For every thousand babies born in the Philippines, 27 do not get to celebrate their fifth birthday. Of those who do, one in three are stunted, as many as 45 percent in poorer provinces. Meanwhile, nine out of 10 children aged ten cannot read proficiently.
Such grim statistics on health and education have far-reaching economic consequences. Because stunted children are less likely to perform well in school due to impaired learning and cognitive abilities, they face a 60 percent reduction in future income. Challenges within the education sector play a role, but poor early childhood care exacerbates the problem. If the state of a country’s children predicts its future, what can we surmise about the prospects for the Philippines?
For years, our health research team at the Philippine Institute for Development Studies has delved into system-level issues to understand the persistent challenge of stunting. Most recently, we supported the Second Congressional Commission on Education’s (EdCom II) investigation into the issue. Despite efforts in the past 30 years, progress in reducing stunting rates and improving educational outcomes has been minimal compared to countries like Vietnam and China.
Stunting results from cumulative “shocks” during pregnancy and until a child turns two. These shocks come from either insufficient quantity and quality of food, repeated exposure to illness resulting from poor sanitation and hygiene, and access to quality primary care.
To prevent stunting, pregnant women and children under two should receive a sequential and timely package of health and nutrition interventions. The package includes access to clean water and toilet; adequate prenatal checks that provide micronutrient, calcium, and protein supplements and prepare mothers to breastfeed, initiate complementary feeding, and stimulate the child. Adequate well-baby checks also provide timely immunization services, vitamin A supplementation, zinc supplementation in case of diarrheal diseases, and food supplementation if needed.
Thus, it is not simply the mother’s ability to care for the child, but the health system’s ability to care for the mother-child duo across time—or the first 1,000 days—that will spell the difference.
Our recent study for EdCom II shows that only a quarter of Filipino children aged six to 12 months meet the recommended energy intake, while only about half of children regularly engage in activities like reading and watching educational content during important growth stages. Participation in early education for Filipino children aged 3 to 4 years is low. While it improved to 20 percent by 2022, it’s still below pre-pandemic levels.
The slow progress in addressing stunting also reflects our policy choices, which rely on reactive and stop-gap solutions. A substantial portion of the country’s nutrition resources is allocated to feeding programs and other short-term interventions that fail to tackle the root causes of stunting and reach an adequate number of children, especially those between the ages of 0 and 2. Our study revealed that only 23 percent of children benefit from them. Reliance on stop-gap measures yields suboptimal benefits and, worse, robs scarce resources from sustainable and impactful solutions.
The country invests poorly in the primary health-care (PHC) system, an ideal platform for the continuous and comprehensive delivery of essential health and nutrition services.
In our report for EdCom II, we outlined comprehensive recommendations. Implementing the following can make a groundbreaking difference in our health and education outcomes: The government must spend more, and spend better, and leverage national resources so local governments can use them on early childcare. Consider earmarking a portion of the internal revenue allotment and implementing matching grants for highly effective health, nutrition, and early education interventions. Additionally, equitable resource allocation should be prioritized to support poorer local government units in implementing essential programs.
The government should fast track the implementation of the Universal Health Care Act, prioritizing investments in primary health care to ensure comprehensive maternal and child health and nutrition services. Revenues from outpatient benefits could be a source for sustainable PHC financing. Increase investments in health-care workers within the PHC system, empowering them to monitor mothers and children from pregnancy to early childhood.
We need to reassess and evaluate the government’s school feeding program to understand its benefits and challenges. Start with thoroughly analyzing implementation hurdles, such as bureaucratic delays and program adequacy. Given limited resources, prioritize targeted allocation to areas with the greatest need, rather than spreading resources thinly nationwide.
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Dr. Valerie Gilbert T. Ulep is a senior research fellow at the Philippine Institute for Development Studies. His paper on early childhood care and development in the Philippines, published in support of the EdCom II, may be accessed at www.edcom2.gov.ph/publications.