Fasli JalalRector of YARSI University

International Conference on Early Childhood Education and ParentingSEAMEO CECEP, JAKARTA, 5 NOVEMBER 2019

Zero Hunger

Corresponding to Post-2015 SDGs (No. 2 and No. 12)

Hunger can be eliminated in our lifetime

1Source : Subandi Sardjoko

3

Stunting (short stature) as chronic malnutrition :

• referred as HAZ < -2 SD Z score of WHO Growth

Standard

• a reduced growth rate in human development

• reflects a process of failure to reach linear growth

potential as to optimal health or nutrition condition

2007 2010 2013 2018

36,8% 35,6% 30,8%37,2%

Trend Prevalence of Stunting In Indonesia

(The Basic Health Survey Indonesia 2007 – 2018, MOH)

WHO CONCEPTUAL FRAMEWORK, 2013

Stunting Problem- Age under 5 years Province trends: 2007 – 2013 – 2018

36.8

46.7

37.2

51.7

30.8

42.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Perc

ent

Province

2007 2013 2018

7Source : Bappenas, 2018

The poor are most affected and the gap is widening

10Source : Aiming High : World Bank, 2018

Child and maternal mortality

Compromised adult health and risk of intergenetational

perpetuation

Decreased Economic

productivity

Impaired physical and cognitive development

Consequensces

Conceptual Framework Of Malnutrition

11Source : Atmarita

Stunting Micronutrient Deficiencies

Low Birth WeightWasting

Malnourished child manifested as:

Problem

12Source : Atmarita

Direct causes

Poor infant/child/maternal nutrition

Inadequate nutrient absorption and nutrient loss due to disease

Inadequate dietary intake

13Source : Atmarita

1. Food insecurity

8. Unsanitary environments and practices

7. Early pregnancy /

Low birth spacing

6. Lack of women empowerment

2. Lack of social safety

nets

3. Poor dietary

diversity

4. Sub-optimal infant and young

child feeding

5. Poor parental

education

10. Poor immune system

9. Poor quality & demand dor

healsth services

Underlying causes

14Source : Atmarita

Social, Economic, Political and Environmental Context

Lack of Capital : Financial, Human, Physical and Social

Basic Causes

15Source : Atmarita

Define how each sector will contribute to address the basic

and underlying causes, and how these will converge and

be integrated?

Conceptual framework – Modified LANCET –Stunting Nasional Strategy

16Source : Atmarita

PROJLJLJLJLJLAJLJFALL;AJ;LA;A;LALKKKK;;; IEORIAPIPERIAPWAPAS;’AAAA;L;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;Proportion of Birth body length < 48 CM infants 0-59 months based on Province (2013,2018)

%Percent

17

Birth Weight Proportion < 2500 GRAM (BBLR)Infants 0-59 Month based on Province (2018)

%Percent

Target RPJMN Tahun 2019 = 8%

18

%Percent

RENSTRA target in 2019=93%

COVERAGE OF COMPLETED BASIC IMMUNIZATION OF INFANTS (12-23 MONTHS) PER PROVINCE (2013,2018)

21

Dietary Energy and Protein Adequacy for Pregnant Women, 2014

22Source : Atmarita

PROPORTION OF ANEMIA IN PREGNANT

WOMEN, 2013- 2018

37.1

48.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

2013 2018

23Source : Atmarita

Smoking of Household Head and Stunting Prevalence by Economic Status, Riskesdas 2010

24

Smoking Non - Smoking

Source : Atmarita

Nutrition is a PILAR for better human resources

Source: Ricardo Uauy, et.al, 2011 25

Impact of stunting on children and society

Stunting in early life is associated with:• Impaired cognitive development• Lower educational attainment• Reduced future productivity• Lower future earnings• Greater risk of poverty

The economic costs of stunting to a nation can be as high as 10percent of GDP. In Indonesia, it is 10.54 precent

26Source : Aiming High : World Bank, 2018

Child Mortality Due to Nutritional Disorders

28

Packages of interventions

31

Mortality in children younger than 5 years could be reduced by 15% (range 9-19%) with:

• 35% (19-43) reduction in diarrhoea-specific mortality

• 29% (16-37) reduction in pneumonia-specific mortality

• 39% (23-47) reduction in measles-specific mortality

• Reduced deaths due to asphyxia and congenital anomaliesLittle effect on maternal mortality

20.3% reduction in stunting (range 11.1-28.9%)

61.4% reduction in severe wasting (range 35.7-72%).

Impact of 10 interventions delivered at 90% coverage

32

Effect of Packages of Nutrition Interventionsat 90% Coverage

Total cost for all packages per year in 34 countries with highest burden = Int$ 9.6 billion

33

Interventions or programmes that address the underlying determinants of fetal and child nutrition and development (food, care, health) and incorporate specific nutrition goals and actions.

Nutrition-sensitive programmes can serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage and effectiveness.

Nutrition-sensitiveInterventions and Programmes

• Agriculture and food security

• Early child development

• Women’s empowerment

• Schooling

• Health & family planning services

• Social safety nets

• Maternal mental health

• Child protection

• Water, sanitation & hygiene

34

Evidence Review of Programmes from 4 Sectors

✓Agriculture

✓Social safety nets

✓Early child development

✓Schooling

Selected based on Relevance for nutrition

Availability of evaluations of nutritional impact

High coverage of the poor

Targeting: programmes that are or could be targeted to reach

nutritionally vulnerable groups

35

Social Safety Nets

Are important

poverty

reduction tools:

Reduce poverty; are often implemented at scale and achieve high coverage of the

poor; increase demand for health and

education services

Help mitigate negative effects of global changes, conflicts,

shocks; protect income, food security, diet quality, assets

and human capital investments among the poor

Enhance women’s empowerment when targeted to women

and when they include specific gender-focused interventions

Key findings Strong evidence of impacts on health care utilisation, but

limited impacts on child nutrition; some studies show

impacts in younger, poorer children, with longer exposure

Lack of clarity in nutrition goals, weaknesses in design and

poor quality health services likely responsible for the limited

nutritional impacts

36

Early Child Development(e.g. psychosocial stimulation, responsive parenting)

Stunting and

poor cognitive

development

share many

risks factors:

Nutritional deficiencies

Intra-uterine growth restriction

Social and economic conditions such as poverty and

maternal depression

Share period of peak vulnerability: the first 1,000 days

Key findings Evidence from small-scale programmes targeted to at-risk children

suggests additive or synergistic effects of ECD and nutrition interventions

on child development and in some cases on nutrition outcomes

Combining ECD and nutrition interventions makes sense biologically and

programmatically and could lead to significant gains in both nutrition and

child development outcomes

37

Nutrition-sensitive programmes in agriculture, social safety nets, ECD and education have enormous potential, yet to be unleashed, to enhance scale, coverage and effectiveness of nutrition-specific actions

Targeted agricultural programmes and social safety nets play a key role in mitigating negative effects of shocks and global changes, supporting livelihoods, food security, diet quality, and women’s empowerment, and reaching nutritionally at-risk populations

Incorporating nutrition in ECD programmes and in school curricula can benefit both nutrition and child development and have long-lasting impacts into adulthood and for future generations and nations

Investments in nutrition-sensitive programmes can play a pivotal role in preventing excess undernutrition and impaired child development that scale-up of nutrition-specific interventions cannot resolve on its own

Paper 3 Key Messages

40

41

42Source : Aiming High : World Bank, 2018

SNAPSHOT INDONESIA

NUTRITION HISTORY

1950The People’s Food Institute (LembagaMakanan Rakyat) began the Nutrition program under the leadership of Prof. Poorwo Soedarmo (Nutrition Father of Indonesia).

2011Indonesia signs up to the global Scaling Up Nutrition (SUN) movement and begins the First 1,000 Days Movement, launched by four ministries.

April 2017Indonesian government delegation visits Peru to learn how it successfully halved

stunting rates in less than a decade.

1979The Family Nutrition Improvement program (UPGK) launched.

2015Indonesia’s government includes targets to reduce stunting in its Medium-Term Development Plan (RPJMN) for 2015-2019.

August 2017Indonesia launches a national strategy to accelerate the prevention and reduction of stunting rates. It acknowledges that stunting is at crisis levels and recognizes the need for a multi-sectoral response.

44Source : Aiming High : World Bank, 2018

Set -Backs• Financial crisis in 1997/1998• Decentralization challenges• Lack of cohesion and convergence• Weak regulations and failure to enforce• Lack of common standards• Fragmented behavior change communications and poor IPC• Inefficiencies in data collection and reporting• Immature accountability mechanisms• Inefficiencies in spending• Implementation capacity weaknesses

45Source : Aiming High : World Bank, 2018

National Strategy to Prevent the Stunting (StraNas Stunting)

47Source : Bappenas, 2018

48

Adolescent reproductive health education; Bina Keluarga Balita (BKB), Parenting

ID card number; Birth certificate; Facilitation of nutrition programs & activities in Public Revenue & Expenditure Budget (APBD)

Prewedding courses; Health & nutrition education for madrasas & Islamic

boarding schools; Encourage the role of religious leaders

Food Safety and Standardization; Monitoring fortified foods, Labeling and Advertising

Non-Cash Food Aid (protein source); PKH; and the use of facilitators for nutrition education

Preschool children (PAUD) with health & nutrition content; Reproductive health and nutrition education, Parenting Class

Food security; Utilization of household yards (KRPL)

Performance Incentive Found to Local Goverment

Nutritional supplementation; Promotion of ASI, MP-ASI, fortification; Nutrition Education; Balanced nutrition promotion &

campaign; Helminthiasis; Nutrition Management; JKN

Development of salt iodization; Salt fortification surveillance, General Fortification

Water supply and sanitation

Convergency of Program and Ministry

budgeting village funds for the village

36

Block Grant to Village

4948

Stranas stunting Key Components

- Sustaining public commitment- Results-based convergence planning and budgeting- Aligning incentives for districts to deliver better- Districts implementation capacity- Multi-sectoral HDW (Human Development Worker)- Nutritional food security- Citizen engagement and community empowerment- Monitoring and evaluation system

50Source : Aiming High : World Bank, 2018

Convergence through a coordinate, multi-sectoral approach at the frontline

- Posyandu is crucial for achieving ambitions to drive down stunting rates- Posyandu Model worked in the past but needs to be revamped (QSDS 2016

analysis)

- Service availability and readiness- Staffing and operations- Capacity - Suboptimal data usage- Lack of convergence

51Source : Aiming High : World Bank, 2018

39

4 Syncronizing between district and

Central

➢ Syncronization the activity on the program between central and

district hence both side can have the advantages of the

programs

3Inter coordination

➢ Involving community organization such PKK, LSM,

professional organization, business organization, Pers,

religions organization, academic and universities,

developer partner, community and individual to speed up

the program

2Integrated intervention up to

Village level

➢ Implementation of integrated intervention the

decrement program mentioned in the

interconnected program in the district up to

village level

1

Planning and Budgetting

➢ To integrate the program and activity for stunting

decrement (inter program and district) into

planning and budgeting documents of district

government

6

Some Hopes to the District Government

Evaluation and Monitoring

➢ Monitoring regularly on the intervention activity

for integrated stunting decrement program and

evalution

5

Innovation & Encouriging for

Good Practise

➢ Innovation to speed up the integrated

stunting decrement program and replicate

for other area/district

Source : Pungkas Bahjuri Ali 54

55

Positions in the Nutrition acceleration program

Government

University and

Professional

organization

Civil Community

organization

MITRA

PEMBANGUNAN

DAN UN SYSTEM

MEDIA

Business, Private &

FILANTROPI

Dengan didukung oleh

Sekretariat Gerakan Nasional

Percepatan Perbaikan

Gizi (SUN)

24 K/L

13 universities & 11

professional

organizations

29 organizations 29 companies

11 developer

partners

Deputi PMMK

Bappenas sebagai

SUN Focal Point

Source : Rapat terbatas

41Location Map of Intervention Focus for Integrated Stunting Prevention in 2019

48 56

22 Percent by 2022 for Under 2s

58Source : Aiming High : World Bank, 2018

14 mio

6 mio

16 mio

4 mio

Business As Usual StraNas

59Source : Aiming High : World Bank, 2018

INDONESIA

CAN DO IT!

WE WILL DO

EXACTLY THAT!

60