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Akim Dharmawan (PhD) is the SUN Movement secretariat manager at the Ministry of National Development and Planning (Bappenas) in Indonesia. He has worked as a nutritionist and public health practitioner for more than 15 years, with experience in programme planning and management, behaviour change intervention, community development and monitoring and evaluation.
Pungkas Bahjuri Ali (PhD) is the Director for Public Health and Nutrition at the Ministry of National Development and Planning (Bappenas), and secretary of the technical team for the SUN Movement Indonesia. He works closely with both national and sub-national governments in aligning health and nutrition programmes.
Dr Entos Zainal is the Deputy Director for Community Empowerment and Public Nutrition at the Ministry of National Development and Planning (Bappenas). He is an expert in public health and nutrition programme planning and implementation.
Ardhianti has an MSc in public health and is part of the team responsible for the planning and technical coordination of Healthy Lifestyle Community Movement and integrated nutrition intervention for accelerating stunting reduction.
Indonesia is a lower-middle income country and the largest economy in Southeast Asia1. Rapid economic growth over the past ten years, coupled with government investments in social development, have led to the poverty rate being halved since 1999, to 10.9% in 20161. However, the benefits of economic growth do not align with an improvement of social and health indicators, and 36% of children under five (CU5) are stunted (low height for age), while 14% are affected by wasting (low weight for height)2.
The national prevalence of stunting (affecting nearly 9 million children under five) has been slowly decreasing for the last decade. However, the reduction of stunting was less than expected (it was 40% in 2007 and 37.2% in 2013)3. Although prevalence is similar across the 34 provinces of Indonesia, east Nusa Tenggara Timur province has a prevalence of 70%, whilst Jambi province has the lowest prevalence at 37.9%3. Children affected by stunting are found among both rural and urban populations (42.1% and 32.5%, respectively)3. Additionally, almost a third (29%) of CU5 among the wealthiest households are stunted, which suggests that stunting is not heavily influenced by location and economic status3.
To improve the quality of multi-sectoral interventions (such as those involving agriculture, education and social protection), a geographically-focused plan was designed to create awareness and commitment for INI in 100 districts (out of 514 districts in Indonesia) in 34 provinces in 2018. The choice of districts was based on a number of criteria, including number of CU5 and prevalence of stunting and wasting in CU5 and prevalence of poverty. There are plans to expand the coverage to a further 160 districts in 2019.
Rembuk Stunting has provided a new platform (to which SUN Movement networks have also been invited) for information sharing and learning between national and sub-national governments with a focus on planning and budgeting for INI. The national-level Rembuk Stunting events were followed by similar events at provincial and district level, with funding coming from the government budget and development partners/donors. So far, five districts out of 34 from the national event have conducted district and/or village level Rembuk Stunting. These were attended by local private sector, local academia, professional organisations, and local civil society organisations who have all contributed to discussions on stunting reduction and prevention at the district/village level.
Bappenas, with support from the World Bank, has developed a Rembuk Stunting curriculum along with facilitator guidelines, which includes stunting and other related health data for each district for discussion among district key leaders, a work plan with an activity and timeline template, and a health and nutrition dashboard. District government have learnt how to use and analyse health and nutrition data, developed recommendations with an evidence-based approach, chosen priority actions based on local problem analysis, and ensured adequate budget to fund selected priority actions. Villages have been urged to use Village Funds (from central government) to reduce stunting by investing in infrastructure, such as health clinics and water and sanitation facilities, and there are reports from the Ministry of Villages that health and nutrition activities have increased among focus districts.
It has been noted that capacity gaps between districts need to be properly assessed, with a follow up district planning session performed by either central or provincial government after a Rembuk Stunting event. Local universities/experts also need to be more widely included to provide technical advice for district governments. Coordinating working with sub-national governments is challenging due to lack of staff and heavy workloads at this level. Selecting a focal point for each Dinas (sub-national government organisations for health, education, village development, public work and housing, etc) and setting/agreeing regular meetings is crucial to ensure everyone is on board. Finally, advocacy tools and communication strategy should be developed to ensure the sustainability of the commitment. In addition, specific governor/mayor regulations are needed to justify and sustain the implementation of the INI.
Rembuk Stunting is shaping up to be an effective advocacy tool for sub-national government leaders and has already provided opportunities for direct learning from field visits between focal districts to increase ownership of INI. Moreover, it has built capacity at sub-national level through improved knowledge and skills in planning, coordinating and monitoring INI, and the initial 34 targeted districts have now developed action plans. Further Rembuk Stunting events are planned to cover the remaining focal districts, and the monitoring and evaluation framework (including visits to each village) is being finalised so that progress can be reported.
Akim Dharmawan, Pungkas Bahjuri Ali, Dr Entos Zainal, Ardhianti, Evi Nurhidayati and Nur Akbar Baha (). Stunting prevention in Indonesia: Raising awareness at the sub-national level. Nutrition Exchange 11, January 2019. p8. www.ennonline.net/nex/11/stuntingpreventionindonesia
Development is the increase in ability (skill) in more complex body structures and functions in a regular and predictable pattern, as a result of the maturation process. Here it involves the process of differentiation of body cells, body tissues, organs, each of which can fulfill Function: Research Objective: To determine the relationship between mother's work and the development of children aged toddlers (1-3 years) in the working area of the Kalabbirang health center, Minasatene sub-district, Pangkep district.
Analytical Survey research design with a Cross Sectional study approach. Samples were drawn using purposive sampling technique from 32 respondents. The data collection technique uses a questionnaire. The collected data was processed using the Chi-Square statistical test using the computer program SPSS version 11.5.
In general, it can be concluded that based on the results of the research conducted, several suggestions can be made to related parties regarding the relationship between maternal employment and the development of toddler children aged 1-3 years. For the Kalabbirang Community Health Center, Minasa te'ne District, Pangkep Regency, so that in this case the nursing staff who carry out nursing care can pay attention to the impact where patients experience conditions where there is a threat of serious illness and a care environment that makes patients feel isolated from other people so as to prevent stress from occurring. and the patient's psychological problems.
Anggania G.A Timporok, Pemsi M Wowor, Sefti Rompas, 2018. The Relationship Between Maternal Employment Status And Exclusive Breastfeeding Exclusive Breastfeeding In The Working Area Kawangkoan Health Center
Directorate of Nursing Services Development Directorate General of Medical Services Development, Ministry of Health, Republic of Indonesia. 2009. Guidelines for indicators of the quality of clinical nursing services in health facilities.
Ministry of Health, RI 2012. Efforts to Accelerate Reducing Maternal and Newborn Mortality Rates. -percepatanpenurunan-angka-kematian-ibu-dan-bayi-baru-lahir-di-indonesia/ . Retrieved 15 October 2014.
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