Adequate nutrition enhances patient outcome

Adequate nutrition plays a crucial role at all life stages. It fortifies the immune system, empowering it to effectively fight infections and various illnesses, ultimately resulting in better health outcomes and an overall enhanced quality of life.

Addressing malnutrition in hospitals leads to enhanced patient care, improved clinical outcomes, and potential cost reduction in hospitalization. These positive patient outcomes result in shorter admission periods.

In 2019, the Department of Health (DOH) took a significant step toward enhancing the quality of medical-nutrition care in Philippine health facilities by issuing an Order on the Guidelines for the Implementation of Nutrition Care Process in Hospitals. This policy applies to both public and private hospitals, emphasizing the importance of ensuring quality nutrition care of admitted patients.

By adhering to these guidelines, healthcare providers can better address patients’ nutritional needs that will eventually contribute to their overall well-being.

In a hybrid roundtable discussion titled ‘Strengthening Nutrition Integration in the Health System: Evaluating the Nutrition Care Process in the Philippines,’ which was organized by the international think tank Stratbase Institute in partnership with Universal Health Care (UHC) Watch, representatives from various sectors came together. Participants included officials from the Department of Health, the Board of Nutrition and Dietetics of the Professional Regulation Commission (PRC), healthcare professionals, academics, civil society organizations, and patient advocates.

In her keynote speech, DOH Undersecretary Emmie Liza Perez-Chiong mentioned that, “the effective implementation of the Nutrition Care Process (NCP) is a crucial component of comprehensive patient care, signifying a commitment to the ongoing quality development within Philippine healthcare facilities.”

Hon. Virgith Buena, Chair of the PRC’s Board of Nutrition and Dietetics, emphasized that NCP is mandated by the Nutrition and Dietetics Law (Republic Act 10862), and that Registered Nutritionist-Dietitians (RNDs) play a crucial role in assessing patients’ nutritional requirements and creating personalized food plans. 

Dr. Aguedo “Troy” Gepte IV, a nutrition consultant and author of a policy paper commissioned by the Stratbase Institute, said that “the adoption and implementation of NCP in the country’s healthcare system represent a significant change towards uniform, research-supported nutritional care.” He stated that “by promoting policies that endorse the nutritional care framework and allocate funds for essential resources, the NCP can be systematically incorporated into the national healthcare strategy.”

Dr. Jose Rodolfo Dimaano Jr. of the Abbott Center for Malnutrition Solutions emphasized that nutrition is a fundamental human right, and universal access to nutritional interventions is a crucial component of addressing malnutrition. “That's why we believe that the NCP has a very big potential in giving a quality of life for patients, and especially to those who are most vulnerable,” he added. 

In the same discussion, RNDs who are clinical dietitians from both government and private hospitals had the opportunity to share their perspectives and express their thoughts on the current implementation of NCP in their respective healthcare facilities. Several challenges were raised, including inadequate management support, resource limitations, staffing shortages, communication gaps among colleagues, lack of peer assistance, time constraints for documentation practices, and reduced confidence among RNDs due to insufficient training. Furthermore, financial constraints and the absence of electronic records contributed to a lack of sufficient data.

Consequently, RNDs recognized the multidisciplinary and collaborative approach in the implementation of NCP. However, a constant barrier that was mentioned was that the duplication on their roles among other health professionals within the hospital setting.

Indeed, hospital administrators play a crucial role in implementing policies inside their organizations. Dr. Ricardo Adriano, who represents the Private Hospitals Association of the Philippines, as well as the Philippine College of Hospital Administrators, admitted that hospital management usually mainly focuses on revenue generating services and departments. Often, the dietary department is not considered a priority. He recognized the need for legislation tackling challenges related to NCP implementation.

Given that the Philippines has a total of 1,308 registered hospitals across the nation (DOH-Health Facility Services and Regulatory Bureau, 2023), In which 446 (34%) are government-owned while 862 (66%) are privately-owned, it is evident that there is a requirement for a unified endeavor to enhance awareness and comprehension of the advantages of NCP among all healthcare professionals and stakeholders. 

Dr. Gepte’s proposed recommendations emphasize not only overcoming the current challenges in implementing the NCP but also laying the groundwork for its sustained effectiveness through legislative measures. This approach aims to address existing implementation hurdles while ensuring the enduring viability, aligning Philippine nutritional care with global standards. His proposal for new legislation to guide NCP implementation in hospitals aims to foster a comprehensive strategy, emphasizing policy reviews, interdisciplinary collaboration, and educational initiatives.

The specter of undernutrition casts a long shadow over our nation’s future—a shadow that reaches beyond mere statistics. It touches the wellbeing of everyone.

As we grapple with this silent crisis, we must recognize that malnutrition isn’t just about food insecurity or scarcity, it is a collective responsibility that extends beyond immediate sustenance. 

It’s about nurturing minds and bodies alike, ensuring that every Filipino has access to sustenance to live productive lives.

Embracing a resource-effective approach to the nutrition care process not only optimizes outcomes but also fortifies the holistic perspective on nutrition.

In the context of achieving universal health care, let us continue to work together to refine and strengthen the Nutrition Care Process implementation and its institutionalization. The participation and support of different stakeholders such as healthcare professionals, the private sector, and civil society is crucial.

Alvin Manalansan is the health and nutrition fellow of the think tank Stratbase Institute and co-convenor of the UHCWatch.