A Community-Led Central Kitchen Model for School Feeding Programs in the Philippines: Learnings for Multisectoral Action for Health

"The model's success was attributed to strong community support for the central kitchen, mobilized into a steady pool of volunteers, embedding the program in the city's and municipalities' social networks."

In 2022, more than 55% of people facing hunger lived in Asia, and 24.7% of children in Southeast Asia were considered stunted, higher than the global average. To address the problem of malnutrition, in 2018, the Philippines institutionalised a national feeding programme (NFP) for undernourished children aged 3-5 years in public day care programmes and a school-based feeding programme (SFP) for children in kindergarten through grade 6 in public schools. Research suggests that community-participatory interventions improve primary health care and nutrition outcomes. Local support for such programmes is critical in the Philippines, where the government is decentralised, and the national agenda for health and nutrition is operationalised by local government units (LGUs). This study presents 2 LGUs, 1 urban and 1 rural, where the adoption of a locally developed central kitchen model for SFPs has withstood shocks and changes in political leadership and improved children's health and communities' civic engagement outcomes.

In 2011, the Ateneo Center for Educational Development (ACED), an education non-governmental organisation (NGO), developed a template for Blueplate for Better Learning, a large-scale feeding programme for public elementary school students. ACED's central kitchen model focused on community empowerment through community ownership, with local volunteers integral to central kitchen and feeding activities. In 2014, Gawad Kalinga, a community development foundation, partnered with ACED to expand the use of the model across the country. This case study focuses on programme operations in elementary schools.

As reported here, multisectoral coordination among schools, parents, the community, LGUs, national government agencies (NGAs), and NGOs is crucial to meet the programme objectives, which are to:

• strengthen the programme to scale up nationally;
• provide access to quality foods, change dietary habits, and improve health and education outcomes: to reduce rates of malnutrition, stunting, and wasting among participating children; and to lay a foundation for lifelong healthy eating based on favourable experiences, the acquisition of sufficient skills, and confidence in one's capacity to practice a healthy lifestyle;
• build maximum community support for the feeding programme, and empower the school community and other stakeholders to take the lead role; and
• encourage a whole-of-society approach through multisectoral investment to improve the health and well-being of students and their families.

To understand programme operations and multisectoral coordination in its implementation, participants from different sectors were recruited for guided focus group discussions (FGDs) in Metro Manila and in Mindanao. Among the various findings: A local government official and an educator in the FDGs reported that programme participation increased school attendance and participation because students no longer needed to find food before classes or leave campus during lunch hours, especially for rural beneficiaries whose homes were far from school. Three interconnected mechanisms facilitated the programme's implementation in the 2 sites:

• Community involvement and programme ownership: Implementation of the SFP necessitated the creation of volunteer networks and grassroots support that increased demand for more community-based health interventions - for example, LGUs made structural investments in social services through programmes sustained by community volunteerism. Community involvement also protected programme sustainability from threats of political interference: The sustainability of the city's volunteer pool over 8 years was attributed to ingraining volunteer operations within community relationships.
• Local government stewardship and coordination: The programme underwent an iterative process of planning, implementation, and evaluation with multisectoral input, which helped overcome challenges faced by traditional feeding models. As one local government official stated, LGUs deliberately engaged other sectors to minimise threats to implementation. By mobilising their civil society groups, LGUs created an initial pool of volunteers. They also responded to context-specific needs. FGD participants often mentioned the modification of the feeding menu for each locale.
• Scale-up and sustainability: Visible successes in multisectoral collaboration have reportedly fostered a culture of data sharing and evidence-based decision making among stakeholders. Respondents from all sectors shared that their SFP protocols were based on research, making them trustworthy. Results and recommendations were presented to school principals, feeding coordinators, and kitchen managers semiannually by the LGU and NGOs. Input from multiple stakeholders led to improvements in existing feeding procedures as well as innovations applicable to other local government programmes. Despite the shift to remote learning during the COVID-19 pandemic, central kitchen operations continued.

The case study presents 3 learnings to account for in the design and evaluation of multisectoral policies:

1. Community buy-in was crucial to sustaining interest in the programme. Civil participation brings nuanced knowledge, social trust, and formal and informal regulation to health programmes. A key contributing factor is the creation of an enabling environment through community engagement, education, and mobilisation.
2. The NGOs' clear delegation of management to the LGU for the success of the pilot served as a political incentive for elected leaders to galvanise parents, community networks, and schools and to negotiate multisectoral arrangements with the local offices of other government agencies in the education, health, and social welfare sectors. These arrangements were instrumental in overcoming siloed performance and the inclination towards sector-specific achievements.
3. Strong leadership demonstrated by local leaders was complemented by their openness to feedback and support for evidence-based innovations to the model. LGUs were able to overcome the lack of formal horizontal accountability mechanisms in multisectoral interventions through monitoring and information systems that enforced each implementer's responsibility to the community and innovations for consolidated databases to identify implementation gaps. Moreover, low tolerance for corruption and noncompliance reinforced necessary social sanctions that led to the programme's sustainability, despite natural hazards, disasters, and other shocks (e.g., COVID-19).

In conclusion: "The roles played by communities in program advocacy, operations, and accountability emphasize the need for community-based interventions to promote local ownership and allow room for nuanced variations to bring about a sense of agency and empowerment....The experiences of [these] 2 successful large-scale implementation sites present a model for improving diet and health, empowering civil society, and holding groups with a variety of interests accountable for multisectoral action in decentralized governments. Local-initiated innovations to traditional social programs increase acceptability and appropriateness....Beyond the cost-effectiveness of constructing a large-scale central kitchen, the model institutionalized multisectoral coordination channels that may serve as a template for how other social services can be scaled and implemented in devolved settings."