SCALING UP THE INTEGRATED SCHOOL NUTRITION MODEL IN THE PHILIPPINES: Experiences and lessons learned

Introduction

The Philippines’ Department of Education (DepEd) instituted a school-based feeding programme (SBFP) as part of the national government’s Accelerated Hunger-Mitigation Program (NNC, 2014) and a school gardening programme referred to as Gulayan sa Paaralan (Vegetable Gardens in School) Program or GPP (DepEd, 2007), to address hunger and promote better attendance and retention among schoolchildren. Unfortunately, implementation issues and weak links between the two programmes continue to affect the effectiveness and sustainability of the programme. Thus, there is a need to understand these issues and gaps, and try to address them via new models of implementation.

After three years of generating evidence through the integrated school nutrition model (ISNM) (Chapter 4), which features bio-intensive gardening (BIG), supplementary school feeding using iron-fortified rice and promotion of nutrient-rich indigenous vegetables from school gardens, and nutrition education, the model has been systematically expanded from one province (Cavite) in 2015 to 2017 to an entire region comprising 5 provinces (IV-A/Calabarzon) in the Philippines. Initially, 58 lighthouse schools (LSs), which now serve as focal points for research, learning and scaling, were established and are now influencing, at varying levels, 2,732 public elementary schools benefitting a total student population of 1,839,445.

Recognizing the value of the model, DepEd pursued a capacity-building programme to establish additional LSs, targeting at least one LS per school division, all over the Philippines. Through training of trainers, a total of 273 LSs are now installed in 17 regions of the Philippines. The ISNM is now being scaled up in schools across the nation via institutionalization and multi-stakeholder engagement and partnerships. Investments by the government and private sector have been important. Currently, national agencies like the Department of Agriculture, the Department of Social Welfare and Development and the National Nutrition Council of the Department of Health have adopted elements of the model in their own programmes (Oro, 2018).

Background

Schools provide strategic, targeted pathways for delivering nutrition interventions among children and, indirectly, to their families and communities. A 3-year action research project (Phase 1: 2012-2015) implemented by IIRR and the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST), in partnership with DepEd, with support from the International Development Research Centre (IDRC), developed and tested an ISNM of school gardening, supplementary school feeding, and nutrition education among schoolchildren in Cavite province in the Philippines. Results showed that supplementary feeding of malnourished schoolchildren using iron-fortified rice and indigenous vegetables from school gardens significantly improved their nutritional status (chapter 4) (Oro and Angeles-Agdeppa, 2015a). Enhanced knowledge, attitude, and practices on gardening and nutrition were observed among parents (Oro and Angeles-Agdeppa, 2015b). The project tested and successfully sustained bio-intensive nutrition gardens and crop museums that aimed to retrieve and conserve traditional crop cul- tivars while improving year-round availability of a diverse range of climate resilient, locally adapted, and nutritionally important vegetables (Oro and Angeles-Agdeppa, 2015c).

Phase 2 (2017-2018) of this project focussed on more in-depth understanding and operationalization of the integrated model by expanding the number of research schools. The potential of schools as platforms for nutritional and environmental learning was investigated. Modalities by which local government and private sector, through public-private partnership, can support school nutrition were explored. A multi-scalar approach tested two pathways for scaling up. The first one was directed towards public elementary schools at a sub-national level. The second was directed at national agencies, policy makers, planners, and the media.

Research results were documented, packaged, and disseminated through publications, national and international forums, reports, policy briefs, and other communication materials (IIRR, 2018a). These knowledge products serve as the basis for advocating the ISNM for wider adoption and support by relevant government agencies such as DepEd, Department of Agriculture, Department of Social Welfare and Development, and the National Nutrition Council of the Department of Health. This chapter discusses the process of scaling and the lessons generated from the experience.

Understanding the concepts of scaling

Scaling up defined

Institutionalization and scaling up reflect wider adoption of a proven model, strategy, technology, or an intervention. Clark makes a distinction among three types of scaling up: project replication; building grassroots movements; and, influencing policy reform. The first two are linked to expansion. Fisher also defined scaling up as a process of influencing policy; she uses the term ‘scaling out’ to describe expansion (Uvin and Miller, 1999).

Scaling up is defined as ‘more quality benefits to more people over a wider geographical area more quickly, more equitably and more lastingly’ (IIRR, 2000). Going to scale, in general, connotes vertical movement across institutional levels and/or horizontal spread as shown in Figure 10.1.

Horizontal scaling up, sometimes referred to as scaling out means geographical expansion to include more communities, institutions, and people. Vertical scaling up refers to higher-level expansion and is institutional in nature. This reflects influence and advocacy to policy makers, donors, development institutions, and investors at national and international levels.

FIGURE 10.1 IIRR’s scaling up framework. Sourer. IIRR, 2000.

In a comparative review of scaling strategies for research in natural resources management, scaling up was linked to a people-centred vision and highlighted the ‘value of time, equity and sustainability dimensions’ (Giindel et al., 2001).

Implementing at scale

What to scale?

DepEd implemented two national programmes: the SBFP and the GPP to mitigate hunger and to increase attendance and retention of public elementary students in schools. However, the two programmes have been operating separately, limiting expected outcomes. Through the action research implemented by IIRR, in partnership with FNRI-DOST and DepEd, the ISNM, an innovative approach to school nutrition for better nutrition and educational outcomes, has been developed and is described in detail in chapter 4. The ISNM integrates three major components: (i) Bio-intensive gardens (Gonsalves et ah, 2015), (ii) Supplementary feeding of underweight children using iron-fortified rice and indigenous vegetables from school gardens, and (iii) Nutrition education of students, parents/care providers/guardians, and teachers to promote the importance of nutrient dense food and good eating habits. The ISNM olfers a way to achieve better nutritional outcomes, which are linked to good educational outcomes. It also ensures sustainability of the gains in school nutrition programmes while optimizing benefits from limited resources.

How to scale? The multi-scalar approach to scaling

The initial three-year (2012-2015) research generated evidence on the etfec- tiveness of the ISNM in addressing under-nutrition among children. Based on lessons generated, the model was refined and implemented at a wider scale to achieve greater nutritional outcomes through institutionalization, wider adoption, better linkages, increased investments, and enabling policies to support integrated school nutrition programming.

Utilizing a multi-scalar approach, the ISNM was brought to scale through two pathways (Figure 10.2). The first pathway was via horizontal scaling where ISNM was institutionalized in public elementary schools in one province (Cavite) and expanded at sub-national level - that is from Cavite province to Region IV-A Calabarzon (comprising of five provinces - Cavite, Laguna, Batangas, Rizal, and Quezon). Schools were selected and designated as LSs, which are focal points for research, learning, sharing, and dissemination hubs of integrated school nutrition innovations (IIRR, 2018b). A critical mass of 58 LSs (40 in Cavite province and 18 in other provinces of Region IV-A) were established, from whom other public elementary schools in Cavite and Region IV-A learned. The LSs also served as crop museums (IIRR, 2017), which are relevant in reintroducing agrobiodiversity as nutritionally important to schools and surrounding communities.

FIGURE 10.2 Research conceptual and theoretical framework. Source: IIRR.

The second pathway (Figure 10.3) was via vertical scaling aimed at the national level, influencing relevant national agencies, policy makers, and decision makers through thematic presentations and related dialogue processes. Through partnership building and networking the wider nutrition community, which includes non-governmental organizations (NGOs), international donors, private (including corporate social responsibility pathways) and public sector, they were engaged towards building a community of practice for school-based nutrition. The platforms and associated knowledge products that came out of the action research influenced national government policy and planning processes to generate impact at the national level, including new policy guidelines in school-based feeding and additional resource allocation in the school nutrition programme.

Learning about scaling up

Experiences from the research project pointed to various issues and dimensions that need to be considered to ensure effective implementation and later up-scaling of an integrated nutrition programme in schools. A scalable, self-sustaining, and effective programme for integrated nutrition programming for Philippines schools must

FIGURE 10.3 Multi-scalar scaling up strategy. Source-. IIRR.

have the following attributes: (1) the programme is supported by administrators, students, and parents at all relevant levels. For this to happen, schools must be able to gain capacity to adapt the programme based on their local context; (2) the programme is consistent with the governments’ education and nutrition objectives and policies; (3) it is supported by appropriate educational resources including garden space, learning resources, linkages to curricula for different subjects; (4) it is supported financially, including contributions from school budgets, NGOs, local governments, and the private sector; and (5) it generates strong synergies among the different elements, including nutrition, agricultural, and environmental education.

Strategies, methods and lessons

It was the intent of the research project to establish a critical mass of schools implementing the ISNM and to generate evidence-based policy recommendations that would enhance existing school-based nutrition programmes to address school-aged malnutrition. Thus, at the outset, strategies for scaling out (to expand coverage of the adoption), as well as scaling up (influencing policies for national adoption), were developed and deployed. Below is a discussion of key strategies and methods, as well as lessons generated from them.