      /

    Early childhood:
      Day care service                                           4 yo    5 yo



5.6 Monitoring and Evaluation

The PTWG monitors the ECCD implementation in the pilot municipalities every quarter.
In teams of five members, they visit the areas to verify project status, identify hindering
factors in implementation, and assess the functionality of ECCD organizational structures
at the municipal and barangay levels.

No monitoring forms are referred to but PTWG members use existing program indicators
to monitor in the field. Data generated from monitoring visits are utilized by the specific
offices (agencies) that provide technical assistance for respective programs
(e.g.,PSWDO). The CWC report forms are accomplished. A provincial ECCD
management information system (MIS) is likewise maintained but, to date, not all of the
consolidated ECCD data from the municipalities and the registry/directory of ECCD
service providers have been encoded or updated yet. ECCD service providers monitor
the outputs of their respective programs regularly. Through them the BCPC/BDC
monitors the projects as well. Survey results, problems, and concerns are presented in
the BDC meetings and discussed in the quarterly Barangay General Assemblies.

The barangay office is housed in a dilapidated structure so all the documents pertaining
to the operations of the BDC are kept in the homes of the Barangay Secretary and
Treasurer. There is no ECCD management information system in Siloy.



                                                                                      103
 Table 3.1.1.5. Zinc deficiency by age
      and by gender (in percent)
   Age        Male   Female        %
                                                                                             Final Report
group/sex                      deficiency
6-11          8.7      9.7         9.1
months
                     References
1 year        11.1   8.4     19.1
2 years        8.6
                   Canlas, Dante, Philippines Midterm Progress Report on the Millennium Development
                     7.8      8.2
                          Goals. http://www.neda.gov.ph/econreports_dbs/MDGs/midterm/Midterm %20
3 years       11.3   6.9      9.1
                          MDG%20 Progress%20Report.pdf
4 years       13.4  13.9     13.7
5 years        9.3 DLSU Social Development Research Center. 2002. Ours to Protect and Nurture: The
                     7.9      8.5
                          Case of Children Needing Special Protection, National Project on Street Children
All           10.6   9.1      9.8
children
                              UNICEF. Manila Philippines
   Sources:          Department of Education and Culture, DSWD. 2002. ECCD Indicators: A Country Case
   DOST-                   Study, Consultative Group on ECCD as cited in UNESCO 2004.
   FNRI
   NNS, 2            Department of Health. 2000. Philippine Health Survey.
                     Department of Science and Technology-Food and Nutrition Research Institute. 1993;
                           1998; 2003; Regional Updating of the Nutritional Status of Children, 1989/1990;
                           1992; 1996; 2001; 2005
                     Department of Social Welfare and Development, Policy Development and Planning
                           Bureau. 2007. Distribution of Day Care Center by Region.
                     Gordoncillo, P.U, CV Barba, , M. M. Paunlagui, Ma. T. Talavera, N. Gordoncillo, R de
                           Jesús, A. Gana, and L. Soliven. 2005. Early Childhood Development Project:
                           Endline Indicators Survey.
                     International Development Research Center, 1988.
                     NSO. Population of Preschool Children by Single Age Group, Philippines: 2000-2007
                     Kennedy, G., G. Nantel, P. Shetty. Assessment of the Double Burden of Malnutrition in
                          Six Case Study Countries. FAO Food and Nutrition Paper 84. 2006. p. 2-20
                     National Statistics Office. 2006. Family Planning Survey.
                     National Statistics Office. 1998 & 2003. National Demographic Survey
                     Pedro , MRA, RC Benavides, CVC Barba. 2006. ―Dietary Changes and their Health
                            Implications in the Philippines.‖ In The Double Burden of Malnutrition – Case
                            Studies from Six Developing Countries. FAO Food and Nutrition Paper 84.
                            pp.206-257
                     Taylor, Lindsay J., M. Gallagher, F. S.W. McCullough. 2004. ―The Role of Parental
                             Influence and Additional Factors in the Determination of Food Choices for Pre-
                             School Children.‖ International Journal of Consumer Studies, Volume
                             28, Number 4, September 2004, pp. 337-346(10)
                     Tuazon, MAG and RCF Habito. 1997. The National Salt Iodization Program, the
                           Philippines. Undated. http://inffoundation.org/pdf/phillipines%20IDD.pdf




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Description: Plan of Work malnutrition