BARANGAY NUTRITION ACTION

PLAN
CY 2023-2025

Barangay: SAN RAFAEL

City/Municipality: SAN ESTEBAN
Province: Ilocos Sur
Region: I
 BNC

THE BARANGAY NUTRITION COMMITTEE

Printed Name Designation Office Signature

Chairman: Barangay Captain
Co-Chairman: Kagawad, Committee of Health
BNS: Barangay Nutrition Scholar

Members:
Kagawad, Committee on Agriculture
Kagawad, Committee on Education
Kagawad, Committee on Infrastructure
Committee on Budget
Kagawad, Committee on Peace and Order
 3-Year Barangay Nutrition Action Plan
2023-2025
Barangay of SAN RAFAEL

TABLE OF CONTENTS

Outline
1. Introduction
2. The Nutrition Situation
3. Goals and Objective
4. Work Plan
5. Quarterly Accomplishments of PPA
6. Monitoring and Evaluation Scheme
7. Budgetary Requirements
8. Reference

Attachment
1. LDP
2. AIP

Annexes
Annex 1. Identification of Interventions
Annex 2. Priotization of Interventions
 Barangay Nutrition Situation
Barangay _________SAN RAFAEL_________________
CY __2022_______
Barangay _________________________ has a total population of ____________ or ______ households
distributed in its _________ puroks (Family Profile CY ________). There is a Barangay Nutrition
Office, ______ Barangay Health Station, ______ Day Care Centers and _______ Elementary Schools.
There are _____ Botika ng Barangay and _____ Tindahan ng Barangay found in the Barangay.
Barangay Nutrition Committee composed of ______________________________________.
There are _____ infants 0-5 months and ______ 6-23 months and ______ 24-59 months old children.
There are also ______ pregnant and _______ lactating mothers are revealed in the latest family
profile. Based on the OPT Plus results of CY _______ which covered ______% of children 0-59
months old, there are _______ (______%) wasted and ______(______%) severely wasted 0-59 months
old children, and ______(______%) stunted and ______(______%) severely stunted 0-59 months old
children.
The overall prevalence of underweight preschool children in 20___ at ______% is higher / lower
than in 20____ and 20____. the possible reasons for the (Increase / decrease) may be, the
(improvement / deterioration) in the overall (food supply / purchasing power / increase in the
price of _______/ increased cases of infections / food consumption) as indicated by the following
data from ________:
Table _____: Number of meals consumed per day, CYs _____-______

Number of Households %
No. of average meals consumed per day
More than 3 meals a day
3 meals a day
less than 3 meals a day

Of the ______ puroks, Purok ____ has the highest percentage of families with unemployed heads
and/or earning less than P3000/month and has the most number of undernourished children.
Puroks ____ and ____ are the next 2 puroks with the highest prevalence of undernourished
children.
_______(_____%) out of _______school children were weighed at the start of the school year and
the baseline result showed that ______ (_______%)are severely wasted, _____ (_____%) are wasted,
______(______%) are normal, ______(______%) are overweight and ______(______%) are obese.
Compared to last year's baseline data, the prevalence of severely wasted school children (_____
%) increased/decreased, whereas, the prevalence rate (_____%) of wasted schoolchildren
increased/decreased.

In terms of access to safe water, only _____ households have piped water supply (level III),
_______ households source their water from the nearby faucet (less than 100 meters), while
______ get water from deep well and springs. An estimated _____ number of hoseholds source
their drinking water from water refilling stations. Only ______ households have their own
water-sealed toilets while (_____) while (_____) household share their toilet with other
households and ______ households do not have sanitary toilets. Based on BHS records in CY
______, there was an increase in the number of diarrhea cases observed, e.g. from _____to _____
among households getting their drinking water from spring.
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 BARANGAY PROFILE

Format A
BARANGAY PROFILE - I. Health and Nutrition Status

POBLACION
Name of Barangay: ____ANSAD___________
City/Municipality: __SAN ESTEBAN_________
Province: ____ILOCOS SUR________________
PART - A SCHOOL CHILDREN (SC)
(1) Total Number of Pur _ (14) No. of Normal Weight: __________ ____
(a) Latest Period of OPT: _________JANUARY 07,2022___________________
(2) Total No. of Population: ________________ (15) No. of Wasted: _______________ (b) % OPT Coverage: _____________________________________________________
(3) Total No. of Households: _______ (16) No. os Severely Wasted: ________ ( c) Age specific Proportionate Mortality Rate (ASPMR) ________________
(4) Total No. of Preschoolers: ___________ (17) No. of Overweight: _____________ (d) No. of Households with Home Gardens: _____________________________
(5) Total No. of School Children: ____________ (18) TOTAL WEIGHED: _________ (e) Common Occupation: _________________________________________________
(6) Total No. of Pregnant Women: _______ (f) Total No. of Households with SUW and UW PS: ______________________
(7) Total No. of Lactating Women: _____ (g) Total No. of Households with SUW School Children: ________________

PRE-SCHOOL CHILDREN (PS)

(8) No. of Normal Weight: _____________ SC P/L 15 yrs & above

(9) No. of Underweight: __________________ (19) Night Blindness ___________ ____________ ____________ _____________
(10) No. of SEV Underweight: ___________ (20) Anemia ___________ ____________ ____________ _____________
(11) No. of SEV and Underweight: ______ (21) Goiter ___________ ____________ ____________ _____________
(12) No. of Overweight: ________________ (22) Diarrhea ___________ ____________ ____________ _____________
(13) TOTAL WEIGHED: _________%________ (23) Harelip/ Cleft Palate _______ ____________ ____________ _____________
PART - B
TOTAL NUMBER PRE-SCHOOL CHILDREN SCHOOL CHILDREN

PUROK (Name or R
Number) Wasted + Over Total Night Harelip/ A
Pregnant Lactating UW + SUW Over Total Weighed Anemia Goiter Diarrhea
Population HH PSC SC N UW SUW Normal Severely weight Weighed Blindness Cleft
Women Women weight Wasted Palate N
K
11 13 15 17 18 19 20 21
15 yrs & 15 yrs &
SC
1 2 3 4 5 6 7 8 9 10 No. % 12 No. % 14 No. % 16 No. % PS SC SC P/L over PS SC P/L over 22 23

TOTAL
 FORMAT B

FORMAT B
BARANGAY PROFILE
CY __2022___
I. GEOGRAPHICAL PROFILE II. GEO-G AND SOCIO-ECONOMIC SITUATION III. SOCIO-ECONOMIC SITUATION

A. Family Size (household Size)

A. Location/ Boundary A. 3 Existing Grains Warehouse
A. 1 Within City/Poblacion A.3.1 Government Operated No. of Family Members No. of Families Total Population
A. 2 Along Shoreline (Lake-sea) A.3.2 Privately Operated 12
A. 3 Near Shoreline (Lake-sea) 11
A. 4 Inland B. Major Food Crops Grown 10
A. 5 Hinterland 9
B.1 Most Common Agricultural Products (Ranking) 8
B. Topography 7
B. 1 Plain B.1.1 Rice 6
B. 2 Rolling Terrain B.1.2 Corn 5
B. 3 Predominantly Upland B.1.3 Rootcrops (camote,cassava, gabi, etc.) 4
B.1.4 Vegetables (tomato, squash, etc.) 3
II. AGRICULTURAL PROFILE B.1.5 Others (specify) 2
1
A. 1 Agricultural Facilities Existing in the Barangay B.2 Most Common Livestock/Poultry (Ranking) Total
B.2.1 Swine
A. 1.1 Rice Mill (Private or Government B.2.2 Goat B. Most Common Type/Kind of Dwelling Units (Ranking)
A. 1.2 Cono B. 2.3 Chicken Type
A. 1.3 Kiskisan B.2.4 Ducks Concrete
B.2.5 Others (Specify) COW/CARABAO Semi-Concrete
A. 2 Irrigated System Existing in the Barangay Nipa/Bamboo
B.3 Other Porducts (Ranking) Wood
A. 2.1 National B.3.1 Fish Barong-barong
A. 2.2 Communal B.3.2 Seaweeds Others (Specify)
A. 2.3 Pumps B.3.3 Rattan C. Most Common Source of Potable Water Supply (Ranking)
A. 2.4 Mountain Spring (Gravity) B.3.4 Charcoal/firewood Pipe/Waterworks/Refilling Station
B.3.5 Wild Bamboos Deep Wells (Shallow)
B.3.6 Others (Specify) Spring
None
FORMAT B
 Cont. Format B

Cont. Format B. Barangay Profile

D. Electric & Telephone Services (%Coverage) G. Infrastructure

D.1 Electric _______99________ Transversed Along Near Far Very Far None
D. 2 Telephone/Cellphone __100______ G.1 Natioal Road (Highway)
G.2 Provincial Road
E. Presence of Educational Institutions in the Barangay (Checkonly) G.3 Municipal Road
G.4 Feeder Road
E.1 Government G.5 Seaport
G.6 Airport
E.1 .1 Elementary
E.1.2 High School H. Most Common Transport Facilities (Ranking) 1.4 Over-sea Contractual Workers
E. 1.3 College H.1 Buses
E.1.4 Vocational H.2 Jeepney 1.5 Pursuit of Profession (like Law/
H.3 Tricycle Private doctor/Midwifery,Etc.
E.2 Private H.4 Others
K. Main Source of Income of the Barangay
E.2.1 Elementary I. Type of Toilet Facility %
E.1.2 High School % of Total Household 1. Share from Real State Tax
E. 1.3 College Water Sealed 2. Share from Development Fund
E.1.4 Vocational Antipolo/Open Pit 3. Business and other taxes
Others (Specify)
F. Medical Facilities in the Barangay (Check only) None

F.1 Government J. Source of Income of the Household's Main Earners (Ranking)

F.1.1 BHS 1.1 Employment
F.1.2 Health and Nutrition Center 1.1.1 Government Offices
F.1.3 Community Hospital/Clinic 1.1.2 Private Enterprises
1.1.3 Family Business
F.2 Private
F.2.1 Dental Clinic 1.2 Farming
F.2.2 Medical Clinic
F.2.3 Hospitals 1.3 Self-Employed
 Three-year Work Plan

THREE- YEAR WORK PLAN

TARGET
Sector / Estimated
Program / Project 2020 2021 2022 Person In- Fund Source of Expected
Grp No Grp No Grp No Location charge Schedule requirement Fund Result

I. FOOD PRODUCTION

A.) ESTABLISHMENT OF BACKYARD GARDENING

Prepared by the Local Nutrition Committee____________________________________________

 Annual Work Plan

PROJECTS AND ACTIVITIES

CY ________

ANNUAL TARGETS
IMPLEMENTOR TOTAL TIMETABLE FOR IMPLEMENTATION
LOCATION Total Total POSSIBLE FREQUENCY / (KINDLY CHECK )
PROJECTS / ACTIVITIES (Purok) (Name and Target BUDGET
SOURCE DURATION
Position) Groups Number Number REQUIRED
Identified Targeted
(12)
(1) (2) (3) (4) (5) (6) (7) (8) (9) J F M A M J J A S O N D
 MONITORING AND EVALUATION SCHEME

MONITORING AND EVALUATION INDICATORS

LEVEL TYPE OF INDICATOR DATA SOURCE HOW TO COLLECT DATA PERSON IN-CHARGE FREQUENCY OF DATA
COLLECTION
Goal Impact

General/Outcome Objective Outcome

Specific/Output Objective 1 Output

Intervention 1 Input

Specific/Output Objective 2 Output

Intervention 2 Input
 BUDGETARY REQUIREMENTS

BUDGETARY REQUIREMENTS

Maintenance, Operations, and

Personnel Services Overhead Expenditure Capital Outlay Total
(MOOE)
References

Attachment 1
Three-year Local Development Plan of _________________
Year 2023-2025

Performance Area: __________________________________________

Goal:_________________________________________________________

Period of Implementation and Program/Project Cost

Objective Program /Project / Activity Legend Agency
2023 2024 2025

Prepared by the Local Nutrition Council: ________________________________________________________

Attachment 2

Annual Investment Plan (AIP)

According to Program /Project/Activity by Performance Area

Province/City/Municipality/Barangay:_________________________________________________________________________
Performance Area:_________________________________________________________________________________________________
Period of Implementation
Period of Implementation and Project
Source of Cost
AIP Reference Code Program/Project/Activity Lead Agency Expected Result
Funds Personnel Capital
Starting Date Ending Date MOOE TOTAL
Services Outlay
Reference

Attachment 3

Three- year evaluation of LNAP

Year 1 Year2 Year 3
Level Expected Result
Target Actual Target Actual Target Actual
General/
Outcome Objective

Specific Objective

Attachment 4
Three- year monitoring program/project of LNAP
Year 1 Year 1 Year 1

Program/Project Expected Result Accomplishment Accomplishment Accomplishment

Target Target Target
No. % No. % No. %
 QUARTERLY ACCOMPLISHMENT REPORT

QUARTERLY ACCOMPLISHMENTS OF PROGRAMS, PROJECTS AND ACTIVITIES

ACCORDING / AS PER BNAP (CUMULATIVE)
CY ____________

ANNUAL TARGETS QUARTERLY OUTREACH

PROGRAMS / PROJECTS / LOCATION 1st QUARTER 2nd QUARTER 3rd QUARTER 4th QUARTER
ACTIVITIES (PUROK ) No. % No. % No. % No. %
Target Groups Total Number Total Number
Identified Targeted

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
 FAMILY PROFILE

BNS PROFILE No. 1A

Philippine Plan of Action for Nutrition
FAMILY PROFILE

Zone/Sitio:______________________________________ Municipality:______________________________________
Barangay: _______________________________________ City/Province:_____________________________________
No. of Children Check if: Check if: Fill in: Check if:

No. of HH Breastfeeding < or equal 6 mos. Child Toilet Type Water Food Production HH Using HH
HH No. Members 0-5 mos 6-23 mos 24-59 Name of Household Head/Spouse Occupation Educational Mother Couple Practice (WS, OP, O, Source ( P, Activity (VG, P/L, Iodized Using
old old mos old Attainment Pregnant Family Planning N) W, S) FP) Salt IFR
Mixed Milk
EBF Feeding Bottle Feeding
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

Total

Abbreviations Educational Attainment Water Source Food Production Activity

CF - Complimentary Feeding IFR- Iron Fortified Rice EU - Elementary Undergraduate CU- College Undergraduate P - Pipe VG - Vegetable garden
EBF - Exclusive Breastfeeding (F) - Father EG - Elementary Graduate CG - College Graduate W - Well P/L - Poultry/Livestock
HH- Household (M) - Mother HU - HS Graduate V - Vocational S - Spring FP - Fishpond
HG - HS Graduate O - Others
 OPT Plus

Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1. List of preschoolers with weight and height measurements and identified nutritional status
Series 2012
Barangay: ______________________________ City/Municipality:________________________ Province: _____________________ Year: _________ Date of OPT Plus: _____________________
Date of (Yr-Mo-Day) Nutritonal Status*
Measurement
Name of Household Head/ Name of Preschooler Sex Age in Weight (kg) Length/ Weight for
Purok
Mother/Caregiver Birthday Months Height (cm) Weight for Length / Ht
Length /
Age for Age
Weight Length/Height Height

(1) (2) (3) (41) (5) (6) (7) (8) (9) (10) (11) (12) (13)

*Codes: for Nutritional status: Weight-for-Age: N-Normal UW- Underwight SUW- Severely Underweight OW- Overweight
Length-for-Age: N-Normal St- Stunting Sst- Severely Stunting T- Tall
Weight-for-Length/Height: N- Normal W- Wasted SW- Severely Wasted OW-Overweigth Ob- Obese
"Age-in-months" always refers to completed number of months, i.e. 34 months and 30 days is considered 34 months only.

Prepared by: __________________________________________________________ Cheked by: _____________________________________________________________________________________________

Name & Signature of Barangay Nutrition Scholar Name & Signature of Midwife/Nurse/District/City Nutriton Program Coordinator
Date: _____________________________________ Date: _____________________________________
 OPT Form 1 B
List Affected

Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1B. List of Affected/At-Risk Preschoolers 0-59 Months old
Series 2012

Barangay:______________________________________________
City/Municipality: __________________________________

Instructions:
In column 1, copy the household number from the Family Profile. In column 5 "NA" if not applicable, specify specific indegenous group/tribe.
In column 2, write the family name first, followed by name of the household head. In column 6, indicate the age in months based on last completed month.
In column 3, write the first name of the preschool child only. In column 7-14, check the appropriate nutritional status.
In column 4, write "B" for boy and "G" for girl.

Nutritional Status
Household Name of Household Name of Preschooler Sex Indegenous Age in
Number Head/Mother/Caregiver Group Months UW SUW St Sst W SW OW Ob
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

Prepared by: ______________________________________________________ Checked by:__________________________________________________________Approved by: ___________________________________________________

Name & Signature of Barangay Nutrition Name & Signature of Midwife/Nurse/District/ Name & Signature of Barangay Captain,
Scholar City Nutrition Program Coordinator BNC Chairperson
Date: ________________________________________________ Date: ___________________________________________________ Date: _____________________________________________
BNS Form #4

Philippine Plan of Action for Nutrition

MONTHLY ACCOMPLISHMENT REPORT
For the Month of ____________________________

Name of BNS: ____________________ Province: __________________ City: _________________________ Municipality: __________________

Number Reached This Month

LAST
TARGET Old Cases MONTHS
(Cases THIS
TARGET NUMBER (As New Cases TOTAL (Write
ACTIVITY stated in the reached on the MONTHS
GROUP (Cases the entry from (Add column 5
BNS Action previous reached for the column 6 of
month who the first time) the last month and 6)
Plan)
reached again report)
this month)

(1) (2) (3) (4) (5) (6) (7)

A. WEIGHING ACTIVITIES
1. Full Weighing
- Preschoolers 0-59 mos
2. Monthly Reweighing
- 0-23 months 0-23 mos