Role of Multi-Role of Multi-SStakeholdertakeholderss Forum Forum in Reducing Vulnerability and Poverty: in Reducing Vulnerability and Poverty:

Perspective and Lessons From Nusa Tenggara, Perspective and Lessons From Nusa Tenggara, IndonesiaIndonesia

Dr. Astia Dendi, and Dr. Ahmad ZainiDr. Astia Dendi, and Dr. Ahmad Zaini

A Presentation at the 3A Presentation at the 3rdrd ARSA International ARSA International Conference Conference

Sanhe City, China, 8-10 August 2007Sanhe City, China, 8-10 August 2007

Structure of PresentationStructure of Presentation

Background and context;Background and context; Conceptual framework, key questions and Conceptual framework, key questions and

methods of data collection;methods of data collection; Overview of health and nutrition status in Overview of health and nutrition status in

Indonesia;Indonesia; Factors underlying people vulnerability Factors underlying people vulnerability

with a focus on health and nutrition;with a focus on health and nutrition; Role and prospect of stakeholder forum to Role and prospect of stakeholder forum to

help reduce poverty and vulnerability;help reduce poverty and vulnerability; Lessons learnt and recommendations Lessons learnt and recommendations

BACKGROUND AND CONTEXTBACKGROUND AND CONTEXT• The “Big Bang” decentralization in Indonesia; The “Big Bang” decentralization in Indonesia;

• Poverty remains high in Indonesia, but more Poverty remains high in Indonesia, but more prevailing in eastern Indonesia;prevailing in eastern Indonesia;

• Overall, Indonesia HDI improved considerably from Overall, Indonesia HDI improved considerably from 0.677 in 1999 to 0.711 in 2006 (rank 108 of 177 0.677 in 1999 to 0.711 in 2006 (rank 108 of 177 countries), but: countries), but: • Less progressive compared to neighboring countries and Less progressive compared to neighboring countries and

there is notable inter-regional variationthere is notable inter-regional variation

• High incidence of malnutrion and high rate of infant and High incidence of malnutrion and high rate of infant and maternal mortality in eastern Indonesia;maternal mortality in eastern Indonesia;

• West Nusa Tenggara province (NTB) is among the most West Nusa Tenggara province (NTB) is among the most critical regions in Indonesia in term of infant and maternal critical regions in Indonesia in term of infant and maternal mortality rate:mortality rate:

• IMR in NTB (BPS, 2004) = 73.5/ 1000 live birth (national=45/ IMR in NTB (BPS, 2004) = 73.5/ 1000 live birth (national=45/ 1000 live birth);1000 live birth);

• MMR in NTB= 370/ 100,000 live birth (national = 307/ 100,000 MMR in NTB= 370/ 100,000 live birth (national = 307/ 100,000 live birth);live birth);

Global Poverty: Global Poverty: Indonesian positionIndonesian position

Sachs, J. (2005:180)-The end of poverty: How we can make it happen in our lifetime?

Life Expectancy Vs HLife Expectancy Vs Human uman DDevelopment evelopment IIndexndex

Human Development Index Life expectancy

Province

POVERTY

Low Food Intake Frequent Infectious Diseases

Hard Labour Frequent Pregnancy

Big Household Size

Nutrition Status

High expenditures for

health careReduce productivity

due to bad physical condition

Reduce productivity due to low inteligence and education status

Source: Repositioning Nutrition as Central of Development (World Bank, 2006)

CONCEPTUAL FRAMEWORK

Key QuestionsKey Questions

What factors underlying the high rate of What factors underlying the high rate of undernourishment of children U5, infant and maternal undernourishment of children U5, infant and maternal mortality in eastern Indonesia, primarily West Nusa mortality in eastern Indonesia, primarily West Nusa Tenggara (NTB)?;Tenggara (NTB)?;

What is the prospect of stakeholder’s forum at What is the prospect of stakeholder’s forum at community and local levels toward reducing vulnerability community and local levels toward reducing vulnerability of the poor?;of the poor?;

What lessons can be learnt from these forums initiative?;What lessons can be learnt from these forums initiative?;

What are someWhat are some ways forward? ways forward?

METHODS OF DATA COLLECTIONMETHODS OF DATA COLLECTION

Desk study (secondary data)Desk study (secondary data)Primary data collection:Primary data collection:

Key informants interviewsKey informants interviewsFocus Group DiscussionFocus Group DiscussionObservationObservation

Overview of health and nutrition Overview of health and nutrition issues in Eastern Indonesiaissues in Eastern Indonesia

Trend of children UTrend of children Under nder 5 5 Years Old (U5)Years Old (U5)

suffering severely under nourished (Z score <-3)suffering severely under nourished (Z score <-3)

0

5

10

15

20

25

1995 1998 1999 2000 2002 2003 2005

Year

Se

ve

rely

un

de

r n

ou

ris

he

d (

%)

NTB

NTT

Maluku

Papua

National

Source: Susenas 1995-2005

Trend of children U5 suffering under Trend of children U5 suffering under nourishednourished

(Z score -3.00 to -2.00) (Z score -3.00 to -2.00)

0

5

10

15

20

25

30

1995 1998 1999 2000 2002 2003 2005

Un

de

r n

ou

ris

he

d (

%)

NTB

NTT

Maluku

Papua

Nasional

Source: Susenas 1995-2005

Under nutrition of Children U5 Under nutrition of Children U5 in Indonesia (2003)in Indonesia (2003)

UNDER NUTRITION

FOOD DISEASES

Availability of Food at Household Level

Care of Children & Pregnant

Women Health and Sanitation services

Resources :• Purchasing power• Agriculture land• Think (mindset)

• Skill

PoliticsEconomy, Social

Direct Causes

Indirect Causes

Core Problems

Roots of the problems

UNICEF, 1998

FACTORS UNDERLYING UNDER NUTRITION

Problems/ challenges at community level:Problems/ challenges at community level:

Low education level;Low education level;

Low incomeLow income

Women work as hard labors (including Women work as hard labors (including migrant labor to neighboring countries);migrant labor to neighboring countries);

Lack of time to care children U5;Lack of time to care children U5;

Lack of healthcare during pregnancy;Lack of healthcare during pregnancy;

Lack of knowledge and skills in post natal Lack of knowledge and skills in post natal health care; health care;

Governance problems:Governance problems:

Lack of political commitment at provincial and local Lack of political commitment at provincial and local levels;levels;

Insignificant budget allocation for financing health and Insignificant budget allocation for financing health and nutrition programs for the poor compared to that for nutrition programs for the poor compared to that for apparatus (operational) expenditures; apparatus (operational) expenditures;

Lack of transparancy ofLack of transparancy of budgeting and public budgeting and public expenditures;expenditures;

Lack of community participation in public policy Lack of community participation in public policy formulation (particularly budgeting);formulation (particularly budgeting);

Local parliament members lack the understanding on Local parliament members lack the understanding on factors underlying poverty and under nutrition problems;factors underlying poverty and under nutrition problems;

Local parliament members have inadequate knowledge Local parliament members have inadequate knowledge and skills in the formulation of pro-poor planning and and skills in the formulation of pro-poor planning and budgeting;budgeting;

The monitoring and supervision haThe monitoring and supervision haveve been been administrative-focus rather than results-focus; administrative-focus rather than results-focus;

Role and prospect of Stakeholder’s Forum

Media for collective learning;Media for collective learning;

Media for building mutual understanding, trust, and Media for building mutual understanding, trust, and mutual agreement;mutual agreement;

Promote responsibility sharing;Promote responsibility sharing;

Induce collective action;Induce collective action;

Stimulate and catalyze social changes Stimulate and catalyze social changes

Stakeholder’s dialog fosters collective learning and responsibility sharing for actions

Example: Teniga Village, West LombokExample: Teniga Village, West Lombok

Self-financed village office building

Community watch-dog against illegal logging

Road improvement to facilitate community access to the integrated health services (Polindes /Posyandu)

Installation of clean water pipes for 7,012 meter and mass water reservoir (3x2x1.5m)

Community fund-raising to hire a building for Village Health Clinic (Polindes) office

New rotary saving groups (arisan) were founded to support Posyandu activities

Example: Sigar Penjalin Village, Example: Sigar Penjalin Village, West LombokWest Lombok

Road improvement by community to improve Road improvement by community to improve access to Health Care Service (Posyandu) at access to Health Care Service (Posyandu) at

Sub-village levelSub-village level

Installation of clean water pipes (7.02 km), self-financed by the community of Sigar Penjalin village, West Lombok

The community built a “berugaq”’ (a traditional platform) for dialogues;

The community work together to clean their surroundings twice a week;

Community participation to facilitate integrated health care services (Posyandu activities);

New “rotary saving groups” were founded to support posyandu activities.

Sokong Village, West LombokSokong Village, West Lombok

CONCLUSIONS and LESSONS LEARNTCONCLUSIONS and LESSONS LEARNT

StakeholderStakeholders s forum can be an effective forum can be an effective instrument to foster learning and actions instrument to foster learning and actions toward reducing poverty and vulnerability of toward reducing poverty and vulnerability of the poor (e.g. health and nutrition problems); the poor (e.g. health and nutrition problems);

Key factors affecting performance of the Key factors affecting performance of the stakeholders forum, among others:stakeholders forum, among others: Shared understanding among forum members Shared understanding among forum members

regarding problems and needs;regarding problems and needs; Good quality learning process to develop Good quality learning process to develop

leadership and change the mindset of the forum leadership and change the mindset of the forum members;members;

Priority programs are based on mutual Priority programs are based on mutual agreements among forum members depending agreements among forum members depending on community & local needs and self-help on community & local needs and self-help potentials;potentials;

The weakness of development intervention The weakness of development intervention strategies by various agencies in eastern Indonesia, strategies by various agencies in eastern Indonesia, among others, is the rush to focus directly on among others, is the rush to focus directly on technical aspects;technical aspects;

Such approach overlooks the need for community Such approach overlooks the need for community envisioning, establishing mutual understanding, trust envisioning, establishing mutual understanding, trust and agreements through social learning;and agreements through social learning;

Establishment of stakeholder forum, as we observed, Establishment of stakeholder forum, as we observed, is instrumental and thus a necessary conditions for is instrumental and thus a necessary conditions for increasing effectiveness of development strategies;increasing effectiveness of development strategies;

Policy makers and development implementing Policy makers and development implementing agencies should be made familiar with the existing agencies should be made familiar with the existing forums model in order to promote pro-poor approach forums model in order to promote pro-poor approach in developmentin development;;

CONCLUSIONS and LESSONS LEARNTCONCLUSIONS and LESSONS LEARNT