Project Completion Report

Project Number: 27086 Loan Number: 1606/1607 June 2007

Philippines: Early Childhood Development Project

CURRENCY EQUIVALENTS

Currency Unit – peso (P)

At Appraisal At Project Completion 29 December 1997 30 November 2005

P1.00 = $0.02502 $0.00185 $1.00 = P39.975 P54.12

ABBREVIATIONS

ADB – Asian Development Bank ADF – Asian Development Fund ARI – acute respiratory infection ASIN – Act for Salt Iodization Nationwide CDW – child development worker CWC – Council for the Welfare of Children DCM – day care mom DCW – day care worker DepEd – Department of Education DOH – Department of Health DSWD – Department of Social Welfare and Development EA – executing agency ECCD – early childhood care and development ECD – early childhood development ECDP – Early Childhood Development Project ECE – early childhood education EPI – expanded program on immunization FIC – fully immunized children GMP – growth monitoring program IEC – information, education, and communication IMCI – integrated management of childhood illnesses LGU – local government unit M&E – monitoring and evaluation MDFO – Municipal Development Finance Office MTR – midterm review NDHS – National Demographic and Health Survey NGO – nongovernment organization NNC – National Nutrition Council NPMO – national project management office OCR – ordinary capital resources PCR – project completion report PEM – protein-energy malnutrition PES – parent effectiveness service PMO – project management office R&D – research and development RHM – rural health midwife TT2 – tetanus toxoid 2

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NOTE

In this report, “$” refers to US dollars.

Vice President L. Greenwood, Jr., Operations Group 2 Director General A. Thapan, Southeast Asia Department (SERD) Director S. Lateef, Social Sectors Division, SERD Team leader K. Schelzig Bloom, Poverty Reduction Specialist, SERD Team member C. Fajardo, Project Officer, SERD

CONTENTS Page

BASIC DATA ii MAP vii I. PROJECT DESCRIPTION 1 II. EVALUATION OF DESIGN AND IMPLEMENTATION 1

A. Relevance of Design and Formulation 1 B. Project Outputs 2 C. Project Costs 7 D. Disbursements 8 E. Project Schedule 8 F. Implementation Arrangements 9 G. Conditions and Covenants 9 H. Related Technical Assistance 9 I. Consultant Recruitment and Procurement 9 J. Performance of Consultants, Contractors, and Suppliers 10 K. Performance of the Borrower and the Executing Agency 10 L. Performance of the Asian Development Bank 11

III. EVALUATION OF PERFORMANCE 11 A. Relevance 11 B. Effectiveness in Achieving Outcomes 12 C. Efficiency in Achieving Outcomes and Outputs 12 D. Preliminary Assessment of Sustainability 13 E. Impact 14

IV. OVERALL ASSESSMENT AND RECOMMENDATIONS 15 A. Overall Assessment 15 B. Lessons 15 C. Recommendations 16

APPENDIXES 1 Annotated Design and Monitoring Framework 18 2 Comparison of Planned Investments and Actual Equity Contributed by LGUs 42 3 Project Implementation Schedule 42 4 PMO Staff Mainstreamed/Absorbed by DSWD and CWC 45 5 Status of Compliance with Loan Covenants 46 6 Sustainability Indicators for Selected LGUs 53 7 Overall Assessment Summary Table 56

BASIC DATA

A. Loan Identification

1. Country Philippines 2. Loan Number

− Loan Number 1 1606-PHI − Loan Number 2 1607-PHI (SF)

3. Project Title Early Childhood Development Project 4. Borrower Republic of the Philippines 5. Executing Agency Department of Social Welfare and Development 6. Amount of Loan

− Loan 1606-PHI $15.70 million − Loan 1607-PHI (SF) SDR 6.487 ($8.8 million)

7. Project Completion Report Number PHI 981

B. Loan Data

1. Appraisal − Date Started 18 August 1997 − Date Completed 19 September 1997

2. Loan Negotiations

− Date Started 13 December 1997 − Date Completed 15 December 1997

3. Date of Board Approval 27 January 1998 4. Date of Loan Agreement

− Original 15 April 1998 − Amended and Restated 22 December 2002

(for OCR Loan)

5. Date of Loan Effectiveness − In Loan Agreement 20 July 1998 − Actual 28 September 1998 − Number of Extensions 0

6. Closing Date

− In Loan Agreement 31 January 2005 − Actual Loan account still open − Number of Extensions 1

7. Terms of Loan

1606-PHI − Interest Rate Pool-based, LIBOR-based (15 December 2002) − Maturity 25 years − Grace Period 5 years − Commitment Charge 0.75% per annum 1607-PHI (SF) − Interest Rate 0 − Maturity 35 years − Grace Period 10 years − Service Charge 1% per annum

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8. Disbursements

a. Dates

Initial Disbursements Final Disbursement Time Interval

1606-PHI 22 January 1999 15 November 2005 6.8 years 1607-PHI (SF) 22 January 1999 15 November 2005 6.8 years

Effective Date Original Closing Date Time Interval

1606-PHI 28 September 1998 31 January 2005 6.8 years 1607-PHI (SF) 28 September 1998 31 January 2005 6.8 years

────────────────────────────────────────────────────────────── b. Amounts

Category Original Allocation

Last Revised

Allocation Amount

Cancelled Net

Amount Available

Amount Disbursed

Undisbursed Balance

LOAN 1606-PHI ($) Civil Works 1,400,000 2,678,468 0 2,678,468 2,647,790 30,678 Equipment 2,900,000 1,885,294 0 1,885,294 1,940,647 -55,353 Micronutrients and Food Supplements 2,600,000 1,421,075 0 1,421,075 1,418,407 2,668 Workshops and Seminars 400,000 1,983,403 0 1,983,403 1,297,112 686,291 Materials 1,400,000 1,289,120 0 1,289,120 783,812 505,308

Training 1,600,000 1,388,359 0 1,388,359 1,217,817 170,542 Operating Costs 1,900,000 2,554,281 0 2,554,281 2,008,316 545,965 Interest and Commitment Charge 2,500,000 2,500,000 0 2,500,000 1,905,381 594,619 Unallocated 1,000,000 Imprest Account 208,700 -208,700

Total 1606-PHI 15,700,000 15,700,000 0 15,700,000 13,427,982 2,272,018 LOAN 1607-PHI (SF) (SDR)

Social Marketing and IEC 221,000 448,630 0 448,630 419,931 28,699

Materials and Supplies 2,875,000 4,591,394 0 4,591,394 3,949,432 641,962 Special Studies and Surveys 1,253,000 639,030 0 639,030 433,438 205,592

Consulting Services 1,032,000 512,946 0 512,946 537,109 -24,163 Service Charge 295,000 295,000 0 295,000 151,142 143,858 Unallocated 811,000 0 0 0 0 0 Imprest Account 0 0 0 0 0 0

Total 1607-PHI (SF) 6,487,000 6,487,000 0 6,487,000 5,491,044 995,948 IEC = information, education, and communication. Note: There were over disbursements in some categories.

The expenditures were incurred towards the end of the Project and it was decided not to process a reallocation of loan proceeds.

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Disbursement

9. Local Costs Financed (1606-PHI) − Amount ($’000) 8,629 − Percent of Local Costs 40 − Percent of Total Cost 18

10. Local Costs Financed (L1607-PHI) − Amount ($’000) 4,007 − Percent of Local Costs 19 − Percent of Total Cost 8

C. Project Data

1. Project Cost ($’000)

Cost Appraisal Estimate Actual Foreign Exchange Cost 20,700 25,700 Local Currency Cost 44,300 21,500 Total 65,000 47,200

2. Financing Plan ($’000)a

Appraisal Estimate Actual Costs

Foreign Local Total Foreign Local Total Implementation Costs Borrower Financed 0 18,100 18,100 0 8,800 8,800 ADB Financed 7,400 14,300 21,700 6,300 12,700 19,000 World Bank Financed – – –

– – 17,300

Subtotal 13,600 44,300 57,800 23,600 21,500 45,100 IDC Costs Borrower Financed 0 0 0 0 0 0 ADB Financed 2,900 0 2,900 2,100 0 2,100 World Bank Financed 4,300 0 4,300 0 0 0 Subtotal 7,200 0 7,200 2,100 0 2,100 Total Cost 20,700 44,300 65,000 25,700 21,500 47,200 ADB = Asian Development Bank, IDC = interest during construction. a Calculations are based on the exchange rate to the dollar for each fiscal year. The actual cost in ADB

financing is the dollar equivalent as of 1 March 2007. Full data on World Bank financing still awaited from Department of Social Welfare and Development.

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3. Cost Breakdown by Project Component ($’000)

Component Appraisal Estimate Actual Foreign Local Total Foreign Local Total Civil Works 200 2,200 2,500 1,300 2,700 4,000 Equipment and Vehicles 3,900 1,700 5,600 4,900 1,200 6,100

Materials and Supplies 2,200 9,000 11,100 5,800 7,900 13,700 Micronutrients and Food Supplements 4,800 2,000 6,800

3,000 0 3,000

Special Studies and Surveys 400 1,700 2,000 100 800 1,000 Social Marketing and IEC 200 1,400 1,600 500 1,000 1,500 Training 600 5,800 6,400 1,900 3,500 5,400 Workshops and Seminars 0 1,200 1,200 0 1,400 1,400 Monitoring and Evaluation 400 1,200 1,600 0 0 0 Operation and Maintenance 0 200 200 0 100 100 Project Staff Salaries 0 1,900 1,900 0 2,000 2,000 Caregiver Incentives 0 7,500 7,500 0 0 0 Specialized and NGO Consulting

Services 100 1,700 1,800 5,800 800 6,600 Taxes and Duties 0 1,700 1,700 0 0 0 Imprest Account 0 0 0 200 200 200 Contingencies 900 5,300 6,200 0 0 0 Service Charges 7,200 0 7,200 2,100 0 2,100 Total 20,700 44,300 65,000 25,700 21,500 47,200 IEC = information, education, and communication, NGO = nongovernment organization. Notes: Appraisal estimate based on the Report and Recommendation of the President. Totals may not add due to rounding. Cost breakdown is based on dollar equivalents as of 1 March 2007. 4. Project Schedule

Item Appraisal Estimate Actual Establish Core and Full PMO From Q3 1997 to Q1 1998 From Q2 1998 to Q4 1999 Hiring of Consultants for PMO From Q1 1998 to Q1 1998 From Q1 1998 to Q4 2002 Installation of Cold Chain From Q3 1998 to Q4 1998 From Q3 2001 to Q4 2004 Orientation and Seminars on IMCI andTraining From Q2 1998 to Q2 2000 From Q3 1999 to Q4 2004 Establish Training Centers From Q3 1998 to Q4 1998 From Q4 1999 to Q3 2000 Hiring of Consultants for Food Fortification From Q2 1998 to Q2 1998 From Q1 1999 to Q3 2002 Communication Plan Development andImplementation From Q4 1998 to Q4 2004 From Q3 2001 to Q4 2005 Manual and Materials Development and Training for PES From Q2 1998 to Q4 2001 From Q1 1999 to Q4 2004 Development of Training Manuals and Materials for ECE and Training From Q1 1998 to Q1 2001 From Q2 1998 to Q1 2001 Procurement of Manipulative Toys From Q2 1998 to Q2 1998 From Q2 1999 to Q3 2001 Pilot Implementation—Batch 1 LGUs From Q3 1998 to Q4 2001 From Q2 2000 to Q4 2005 Pilot Implementation—Batch 2 LGUs From Q1 1999 to Q4 2001 From Q1 2001 to Q4 2005 Pilot Implementation—Batch 3 LGUs From Q3 1999 to Q4 2002 From Q1 2002 to Q4 2005 Baseline Survey From Q3 1998 to Q2 1999 From Q1 2002 to Q4 2003 Research Studies From Q2 1998 to Q4 2003 From Q1 1999 to Q2 2006 Indicators Survey From Q2 1998 to Q4 1999 From Q4 2000 to Q2 2002 Midterm Evaluation From Q3 2001 to Q4 2001 From Q3 2001 to Q4 2001 Longitudinal Study (Phases 1 to 3) From Q1 2000 to Q3 2002 From Q2 2001 to Q2 2005 First Procurement Q1 1998 15 September 2000 Last Procurement Q4 2003 20 September 2005 ECE – early childhood education, IMCI = integrated management of childhood illnesses, LGU = local government unit, PES = parent effectiveness service, PMO = project management office.

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5. Project Performance Ratings Ratings Implementation Period Development Implementation Objective Progress From 30 November 1998 to 30 March 2002 Satisfactory Satisfactory From 31 March 2002 to 29 June 2002 Satisfactory Highly Satisfactory From 30 June 2002 to 30 August 2003 Satisfactory Satisfactory From 31 August 2003 to 28 February 2004 Satisfactory Highly Satisfactory From 29 February 2004 to 29 November 2005 Satisfactory Satisfactory From 30 November 2005 to 31 January 2007 Satisfactory Highly Satisfactory

D. Data on Asian Development Bank Missions

Name of Mission Date No. of

Persons No. of

Person-Days Specialization of Members

Loan Inceptiona Loan Review/Supervision 12–25 Oct 2000 3 33 a, b Loan Review 28 May–1 Jun 2001 2 10 a, b Midterm Review Missiona 14 Nov–3 Dec 2001 Loan Review 13–29 May 2002 3 14 a, b Loan Review 14–16 Jan 2004 2 6 a, b Loan Review/Supervision 7–11 Feb 2005 2 10 a, b Loan Review (Final), Supervision 27–29 Sep, 8–11 Nov 2005 2 14 a, b Project Completion Review 29 Jan–9 Feb 2007 3 30 a, b, c a - project officer, b - project analyst, c - consultant. a Loan Inception and Midterm Review Mission back-to-office reports are not available.

P A C I F I C O C E A N

S o u t h C h i n a S e a

S u l u S e a

Panay Gulf

LeyteGulf

C e l e b e s S e a

M o r o G u l f

Babuyan Channel

P h i l i p p i n e S e a

VisayanSea

Sibuyan Sea

Bohol Sea

Oroquieta

Malaybalay

Cagayan de Oro

MarawiTubod

Siquijor

Mambajao

Dipolog

Dumaguete

Zamboanga

Isabela

IpilPagadian

Jolo

Panglima Sugala

San Jose

IloiloBacolod

Jordan

KaliboRoxas

Romblon

Boac

Mamburao

Calapan

Lucena

Puerto Princesa

Cebu

Tagbilaran

Catarman

Tacloban

Catbalogan

Naval

Daet

PiliVirac

Sorsogon

Legaspi

Trece Martires

ManilaBalanga

Binangonan

Sta. Cruz

Batangas

Palayan

Baler

Tarlac

San Fernando

Malolos

Iba

Lingayen

San Fernando

Baguio

La Trinidad

Lagawe

Cabarroguis

IlaganBontoc

Bayombong

Laoag

Vigan

BanguedTuguegarao

Tabuk

Kabugao

Masbate

Borongan

Maasin

Surigao

Butuan

Prosperidad

Tandag

Koronadal

Alabel

Isulan

Shariff AguakKidapawan

Digos

Mati

Tagum

Nabunturan

Davao City

Basco

Itbayat

Sabtang

AKLAN

CAPIZ

ILOILO

ANTIQUE

GUIMARASCEBU

PALAWAN

BOHOL

SIQUIJORCAMIGUIN

MASBATE

MARINDUQUE

ROMBLON

ALBAY

SORSOGON

CATANDUANES

SURIGAODEL NORTE

SURIGAO DEL SUR

BUKIDNON DAVAODEL

NORTE

COMPOSTELA VALLEY

DAVAO ORIENTAL

DAVAO DEL SUR

SARANGANI

SOUTHCOTABATO

SULTAN KUDARAT

MAGUINDANAO

BASILAN

SULU

TAWI-TAWI

ZAMBOANGADEL NORTE

ZAMBOANGASIBUGAY

ZAMBOANGADEL SUR

NORTH COTABATO

KALINGA

APAYAO

CAGAYAN

ISABELA

MT. PROVINCE

ABRA

ILOCOS SUR

ILOCOS NORTE

BENGUET

QUIRINO

AURORAPANGASINAN

ZAMBALES

TARLAC

BATAAN

BULACANPAMPANGA

NUEVAECIJA

NUEVAVIZCAYA

QUEZON

CAVITE LAGUNA

BATANGAS

RIZAL

Polillo

LA UNION

IFUGAO

CAMARINESNORTE

CAMARINESSUR

AGUSANDEL SUR

AGUSANDEL NORTE

MISAMISOCC.

MISAMISORIENTAL

LANAODEL SUR

LANAODEL NORTE

LEYTE

BILIRAN

SOURTHERNLEYTE

WESTERNSAMAR

EASTERNSAMAR

NORTHERN SAMAR

NEGROS OCCIDENTAL

OCCIDENTALMINDORO ORIENTAL

MINDORO

NEGROSORIENTAL

Burias

Ticao

BATANES

REGION IV-ACALABARZON

REGION IV-BMIMAROPA

CAR

REGION IIlocos REGION II

Cagayan Valley

REGION IIICentral Luzon

REGION VBicol

REGION VIIIEastern Visayas

REGION VIWestern Visayas

REGION VIICentral Visayas

NCR

REGION IXZamboanga Peninsula

A R M M

REGION XIIICARAGA

REGION XIDavao Region

REGION XIISOCCSKSARGEN

REGION XNorthern Mindanao

NCRARMM

CALABARZONCAR

CARAGA

MIMAROPASOCCSKSARGEN

- National Capital Region- Autonomous Region in Muslim Mindanao- Cavite, Laguna, Batangas, Rizal, Quezon- Cordillera Administrative Region- Agusan del Norte, Agusan del Sur, Surigao del Norte, and Surigao del Sur- Mindoro, Marinduque, Romblon, Palawan- South Cotabato, North Cotabato, Sultan Kudarat, Sarangani, and General Santos

National Capital

City/Town

Main Road

Provincial Road

Provincial Boundary

Regional Boundary

Boundaries are not necessarily authoritative.

Regions VII and XII

Region VI

World Bank Financed

ADB Financed (includingLanao del Norte formerlyRegion 12)

Note: Lanao del Norte formerly under Region XII

PHILIPPINES

EARLY CHILDHOODDEVELOPMENT PROJECT

Kilometers

0 50 100 150

N

07-1079 HR

125 00'Eo

125 00'Eo

119 00'Eo

119 00'Eo

8 00'No 8 00'No

16 00'No16 00'No

122 00'Eo

122 00'Eo

21 00'No

21 00'No

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I. PROJECT DESCRIPTION 1. The Early Childhood Development Project was approved on 27 January 1998 and became effective on 28 September 1998. The total project cost was estimated at $65 million, to be comprised of $24.5 million from Asian Development Bank (ADB), $22.4 million from the World Bank and $18.1 million from the Government of the Philippines. ADB financing was to include $15.7 million from ordinary capital resources (L1606-PHI) and $8.8 million from the Asian Development Fund (L1607-PHI). Both loans were approved and became effective at the same time. 2. The executing agency (EA) was the Department of Social Welfare and Development (DSWD), working in close coordination with three implementing agencies: the Department of Health (DOH), Department of Education (DepEd), and Council for the Welfare of Children (CWC). The overall purpose (impact) of the Project was to support government efforts to improve child survival and increase readiness for productive life. The Project’s outcomes were (i) to provide integrated early childhood development (ECD) service delivery under local government unit (LGU) management, (ii) to provide support systems for the integrated ECD service delivery, and (iii) to support research and development for improved ECD service delivery and management. The project had 10 key performance indicators (see Table A1.1). The project design and monitoring framework with project performance at the time of the Project Completion Review Mission is in Appendix 1. 3. The Project was implemented in 132 LGUs in 10 provinces in regions VI, VII and XII.1 The Project was financed on a parallel basis by ADB and the World Bank, with ADB financing ECD interventions in regions VII and XII and the World Bank covering Region VI.

II. EVALUATION OF DESIGN AND IMPLEMENTATION A. Relevance of Design and Formulation

4. The Project was the first investment project designed to operationalize the Government’s 10-year (1998–2007) National Early Childhood Development Program, which called for increased investment to strengthen the country’s child health, nutrition, and early education programs. The Project was a timely and appropriate response, given the poor health, nutrition, and psychosocial development of children in the country. 5. The Project responded to young children’s needs with a comprehensive and integrated package of cost-effective ECD interventions and services. A complex undertaking across the health, education, and nutrition sectors, the Project provided services at each stage of child development from prenatal care to birth to enrolment in the first grade. It geographically targeted poor children and tailored interventions to indigenous peoples groups. The service packages included integrated management of childhood illnesses, an expanded immunization program, supplemental feeding, micronutrient supplementation, and deworming. All of these are known to be effective measures in ensuring child survival. The Project also promoted an enriched, 8-week early childhood education (ECE) curriculum, proven in a pilot initiative to be an effective intervention for ensuring school readiness for entrants to the first grade.

1 The 10 Project provinces were Antique, Capiz, Guimaras, Iloilo, and Negros Occidental in Region VI; Bohol, Cebu,

and Negros Oriental in Region VII; and Lanao del Norte and North Cotabato in Region XII (although Lanao del Norte later became part of region X). The provinces were selected based on a national ranking of all regions, cities, and municipalities with high need for ECD services. That need was defined by high infant and child mortality rates, high prevalence of protein-energy malnutrition and micronutrient malnutrition, and high dropout rates in primary schools. Also considered was expressed local support and willingness to strengthen ECD service delivery.

2

6. The Project was adapted to the devolved health and social service delivery, thus ensuring the participation and involvement of the LGUs now mandated to deliver the services. The design appropriately incorporated capacity building for ECD program policymakers, managers, and service providers at the national, regional, and local levels. It also incorporated establishing ECD coordination mechanisms and management support systems to address early childhood needs in a harmonized and integrated manner. The Project interventions and capacity building efforts were based on numerous research and development (R&D) studies supported by the Project. The R&D component assured evidenced-based policy and guidelines formulation, and focused ECD actions on actual needs. On the whole, the Project as designed was timely, appropriate, and comprehensive. B. Project Outputs

7. The Project had three outputs, or components, with numerous subcomponents. Of the 10 key performance indicators (see Table A1.1), three are output-level indicators: the proportion of municipalities with functional protein-energy malnutrition prevention, the proportion of municipalities with active child development workers, and the proportion of targeted municipalities with ECD subprojects.2 All three of these indicators show that targets were either met or exceeded. The proportion of LGUs with active child development workers is 63% (as against the target of 50%), and, as of the Project Completion Review Mission, LGUs continue to fund most of their child development workers in a cost-sharing arrangement with barangay councils. The target of 132 LGUs implementing ECD subprojects was fully achieved. The targeted 50% of LGUs with functional programs to address protein-energy malnutrition was exceeded, as 90% of LGUs had implemented the growth monitoring program and 69% had implemented the feeding program.

1. Component 1: Program Support for Provinces 8. Component 1 upgraded the ECD service delivery system through five service packages, and supported the integration of service delivery through an LGU financing facility.

a. Province-wide ECD Service Delivery Upgraded

9. Five ECD service packages were designed to strengthen the capacity of the project provinces to administer adequate integrated child survival and development programs to address health, nutrition, and psychosocial concerns. These were: (i) expanded program on immunization (EPI), (ii) integrated management of childhood illnesses (IMCI), (iii) micronutrient malnutrition prevention and control, (iv) parent effectiveness service (PES), and (v) Grade 1 early childhood education.

10. Expanded Program on Immunization (EPI). Under this component, the Project upgraded the cold chain facilities of all three regional health offices and installed new cold chain equipment in rural health units and city health offices to increase the proportion of health facilities with functional cold chain systems3 from 227 in 2000 (67%) to 277 in 2004 (84%). The Project improved the skills of 95 public health nurses regarding the revised system of cold chain management and trained 75% of the targeted service providers in basic EPI services. This resulted in better management and administration of immunization services. A total of 4,575 2 The original design and monitoring framework did not have specific or measurable targets. The 10 key

performance indicators (a separate appendix in the project document) were not attributed to the impact, outcome, and output levels. This attribution was done for purposes of the project completion report.

3 A rural health unit with a functional cold chain system is defined as having at least a refrigerator, thermometer, and vaccine carriers with complete sets of ice packs for each midwife within the rural health unit’s catchment area.

3

copies of the EPI basic skills modules and posters on measles and tetanus immunization were also provided as reference materials. However, only a very low 53% of the total 330 rural health units and city health offices were found to be in strict compliance with proper cold chain management protocol.4 11. Integrated Management of Childhood Illnesses (IMCI). The Project helped introduce the country to the World Health Organization IMCI protocol in managing and treating six common childhood illnesses.5 The Project (i) developed an 11-day course and IMCI training curriculum; (ii) established nine IMCI training centers that deliver training for service providers nationwide; (iii) trained 61% of health service providers lacking IMCI skills; (iv) improved IMCI counseling skills of 1,507 service providers through a 5-day course focused on 14 core health and nutrition messages; (v) integrated the IMCI module into the curriculum of 45 midwifery schools, 60 nursing schools, and seven medical schools in collaboration with the Association of the Philippine Midwifery Schools, the Association of Deans of Philippine Colleges of Nursing, and the Association of Philippine Medical Colleges; and (vi) established functional rural health units and barangay health and nutrition posts, although only half of these (49%) have fully adopted the IMCI protocol.

12. Micronutrient Malnutrition Prevention and Control. This component supported the prevention and control of iron, iodine, and vitamin A deficiencies through direct supplementation, deworming, protein-energy malnutrition prevention, and food fortification. In particular, the Project supported the iron supplementation of low birth weight infants, infants 6–11 months old, Grade 1 students, and pregnant women in all ECD areas;6 as well as vitamin A supplementation for infants 6–11 month old, children 12–71 months old, and lactating women.7 The Project’s longitudinal study8 showed an increase in the proportion of children who received iron and vitamin A supplements from 2001 to 2003 in Regions VI and VII. Deworming tablets (albendazole) were also provided to Grade 1 pupils and children 24–71 months old. For protein-energy malnutrition prevention, the Project (i) enhanced the food supplementation guidelines, which adopted the International Reference Standards and protocol, with a menu list as a guide for local supplemental feeding; (ii) trained child development workers and nutritionists on the use of the guidelines; (iii) regularly monitored the growth of children 0–23 months old (monthly) and of children 24–71 months old (quarterly); and (iv) enrolled children found to be underweight in a 90-day feeding program, although only half of them were considered rehabilitated at the end of the program. 13. The Project spearheaded drafting of the 2000 Food Fortification Law (RA 8976) and its implementing rules and regulations. As a result of the intensified promotion of RA 8976, the staple foods began to be fortified. As of December 2006, all 12 Philippine flour millers are fortifying flour with vitamin A and iron, six received the Diamond Sangkap Pinoy Seal for their 49 brands. Thirty-six of the 46 oil refineries fortify their cooking oil with vitamin A (42 brands with 4 Proper cold chain management requires the presence of an EPI refrigerator thermometer, a monitoring chart

posted on or near the storage facility, two-time temperature charting (morning and afternoon), maintenance of proper temperature in the freezer (-15 to -25 degrees centigrade) and in the body of the refrigerator (+2 up to +8 degrees centigrade), proper placement of polio and measles vaccine in the freezer and the BCG, DPT and TT vaccines and diluents in the body of the refrigerator, absence of expired vaccines and of other items aside from vaccine in the refrigerator, and a power failure plan.

5 Diarrhea, pneumonia, tuberculosis, measles, malaria, and anemia (including dengue fever). 6 Iron supplementation was provided for 65,415 low birth weight infants, 734,969 infants 6–11 months old, 883,405

grade 1 students, and 1,092,224 pregnant women (Government PCR). 7 Vitamin A supplementation was provided for 956,285 infants 6–11 month old, 4,991,913 children 12–71 months

old, and 852,576 lactating women (Government PCR). 8 The longitudinal study was conducted in regions VI and VII (with Region VIII as the control) over three rounds in

2001, 2002, and 2003.

4

the Diamond Sangkap Pinoy Seal). One sugar trader fortifies refined sugar with vitamin A (two brands with the Diamond Sangkap Pinoy Seal) while 30% of the National Food Authority rice for the Food for School Program is fortified with iron. The regular Sangkap Pinoy Seal has been awarded to 98 voluntarily fortified processed foods. The Project strongly promoted the Act for Salt Iodization Nationwide, or ASIN, RA 81729 and a 2005 Food and Nutrition Research Institute survey found that 95% of salt on the market tested positive for iodine and 75% of households used iodized salt. 14. Parent Effectiveness Service (PES). The Project enhanced the delivery of PES in the Project sites and upgraded the skills of day care workers and child development workers for delivering these services through (i) development of reference guides, including an enhanced PES manual with nine modules10 and a revised day care manual; (ii) development, procurement, and distribution of ECD advocacy materials for parents; and (iii) training of supervisors and service providers in the PES modules, use of the revised day care manual, supervised neighborhood play, and integrated ECD. These inputs contributed to parents’ increased awareness of PES, and the longitudinal surveys showed their participation doubling from 17% in 2001 to 34% in 2003 (although participation of fathers in PES was very low). The Project introduced tools to track services in an integrated manner, such as the Mother and Child Book (for recording the services provided to the mother during pregnancy and postpartum and those provided to her child from birth to 6 years), as well as the Early Childhood Care and Development (ECCD) Checklist (to assess the child’s progress from birth to 6 years in terms of health, nutrition, and psychosocial development). 15. Grade 1 Early Childhood Education (ECE). The Project institutionalized the 8-week ECE curriculum in all elementary schools nationwide, which was a remarkable achievement. Aiming to improve the readiness of children 5–6 years old for elementary education, the ECE curriculum is based on a set of stimulating, innovative, and participatory learning approaches for school entrants. Grade 1 classrooms were equipped with educational materials, manipulative toys, and other supplies. The Project enhanced the provision of appropriate ECE interventions by developing a school readiness assessment tool to identify school entrants as either ready or not ready for elementary education. Results of the assessment guide teachers and focus attention on the not-ready (in larger schools with multiple Grade 1 sections the children are divided into ready and not ready classrooms). DepEd, through the Commission for Higher Education, integrated the 8-week ECE curriculum into the pre-service teacher education curriculum in all universities and colleges.

b. LGU Financing Facility for Integrated ECD Service Delivery Provided 16. An LGU financing facility for integrated ECD service delivery was made available under the Project to 132 LGUs with a high need for ECD services.11 Through this subcomponent, the Project supported LGUs in formulating a 3-year investment plan that addressed local ECD needs and established a multisectoral ECD team responsible for ensuring the continuous 9 Strengthening efforts included the passage of local ordinances and resolutions; social marketing and several media

relations activities; quarterly market, warehouse and port inspections (known as patak sa asin); mobilization of the leagues of local officials; formation of food fortification task forces; organization of cooperatives; and formulation of various guidelines (e.g., Patak sa Asin Guidelines, Handbook on ASIN Law Enforcement, and Handbook on Enhancing Capability to Implement Social Marketing).

10 The nine modules are: (i) Myself as a Person and a Parent, (ii) The Filipino Family, (iii) Challenges of Parenting, (iv) Child Development, (v) Keeping Your Child Safe from Abuse, (vi) Building Children’s Positive Behavior, (vii) Health and Nutrition, (viii) Home Management, and (ix) Keeping a Healthy Environment for Your Children.

11 The original target at appraisal was 165 LGUs. This target was reduced to 132 based on the pilot implementation and in order to increase the financing available to each LGU.

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provision of ECD services to children in their areas. The facility increased local officials’ awareness of and support for ECD. They pledged counterpart funds, formulated and issued ECD-supportive local ordinances and resolutions, and established multisectoral councils for the welfare and protection of children. This subcomponent operationalized the relationship between LGUs and the national, regional, and provincial levels for the delivery of ECD services in the context of devolved health and social services delivery. 17. The facility supported the delivery of four core ECD service packages: rural health midwife, day care worker, child development worker, and day care mom. In particular, the facility (i) constructed and equipped new ECD facilities and repaired old ones to cater especially to children and women in remote areas and poorer segments of the population;12 (ii) hired and deployed 1,680 new midwives, 4,087 day care workers, 1,630 child development workers, and 18 day care moms in areas where ECD services were absent or inaccessible; and (iii) trained the new and existing service providers on several ECD-related programs and processes. A total of 105 LGUs established ECD resource centers, which at the time of the Project Completion Review Mission continued to offer ECD learning materials, manipulative toys and other materials to ECD workers and, to a lesser extent, parents.

2. Component 2: Support to Service Delivery

18. This component complemented the financial assistance to LGUs with technical support in four areas: (i) communications; (ii) planning, targeting, and management information systems; (iii) training and human resource development; and (iv) institutional development at all levels of operations. It developed the capacity of policymakers, program managers, and ECD service providers; strengthened the CWC as the coordinating body for ECD programs and services; and mobilized the support of the private sector on food fortification.

19. Support to Communications. The Project promoted ECD awareness among policymakers, program managers, service providers, and families with regard to their respective responsibilities in ensuring the physical, mental, and psychosocial development of their children. Local officials’ support for ECD was mobilized and resulted in 132 municipalities and cities participating and contributing a total of P274.1 million as equity, representing 25% of the total investment. Actual disbursements of some LGUs were much higher than their expected counterpart contributions (see Appendix 2). After project closure in 2005, several LGUs have continued to allocate funds for ECD services. Communication efforts also resulted in strengthened project teams and local councils for ECD. Several resolutions and ordinances were passed to improve ECD services at the local level. The Project substantially supported the Bright Child campaign (under Executive Order No. 286) as the single “brand” for all ECD-related efforts. This campaign is an offshoot from passage of the Early Childhood Care and Development (ECCD) Act in December 2000. 20. The Project developed communication planning skills in the EA and in regional and local implementing agency offices. Local communication plans were formulated with a focus on the benefits of the interventions supported by the Project (e.g., immunization, food fortification, PES, prenatal care, day care centers, and so on). It also fostered better linkages and coordination among concerned agencies at the national, regional, provincial, and city or municipal levels.

12 The ECDP constructed 254 new barangay health stations and repaired or renovated 505; constructed 945 new day

care centers and renovated or repaired 1,009; and renovated or repaired 28 day care moms’ houses and child minding centers. Barangay health stations were equipped with basic health instruments (blood pressure apparatus, weighing scales), televisions and VCD players, karaoke machines, typewriters, oscillating fans, and supplies in the form of albendazole tablets for deworming, as well as ferrous sulfates and vitamin A capsules for preventing anemia and vitamin A deficiency.

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Promotional activities and materials were developed to advance understanding of the ECCD and related laws (e.g., Food Fortification Law, ASIN). Private food corporations and companies joined the Government in developing and promoting fortified foods. Local offices joined together in ensuring the compliance with ASIN (e.g., salt producers and manufacturers, police,) while some organized community groups participated in selling iodized salts. 21. Support to Planning, Targeting, and Management Information Systems. The Project developed an automated needs-based ECD planning template as a guide to formulating the LGUs’ 3-year investment plans. Several management information systems were developed to facilitate project implementation: (i) a financial management system to track the Project’s physical and financial targets; (ii) a procurement management system to track the procurement, delivery, and disbursement of goods and civil works; (iii) an ECD service delivery information system that generates information on the services received by the Project beneficiaries through the ECD service providers; and (iv) a document and contract tracking system to facilitate communication and transactions. The Project initiated development of a child identification system to track all services received by a child from service providers, but this initiative never got off the ground.13 22. Support to Training and Human Resource Development. The training and human resource development outputs of the Project were numerous and covered a broad array of relevant topics. Table A1.8 enumerates the training by type and group of stakeholders covered. The human development efforts resulted in a cadre of more competent ECD policymakers, program managers, service providers, and ECD advocates at various levels. 23. Support to Institutional Development. The Project instituted coordination mechanisms among agencies involved in ECD programs and activities at all levels that were still functioning at the time of the Project Completion Review Mission. Multisectoral committees for the welfare and protection of children were formed at the national, regional, and local levels. Regular coordination meetings were held to provide updates, formulate policies and guidelines, and make decisions on project implementation issues. Program implementation reviews to assess the progress of ECD work became an integral activity of the various agencies and committees. At the time of the Project Completion Review Mission, ECD teams at the local (municipal) level continued to serve as the focal coordinating bodies for all ECD activities. Many stakeholders reported that the Project significantly improved their coordination and rapport with one another. At the regional level, a series of workshops (e.g., regarding investment planning, financial information systems, and procurement systems) was undertaken, enabling the committee members regularly to track the progress in financial disbursements and procurement. The regions demonstrated the capacity to manage pooled procurements of ECD goods and services needed by the LGUs. ECD resource centers were established in 105 LGUs,14 and now continue to be operated by the LGUs. These resource centers aim to meet the information needs of ECD service providers and parents, as well as to serve as loci for child development learning and local ECD-related meetings and events. 24. The Project strengthened the capacity of the CWC as the lead agency for coordinating implementation of the ECCD Law. The Project provided training to CWC officials and staff and

13 However, the CWC is now reviewing systems developed under the Project, including the child identification

system, in order to identify which can be modified and/or enhanced to support implementation of the ECCD Law. 14 ECD resource centers serve as (a) mechanisms for barangay-level coordination and meetings on ECD concerns,

(b) venues for a distance learning program envisaged for continuing education of service providers under the ECCD Law, (c) lenders of ECD toys and learning materials for both service providers and parents, and (d) areas where children in the community can go for special ECD sessions.

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equipped the office with advocacy and communication equipment and materials. As the lead agency in managing the R&D component after the Project’s midterm review, the CWC established an R&D unit and strengthened its capacity to manage research studies, as well as to disseminate findings and advocate their use in policy formulation, program planning, and designing interventions. At the time of the Project Completion Review Mission, the CWC R&D unit continued to manage contracted research and to conduct in-house studies. A national ECD resource center was established in CWC to serve as the repository of various project studies.

3. Component 3: Research and Development 25. Pilot-Test of Project Interventions in Five LGUs. This subcomponent aimed to test and enhance service delivery interventions prior to project expansion. The pilot services included protein-energy malnutrition prevention, upgraded PES, and the ECD service delivery packages (rural health midwives, day care workers, and so on). The pilot test was implemented much later and took much longer than originally designed. From the original five pilot LGUs it expanded to 10 LGUs. 15 The original plan to test ECD interventions in traditional and nontraditional settings was not implemented, nor was the adequacy of the IMCI referral care tested. There were delays in completing the pilot, and there was pressure to implement the expanded project in the first batch of LGUs. Implementation of the Project in the first batch of LGUs thus overlapped with the pilot. 26. Research and Development Studies. Fifteen research studies were completed, most of which were not part of the original list identified at appraisal. Of the 16 original research topics, only five were implemented. The rest were deemed no longer relevant at the time of the midterm review. Ten new research agendas were identified in 2002 and were ultimately completed. The Project organized workshops and other venues for disseminating findings at various levels. Some studies were turned into popularized versions using flyers, brochures, and posters. Ten of the completed studies are available for downloading from the CWC website. The CWC continues to advocate use of the research findings, some of which have served as inputs to the formulation of policies, guidelines, and ECCD tools and interventions. The research studies undertaken under the Project are summarized in Table A1.9. 27. Monitoring and Evaluation. Four monitoring tools were implemented to assess the outcomes and benefits of the Project: (a) the baseline indicator survey, the results of which were used to validate the project objectives and targets (completed quite late, in 2001); (b) the baseline survey of indigenous people’s access to and utilization of ECD services (2001); (c) longitudinal surveys (Phases 1–3 in 2001, 2002, and 2003); and (d) the end-of-project survey. (See Table A1.9.) C. Project Costs

28. At appraisal, the Project costs were estimated at $65.0 million equivalent and were to be financed by (i) ADB loans of $24.5 million, sourced from the Asian Development Fund (ADF) ($8.8 million) and ordinary capital resources (OCR) ($15.7 million); (ii) a World Bank loan of $22.4 million; and (iii) the Philippine Government, with $18.1 million to be contributed by the EA and LGUs. No part of the loan was cancelled during project implementation. At completion, the actual project cost amounted to $47.2 million, made up of (i) ADB lending of $21.0 million ($13.4

15 The pilot LGUs were Alimodian, Lambunao, and Passi City in Iloilo Province; Bais City in Negros Oriental;

Buenavista and Jordan in the Province of Guimaras; Dalaguete in Cebu Province; Iligan City in Lanao del Norte; Pilar in Capiz Province, and Tagbilaran in Bohol Province.

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million from OCR and $7.6 million from ADF) (44% of total); (ii) World Bank lending of $17.3 million (37%); and (iii) the Government’s contribution of $8.8 million (19%). D. Disbursements

29. Disbursements were sluggish at the start. At the time of the midterm review, utilization of the two loans was at a very low 9% and 14%. This was caused by (i) the delayed start of the Project; (ii) challenges in establishing the system for fund releases, and especially for the LGU financing facility subcomponent; (iii) the difficulty of some participating LGUs to secure equity; and (iv) cumbersome procurement processes. As designed, the loan proceeds for the use of the national agencies (DOH, DepEd, and DSWD) were channeled through the Department of Finance. The financing facility was initially coursed through the Municipal Development Fund Office (MDFO) but an adjustment was made after the midterm review so that financing facility funds were channeled directly from DOF to DSWD and then transferred to the LGUs. 16 Separate accounts were established by each national agency and in each of the participating LGUs. The LGUs had to establish another separate account for their counterpart funds. 30. Reprogramming of funds across components and subcomponents was effected after the midterm review had identified gaps. Additional amounts were provided to procure goods for the national implementing agencies, civil works, workshops and seminars, operating costs, social marketing, and supplies and materials. The allocation for research studies was reduced, as was that for procuring micronutrients, since substantial quantities of iron and vitamin A were already being procured by the Women’s Health and Safe Motherhood Project (also funded by ADB and the World Bank). E. Project Schedule 31. Both the OCR and ADF loans became effective on 28 September 1998. The Project was officially launched in March 1999 and was originally scheduled to end by 31 December 2004. The Project was extended once, for 11 months, to 30 November 2005. As of the Project Completion Review Mission, however, ADB had still not officially closed the financial accounts pending the submission of additional requirements from the EA. Appendix 3 compares the original project schedule with actual implementation. 32. The Project was implemented under three different political administrations from loan effectiveness to project closure. Top project management (at the director and coordinator levels) also changed several times. There was a substantial delay in establishing fully functional project management offices (PMOs) at the national and regional levels. Consultants to be hired early on in the Project were not deployed, and neither was the external service to conduct the baseline studies. The ECD pilot was expanded from five to 10 LGUs and was not completed as originally envisaged, while the financial management systems for the LGU financing facility took time to get off the ground. The turnover of leadership, termination of services, and changes in management structure contributed to the implementation delays, and especially during the first half of the Project.

16 In April 2002, ADB approved a request to transfer the Loan 1607 imprest account from MDFO to DSWD on the

justification that MDFO added a cumbersome layer to the process, causing delays in fund releases. The imprest account transfer to DSWD resulted in faster review, approval, and release of funds. DSWD assigned staff from its Finance Service Office and hired new staff to handle the project account. MDFO had been unable to respond promptly to the ECDP account as a result of its other commitments: at the time, the MDFO was handling a total of 22 projects. Only two staff had been assigned (not exclusively) to handle the ECDP in MDFO.

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F. Implementation Arrangements

33. The DSWD was the executing agency, working with three implementing agencies: DOH, DepEd, and CWC. The LGUs, as beneficiaries of the financing facility, were directly responsible for implementing local ECD service packages, while the provincial governments managed the province-wide ECD assistance together with the regional offices of DSWD, DOH, and DepEd. A multi-agency project steering committee was established at the national level and in each project region to provide overall policy direction and technical oversight 17 Six technical consultative committees were initially established at the national level to provide technical guidance in implementing each major component and subcomponent, 18 but only two, the Communications Consultative and Research and Development committees, functioned throughout the life of the Project. 34. At the outset, day-to-day operations at the national level were managed by a 28-person national project management office (NPMO) based at DSWD. Another two to three NPMO staff were assigned in DOH and DepEd. Corresponding regional PMOs were established in each of the three project regions. Project teams were also organized at the provincial and municipal or city levels. By the midterm review in late 2001 and early 2002, the NPMO staff had been mainstreamed into the offices mandated to manage the components and subcomponents, with only a small staff remaining at NPMO. Four were deployed to CWC for project monitoring, research and development, and management information systems. The EA’s mainstreaming of NPMO staff was a highly commendable move that paved the way for institutionalizing ECD management capacities beyond the life of the Project. Appendix 4 lists the project personnel absorbed at the national and regional DSWD offices as of the Completion Review Mission. G. Conditions and Covenants

35. Compliance with the covenants of the ADF and OCR loan agreements was satisfactory. Six additional conditions were required prior to the effectiveness of the OCR loan agreement. The Government satisfactorily complied with these. Appendix 5 shows that all loan covenants were met. H. Related Technical Assistance

36. There was no related technical assistance under these loan agreements. I. Consultant Recruitment and Procurement

37. A total of 6 person-months of international consultant services (on food fortification) and 870 person-months of local consultant services were originally planned for (i) food and nutrition situation analysis, (ii) design of community monitoring surveys, (iii) LGU appraisals, and (iv) development of a financial performance monitoring and referral system operations plan. Modifications were made over the course of implementation, and some consultants originally envisaged were not recruited. Terms of reference for some consultants were modified and new ones were developed. Recruiting consultants for the various components followed ADB procedures while changes in terms of reference necessitated prior ADB concurrence.

17 The national-level project steering committee comprised the DSWD (Secretary as Chair), DOH, DepEd,

Department of the Interior and Local Government, the National Economic and Development Authority, DOF, CWC, and National Nutrition Council. The regional project steering committees were chaired by the Regional Director of DSWD, with membership from the same line agencies, and including a civil society representative.

18 The technical consultative committees were for (i) service delivery; (ii) communications; (iii) planning, targeting, and management information systems; (iv) training and human resource development; (v) institutional development; and (vi) research and development.

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38. The Project procured goods, works, and services in accordance with ADB’s procurement guidelines. Various procurement methods were applied depending on the package and estimated cost. Four major groups of goods were procured: (i) micronutrients and supplements, (ii) manipulative toys and other learning aids and materials, (iii) cold chain equipment and supplies, and (iv) computers and other office equipment. The NPMO administered all the procurement activities according to the 1998 interagency memorandum agreement among the DSWD, DOH, and DepEd. The latter two agencies assisted with procurement for their particular subcomponents. Under the LGU financing facility, LGUs procured their own goods and services. For some items, bulk procurement was managed by the regional DSWD office. Despite the development of a project procurement plan, updated on an annual basis, there were still some delays in procurement. Notably delayed procurement included for (i) consultancy services, (ii) research studies, and (iii) cold chain equipment and micronutrients. Delays were caused mainly by a lack of understanding (at all levels) of ADB procurement procedures. The services of an external international procurement agency hired during the initial phase of the Project were terminated, which caused further delays. An in-house procurement consultant was later hired. J. Performance of Consultants, Contractors, and Suppliers

39. The performance of consultants is rated partly satisfactory. Some consultant contracts were not renewed due to poor performance (e.g., the five original consultants hired for the food fortification subcomponent and the external procurement agency). Significant delays were encountered in completing research studies contracted to various consulting firms and organizations, caused not only by poor consultant performance but also delays in finalizing terms of reference, processing other requirements, and the iterative consultations with stakeholders on various levels at different stages of the study. The performance of the contractors for the construction and renovation of ECD facilities at LGU level was satisfactory. K. Performance of the Borrower and the Executing Agency

40. DSWD, DOH, DepEd, CWC, and LGUs demonstrated strong commitment to successfully implementing the Project. Given the delayed release of project funds during the initial phase, DepEd proceeded with the training of school teachers on the 8-week ECE curriculum using its own budget. Several pilot and Batch 1 LGU financing facility participants advanced payment for activities that were meant to be financed by loan proceeds. Project start-up was slow given DSWD’s inexperience in managing large externally funded projects. The rigorous government procedures and varied requirements on the part of ADB and the World Bank compounded these problems. Technical committees took time to be established and become functional. There were initial difficulties in project ownership at various levels and in high-level management’s attendance at the regular committee meetings. Despite the slow start-up, DSWD made solid progress in project implementation from the midterm review. Key management and operations issues were addressed and several reforms instituted to strengthen project management. 41. The Project’s complexity must be emphasized. An endeavor necessitating multi-agency collaboration, it involved three large government departments and other national-level agencies, plus multi-level coordination (national, regional, provincial, and municipal). It required adaptive responses to the devolved context of health and social service delivery.19 These elements alone would make coordination challenging before adding in the difficulties of having two major funding sources and the relative inexperience of DSWD in handling large foreign-funded projects. Multiple changes in project directorship and project coordinators contributed to the 19 The delivery of education services was never decentralized, so coordination of the ECE subcomponent was easier.

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initially slow progress. Project implementation was also affected by organizational changes within each agency (e.g., reengineering of the DOH, changes in leadership at the DSWD and DepEd), transitions in national and provincial political leaderships, and the internal movement of project staff. Despite these challenges, the Project accomplished a majority of its objectives. Project performance greatly improved during the second half of the Project. Overall, the performance of DSWD, DepEd, DOH, CWC, and the LGUs is rated satisfactory. L. Performance of the Asian Development Bank

42. ADB performance is rated satisfactory. ADB fielded successful missions over the life of the Project, although there were too few during its first half. The first documented ADB mission came a year after loan effectiveness. Given the delayed start-up of the Project, ADB missions early on should have been more frequent. ADB review mission aide memoires were often prepared together with the World Bank, which, while commendable, also meant delays in finalizing and returning to the EA. ADB supervisory missions and project management improved over the life of the Project, with faster turnaround of communications and a steady increase in utilization rates. Upon the DSWD’s request, ADB approved an 11-month extension of the Project, which allowed the Project to achieve a number of deliverables.

III. EVALUATION OF PERFORMANCE

A. Relevance

43. The Project was highly relevant at the design stage and remained so a decade later at the time of the Project Completion Review Mission in 2007. The Project was a timely response to low child survival and development indicators in the country. Although there has been a decrease in the under-5 mortality rate over the past 30 years, the decline has decelerated in the last decade and the rate remains at levels much higher than in other Asian countries. Children’s poor health and nutritional status can lead to low completion rates for Grade 1, which in turn perpetuates poverty. The Project’s integrated approach to providing services helped address these issues in a holistic manner. Focusing assistance on poorer LGUs and poorer children by directing financial support to localities with high unmet ECD needs was strategic. The Project was implemented in the newly devolved health and social service delivery context, thus helping to operationalize relationships among the national, provincial, and local governments in delivering ECD services. The Project was highly relevant, as it motivated, equipped, and tasked the LGUs to fulfill their mandate as lead providers of ECD services. 44. The Project paved the way for the passage and implementation of the December 2000 ECCD Act, a fundamental reform supporting human development in the Philippines. The Project introduced the Child 21 plan and the Bright Child brand nationwide as the Government’s overarching ECD framework. When the Philippines became one of the 189 signatories to the Millennium Declaration in 1999, the significance of the Project became all the more pronounced as it directly supported achieving five of the 10 Millennium Development Goals.20 The Project addressed the institutional capacity gaps and limited coordination among agencies mandated to work in ECD. Foremost was the strengthening of the CWC as the overall coordinator of ECD-related efforts and the harmonization of ECD policies, guidelines, and interventions relative to child survival and development. The (revised) R&D component of the Project was highly relevant, as it supported studies that addressed information gaps necessary for developing and establishing more responsive ECD policies, interventions, and standards. 20 The five goals supported by ECDP: eradicate extreme poverty and hunger, halve the proportion of the population

below the minimum level of dietary energy consumption and halve the proportion of underweight children below 5 years old, achieve universal primary education, reduce child mortality, and improve maternal health.

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B. Effectiveness in Achieving Outcomes

45. Four of the 10 key performance indicators can be assigned as project outcomes. These are the proportion of children aged 6 months to 4 years with anemia, the proportion of children aged 1–2 years who are fully immunized, the proportion of children 0–4 years old below average in overall psychosocial development (according to a combined index of child development), and the proportion of children aged 3–5 years in targeted municipalities attending day care centers. Results are mixed: two of these indicators saw positive change, two did not. On balance, however, the Project is rated effective (see tables A1.1 to A1.5). 46. The proportion of children 0–4 years old below average in overall psychosocial development was significantly reduced from 2001 to 2003, with the most pronounced improvement in the area of gross motor development. The proportion of children 3–5 years old attending day care rose from 2001 to 2003, but the overall participation rate remained below the 75% target. The proportion of children 0–4 years old with anemia was not reduced by the target of 30% despite the Project’s iron supplementation and deworming efforts. National-level data show only a slight decrease in the overall proportion of children under 6 years old with anemia, which was 31.8% in 1998 and still 29.1% in 2003. The target of 90% fully immunized children was also not met. Unfortunately, routine reports show a consistent decrease in the latter figure over the period 2000–2005. The national rate of fully immunized children also decreased (from 73% in 1998 to 70% in 2003, according to the National Demographic and Health Survey). 47. Performance in other relevant indicators can be gleaned from the longitudinal study and routine LGU and national government reports. The proportion of children 0–4 years old receiving vitamin A supplementation increased, two thirds were reported to consume fortified food products, and participation in the deworming program grew. Participation of underweight children in feeding programs more than doubled. Mothers’ awareness of iodized salt was high, and the proportion of those who took iron supplements during their most recent pregnancies grew. There was also an increased awareness of PES among mothers (from 18% at baseline to 34% in the end-of-project survey) C. Efficiency in Achieving Outcomes and Outputs 48. Overall, the Project is rated less efficient. There were substantial implementation delays from start-up to midterm review, but efforts were then redoubled and implementation caught up toward the end. The Project only required a one-time extension of 11 months. Fund disbursements at closing on 30 November 2005 reached 86% of total estimated cost. The Project aimed at providing pro-poor health, nutrition, and psychosocial services by targeting the poorest provinces and municipalities as pilot and expansion areas. The LGU financing facility was properly targeted to poorer LGUs where access to ECD services was very limited. 49. The delayed project start-up limited full utilization of the outputs of the various components. The piloting of ECD intervention packages in 10 LGUs took longer than anticipated, and Batch 1 LGUs ran parallel with the pilot, missing the opportunity to benefit from lessons learned in the pilot. Other less efficient aspects of the Project were that the baseline survey was only completed near project midterm, limiting its usefulness in further sharpening the focus of the ECD interventions and approaches in the initial phase. The updated and more relevant R&D agenda was commendable, but the delay meant that half of the studies were only completed towards the end of the Project. Application of their findings under the Project was thus limited.

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50. Installing support systems and completing the ECD manuals, references, and tools (e.g., Mother and Child Book, ECCD Checklist) took longer than anticipated. Utilization of these systems and tools was thus not fully maximized. As of the Project Completion Review Mission, the CWC had yet to assess the applicability of the systems and tools for the ECCD implementation. The production of the Mother and Child Book came near the end of the Project, thus preventing full adoption by the service providers. Several providers interviewed were not aware of its existence. Reproduction and translation of materials into dialects understood by the mothers was left to the discretion of the LGUs and depended on the availability of funds. Health staff were not convinced of the importance of the ECCD Checklist and tended to find it too cumbersome to administer given their workload. There was also little advocacy for the use of the checklist by teachers in DepEd preschools. A number of strong communication campaigns were mounted under the Project, but coordination was not always effective (the Project-supported Bright Child campaign overlapped with a similar CWC program). 51. Interventions were not always properly synchronized. For example, in some schools deworming drugs were delivered only after the school feeding program had been undertaken. The Project Completion Review Mission found that Grade 1 teachers in some schools were not trained in the 8-week ECE curriculum but were assigned to the non-ready classes of school entrants, while those classes comprising primarily ready children were handled by more senior and ECE-trained teachers. D. Preliminary Assessment of Sustainability 52. Available evidence and recent developments at national and local levels show project gains as very likely sustainable. At national level, passage of the ECCD Law and its ongoing implementation nationwide indicate that ECD remains high on the national leadership’s agenda. The Government’s focus on localization of the Millennium Development Goals and mobilizing the support of the private and NGO sector provides fertile ground for continued utilization of project outputs. Concern for the Millennium Development Goal targets in hunger and malnutrition are reflected in the DepEd food-for-school program (1 kg of rice per child per day) and DSWD’s continued supplementary feeding that aims to mitigate hunger and possibly address the issue of malnutrition among poor children. Advocacy events at the local government level, such as the annual Child-Friendly Awards, help sustain the support of local officials for children’s welfare and development. 53. The intensive capacity development efforts provided to ECD stakeholders at all levels have strengthened the institutional system for delivering quality ECD services. The continued strengthening of the CWC and the post-project regular meetings of the councils for the welfare of children at various levels are likely to carry on the Project’s momentum. There is continued effort on the part of the national government in implementing the Food Fortification Law and the ASIN in tandem with LGUs and the private sector, creating a supportive policy and strengthened regulatory environment to address long-term micronutrient malnutrition in the country. The DOH continues to offer the IMCI curriculum in medical, nursing, and midwifery schools. DepEd has integrated the ECE curriculum into the Bachelor of Education course offered by all colleges and universities. It has also issued a memorandum to all elementary schools to adopt the School Readiness Tool. DSWD has made the ECCD Checklist one of the criteria for day care center accreditation. It is also one of the criteria by which Child-Friendly LGUs are judged. 54. At the local level, the commitment of provincial and municipal officials to instituting ECD mechanisms and the Bright Child vision is evident. The local ECD teams and councils for the welfare of the children continue to meet regularly and undertake joint activities, passing local

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resolutions to support ECD services and allocating funds for selected ECD interventions. Many LGUs (including all of those visited during the Project Completion Review Mission) have fully or partially absorbed the service providers hired under the Project (midwives, child development workers, day care workers, resource center custodians). Health facilities that have attained the Sentrong Sigla Certification and PhilHealth Accreditation are able to deliver quality health care especially for children with the availability of additional resources.21 E. Impact 55. The Project’s intended impact (as per the design and monitoring framework) was to support government efforts to improve child survival and increase readiness for productive life. The target was to strengthen DSWD, DOH and DepEd capacity to manage the ECD program. In this vague sense, the impact has been achieved. The Project supported government efforts, and agencies’ capacity was strengthened. But for impact evaluation purposes, the Project Completion Review Mission chose to assess child survival and increased readiness for productive life. The three remaining key performance indicators are used as proxies: reduced under-5 mortality, reduced proportion of malnourished children, and increased Grade 1 completion rate. Changes in these indicators show that the impact has not yet been achieved, but some trends are promising.22 56. The targeted reduction in the under-5 mortality rate by 30% has not yet been attained. The national rate fell from 55 per 1,000 live births in 1998 to 42 in 2003. DOH analysis shows that a significant proportion of the under-5 mortality rate in the Philippines can be attributed to neonatal deaths (<1 month old), and that this rate has remained constant for the past 30 years.23 The reduction in the under-5 mortality rate thus necessitates a more intensified focus on both maternal and child health interventions. 57. While the Project helped curb acute malnutrition among children 0–4 years old (i.e., low weight for height, or wasting), it was unable to reduce chronic malnutrition (low height for age, or stunting). The proportion of underweight children in project areas was significantly reduced from 29.2% in 2001 to 25.2% in 2003 and the proportion of children with evidence of wasting fell from 7.5% in 2001 to 2.8% in 2003. Nevertheless, the proportion of stunted children increased from 31.3% in 2001 to 35.7% in 2003. A significant proportion of children 0–4 years old were persistently malnourished during the life of the Project—with 17.4% underweight, 25% stunted, and 0.3% wasted—while the prevalence of anemia also persisted throughout. These results show that chronic malnutrition requires further concerted effort targeted at both children and their parents and over a longer time period. 58. The end-of-project survey revealed an average Grade 1 completion rate of 84% across the three project regions. This is not only below the key indicator target of 90% but also represents a decline from the baseline rate of 86%. Routine reports for selected schools visited during the Project Completion Review Mission confirmed that there was no decrease in the dropout rates among first graders. This is a worrisome trend that must become the focus of renewed efforts.

21 Several areas visited have used capitation funds from the PhilHealth Outpatient Benefit Package to procure iron

supplements for mothers and children, antibiotics for pneumonia, plus additional supplies and basic equipment. See Appendix 7.

22 It is not intended that the impact be achieved by the Project’s end. 23 The majority of neonatal deaths are due to preterm birth and asphyxia, severe infection (primarily pneumonia),

diarrhea, congenital abnormalities, and neonatal tetanus.

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IV. OVERALL ASSESSMENT AND RECOMMENDATIONS

A. Overall Assessment 59. Based on the preceding assessment of the Project as highly relevant, less efficient, effective, and likely sustainable, the overall project rating is successful. The Project supported incremental reforms and strengthened capacity at the national, regional, and local levels to manage and deliver ECD services. It was instrumental in formulating and operationalizing a number of laws, policies, and guidelines aimed at addressing gaps in child survival and development. It expanded access for poor children in poor LGUs to better quality ECD services and institutionalized systems for integrated delivery of services at the local level. The Project strengthened coordination and communication among stakeholders at national and local government levels, in the concerned agencies, and in the private and public sectors. Though the Project did not meet all the key performance indicators, it put in place the basic building blocks for strengthened and integrated ECD service delivery. Evidence also suggests that the Project improved the willingness of local officials to prioritize ECD and to sustain project gains. Despite the initial implementation delays, many of the Project’s objectives were ultimately achieved. B. Lessons Learned

60. First, while certain child survival and development issues can be addressed within a relatively short timeframe through targeted assistance, others will require much more long-term assistance because they are so inextricably linked with the larger challenge of poverty. Children from poor families are three times more likely to die before age 5 than children from well-off families. Chronic malnutrition is largely the result of mothers’ poor nutrition. Low Grade 1 completion rates are also a function of poverty: students tend to drop out because their families are unable to pay for daily transport, food, uniforms, or supplies. The Project expanded the ECD service delivery points and made an effort to bring services closer to the clients, but many potential clients lacked the money to take full advantage of those services.

61. Second, integrated ECD services take time to become truly operational. By the Project’s end, some of the mechanisms intended to facilitate integration (e.g., the ECCD Checklist, Mother and Child Book) had not been fully maximized. The interface of the various actors expected to provide services to children prior to birth, postpartum, and throughout their development up to Grade 1 has not yet been fully integrated at the community level. ECD service delivery requires a conscious effort to harmonize policies, interventions, and systems in support of ECD at all levels. Such efforts are ongoing. 62. Third, child development, protection, and survival require the commitment and participation of many stakeholders at various levels of operations. The Project demonstrated that partnership between the national and/or regional agencies and local governments in addressing child-related issues and concerns is feasible under a devolved system. Strong national government support coupled with local officials’ political will contributed in large part to the Project’s successes. The Project underscored the critical role of the regional offices and the provincial government in continuously providing technical assistance and guidance to the LGUs even after the Project ended.

63. Fourth, management of large externally funded projects necessitates overall direction and regular guidance from senior management, and it requires ownership of the project goals and strategies by the offices and staff mandated to run the programs and activities. The

16

assignment of a committed DSWD undersecretary as project director significantly sped up project implementation after the midterm review. Mainstreaming NPMO staff into the structure of the EA and implementing agencies is a good way to ensure sustainability. C. Recommendations 1. Project-Related

64. As the lead ECCD implementing agency, the CWC should continue to monitor ECD programs at the local level to ensure that the sustainability plans developed by each LGU at project closure are supported and implemented. It should continue to support the LGUs in integrating ECD service delivery. This can be done by strengthening the councils for the protection and welfare of children at the municipal and barangay levels (2007 and beyond). The CWC should furthermore disseminate the completed body of research and consider preparing and publicizing a consolidated list of recommendations drawn from the research (by end 2007). 65. The EA and implementing agencies must continue to promote the project gains in order to sustain the momentum for ECD activities at the national, subnational, and local levels. The CWC should assess the project-designed management information systems for possible adoption in implementing the ECCD Law (by end 2007). The CWC (in collaboration with DOH, DepEd, and DSWD) should assess utilization of the ECCD Checklist, with a particular focus on acceptability and ease of use among midwives and its possible adoption by DepEd preschools. The study should establish how results of the ECCD Checklist assessment will be addressed by service providers at the local level (by end 2007). DepEd should work toward refining the School Readiness Assessment with the goal of integrating it into the curriculum of higher education (by end 2008). 66. Access to services is problematic for the poor. Where physical access is the problem, mobile ECD resource centers could serve hard to reach areas. This would particularly benefit mountainous indigenous people’s communities. The CWC should consider this in its ECCD activities (2007 and beyond). Where financial constraints hamper access, supply-side projects that develop services should be complemented with demand-side interventions to encourage and motivate beneficiaries to make full use of those services. A conditional cash transfer program—where poor families receive a cash benefit on the condition that they make human capital investments such as enrolling children in school and making sure they attend regularly or taking part in nutrition seminars or a PES session, for example—could be designed to enhance results in the ECD agenda. DSWD should explore the design and pilot testing of a conditional cash transfer program (by end 2008).

67. With a rapidly growing population and little progress in poverty reduction, the challenges of child survival and development in the Philippines are substantial and will require an investment and effort of gargantuan proportions. The Project only targeted 10 of the 79 provinces and a mere 8% of the more than 1,600 LGUs in the country. While the ECCD Act provides for the allocation of P2 billion to cover all provinces, P16.7 million per province for 3 years (the current CWC allocation) will likely be insufficient to make an impact and cover interventions in all municipalities in each province. Given the official commitment to achieving Millennium Development Goal targets in under-5 mortality, poverty alleviation, and hunger mitigation by 2015, the agencies concerned should consider an ECDP follow-on activity that builds on the many institutional development gains and lessons learned (by end 2008).

17

2. General 68. Recognizing that the MDFO has grown much more experienced in the last 5 years, it nevertheless should make sure that sufficient staff is allocated to particular projects in order to maximize efficiency and avoid implementation delays. ADB should work with the Government to further develop direct lending to subsovereign borrowers in order to reduce transaction costs. 69. In designing projects, EA capacity should be carefully assessed at appraisal, so that early steps may be taken to fill any gaps. This would contribute to more efficient project start-up, which would ultimately enhance project results. Monitoring and evaluation should be afforded a much higher priority in project implementation. One unfortunate aspect of the project monitoring and evaluation system was a baseline survey that was undertaken only near project midterm. Where evidence-based impact evaluation shows positive results, political support can be generated. Where problems are uncovered, program adjustments can be made. Where successes are publicized, additional funding might be mobilized. The importance of monitoring cannot be overstated.

18 Appendix 1

ANNOTATED PROJECT DESIGN AND MONITORING FRAMEWORK Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

1. Sector/Area Goal (Impact) To support government efforts to improve child survival and increase readiness for productive life

To strengthen the Department of Social Welfare and Development (DSWD), Department of Health (DOH), and Department of Education (DepEd) in their capacities to manage the Early Childhood Development Project (ECDP)

Policy dialogue and supervision missions

The Project significantly strengthened the capacities of DSWD, DOH, and DepEd to manage programs and activities related to early childhood development (ECD). Several national laws, policies, and guidelines were generated to provide a supportive policy environment at national and local levels for ECD (e.g., the Early Childhood Care and Development [ECCD] Law, Food Fortification Law and its implementing rules and regulations, Guidelines in the Implementation of National Supplemental Feeding, Operational Guidelines on the Food for the School Program, DOH Guidelines on Vitamin A and Iron Supplementation). Technical staff competencies improved in various programs, and capacity in planning, communications, and training was enhanced, which enabled staffs to provide technical assistance to local counterparts. Close coordination among concerned agencies at national and local levels continues, as evidenced by regular meetings and attendance of key officials in major ECD events.

2. Objective/Purpose (Outcome) 2.1 To provide integrated service delivery under local government unit (LGU) management

To reach targeted geographical areas, poor families, and children at risk

Baseline and other project-supported surveys

Please refer to Component 1 (Section 3.1).

2.2 To provide support systems for ECD service delivery

To improve monitoring and project management through communications, information systems, and planning

Baseline, midterm, and project completion survey; ADB missions; performance-based annual budget reviews

Please refer to Component 2 (Section 3.2).

2.3 To support research and development for improved ECD services delivery and management

To take corrective actions based on research findings for improved management

Annual planning and budget reviews, research and development (R&D) proposal screening and review team

Please refer to Component 3 (Section 3.3).

19 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

3. Project Components (Outputs) 3.1 ECD Service Delivery

Sustained reduction in infant and child mortality through province-wide support for:

Baseline and project surveys, evaluation indicators, project management office (PMO) semiannual reports, service statistics, indicators measuring school readiness and improved achievement scores monitored by primary schools

Sustained reduction in under-5 mortality is difficult to ascertain as of the project completion report (PCR). The 1998 and 2003 National Demographic and Health Surveys show that under-5 mortality worsened in regions VI and VII but significantly declined in Region XII over the same period. Program performance varied across project regions and provinces. Six of the 10 key performance indicators improved (Table A1.1) but others did not. Other indicators (see Table A1.2) also reveal mixed outcomes. Comparing the 2000–2005 routine Field Health Service Information System reports of the project regions and provinces (Table A1.3) and selected LGUs visited by the Projection Completion Review Mission (Table A1.4) showed varying results. Dropout rates in Grade 1 also varied from school to school (Table A1.5)

• immunization program

Very slight improvements in fully immunized children (FIC) and tetanus toxoid 2 (TT2) immunizations were noted at almost all project sites. FIC increased very slightly in regions VI and VII from 2001 to 2003 (Table A1.1). Only four of the project provinces registered an improved FIC from 2000 to 2005 (Table A1.3) The 1998 and 2003 National Demographic and Health Surveys further confirm a declining FIC nationwide, which is considerably below the 95% benchmark (Table A1.1). The proportion of pregnant mothers given TT2 plus immunization slightly increased from 2001 to 2003 (Table A1.2). Only four of project provinces registered an improved level of TT2 immunization from 2000 to 2005 (Table A1.3).

• micronutrient supplementation

The proportion of children 9–11 months old given routine vitamin A supplementation improved in most of the project sites and regions (Table A1.3). The proportion of children 0–4 years old taking iron supplements grew significantly from 13.8% in 2001 to 24.3% in 2003 (Table A1.2). The proportion of pregnant mothers taking iron supplements also improved from 2001 to 2003 (Table A1.2).

Upgrade province-wide ECD program support.

• integrated management of childhood illnesses

Refer to Component 2.1—LGU Financing Facility

20 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

• Reduced dropouts and improved academic achievement in Grade 1 through strengthening of parent effectiveness service and early child education curriculum enrichment in Grade 1

The proportion of mothers aware of parent effectiveness service (PES) and those attending PES sessions increased from 2001 to 2003, but overall levels were quite low. The same low participation is seen in the proportion of children 3–5 years old attending day care services, which barely increased from 33.7% in 2001 to 34.1% in 2003. The proportion of children enrolled in Grade 1 decreased from 56.7% in 2001 to 42.6% in 2003. The proportion of children completing Grade 1 also decreased slightly from 2001 to 2003 in regions VI and VII. Grade 1 completion rates in regions VI and VII did not reach the expected level of 90% (Table A1.2). Dropout data from DepEd and several schools visited also confirmed unimproved Grade 1 dropout rates. (Table A1.4). However, the overall psychosocial development among children 0–4 years old improved. There was a significant reduction in the proportion of children with below-average psychosocial development in regions VI and VII from 2001 to 2003 (Table A1.1).

Provide LGU financing facility for integrated service delivery at municipal and city levels

Delivery of an appropriate package of health, nutrition, and early education services to children under 6 in each LGU; development and generation of resources for ECD advocacy and program support

The Project expanded the provision of ECD services in 132 municipalities and cities through constructing or renovating ECD facilities and deploying service providers in priority areas where access to ECD services was very limited. This included:

- 254 new barangay health stations constructed - 945 new day care centers constructed - 505 barangay health stations and 1,009 day care centers renovated - 4,087 day care workers hired - 1,680 rural health midwives hired - 1,630 child development workers hired - 18 day care moms hired

A total of 105 ECD resource centers were established and now serve as sources of information materials for ECD service providers and parents, spaces where children can attend learning sessions, and loci for meetings of ECD service providers. Field visits affirmed their continued utilization. Visits to selected project sites showed that LGUs absorbed most of the ECDP-hired service in partnership with barangay councils. Review of actual disbursements showed that LGUs provided funds much greater than their required equity. Some of them continue to allocate budget for ECD, mainly from the 20% development fund.

21 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

Reduction in incidence of acute respiratory infection (ARI) and diarrhea

Service statistics performance indicators; annual budget review; ADB missions, service statistics; project indicators; baseline, midterm, and project evaluation surveys; PMO semiannual reports

The prevalence of cough, fever and ARI cases increased from 2001 to 2003. The proportion of diarrhea cases seeking treatment from health facilities and service providers declined (Table A1.2), but an increasing proportion of pneumonia cases was noted in the majority of the project provinces (7 out of 10) (Table A1.3).

Accelerated reduction in low birth weight, stunting, and wasting from preschool child protein-energy malnutrition

The proportion of infants with low and very low birth weights considerably increased from 2001 to 2003 (Table A1.2). The same is seen in seven of the project provinces, which had increased proportions of low birth weight infants from 2000 to 2005 (Table A1.3). Acute malnutrition (underweight and wasting) showed a declining pattern but chronic malnutrition (stunting) continued unabated; (Table A1.1). A considerable proportion of children also remained consistently malnourished from 2001 to 2003 (Table A1.2).

Virtual elimination of micronutrient deficiencies from vitamin A and iodine, and substantial reduction in iron deficiency anemia in preschoolers

The proportion of children experiencing night blindness decreased from 2001 to 2003 (Table A1.2). The proportion of anemic children declined from 2001 to 2003 but the expected level of reduction was not achieved (Table A1.1).

3.2 Support for ECD Service Delivery

Promotion of participation of nongovernment organizations and communities in ECD programs and activities

The private sector was mobilized to participate in the food fortification program. Mothers at the community level participated in the supplemental feeding program.

22 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

Communications packages to enhance LGU program ownership

Motivate greater LGU investment in ECD; raise demand for ECD services and fortified foods among providers and consumers; IEC (information, education, and communication) to modify behaviors of ECD providers and family caregivers; forging and strengthening mechanisms for central and local government partnership, technical cooperation, and cost-sharing to promote and deliver essential ECD services

Providers, beneficiaries, and household surveys; monitoring and evaluation indicators; LGU consultations; annual planning reviews

Intensive advocacy and communication efforts led to a total of 132 LGUs participating in the LGU financing facility. Project Completion Review Mission field visits showed continuing commitment for ECD as evidenced by (i) the absorption of ECDP-hired service providers after project closure, (ii) continued budget allocations for ECD programs and activities, and (iii) passage of resolutions and ordinances in support of ECD. Capacity of various ECD stakeholders improved, particularly in basic communication processes, planning, and strategies; IEC material development and presentation; and media relations. Despite the intensive IEC efforts undertaken, only modest improvements were seen on the health and social care seeking behavior of the mothers and children (see below), suggesting the need for a more concerted effort to inform and educate the mothers at the local level. See Table A1.6. (i) While 91.0% of households were aware of iodized salt, only 53.0%

used it. (ii) Although 93.5% of mothers breastfed their babies, only 17.6% do it

exclusively up to 6 months. (iii) Only 26.9% of mothers were aware of PES sessions. (iv) Only 12.3% of underweight children attended the feeding program. (v) Only 38.2% of children attended the deworming program. (vi) Only 19.0%–24.6% of children who were sick with cough, fever, ARI

and diarrhea sought treatment. Management information system for ECD planning and decision making

Establishment of an effective monitoring and surveillance system for ECD at the local and national levels; ECD plan for all project LGUs, with appropriate cost-sharing

PMO; regional and provincial planning teams

The automated planning template was a useful tool for the ECDP LGUs in formulating their 3-Year ECDP investment plans but was not adopted in implementing the ECCD. Investment plans of ECCD-assisted LGUs are integral to the LGUs’ overall local development and investment plans for children. Usefulness of the 13 management information systems developed under ECDP was limited to the life of the Project. The child ID system in particular designed to track all services provided to a child from birth to 6 years of age did not materialize. LGUs also stopped using the ECD service delivery information system and the municipal and city reporting after the Project ended. The Council for the Welfare of Children (CWC) is now assessing how some of these systems can be applied to the monitoring and tracking of the ECCD implementation. Refer to Table A1.7.

23 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

Training Core training modules and courses based on competency standards given to all categories of ECD workers, supervisors, and managers

Service delivery surveys to monitor coverage and impact of training, annual evaluation of accredited training institutions

Table A1.8 shows relatively good coverage of training among ECD service providers in all courses except on community-based integrated management of childhood illnesses (IMCI) (18.1%); use of international reference standards (38.3%); revised day care manual (58.5%); and supplemental feeding and nutrition education (54.3%). Pockets of service providers, though, were not trained on the use of tools that were developed late (e.g., ECCD Checklist). Training of Grade 1 school teachers was remarkable with all training completed as early as 2001. Newly-hired Grade 1 teachers were given orientation by colleagues who attended the early childhood education training, but some remained untrained. Training both the supervisors and service providers was a commendable move ensuring harmonized understanding of programs and interventions. Given high staff turnover at the local level, a regular budget for training must be mobilized.

Institutional development: institutional capability at the national and local levels to deliver integrated ECD services targeting the most disadvantaged families

Strengthening CWC; strengthening coordination of DSWD, DOH, and DepEd; contracting out project management; strengthening public-private partnership for food fortification

PMO; monitoring and evaluation indicators for quality management; regional ECD planning teams

The Project strengthened the capacity of CWC as the overall coordinating body for ECD-related programs. Composed of multi-sectoral representatives, these national and subnational councils meet regularly to tackle ECD-related issues and concerns. Local ECDP teams still function as coordinating bodies at their respective levels and most play the same functions as those of councils for the welfare and protection of children. Ongoing efforts are being undertaken to establish more barangay councils for the protection of children. The establishment of an R&D unit in CWC was a result of the Project. To date, the CWC boasts a 4-person R&D unit capable of managing contracted research and in-house studies. The unit has expertise in developing popular versions of large studies and in disseminating research results to wider audience in various forms. It has also established a website where completed studies are posted for wider dissemination. The Project successfully produced a stronger public-private collaboration for food fortification as evidenced by the number of private companies and food companies complying with the Food Fortification Law.

3.3 Research and Development for Project Support

Improve quality assurances for ECD service delivery and quality ECD management

Research Screening Committee, PMO, LGU financing facility

24 Appendix 1

Design Summary Targets Project Monitoring

Mechanism Status as of the Project Completion Review

Pilot-testing of project interventions in five LGUs in first year

Prove efficacy of integrated service delivery packages in traditional and nontraditional settings, test protein-energy malnutrition reduction strategy through alternative community-based models, test adequacy of first referral care for sick children under IMCI

PMO, ECDP-management team; ECDP steering committee; ADB supervision

The pilot test was undertaken in 10 areas instead of five as originally designed. The lessons learned during the pilot were documented but results were not disseminated. The pilot implementation started late. Expansion (Batch 1 LGUs) already started to implement while the pilot implementation in 10 areas was still ongoing. Considering the late start of the pilot and non-dissemination of the findings, the utilization of results of the pilot may not have been fully maximized. Main changes noted in the implementation for Batch 1 LGUs was a ceiling of P5.0 million imposed per participating LGU and a 25% cap for civil works allocation compared to the pilot where no ceiling was followed. The pilot test did not produce information on the specified interventions in traditional and nontraditional settings, use of community models, and the adequacy of a referral scheme for sick children.

R&D studies Test feasibility of, and develop technologies for, innovative ECD policies and programs; support action research to correct generic problems; study longitudinal impact of ECD programs on child development

R&D committee, CWC, supervision missions, annual provincial planning workshops

Only five of the 16 originally listed research studies were completed. Ten new studies were added after the midterm review. These were all undertaken, yielding a total of 15 research projects completed under the Project. Four of these studies, though, were only completed in 2006. Ten completed studies are posted to the CWC website for wider dissemination. Results of some have already been utilized in formulating policies and guidelines and in developing ECD-related tools (e.g., the school readiness tool, Mother and Child Book, ECCD Checklist). Studies on food fortification were helpful inputs in drafting the Food Fortification Law and its implementing rules and regulations. The Project also supported the 2003 National Nutrition Survey studies completed in 2005 and 2006. CWC has developed a consolidated list of recommendations drawn from the 15 completed research projects. See Table A1.9

Monitoring and Evaluation

Baseline, midterm, and final evaluation surveys to measure project impact; track ECD indicators; cluster surveys in sample areas to test interventions; nutrition sampling in project regions under

Monitoring and evaluation system team; ADB and World Bank supervision

All four studies were undertaken and completed, but the baseline survey was only implemented in 2001 (at the midpoint of the Project). The Baseline Survey of Indigenous People’s Access to and Utilization of ECD Services was partially used for designing intervention packages.

25 Appendix 1

National Nutrition Surveys 1998 and 2003

ADB = Asian Development Bank; ARI = acute respiratory infection; CWC = Council for the Welfare of Children; DepEd = Department of Education; DOH = Department of Health; DSWD = Department of Social Welfare and Development; ECCD = early childhood care and development; ECD = early child development; ECDP = Early Child Development Project; FIC = fully immunized children; IEC = information, education, and communication; IMCI = integrated management of childhood illnesses; LGU = local government unit; PCR = project completion report; PES = parent effectiveness service; PMO = project management office; R&D = research and development; TT2 = tetanus toxoid 2. Sources: The Philippine Government ECDP PCR; World Bank ECDP PCR; 2000–2005 Field Health Service Information System reports; 2000–2006 DepEd accomplishment reports; National Demographic and Health Survey, 1998 and 2003; A Study of the Effects of Early Childhood Interventions on Children’s Physiological, Cognitive and Social Development (Results of the Longitudinal Evaluation Study); National Nutrition Survey, 1998 and 2003; The Endline Indicators Study; Project Completion Review Mission key informant interviews.

26 Appendix 1

Table A1.1: 10 Key Performance Indicators

ECDP Longitudinal Study 10 Key Performance Indicators

Target Year/Round Regions VI

and VII

Other Data Achievement

1. Under-5 mortality rate

Reduce by 30% from baseline value

Not covered

Not covered 1998 Target 2003 NDHS Reduction NDHS Region VI 41.6 29.1 50.0 Region VII 38.4 26.9 39.0 Region XII 75.9 53.1 37.0 Region VIII 85.6 32.9 57.0 National 54.9 38.4 42.0

Results of 1998 and 2003 NDHSs show that rate worsened in regions VI and VII from 1998 to 2003 but significantly decreased in Region XII. Rate in Region VIII and the national average declined, but not by the expected 30%.

2.1 Proportion of children 0–4 years old who are underweight

2001 round 2003 round Difference

29.2 25.2

6.1a

1998 Target 2003 NDHS Reduction NDHS national average 32.0% 19.2% 27.0%

Significant improvement from 2001 to 2003 in regions VI and VII, but reduction was not so great as targeted 40%. National average also declined from 1998 to 2003, but reduction was very modest.

2.2 Proportion of children 0–4 years old and below who are stunted

2001 round 2003 round Difference

31.3 35.7

-6.0 a

1998 Target 2003 NNS Reduction NNS national average 34.0% 20.4% 30.0%

Reduction target for stunted children not achieved. In fact, proportion of stunted children even increased significantly over 2 years in regions VI and VII. The national average, though, showed a decline but not by so much as originally targeted.

2.3 Proportion of children 0–4 years old and below who are wasted

Decrease by 40% from baseline value

2001 round 2003 round Difference

7.5 2.8

5.3 a

1998 Target 2003 NNS Reduction NNS national average 6.0% 3.6% 5.5%

Significant improvement from 2001 to 2003 in both regions VI and VII, but this did not achieve the reduction target of 40%. National average of wasted children also decreased, but very slightly.

3. Proportion of children 6 months to 4 years old with anemia

Reduce by 30% from baseline value

2001 round 2003 round Difference

41.5 39.6 -6.0

1998 Target 2003 NNS Reduction NNS national averages 6 months to to 1 year 56.6% 39.6% 66.9% 1–5 years old 29.6% 20.7% 29.1%

The proportion of children 6 months to 4 years old who are anemic declined from 2001 to 2003 but did not achieve the expected 30% reduction. National average shows a worsening proportion of anemic infants 6 months to 1 year old from 1998 to 2003 and a constant proportion of anemic children 1–5 years old over the same period.

4. Proportion of children 1–2 years old who are fully immunized

90% of children in that age group

2001 round 2003 round Difference

87.8 88.8 0.6

1998 Target 2003 NDHS NDHS national average 73.0% 90.0% 70.0%

There was a very slight improvement in the proportion of fully immunized children from 2001 to 2003 in regions VI and VII, but the increase did not reach the 90% target level. The 1998 and 2003 NDHS also show a consistent decline of fully immunized children.

27 Appendix 1

ECDP Longitudinal Study 10 Key Performance Indicators

Target Year/Round Regions VI

and VII

Other Data Sources Achievement

5. Proportion of children aged 0–4 years below average in overall psychosocial development (combined index of child development).

Target to be deter-mined during baseline study

2001 round 2003 round Difference

7.1 1.9

8.7 a

Significant reduction in the proportion of children 0–4 years old below average in overall psychosocial development in both regions VI and VII.

6. Proportion of children aged 3 to 5 years in targeted municipalities attending day care centers

75% of children in that age group

2001 round 2003 round Difference

33.7 34.1

(3.1)

The proportion of children 3–5 years old in regions VI and VII utilizing day care center services was far below the 75% target. There was also no significant improvement in the proportion of children attending day care centers over the 2-year period. In Region VII, this even declined significantly.

7. Completion rate for Grade 1

90% of children entering Grade 1

Round 1 2000–2001 2001–2002 Round 2 2002–2003

88.3 87.9

87.7

national level: 2000 DepEd report 58% 2005 DepEd report 89% Endline Survey: 83.6% in regions 6, 7, and 12

The proportion of children completing Grade 1 slightly decreased from 2001 to 2003 in regions VI and VII. Completion rates in both regions did not reach 90%.

8.1 Proportion of LGUs with functional protein-energy malnutrition prevention (growth monitoring program [GMP])

2003 round Total LGU % with GMP

35 369.7

86.4% based on Endline Survey

8.2 Proportion of LGUs with functional protein-energy malnutrition prevention (feeding programs)

50%

2003 round Total LGUs % having feeding program

25 36

69.4

59.1% based on Endline Survey

Municipalities with functional PEMs were those with GMPs and those that undertake feeding programs. This target was substantially met with 89.7% of municipalities having GMPs and 69.4 having feeding programs.

9. Proportion of LGUs with active child development workers

50% 63.0% based on Endline Survey Achieved.

10. Proportion of targeted municipalities having implemented early childhood development subprojects

90% Endline Survey: Targeted LGUs for ECDP subprojects: 135 Actual number LGUs Participating: 132 Percent: 100

Achieved.

DepEd = Department of Education, ECDP = Early Childhood Development Project, GMP = growth monitoring program, LGU = local government unit, NDHS = National Demographic and Health Survey, NNS = National Nutrition Council, PEM = protein-energy malnutrition. a Significant difference from zero at p < 0.05. Sources: 1998 and 2003 National Demographic and Health Surveys; A Study of the Effects of Early Childhood Interventions on Children’s Physiological, Cognitive and Social Development (Results of the Longitudinal Evaluation Study), 1998 and 2003 National Nutrition Surveys, The Endline Indicators Study.

28 Appendix 1

Table A1.2: Other Relevant Early Childhood Development Indicators in Project Regions, 2001 and 2003

Intervention Packages Indicators with Improvement Indicators without Improvement

Immunization • The proportion of pregnant mothers given TT2 rose slightly, from 61.7% in 2001 to 62.3% in 2003.

• The prevalence of other illnesses slightly increased from 2001 to 2003: Illnesses 2001 2003 ARI 6.9% 9.6% cough 40.6% 44.3% fever 23.5% 25.8%

Integrated Management of Childhood Illnesses

• There was a slight reduction in the prevalence of diarrhea, from 7.1% in 2001 to 2.6% in 2003.

• The proportion of cases seeking treatment decreased from 2001 to 2003: Illnesses 2001 2003 ARI 57.5% 19.0% cough 29.4% 22.5%

fever 33.3% 24.6% diarrhea 27.1% 25.2%

Malnutrition Prevention

• The proportion of children less than 1 year old with low and very low birth weights doubled from 16% in 2001 to 33% in 2003.

• A considerable proportion of children 0–4 years old were malnourished from 2001 to 2003: 17.4% were consistently underweight, 25% were consistently stunted, and 0.3% were consistently wasted.

PEM Prevention - Growth

Monitoring Program

- Feeding Program

• The proportion of underweight children participating in feeding programs rose from 9% in 2001 to 30% in 2003.

• The proportion of underweight children participating in feeding programs grew from 4% in 2001 to 8% in 2003.

• The proportion of children participating in growth monitoring programs significantly decreased from 82.5% in 2001 to 56.1% in 2003.

Micronutrient Supplementation

• Only a negligible proportion of children were reported to have night blindness.

• The proportion of children 6–59 months old taking vitamin A supplements rose from 79% in 2001 to 81% in 2003.

• The proportion of children 0–4 years old taking iron supplements grew significantly from 14% in 2001 to 24% in 2003.

Appendix 1 29

Intervention Packages

Key Performance Indicators with Improvement

Key Performance Indicators without Improvement

• The proportion of mothers taking iron supplements during pregnancy increased from 76.1% in 2001 to 84.1% in 2003.

Deworming • The proportion of children with worm infestation slightly decreased from 26.8% in 2001 to 25.8% in 2003.

• The proportion of children participating in deworming programs rose slightly from 36.2% in 2001 to 38.2% in 2003.

• The proportion of households using iodized salt increased from 41.5% in 2001 to 53.0% in 2003.

Food Fortification

• The proportion of households aware of salt iodization increased from 88.7% in 2001 to 91.9% in 2003.

• The proportion of children 0–4 years old consuming fortified food products grew from 66.2% in 2001 to 72.1% in 2003.

Parent Effectiveness Service

• The proportion of mothers aware of parent effectiveness service increased from 12.3% in 2001 to 26.9% in 2003.

• The proportion attending parent effectiveness service increased from 17.2% in 2001 to 34.0% in 2003.

• The proportion of children 3–5 years old attending day care services barely increased from 33.7% in 2001 to 34.1% in 2003.

Early Childhood Education

• Completion rates of Grade 1 students decreased from 88.3% in 2000/01, to 87.9% in 2001/02 to 87.7% in 2002/03

ARI = acute respiratory infection, PEM = protein-energy malnutrition, TT2 = tetanus toxoid 2. Source: A Study of the Effects of Early Childhood Interventions on Children’s Physiological, Cognitive and Social Development (Results of the Longitudinal Evaluation Study).

30 Appendix 1

Table A1.3: Health Output/Outcome Indicators in Project Regions and Provinces, 2000 and 2005

Prenatal and Post Natal Care Child Care Pregnant

Women w/ 3 or More Prenatal

Visits

Pregnant Women Given

TT2 Plus Immunization

Post Partum Women with at lest 1 PP

visit

Lactating Mothers

Given vitamin A

15-49 Year Old Women

Given Iodized Oil Capsule

Facility-Based

Deliveries

Infants with Low Birth

Weight (<2,.5 kg)

Fully Immunized

Children

Diarrhea Cases Given

ORS

Pneumonia Cases Given

Treatment

9-11 Months Old Children

Given Vitamin A

12-59 Months Old Children

Given vitamin A

Project Area

2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 National 64.8 62.2 61.4 58.8 74.6 69.1 57.0 54.8 7.5 .4 26.8 30.0 13.1 9.1 86.5 83.7 24.1 14.7 93.9 95.3 76.9 81.3 101.3 97.8 Region VI 54.2 50.4 49.9 51.6 63.4 59.8 54.6 56.0 5.5 .02 30.7 39.5 13.1 7.7 78.0 78.0 18.1 9.0 91.5 98.2 71.4 84.2 93.6 87.2 Capiz 50.8 49.8 51.7 47.9 59.2 49.5 49.5 46.1 2.3 nd 13.2 22.5 9.0 10.4 85.5 69.7 16.5 10.3 91.2 100.0 73.7 69.0 3.8 46.4 Guimaras 68.8 60.8 58.5 59.4 58.2 61.9 64.5 61.3 2.0 nd 28.3 41.4 5.3 2.8 80.5 83.5 12.9 4.3 99.5 100.0 75.0 90.8 60.8 109.2 Iloilo 53.8 51.1 43.9 49.7 69.4 63.8 53.7 55.3 9.4 .03 23.2 31.5 12.0 6.2 71.2 78.2 14.5 4.9 95.4 97.0 57.6 74.2 119.2 57.2 Negros Occidental

55.6 52.2 52.3 53.3 62.6 62.4 61.2 59.0 6.4 nd 16.4 31.0 22.5 6.2 75.7 74.9 19.3 13.1 80.7 98.9 71.0 80.5 110.6 109.1

Region VII 59.3 58.4 62.5 61.4 85.4 78.5 60.0 60.4 16.7 .2 25.0 30.0 16.6 16.7 84.5 84.0 44.9 34.1 98.1 97.9 70.4 84.1 135.0 122.5 Bohol 69.0 74.7 58.0 59.9 87.1 79.9 52.3 65.9 23.2 .2 14.2 20.5 14.7 3.6 77.5 76.3 60.0 52.1 99.4 97.5 61.9 82.4 90.5 95.7 Cebu 53.0 50.7 62.9 57.7 83.8 74.9 35.7 56.6 .1 .4 11.2 17.0 14.8 15.9 82.8 81.9 45.6 20.0 97.2 97.0 68.3 87.8 142.9 112.1 Negros Oriental

99.3 67.4 78.4 59.6 104.6 68.9 113.6 53.1 49.8 .001 12.6 16.5 13.2 16.0 99.2 75.2 56.0 35.6 98.7 98.2 75.3 67.8 243.8 153.2

Siquijor 67.4 72.9 56.3 42.6 70.3 47.9 34.9 56.2 .1 nd 27.4 35.6 4.8 3.9 64.3 61.1 21.7 8.5 90.1 100.0 21.4 64.0 87.3 110.3 Region XIIa

56.5 44.9 70.3 58.8 75.4 55.7 56.4 50.6 11.6 2.7 17.2 22.6 6.9 6.0 79.6 77.9 27.0 14.7 95.6 69.2 72.2 92.1 92.4 79.8

Laanao Norte

63.6 64.6 58.2 63.5 64.6 93.6 58.8 62.0 11.7 2.2 10.2 18.6 5.8 5.1 74.2 74.9 21.8 16.4 95.8 98.8 66.7 80.4 100.5 95.2

North Cotabato

47.1 57.1 52.1 56.2 56.4 59.4 48.6 44.4 8.0 .3 7.5 17.4 6.5 17.0 76.7 80.3 31.8 13.1 98.0 96.5 65.7 102.0 81.8 147.3

Iligan City 49.9 50.0 42.5 47.8 73.4 47.2 45.9 24.9 9.8 nd 41.5 46.8 2.4 6.9 83.4 72.6 12.1 4.8 100.0 95.4 83.4 85.4 102.4 123.2 No. LGUs/ Regions with Improved Performance from 2000 to 2005

2/11 LGUs 0 region

4/11 LGUs 1/3 regions

1/11 LGUs 0 region

4/11 LGUs 1/3 regions

1/11 LGUs 0 region

8/11 LGUs 2/3 regions

6/11 LGUs 2/3 regions

4/11 LGUs 0 region

0 LGU 0 region

7/11 LGUs 1/3 regions

10/11 LGUs 3/3 regions

nd = no data, TT = tetanus toxoid, PP = postpartum, kgs = kilograms, ORS = oral rehydration salt. a - In 2005, provinces under Region XII include North Cotabato, Sultan Kudarat, Sarangani, and South Cotabato, while Lanao Norte and Iligan City became part of Region 10. Source: Field Health Service Information System, 2000 and 2005.

Appendix 1

31

Table A1.4: Health Output/Outcome Indicators in Selected Project Municipalities and Barangays, 2000 and 2005

Prenatal and Post Natal Care Child Care % Pregnant Women With >3 Prenatal

Visits

% Pregnant Women With

TT2 Plus

% Pregnant Women Given

Complete Iron Dosage

% of Post Partum Women Initiated

Greastfeed-ing

% Lactating Women Given Complete Iron Dosage

% Lactating Given

Vitamin A

% 911 Months

Infants Fully Immunized

% of Diarrhea Cases Given ORS

% of Pneumonia

Cases Given Treatment

% of 9-11 Months Children

Given Vitamin A

% 12-59 Months Children

Given Vitamin A

% of 6─59 mos. children moderately and severely malnourished

Project Area

2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 LGU Barili, Cebu

43.0 (2001)

70.0 66.0 (2001)

77.0 (2006)

38.0 (2001)

54.0 (2006)

nd nd nd nd 30.0 (2001)

61.0 (2006)

nd nd 195.0 (2001)

155.0 (2006)

139.0 (2001)

94.0 (2006)

71.0 (2001)

173.0 (2006)

93.0 (2001)

91.0 (2006)

nd nd

Pilar, Bohol

30.0 (2002)

40.6 37.3 (2002)

53.9 52.6 (2002)

85.1 56.6 (2002)

58.3 61.9 (2002)

70.1 2.6 (2002)

8.4 65.6 (2002)

73.8 1.2 (2002)

11.7 59.1 (2002)

9.6

29.5 (2002)

63.3 91.2 (2002)

131.7 4.5 (2002)

12.3

Tubigon, Bohol

108.4 63.1 68.7 55.7 73.3 56.7 87.6 61.7 86.4 65.6 90.4 75.5 100.1 66.9 100.0 100.0 87.6 66.4 90.4 75.5 98.7 79.7 3.6 13.4

Kapatagan Lanao Norte

57.2 47.1 49.0 61.5 76.0 71.1 73.4 63.1 66.9 63.1 73.6 62.7 82.6 87.0 18.1 13.5 44.3 43.2 86.4 83.6 103.1 177.4 15.4 14.1

Barangay Lundag, Pilar

19.5 (2002)

76.3 11.5 (2002)

71.1 19.5 (2002)

95.0 25.8 (2002)

106.0 19.3 (2002)

106.0 22.6 (2002)

70.6 61.3 (2002)

115.8 4.8 (2002)

20.0 60.00 (2002)

25.0 0.0 (2002)

42.1 63.5 (2002)

92.2 4.8 (2002)

32.1

Balili Kapatagan

56.4 (2002)

72.4 27.7 (2002)

53.1 64.9 (2002)

120.3 34.0 (2002)

78.2 59.2 (2002)

78.2 59.2 (2002)

78.2 67.0 (2002)

89.1 11.9 (2002)

8.7 88.2 (2002)

38.5 69.0 (2002)

78.2 204.3(2002)

123.9 nd (2002)

18.8

Acmac Iligan City

43.8 (2001)

55.7 61.2 (2001)

52.4 2.2 (2001)

59.5 52.3 (2001)

59.5 1.3 (2001)

59.5 nd 63.1 75.2 (2001)

73.0 10.6 (2001)

15.4 10.8 (2001)

41.6 42.5 (2001)

79.4 nd (2001)

69.3 nd (2001)

6.7

nd = no data, tetanus toxoid = tetanus toxoid, ORS = oral rehydration salt. Source: Field Health Service Information System, 2000 and 2005.

32 Appendix 1

Table A1.5: Dropout Rates among Grade 1 Students in Selected Project Regions, Divisions and Schools SY 20002001 to SY 2005─2006

SY 20002001 SY 2001─2002 SY 20022003 SY 2003─2004 SY 20042005 SY 2005─2006 Region/

Division

Enrollees Drop-outs

% Drop- Out

Enrollees Drop- outs

% Drop- Out

Enrollees Drop- outs

% Drop- Out

Enrollees Drop -outs

% Drop- Out

Enrollees Drop- outs

% Drop- Out

Enrollees Drop- outs

% Drop- Out

Region VII 189,171 8,600 4.6 189,983 8,687 4.6 196,046 9,223 4.7 187,726 10,06

1 5.4 191,612 9,927 5.2 182,418 9,379 5.1

Bohol 34,489 1,620 4.7 34,346 1,773 5.2 33,756 1,905 5.6 32,723 1,859 5.7 34,269 1,938 5.7 32,763 1,863 5.7 Tubigon East Central School

1,299 51 4.0 1,320 49 4.0 1277 66 5.0 1255 73 6.0 1308 93 7.0 1445 72 5.0

Tagbilaran City

Part of Bohol (Mother Division) 1,650 53 3.2 1,623 52 3.2 1,711 51 3.0 1,807 67 3.7

Negros Oriental

42,172 1,640 3.9 42,854 1,400 3.3 36,745 1,362 3.7 32,368 1,290 4.0 32,192 1,382 4.3 29,892 1,373 4.6

Bais City Part of Negros Oriental (Mother Division) Part of Negros Oriental 2863 66 2.3 2,771 72 2.6 2,622 103 3.9 Bayawan City

Part of Negros Oriental (Mother Division) 5,035 148 2.9 4,906 155 3.2 4,971 153 3.1 4,570 126 2.8

Dumaguete City

2,444 25 1.0 2,394 28 1.2 2,407 41 1.7 2,421 17 0.7 2,475 55 2.2 2,209 14 0.6

Cebu 70,762 4,041 5.7 70,690 4,078 5.8 64,485 4,035 6.3 61,513 4,091 6.6 62,310 3,775 6.1 59,770 3,810 6.4 Barili Central 258 18 7.0 261 20 7.7 191 19 9.9 243 10 4.1 262 14 5.3 249 8 3.2 Siquijor 2,111 17 0.8 2,087 40 1.9 2015 40 2.0 1,904 19 1.0 2,077 29 1.4 1,983 19 1.0 Region XII Kapatagan East Central School

398 4 1.0 393 10 2.5 360 4 1.1 287 0 0.0 333 2 0.6 354 6 1.6

Iligan City East Central School

553 0 0.0 535 0 0.0 544 0 0.0 547 0 0.0 776 0 0.0 323 0 0.0

Source: Department of Education - Regional, Division and School Annual Accomplishment Report, 20002005.

Appendix 1 33

Table A1.6: Early Childhood Development (ECD) Advocacy and Communications IEC and Advocacy Efforts Undertaken Results 1. Intensive advocacy efforts were undertaken in the local government units (LGUs) selected to be recipients of the LGU financing facility (individual briefings, small group discussions, round table meetings, etc).

132 LGUs participated in the LGU financing facility.

2. Information, education, and communication (IEC) and advocacy materials about the Early Child Development Program were produced and disseminated.

2.1 For Mothers and Children Comic Book—Gabay ni Nanay 4,620 copies Buhay ni Bimboy 10,000 copies Mother and Child Book 5,000 copies Mother’s Card 5,000,000 copies Early Childhood Care and Development Card 12,146,200 copies 2.2 For Service Providers Integrated management of childhood illnesses (IMCI) modules 6,000 copies IMCI recording forms 4,575 copies IMCI wall charts 30 copies Enhanced Child Growth Manual 6,000 copies Updated parental effectiveness service (PES) 9,815 copies Flip Charts on PES 8,340 copies Revised day care center manual 6,997 copies 2.3 For ECD Stakeholders ECD Information Kits ECD Primers Advocacy video two 10-minute video documentaries Radio plugs 45-second radio plug Radio drama episodes: Pitlag: Kwento ng Buhay, Isyu ng Bayan

3. Campaigns Undertaken 3.1 Bright Child Bright Child jingle produced and disseminated 3.2 Social marketing and advocacy activities increased awareness of the benefits of iodized salt and fortified foods while mobilizing support of the private sector in food fortification.

(i) Proportion of households aware of salt iodization increased from 88.7% in 2001 to 91.9% in 2003. (ii) Proportion of households using iodized salt increased from 41.5% in 2001 to 53% in 2003. (iii) Proportion of children 0–4 years old consuming fortified foods increased from 66.2% in 2001 to 72.1% in 2003. (iv) Twelve out of 12 flour millers fortify their flour with vitamin A and iron. (v) Thirty-six of 46 oil refiners had the technology to fortify cooking oil with vitamin A. (vi) One sugar trader fortifies refined sugar with vitamin A. (vii) An increasing number of foods receive the Diamond Sangkap Pinoy Seal:

a. 6 brands of salt from 3 companies b. 49 brands of flour from 6 millers c. 42 brands of cooking oil d. 2 brands of sugar e. 5 brands of rice

(viii) An increasing number of processed foods receives the Regular Sangkap Pinoy Seal

4. Training in basic communication processes, planning, and strategies; developing and presenting IEC materials, and media relations.

254 ECD field implementers trained and developed local communication plans.

ECD = early childhood development; IEC = information, education, and communication; IMCI = integrated management of childhood illnesses; LGU = local government unit; PES = parental effectiveness service.

34 Appendix 1

Table A1.7: Early Childhood Development (ECD) Database Systems

Technical Area Subsystem Use of System

1. Planning Integrated Planning Tool Used as a template in formulating the 3-year investment plans of local government units (LGUs) considering the four core ECD packages for RHM, DCW, CDW and DCM.

2.1 Work and Financial Plan Information System

Tracks the project physical and financial targets.

2.2 investment plan tracking system Tracks targets versus actual physical and financial requirements of LGUs per loan category.

2.3 Physical and Financial Information System

Tracks accomplishment in relation to plans.

2.4 Withdrawal Application System

2. Financial Management

2.5 ECD financial information System Tracks the flow of money, disbursement level of fund releases, and status of the investment plan.

3.1 Procurement Benchmark and Disbursement Target Tracking System

Tracks the procurement process, delivery time, and disbursement target of goods and civil works.

3.2 Asset Registry Generates inventory code for each item procured under the Early Childhood Development Project (ECDP). Also gives current status of every piece of equipment.

3. Procurement Management

3.3 LGU Civil Works Information System

Tracks the percentage accomplishment (physical and financial) of every facility being constructed or repaired.

4.1 Child Identification System Tracks the programs and services provided to each child.

4.2 ECD Service Delivery Information System

Generates information on the services received by the project beneficiaries and services rendered by service providers, integrating all information about the health, nutrition, education, and psychosocial services provided by the RHM, CDW, DCW, DCM, barangay health workers, and Grade 1 teachers.

4. Service Delivery

43. Municipal/City Reporting Form Reporting system jointly developed by representatives from various agencies that integrates and consolidates all the service delivery reports at the community level.

5.1 Document Tracking Tracks the processing of related ECDP documents encompassing communications, reports, and other ECDP-related materials.

5. Document and Contract Management

5.2 Contract Tracking Tracks the movement of contracts particularly for civil works.

CDW = child development worker, DCM = day care mom, DCW = day care worker, ECD = early childhood development, ECDP = Early Childhood Development Project, LGU = local government unit, RHM = rural health midwife. Source: Philippine Government ECDP Project Completion Report, May 2006.

Appendix 1 35

Table A1.8: Early Childhood Development (ECD) Training Report

Topic Target Group Target Number

Number Trained

% Trained

a. Cold Chain Management Public health nurses 804 640 79.6 b. Expanded Program on

Immunization Basic Skills Health workers 4,780 4,468 93.5

c. Integrated Management of Childhood Illnesses Basic Course

Heath workers 4,712 4,032 85.6

d. Family and Community Integrated Management of

Childhood Illnesses

Health and related workers 36,937 6,850 18.5

e. Use of the International Reference Standards for Weight and Height

Nutritionists and child development workers 38,589 14,784 38.3

f. Early Childhood Experience Trainers, coordinators, and school heads Grade 1 teachers

–

15,380

4,228 18,873

–

122.7 g. Integrated Early Childhood Care and Development

Supervisors and trainers Service providers

At least 132

7,503

904 7,334

–

97.7

h. Supervised Neighborhood Play

Supervisors and trainers Service providers

At least 132

2,544

128 1,993

-

78.3

i. Parent Effectiveness Session

Supervisors and trainers Service providers

At least 132

11,303

869 9,355

–

82.7

j. Revised Day Care Manual Supervisors and trainers Service providers

At least 132

7,619

240 4,454

–

58.5

k. Early Childhood Care and Development Checklist

Supervisors and trainers Service providers

At least 132

12,602

240 6,177

–

82.3

l. Supplemental Feeding and Nutrition Education

Supervisors and trainers Service providers

At least 132

7,503

360 4,085

– 54.4

m. Resource Center Management Service providers At least 105 129 –

n. Communication Planning ECD field implementers At least 132 254 –

o. Use and Application of Database Systems

Regional staff Members of local ECD teams

–

–

48 433

–

–

-- = target not established ECD = early childhood development. Source: Philippine Government ECDP Project Completion Report, May 2006.

36 Appendix 1

Table A1.9: Early Childhood Development (ECD) Research Studies

Research Study Type Status Date Completed

Use or Potential Use

Subcomponent 1 – Pilot testing of Project Interventions Pilot Testing of Project Interventions (new PEM program; upgraded PES program, and the new, improved ECD service delivery package)

Appraisal List Completed 2001 Used for formulating policies and guidelines for full project implementation.

Subcomponent 2: Support to Program Innovation and Policy Development Support for Food and Nutrition Research Institute National Nutrition Survey

Appraisal List Completed 2002 Provided national and regional nutritional status information.

(1) Baseline Study on nutritional status, psychosocial development and care of 0–6 year-old children in ECD provinces

Appraisal List Completed 2001 Used to develop the ECCD Checklist that was eventually adopted. DSWD improved its strategy paper for the PES and mandated the regional offices to implement this. Could be used in evaluating project benefits and impacts, as well as for understanding relationships among dimensions covered.

(2) Cost-effectiveness of deworming and weekly iron supplementation in the reduction of anemia among preschoolers. A field test (Anemia Reduction Through Deworming: Field Test to Determine Effectiveness)

Appraisal List Completed 2003 DOH revised its guidelines on iron supplementation to recommend weekly iron supplementation. Could be used for formulating policies and programs on anemia prevention and control.

(3) The efficacy of pan de sal baked from wheat flour fortified with iron and vitamin A in improving the iron status of anemic elementary school children (of Fortification of Wheat Flour with Iron and Vitamin A)

Appraisal List Completed 2004 Provides evidence for wisdom behind mandatory fortification of wheat flour with iron and vitamin A. Useful in advocating for compliance with mandatory fortification and in deciding to continue the mandatory fortification provided for by law.

Appendix 1 37

Research Title By

Component Type Status Date

Completed Use or Potential Use

(4) School readiness of 5.5 to 6.5 year-old children in various socio-economic environments

Appraisal List Completed 2004 Used to develop the school readiness assessment tool, adopted for use in the public school system. Used as one of the bases for formulating the National Preschool Program. Tool can help teachers in appropriate interventions to improve learning ability of grade school entrants. Can be used in formulating appropriate policies and programs for preschool and Grade 1 education.

(5) Methods of early detection and intervention of children with special needs

Appraisal List Completed 2006 Policy formulation and program and/or project development for ECD packages.

(6) Impact study of ECD-related information, education, and communication materials

Appraisal List Not done. Was rescheduled to Q4 2003 but did not materialize because of budget constraints.

(7) Effectiveness of RHM, CDW, DCM, and DCW in the implementation of ECD activities

Appraisal List Not done as a separate study but incorporated under subcomponent 3 into the evaluation and longitudinal study.

(8) Impact of Project on Development Status of Zero to Five Year Old Children

Appraisal List Not done as a separate study but incorporated under subcomponent 3 into the evaluation and longitudinal study.

38 Appendix 1

Research Title By Component

Type Status Date Completed

Use or Potential Use

(9) Feasibility study of forming salt producers into iodized salt producing and marketing cooperatives

Appraisal List Not done. DOH considered this study no longer needed

(10) Iron supplementation for adolescent girls: pilot testing and impact assessment

Appraisal List Not done. DOH indicated this study was no longer a priority since a similar study had already been conducted 2 years before.

(11) Household Demand Studies to assess potential for partial recovery costs of food supplements and CDW salaries

Appraisal List Not done.

(12) Pilot Testing of project-financed weaning food production, distribution and marketing of prequalification bidding using national, regional and provincial models

Appraisal List Not done, since there was no project-financed weaning food.

(13) Strengthening first referral hospitals for management of childhood illnesses

Appraisal List Not done. DOH indicated the study was no longer needed.

(14) Improving Family Behaviors to support Child Health

Appraisal List Not done. DOH indicated the study was no longer needed

(15) Gender Research to Ensure Equal Access to ECD Services

Appraisal List Not done.

Appendix 1 39

Research Title By

Component Type Status Date

Completed Use or Potential Use

(16) Testing alternative growth monitoring and promotion regiments under the Government’s child weighing program and the Project

Appraisal List Not done. Despite advertising twice, no bids were received. There was a plan to convert this into two substudies: (i) Economic Consequences of Selecting Various IMCI Interventions, Alone or in Combination (this was considered by the National Screening Committee but was not pursued due to budget constraints); (ii) Effective interventions for overcoming constraints to care-seeking and promotion of timely and appropriate family action for health (but was also not undertaken)

(17) Correlation analysis of children’s nutritional status, dietary intake and psychosocial development, and pregnant and lactating mother’s dietary intake in ECD and non-ECD Program areas

Post- Midterm Review List

Completed Policy formulation and program and/or project development for ECD packages or for single-sector interventions.

40 Appendix 1

Research Title By

Component Type Status Date

Completed Use or Potential Use

(18) Perception and practice on parenting roles of Filipino fathers and mothers

Post- Midterm Review List

Completed 2006 Policy formulation and program and/or project development for ECD packages.

(19) The effects of iron-fortified pan de sal on the iron and anthropometric status of anemic school children

Post- Midterm Review List

Completed undated Provides evidence for wisdom behind mandatory fortification of wheat flour with iron and vitamin A. Useful in advocating for compliance with mandatory fortification and in deciding to maintain the mandatory fortification provided for by law.

(20) The effects of iron-fortified pan de sal and weekly iron tablet supplementation on hemoglobin concentration and anthropometric status of anemic school children

Post- Midterm Review List

Completed undated Useful for formulating polices and programs to prevent and control PEM and iron deficiency anemia.

(21) Iron status of anemic school children in Compostela, Cebu before and after 7 months of weekly iron supplementation

Post- Midterm Review List

Completed undated Useful for formulating polices and programs to prevent and control PEM and iron deficiency anemia.

(22) The effects of iodized salt on the quality of selected processed food

Post- Midterm Review List

Completed undated Policy formulation, particularly on the scope of mandatory fortification.

(23) Household food consumption survey

Post- Midterm Review List

Completed undated Results now used as national data. Basis for policy formulation and program and/or project development in agriculture and nutrition.

(24) Evaluation of the continuum and best practices of project educational activities: case studies of selected sites

Post- Midterm Review List

Completed 2006 Policy formulation and program and/or project development of ECD packages

(25) Cost-effectiveness study of ECD interventions and CDW, RHM,DCW and DCM and the early childhood enrichment packages

Post- Midterm Review List

Completed undated Policy formulation and program and/or project development of ECD packages.

(26) Pre-testing of the Mother and Child Book

Post- Midterm Review List

Completed undated Used as basis for refining and finalizing the Mother and Child Book.

Appendix 1 41

Summary 16 Appraisal List = 5 completed, 2 incorporated into other studies, 9 not

pursued 10 Post-Midterm Review List = 10 completed Total Completed = 15 studies

Component 3: Benefit Monitoring and Evaluation (1) Baseline Indicators Survey Appraisal List Completed 2001 Used to validate project

objectives and targets. (2) Baseline survey of indigenous people’s access to and utilization of ECD services in regions VI, VII and XII

Appraisal List Completed 2001

(3) Longitudinal surveys, Phases 1–3

Appraisal List Completed 2005

Will establish the benefits obtained from the Project, which can be useful for advocating continued investments in the interventions and in the effort of integrated delivery of services.

(4) End-of-project survey

Appraisal List Completed 2006 Policy formulation and program and/or project design for ECD packages.

CDW = child development worker, DCM = day care mom, DCW = day care worker, DOH = department of health, DSWD = Department of Social Welfare and Development, ECCD = early childhood care and development, ECD = early childhood development, ECDP = Early Child Development Project, IMCI = integrated management of childhood illnesses, PEM = protein-energy malnutrition, PES = parent effectiveness service, RHM = rural health midwife. Sources: Council for the Welfare of Children; Philippine Government ECDP Project Completion Report, May 2006.

42 Appendix 2

COMPARISON OF PLANNED INVESTMENTS AND ACTUAL EQUITY CONTRIBUTED BY SELECTED LGUS

Total Investment for 3-Year Period Selected Project

Area/Site Loan Proceeds National Government

(Grant)

Local Government

(Equity)

Total

Barili, Cebu Investment 6,020,091.34 5,650,445.38 3,484,329.85 15,154,866.57

Actual Disbursement 6,020,091.34 5,650,445.38 4,436,357.85 16,106,894.57 Percent 100.0 100.0 127.3 106.3

Pilar, Bohol

Investment 4,651,383.50 2,560,959.50 1,366,912.00 8,579,255.00 Actual Disbursement 4,651,383.50 2,560,959.50 1,821,025.54 9,033,368.54

Percent 100.0 100.0 133.2 105.3 Tubigon, Bohol

Investment 6,838,946.28 2,957,564.72 1,751,568.00 11,548,079.00 Actual Disbursement 6,838,946.28 2,957,564.72 1,827,532.12 11,624,043.12

Percent 100.0 100.0 104.3 100.7 Iligan City

Investment 4,964,282.37 4,341,004.43 12,807,940.70 22,113,227.50 Actual Disbursement 4,964,282.37 4,341,004.43 12,807,940.70 22,113,227.50

Percent 100.0 100.0 100.0 100.0 Kapatagan, Bohol

Investment 4,580,234.76 9,743,093.49 4,459,808.75 18,783,137.00 Actual Disbursement 4,580,234.76 9,743,093.49 4,664,608.75 18,987,937.00

Percent 100.0 100.0 104.6 101.1 Source: LGU data.

Appendix 3 43

PROJECT IMPLEMENTATION SCHEDULE

1997 1998 Year 1

1999 Year 2

2000 Year 3

2001 Year 4

2002 Year 5

2003 Year 6

2004 Year 7

2005 Year 8

2006 Year 7

Project Milestone

3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Loan Effectiveness Project Start-Up/ Organization

- establish core and full PMO - hire consultants for project

management EPI

- instal cold chain

- training on EPI

IMCI - orientation/seminars on IMCI - establish training centers - training

Food Fortification - hiring of consultants - national food fortification

planning - communication plan

development and implementation

PES - manual and materials

development - training

44 Appendix 3

Sources: Implementation schedule, report and recommendation of the President to the Board of Directors, aide memoire, back-to-office reports, ECDP accomplishment reports, Interview of ECDP NPMO staff.

1997 1998 Year 1

1999 Year 2

2000 Year 3

2001 Year 4

2002 Year 5

2003 Year 6

2004 Year 7

2005 Year 8

2006 Year 7

Project Milestone

3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 ECE

- develop training manuals and materials

- training - procure of manipulative

toys and other materials Pilot Implementation Batch 1 LGUs Batch 2 LGUs

Batch 3 LGUs

Procurement - Year 1 - Year 2

Baseline Survey Research Studies Indicators Survey Midterm Evaluation Longitudinal Study

(Phase 1 to 3) End-Project Evaluation

Planned Actual

Appendix 4 45

PMO STAFF MAINSTREAMED/ABSORBED BY DSWD AND CWC Office/Name Current Position Office/Program Status of

Employment DSWD - National Technical 1. Victoria Navida Social Welfare Officer IV DSWD - Program Management

Bureau (PMB) plantilla

2. Virginia Nosenas Project Devt. Officer IV DSWD - PMB MOA 3. Imee Rose Castillo Social Welfare Officer III DSWD - PMB plantilla 4. Miramel Laxa Social Welfare Officer III DSWD - PMB MOA 5. Mishael Argonza Project Manager DSWD - World Food Program project-based 6. Bernadette Aligaen Information Officer II DSWD- Social Mobilization Service plantilla 7. Estrellieta Marayag Project Officer CWC- Research Division MOA 8. Sharon Lumpias ECCD National Coordinator CWC-ECCD MOA 9. Adelino Racusa Management Information

Systems Officer CWC-Management Information Systems

MOA

Administrative/Finance 1. Yolanda Gunabe Administrative Assistant DSWD -PMB contractual 2. Evangeline Garcia Administrative Supply Officer DSWD - PMB MOA 3. Oliva Arcaina Administrative Officer V DSWD - PMB regular plantilla 4. Amme Sevilla Administrative Officer II DSWD - DSWD,Finance and

Management Service (FMS) MOA

5. Desiree Decano Administrative Aide VI DSWD - CASH Division contractual 6. Jane LArdizabal Administrative Assistant III DSWD - Accounting Division contractual 7. Ma. Consuelo Solis Internal Auditor I DSWD -Internal Audit Service (IAS) MOA 8. Cristina Gaming Internal Auditor II DSWD - IAS MOA 9. Arceli Divina Internal Auditor II DSWD - IAS MOA 10. Enoriel Diaz Driver DSWD – ASEC Montano co-terminous 11. Rodolfo Maano Driver DSWD – USEC Yango co-terminous 12. Jocelyn Manuel Finance Officer CWC-Finance Service MOA Region VII 1. Josephine

Belotindos Social Welfare Officer IV DSWD-TAD Plantilla

2. Gemma Tabanao Nurse DSWD-RSCC MOA 3. Frederick Fulache Driver DSWD-CIU MOA 4. Roland Mesterio Clerk KALAHI-CIDSS MOA 5. Joel Rivera Planning Officer DSWD-TAD Plantilla 6. Carmela Rota Budget Assistant KALAHI-CIDSS MOA 7. Jose Dagaas Bookkeeper KALAHI-CIDSS MOA DSWD – Region XII 1. Abdulwahid Linso Project development Officer KALAHI casual 2. Noraida Busran Administrative Officer II Training Officer casual 3. Stephanie Solano Executive Assistant City Government casual 4. Bebeth Mampen Social Welfare Assistant DSWD – Region XII MOA 5. John Tugunon Social Welfare Assistant DSWD – Region XII MOA 6. Bai Aleha Beruar Bookkeeper KALAHI MOA 7. Zahaira Pantao Bookkeeper KALAHI MOA 8. Jonaida Maungco Social Welfare Assistant DSWD – Region XII MOA 9. Edgar Guerra BookKeeper DSWD-Region XII plantilla Source: Department of Social Welfare and Development.

46 Appendix 5

STATUS OF COMPLIANCE WITH LOAN COVENANTS Covenants of Loan Numbers 1606 and 1607 Reference in

Loan Agreement Status of

Compliance 1. The Borrower shall cause the project to be carried out with

due diligence and efficiency and in conformity with sound administrative, financial, engineering, environmental and child development practices.

Section 4.01(a) Complied with

2. In carrying out the project and operation of the Project facilities, the Borrower shall perform, or cause to be performed, all obligations set forth in schedule 6 to these Loan Agreements.

Section 4.01(b) Complied with

3. The Borrower shall make available, promptly as needed the funds, facilities, services and other resources which are required, in addition to the proceeds of the Loans and the IBRD loan for the carrying out of the Project and for the operation and maintenance of the Project facilities.

Section 4.02 Complied with

4. In carrying out of Project, the Borrower shall cause competent and qualified consultants, acceptable to the Borrower and ADB, to be employed to an extent and upon terms and conditions satisfactory to the Borrower and Bank.

Section 4.03 (a) Complied with

5. The Borrower shall cause the Project to be carried out in accordance with plans, design standards, specifications, work schedules, and construction methods acceptable to the Borrower and to the Bank. The Borrower shall furnish, or cause to be furnished, to the Bank, promptly after their preparation, such as plans, design standards, specifications and work schedules, and any material modifications subsequently made therein, in such detail as the Bank shall reasonable request.

Section 4.03 (b) Complied with

6. The Borrower shall ensure that the activities of its departments and agencies with respect to the carrying out of Project and operation of the Project facilities are conducted and coordinated in accordance with sound administrative policies and procedures.

Section 4.04

Complied with

7. The Borrower shall make arrangements satisfactory to ADB for insurance of the Project facilities to such extent and against such risks and in such amounts as shall be consistent with sound practice.

Section 4.05 (a) Complied with

8. The Borrower undertakes to insure, or cause to be insured, the goods to be imported for the project and to be financed out of the proceeds of the Loan against hazards incident to the acquisition, transportation and delivery thereof to the place of use or installation and for such insurance any indemnity shall be payable in a currency freely usable to replace or repair such goods.

Section 4.05 (b) Complied with

9. The Borrower shall maintain, or cause to be maintained records and accounts adequate to identify the goods and services and other items of expenditure financed out of the proceeds of the Loan, to disclose the use thereof in the Project, to record the progress of the project (including the cost thereof) and to reflect, in accordance with consistently maintained sound accounting principles, the

Section 4.06 (a) Complied with

Appendix 5 47

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

operations and financial condition of the agencies of the Borrower responsible for the carrying out of the project and operation of the Project facilities, or any part thereof.

10.The Borrower shall (i) maintain or cause to be maintained, separate accounts for the Project; (ii) have such accounts and related financial statements audited annually, in accordance with appropriate auditing standards consistently applied, by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB; (iii) furnish to ADB, as soon as available but in any event not later than nine (9) months after the end of each related fiscal year, certified copies of such audited accounts and financial statements and the report of the auditors relating thereto (including the auditor’s opinion on the use of the Loan proceeds and compliance with the covenants of this Loan Agreement), all in the English language; and (iv) furnish to ADB such other information concerning such accounts and financial statements and the audit thereof as ADB shall from time to time reasonably request.

Section 4.06 (b) Complied with

11. The Borrower shall enable ADB, upon ADB’s request, to discuss the Borrower’s financial statements fir the Project and its financial affairs, related to the Project from time to time with the Borrower’s auditors, and shall make necessary arrangements for any representative of such auditors to participate in any such discussions requested by ADB, provided that any such discussion shall be conducted only in the presence of an authorized officer of the Borrower unless the Borrower shall otherwise agree.

Section 4.06 (c) Complied with

12. The Borrower shall furnish, or cause to be furnished, to ADB all such reports and information as ADB shall reasonably request concerning (i) the Loan, and the expenditure of the proceeds and maintenance of the service thereof; (ii) the goods and services and other items of expenditure financed out of the proceeds of the Loan; (iii) the Project; (iv) the administration, operations and financial condition of the agencies of the Borrower responsible for the carrying out of the Project and operation of Project facilities, or any part thereof; (v) financial and the economic conditions in the territory of the Borrower, and the international balance-of-payments position of the Borrower, and (vi) any other matters relating to the purposes of the Loan.

Section 4.07 (a) Complied with

13. Without limiting the generality of the foregoing, the Borrower shall furnish, or cause to be furnished, to ADB semiannual reports on the carrying out of the Project and on the operation and management of the Project facilities. Such reports shall be submitted in such form and in such detail and within such a period as ADB shall reasonably request, and shall indicate, among other things, progress made and problems encountered during the period under review, steps taken or proposed to be taken to remedy these problems and a proposed program of activities and

Section 4.07 (b) Complied with

48 Appendix 5

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

expected progress during the following six (6) months. 14. Promptly after physical completion of the project, but in

any event not later than three (3) months thereafter or such later date as may be agreed for this purpose between the Borrower and ADB, the Borrower shall prepare and furnish to ADB a report, in such form and in such detail as ADB shall reasonably request on the execution and initial operation of the Project including its cost, the performance by the Borrower of its obligations under this Loan Agreement and the accomplishment of the purposes of the Loan.

Section 4.07 (c) Complied with

15. The Borrower shall enable ADB’s representatives to inspect the project, the goods financed out of the proceeds of the Loan, and any relevant records and documents.

Section 4.08 Complied with

16. The Borrower shall ensure that the Project facilities are operated, maintained and repaired in accordance with sound administrative, financial, engineering, environmental, and maintenance and operational practices.

Section 4.09 Complied with

17. It is the mutual intention of the Borrower and ADB that no other external debt owed a creditor other than ADB shall have any priority over the Loan by a way of a lien on the assets of the Borrower. To that end, the Borrower undertakes (i) that except as ADB may otherwise agree, if any lien shall be created on any assets of the Borrower as security for any external debt, such lien will ipso facto equally and ratably secure the payment of the principal of, and interest and other charges on, the Loan, and interest and other charges on, the Loan: and (ii) that the Borrower, in creating or permitting the creation of any such lien, will make express provision to that effect.

Section 4.10 (a) Complied with

Execution of Project, Financial and Other Matters Schedule 6 I. Project Management and Coordination A. Project Executing Agency 1. In its capacity as Project Executing Agency, the DSWD

shall have the overall responsibility for execution of the Project. Assisting the DSWD in the implementation of the project shall be the various agencies of the Borrower involved in child health, nutrition, psychosocial development and early education.

Schedule 6 I.A.1

Complied with

2. Promptly after the Effective date, and in any event by no later than 31 March 1999, DSWD shall be responsible for (i) setting up the project management information system at the national, regional, and provincial PMOS, and in the first group of cities and municipalities, including the CWC information resource center; (ii) procuring all necessary facilities and equipment for the central, regional and provincial PMOs, and in the first group of participating LGUs; the management units in the first group of participating LGUs; (iii) technical assistance to complete the core training courses, training packs, curriculum

Schedule 6. I.A.2 Complied with but with delays in setting up the Project Management Information Systems, completion of the core training materials, terms of reference for the

Appendix 5 49

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

materials and training aids; (iv) setting up the LGU Financing Facility; (v) finalizing the terms of reference for the research and development agenda and the guidelines for awarding of contracts to qualified and accredited institutions; and (vi) developing and producing prototype communications support materials and their reproduction and translation into the dialects of the intended audiences.

research and development agenda

3. An inter-agency Project Steering Committee, chaired by the Secretary of DSWD, shall meet quarterly to review the progress of the project and to provide the policy directions and guidance to the national PMO referred to in paragraph 5 below.

Schedule 6 I.B.1 Complied with but the committee did not meet as often as stipulated;

4. DSWD shall assume overall responsibility for setting up PMOs at three levels: national, regional and provincial. The Borrower, through the DSWD and the concerned regional and provincial governments, shall ensure that all PMOs are adequately staffed and maintained throughout the Project implementation period.

Schedule 6.I.C.4 Complied with

5. Promptly after the Effective Date, a national PMO shall be set up within the office of the Secretary of DSWD to administer the day to day operations of the Project. An Undersecretary of DSWD, to be designated the Project Director, shall head the national PMO. The Project Director shall be assisted by a Project Coordinator (also a regular DSWD official) who shall direct and manage Project implementation on a full time basis. The Project Coordinator shall be assisted by a fulltime contractual Project Manager who shall be responsible for the day-to-day operations of the national PMO.

Schedule 6.C a.5 Complied with but the national PMO was established under the Office the Undersecretary;

6. The national PMO shall have four operating units covering: (i) management services (including procurement and disbursement); (ii) technical services; (iii) financial management; and (iv) research and development.

Schedule 6.I.C.(a).6 Complied with. At mid-term, PMO units were mainstreamed into the respective offices in the DSWD and CWC.

7. At the regional level, the Borrower through DSWD shall cause regional PMOs to be established in Region VI, Region VII and Region XII, respectively, within one month of the Effective Date. The regional PMOs shall each have the following three units: a regional management support unit, a regional technical support unit, and a regional fund management unit. Each regional PMO shall be guided by a regional ECD team created by DWSD within each region. Each ECD team shall be headed by the DSWD Regional Director, and the DSWD Assistant regional Director shall serve as regional project coordinator.

Schedule 6.I.C.(b).7 Complied with

8. At the provincial level, the Borrower shall cause the 13 provincial governments having jurisdiction within the Project area to establish provincial PMOs. Each provincial PMO shall be staffed by a provincial ECD action officer and one assistant. Each provincial PMO shall work with the relevant provincial ECD team. Together, they shall be

Schedule 6.I.C.(c).8 Partially complied with. Provincial ECD teams exist but PMOs were not established since the national

50 Appendix 5

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

responsible for assisting mayors in planning and preparing LGU subproject proposals, using the Project, planning software developed for that purpose, and monitoring, supervising and evaluating LGU projects.

and regional PMO coordinated directly with the LGUs in order to fast track the implementation.

9. Each provincial PMO shall prepare an annual operational plan covering all activities under Part A.1 of the project by 1 July of each year during the Project implementation period, to be reviewed by the regional PMO and approved by the national PMO.

Schedule 6.I.C.c.9 Complied with

10. The Borrower shall cause the mayor of every municipality or city undertaking an LGU subproject to appoint a municipal/ city ECD action officer on either a full-time or part-time basis. The municipal/city ECD action officer shall work with a municipal/city ECD team, formed by the mayor from among the mayor’s staff, who shall, as part of their regular duties, assist in implementing and monitoring the relevant LGU subproject.

Schedule 6.I.D.10 Complied with

11. Promptly after the Effective Date, the national PMO shall enter into a MOA with each of the 13 provincial governments of the Project area in respect of Project activities under Part A.1 of the project. Cost-sharing between the national government and the provincial governments for activities under Part A.1 of the Project shall be on a grant equity basis, whereby grants from the national government shall be supported by provincial equity in kind in the form of designated personnel, vehicles, and other means of supporting project management and supervision. MOA signatories shall be the governor of the province and the DSWD Regional Director for the national PMO.

Schedule 6.II.11 Complied with. The MOAs were entered into between the national PMO and the 13 project provinces

12. All LGU subprojects under Part A.2 of the Project shall be selected, prepared and approved in accordance with criteria and procedures to be agreed upon among the Borrower, the Bank and IBRD.

Schedule 6.III.12 Complied with

13. The national PMO shall enter into a MOA with each of the participating city and municipal LGUs concerned in respect of project activities under Part A.2 of the project. The MOAs with the LGUs shall specify responsibilities of the parties as detailed in the approved LGU subproject proposals and the LGU Financing Facility Operations Manual. MOA signatories shall be the mayor of the municipality or city and the DSWD Regional Director for the national PMO.

Schedule 6y.III.13 Complied with

14. Social and technical preparations and planning for the 5 pilot LGU subprojects shall be done within one month after the Effective Date. Preliminary planning assistance and communications support for the first group of municipalities and cities to be targeted for a pilot-testing in the priority provinces shall be completed by 31 December 1998. DSWD shall ensure that the national PMO has approved (i) 45 LGU subprojects (including 5 pilot LGU

Schedule 6.III.14 Partial compliance: The number of pilot LGUs was increased from 5 to 10. Post-pilot, the target number of LGU subprojects was adjusted downward to

Appendix 5 51

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

subprojects) by the end of the first year of Project implementation; (ii) an additional 60 LGU subprojects by the end of the second year of project implementation; and (iii) a final group of 64 LGU subprojects by the end of the third year of Project implementation. All LGUs that participate in the project shall implement their respective ECD plans and receive ECD financing for three years.

132 to allow a higher level of financing per LGU.

15. Within 3 months of the Effective date, the Borrower shall adopt a project monitoring and evaluation (M&E) plan acceptable to the Bank and IBRD. The and E plan shall include the key indicators to be used to measure the overall achievement and impact of the Project, a matrix of principal indicators to be used for monitoring implementation and impact and a description of the surveys that shall be used for M&E purposes. The 10 key indicators shall cover inter alia, (i) child mortality, (ii) child malnutrition, (iii) child anemia, (iv) child immunization, (v) combined index of child development, (vi) day care center assistance; (vii) Grade 1 completion, (viii) proportions of municipalities implementing LGU subprojects, (ix) functioning protein-energy malnutrition (PEM) programs, and (x) active CDWs.

Schedule 6. IV.A.15 Complied with

16. The Borrower shall ensure that M&E under the project concentrates on tracking Project management requirements such as: (i) financial tracking of disbursement and expenditures; (ii) contract monitoring to track delivery of outputs by contractors; (iii) commodities procurement tracking; (iv) monitoring LGU subprojects with a sub-loan component; (v) monitoring of implementation progress (tracking consumption of inputs supplemented by sentinel site reporting system) and (vi) impact evaluation (through cluster surveys and sample surveys).

Schedule 6.IV.A.16 Complied with

17. A baseline survey for the project shall be carried out not later than 31 December 1998 and its findings shall be used to confirm or modify, in consultation with the Bank, and IBRD, the base values and target values for the Project’s key indicators not later than 30 June 1999. A repeat survey shall be carried out not later than 30 June 2003 for the purpose of evaluating the achievements and impact of the Project.

Schedule 6.IV.B.17 Complied with late (Baseline completed in 2001)

18. The experience of the 5 pilot LGU subprojects, including the Project interventions in child health, nutrition and early education investments supported under the model ECD investment package and financed through the LGU Financing Facility, shall be reviewed with the Bank and IBRD, and the comments of the Bank and IBRD shall be taken into consideration in decisions to modify or replicate such interventions.

Schedule 6.IV.C.18 Complied with

19. A midterm review of the project shall be carried out jointly by the Borrower, the Bank and IBRD not later than 31 December 2000 or such date as the parties may agree.

Schedule 6. IV.D.19 Complied with

20. A consultative strategy for meeting the special needs of Schedule 6.V.A.20 Complied with

52 Appendix 5

Covenants of Loan Numbers 1606 and 1607 Reference in Loan Agreement

Status of Compliance

indigenous peoples in the Project area shall be developed under the Project. Baseline studies of indigenous peoples shall be conducted in all project provinces under Part C.3 of the Project during the first year of project implementation and each province shall adopt an Indigenous people’s strategy based on the survey findings. The provincial strategies shall be adopted, implemented, and monitored in accordance with arrangements agreed among the Borrower, the Bank and IBRD.

late: the indigenous peoples study was completed in 2001.

21. From its non-Project resources, DOH shall annually provide and distribute supplies of vitamin A, iodized oil capsules and iron tablets and syrups in the quantities to be agreed with ADB and IBRD each year during the Project implementation period.

Schedule 6.V.B.21 Complied with.

22. DOH shall prepare an operational plan for satisfying national needs for vitamin A, iodine and iron in a sustainable manner for the years 2004-2008 and shall submit such plan to the Bank and IBRD for review and approval not later than 30 June 2003.

Schedule 6.V.B.22 Complied with.

23. All foodstuffs procured by DSWD, DOH and DECS shall be fortified with vitamin A, iron and/or iodine. Such foodstuffs shall be procured through a competitive bidding process.

Schedule 6.V.B.23 Complied with

24. Weaning foods to be procured under the Project for use as food supplements in the PEM control intervention under Part A.2 of the Project shall be submitted for quality assurance testing to the Bureau of Food and Drugs of DOH and only those certified to be of acceptable quality in accordance with the applicable government standards shall be procured.

Schedule 6.V.B.24 Complied with

25. National R&D screening committee shall be established within one month after the Effective date to annually review the research proposals. Within three months after the Effective Date, detailed guidelines and procedures for the screening and selection of research proposals on topics to be financed under Part C.2 of the Project shall be prepared and submitted to the Bank for approval.

Schedule 6.V.C.25 Complied with.

26. The government shall ensure that the required inputs for the baseline nutrition survey are included in the study design of the scheduled 1998 National Nutrition Survey and that the national PMO has timely access to the baseline data collected there under for the 3 project regions

Schedule 6.V.D.26 Complied with

27. In Addition to the semiannual reports required pursuant to Section 4.06 of this Loan Agreement and Section 4.06 of the Ordinary Operations Loan Agreement, each provincial PMO shall be responsible for preparing progress reports on project implementation and submitting them once a year to the regional PMOs for consolidation and submission to the national PMO. The national PMO shall consolidate such regional PMO reports and submit them to the Bank.

Schedule 6.V.E.27 Complied with

Appendix 6

53

SUSTAINABILITY INDICATORS FOR SELECTED LOCAL GOVERNMENT UNITS (LGUs)

Absorption of Early Childhood Development

(ECD) Personnel

Selected Project

Site Cate-gory

Number hired under ECDP

Number Ab-

sorbed by LGU

Post-Project Budget Allocation for Child Development

Examples of Resolutions Passed or Issued in Support of ECD

Plan for Child Development

Sentrong Sigla

Certification or PhilHealth Accreditation

RHM

2 2

DCW

1 1

CDW

46 17

Barili, Cebu

2005: P25,000—ECDP Equity P30,000—Child Development P100,000—Supplemental Feeding and

Nutrition Education 2006: P25,000—ECDP Equity P50,000—Child Development P100,000—Supplemental Feeding and

Nutrition Education 2007: P150,000—ECDP Equity P90,000—Development Program P392,800—Local Development Program

for Children P100,000 - Supplemental Feeding and

Nutrition Education Note: These amounts are on top of LGUs’ regular budget for day care center maintenance and nutrition programs.

(1) Resolution enacting an ordinance creating the subcommittee on children’s welfare in the entire municipality

(2) Resolution expressing full support for implementation of the Act for Salt Iodization Nationwide (ASIN) and giving certificates of recognition to all stores for selling iodized salt, as well as to all restaurants, caterers and food vendors for using iodized salt in their food

(3) Resolution to promote the completion of elementary education

(4) Ordinance banning computer games within the municipality

(5) Resolution adopting the Children’s Code

Presence of LGU Sustainable Investment Plan for Children

Rural health unit I Sentrong Sigla certified

RHM

3 3

CDW 8 8

DCW - -

Pilar, Bohol

Note: honoraria/salary/ and traveling allowance shared between LGU and barangay.

2005: P40,000—Maintenance of Day Care Center

2006: P486,360—ECD Counterpart P60,000—Nutrition Program P29,014—ECD fund for 21 barangays Note: These amounts are on top of LGUs’ regular budget for day care center maintenance and nutrition programs.

(1) Ordinance supporting supplemental feeding program in partnership with Feed The Children Philippines

(2) Resolution organizing the Municipal Council for the Protection of Children

(3) Resolution adopting the Local Development Plan for the Protection of Children

Presence of Local Development Plan for the Protection of Children Presence of Sustainable Investment Plan for Children

54 Appendix 6

Selected Project

Site

Absorption of Early Childhood Development

Project (ECDP) Staff

Post-Project Budget Allocation for Child Development

Examples of Resolutions Passed or Issued in Support of ECDP and/or

Child Development

Plan for Child Development

Sentrong Sigla

Certification or PhilHealth Accreditation

Type of Staff

No. hired under ECDP

No. hired

by LGU

RHM 1 1 CDW 13 13

ECD Custo-dian

1 1

Tubigon, Bohol

Total counterpart for ECD project for the period 2003–2005 was P1,751,588. 2007 allocation includes: P102,000 for DCW honoraria, and P156,000 for RHM salary (ECD-hired).

Resolution for forging a partnership with the nongovernment organization Feed The Children in order to implement programs for children

Functional local council for the protection of children

RHM 16 16

CDW

24 24

Iligan City

DCW

30 30

2005: P67,889.08—Nutrition Program P76,745—Supplemental Feeding P1,566,544—Purchase of books and

materials for day care children 2006: P75,000—Supplemental Feeding P200,000—Milk Feeding P100,000—Nutrition Program 2007: P1.0 mn—ECCD Counterpart P1.0 mn—ECDP Counterpart P0.2 mn—Construction of two day care

centers P 75,000—Supplemental Feeding P100,000—Counterpart for the ASIN Program

Executive Order No. 04 created the Day Care Worker’s Assessment and Evaluation Committee. Resolution adopting the city’s programs and projects funded out of the 2007 Development Fund, part of which was for social services that include support for children in the amount of P2.2 mn

(1) Functional Council for Protection of Children

(2) ECDP Team meets monthly

(3) ECCD Invest-ment Plan

Appendix 6

55

Selected Project Sites

Absorption of Early Childhood Development

Project (ECDP) Staff

Post-Project Budget Allocation for Child Development

Examples of Resolutions Passed or Issued in Support of ECDP and/or

Child Development

Plan for Child Development

Sentrong Sigla

Certification or PhilHealth Accreditation

Type of Staff

No. hired under ECDP

No. hired

by LGU

(1) (1)

RHM 10 10

DCW

Kapata-gan, Bohol

CDW 3 3 hired by

the baran-

gays but 13th

month bonus

from the LGU

2005: P10,000—Supplemental Feeding P5,000—Rehabilitation for Minors P103,000—Children’s Welfare Program P73,304—ECD Equity 2006: P10,000—Supplemental Feeding P 5,000—Rehabilitation for Minors P113,000—Children’s Welfare Program P12,000—Youth Welfare Program

(2) Executive Order No. 02, 2003 Reconstituting the Local Council for the Protection of Children

(3) Executive Order No. 15, 2004 Reorganizing and Strengthening the Local School Board

(4) Resolution No. 2006-24 (March 2006) adopting and approval of the Municipal Development Plan for calendar year 2006 appropriating P240,000

(5) Resolution No. 2002-165 – Resolution amending Ordinance No. 2, 1997 prohibiting minors to drive tri-sikad or sikad-sikad

(2) Functional Council for Protection of Children

(3) Barangays have a functional BCPC.

(4) Presence of local develop-ment and invest-ment plan for children (2006–30)

(5) 2nd place in regional awards for child-friendly municipal-ity

1. Sentrong Sigla certified 2. PhilHealth accredited 2.1 Outpatient benefit package 2.2 TB-DOTS Package 2.3 Currently working for maternity benefit package.

ASIN = Act for Salt Iodization Nationwide, BCPC = Barangay Council for the Protection of Children, CDW = child development worker, DCW = day care worker, ECCD = early childhood care and development, ECD = early childhood development, ECDP = Early Childhood Development Project, LGU = local government unit, RHM = rural health midwife, TB-DOTS = Tuberculosis Directly Observed Treatment Short-Course

56 Appendix 7

Overall Assessment Summary Table

Criterion Weight (%)** Assessment Rating Value** Weighted Rating

Relevance 20 highly relevant 3 .6

Effectiveness 30 effective 2 .6

Efficiency 30 less efficient 1 .3

Sustainability 20 likely 2 .4

Overall Rating successful 1.9 Highly successful: overall weighted average is greater than 2.7. Successful: overall weighted average is between 1.6 and less than 2.7. Partly Successful: overall weighted average is between 0.8 and less than 1.6. Unsuccessful: overall weighted average is less than 0.8. **Source: ADB Operations Evaluation Department. 2006. Guidelines for Preparing Performance Evaluation Reports for Public Sector Operations. Manila.