Hospital food has a reputation problem, and Bai Nishran Candao knows it well.
“When it’s hospital food, [patients say] it doesn’t taste good,” said Candao, chief nutritionist-dietitian at Cotabato Sanitarium Hospital, a government-run Level 2 hospital in Sultan Kudarat municipality in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). “It’s really hard to change that mindset.”
For Candao, changing that mindset is the point. Her team serves an average of 160 to 170 patients a day, which she says amounts to around 200,000 meals a year across regular and therapeutic diets. Since 2024, she has been leading an effort to bring plant-based protein dishes onto those plates, in a region where, as she puts it, “we are meat eaters.”
Philippine hospitals are required to serve patients meals that meet national nutrition guidelines, including a daily minimum of 1,800 calories. Candao sees the job as bigger than that.
She compares it to medicine: patients who were given paracetamol for a fever in hospital tend to reach for it again at home. Food works the same way, she argues. If a patient with high blood pressure eats a plant-based dish in hospital, likes it, and feels better, that experience can travel home with them.
“When you change their experience, you will change their way of thinking about food,” she said. “So that’s actually sustainability in a way, because sustainability is a big word.”
From skeptic to advocate
Candao was not always an advocate. About five or six years ago, while completing her master’s in food science at the University of Auckland in New Zealand, she met people who ate plant-based diets.
Two friends changed her thinking. One, from Mexico, had grown up eating plant-based food because her family could not afford meat, and kept eating that way even after meat became available. The other was vegetarian for environmental reasons. Candao came to understand not only the health benefits of plant-based diets, but how integral such a shift was to the planet, as well.
Her faith also shaped her thinking. As a Muslim, she sees a connection between halal principles, animal welfare, and care for the environment. “If you understand it deeper, plant-based is actually halal, more halal than just slaughtering the halal way,” she said.
She also points out that halal certification addresses how animals are slaughtered, not how they are raised, and that high demand for halal meat in the region has encouraged intensive production. Reducing reliance on meat, she said, is one way to address animal welfare concerns that certification alone does not cover.
“No one’s going to eat tofu here”
The initiative began in 2024 as a continuous quality improvement project under the hospital’s performance governance system, which requires departments to run a substantive improvement project each year. Candao wanted something more lasting than a one-off seminar.
The early response from colleagues was skeptical. “Even my fellow dietitians said, ‘Ma’am, no one’s going to eat tofu here,'” she recalled. Her cooks were unsure how to prepare plant-based dishes and asked whether they could simply fry them. She said no: “We’re in the hospital, and if you fry it, we’re going to lose the meaning of giving them healthy food.”
Before the project, the hospital’s menu had no plant-based protein dishes at all. Vegetables were served only as a side dish. The team started with a single dish and now has five on its one-month cycle menu, with plant-based protein dishes accounting for about 17% of that menu. The goal is to reach at least 30% by the end of this year while continuing to meet national standards and individual therapeutic diet requirements.
Sourcing has been one of the strongest arguments for the shift. Gluten-based meat alternatives are not readily available in the area and would cost more, so the menu relies on what local markets offer: tofu, mung beans, white beans, and other legumes.
Halal meat, by contrast, often has to come from suppliers in a neighboring municipality, which adds transport emissions. “Beans are there, the farmers are there,” Candao said. “Tofu is easier to find than the halal meats.”
Diversifying protein also supports culturally appropriate meals in a region where many patients do not eat pork, and the hospital follows government green procurement rules that favor economical, efficient sourcing. Next year, Candao plans to work directly with local farmers and cooperatives to grow more beans and legumes for the menu, prioritizing seasonal and underused crops to help reduce food loss at the farm level.
So far, Candao has noted a fairly positive response to the shift in patients’ meal plans. Plate waste for the plant-based dishes has stayed below 30% — a respectable level, according to the hospital.
A positive response to plant-based meals
Despite being located in a largely meat-eating nation, the shift towards plant-based meals is becoming more common. She notes that a hospital run by Seventh-day Adventists in the Philippines serves a fully plant-based menu for religious reasons, and a nearby hospital holds meatless Fridays. But she wants something more embedded. “I wanted to do more than meatless days,” she said. “I wanted it to be part of our hospital culture, not just a performative thing.”
Longer term, she hopes to publish a set of standardized, culturally acceptable plant-based recipes, possibly as part of a formal study, and eventually to inform national guidelines on plant-based meals in hospitals. She is careful not to overstate where things stand: “We’re still in the early stage of this.”
Her advice to others starts with intention. “It’s hard to do a project that you do not believe in just because everyone is doing it,” she said.
