multi-stakeholder approach in reducing malnutrition problem

in Indonesia

BotswanaComoros

Djibouti Egypt

Libya

MozambiqueSao Tome &

Principe

Sierra Leone

Zambia

Benin

Albania

IraqSyria Arab Rep.

Bhutan Azerbaijan

INDONESIA Papua

New Guinea

17 countries of 117

countries, have 3 kind of nutrition problem:

STUNTING,

WASTING , Anemia

and OVERWEIGHT

TRIPLE BURDEN

ECONOMIC GROWTH IS NOT ENOUGH: STUNTING PERSISTS IN INDONESIA AS A

MIDDLE-INCOME COUNTRIES

The Benefit-cost Ratio for Nutrition Specific Intervention Packages with ≥ 90% coverage to Reduce Stunting

Indonesia: 48

Every dollar invested to reduce stunting will be returned 48 dollar

Investing in Nutrition for Human Development

World economists identified that investing in Community Nutrition is the most Smart way to address the top 10 world’s challenges

Investing in nutrition can help to cut off poverty cycle and increase GDP between 2 – 3% per year

The Benefit-cost Ratio for Nutrition specific Intervention packages with ≥ coverage to Reduce Stunting

For every dollar invested in nutrition will be returned about 48 dollar in Improvement of health, education, and economy productivity

The Copenhagen Consensus 2012

What Causes Undernutrition in Indonesia?

Only 36% children 6-23 months consume a “minimum acceptable diet”

(IDHS, 2012)

14% of children have suffered diarrhea in the last 2 weeks

(IDHS, 2012)

• 24% defecated in the open (JMP, 2013)

• 14% do not have access to an improved water source (JMP, 2013)

Only 42% children less than 6 months are exclusively

breastfeed(IDHS, 2012)

12% are below the national poverty line(SUSENAS, 2012)

NUTRITION STRATEGIES OF INDONESIA

1. Nutrition improvement, focusing on the first 1000 days of life (pre-pregnancy, pregnant woment, child)

2. Improving access to food diversification 3. Improving control on food quality and food safety4. Improving Healthy and Hygiene Lifestyle5. Strengthening food and nutrition institution

1. Iron-Folic Supplementation2. Promotion of Exclusive Breastfeeding 3. Adequate Complementary feeding 4. Protection to energy malnutrition

1. Access to improved sanitation2. Food and Nutrition Security3. Family Planning4. Universal Health Coverage5. Food Fortification6. Nutrition Education7. Women empowerment8. Poverty Reduction Program

Women of Reproductiv

e AgePre-pregnancy

Pregnant mother

Lactating mother

Infant and young child

( 0 – 23 month)

5 PILLARS OF ACTION PLAN

SPECIFIC INTERVENTION SENSITIVE INTERVENTION

1. 40% reduction in the number of children under-5 who are stunted

1. 50% reduction of anemia in women of reproductive age

1. 30% reduction in low birth weight

1. No increase in childhood overweight

1. Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%

1. Reduce and maintain childhood wasting to less than 5%

TARGET 2025

Presidential Decree

No. 42.2013 on

National Movement to

Accelerate Nutrition

Improvement within the

Framework of the First

1000 Days of Life

Bringing work together

a. Decrease of MMR & IMR (Mother & Child Health

including Immunization

b. Nutrition improvements especially stuntingc. Infectious Disease Control (ATM: HIV / AIDS,

Tuberculosis & Malaria

d. Control of Non Communicable Diseases (Hypertension,

Diabetes Mellitus, Obesity & Cancer)

Family

Approach

Healthy

Community

Movement

Priorities Are Important:Indonesia Case:

National Midterm Planning 2015-2019

THE MAIN ACTIVIES TO REDUCE STUNTING 2015-2019

Reduction of stunting in childrenunder 2 years

Improvement Nutritionfor Adolescent girl andmarried women:1.delayed marriage2.Iron tablet

supplementation3.nutrition balance diet

campaign

Supplementary Feeding for School Children• Nutrition balance diet Campaign• Education Behavior Clean and Healthy

Nutrition Improvement for

The First 1000 days of life:

1.Supplementary feeding for

pregnant women

2.Promotion and counseling

Early Initiation of

Breastfeeding and

Exclusive breastfeeding

3.Growth Monitoring and

Promotion

4. Infant and Young Child

Feeding

5.Management of Children

with severely Acute

Malnutrition

6.Vitamin A Supplementation

7.Home fortification (Taburia)

4. School Age

3.Infant and Children

5. Adolesence and Reproductive women

2. Lactating Mother

1.Pregnant Women6. Elderly People

• Promotion 0f Exclusive

breastfeeding

• Breastfeeding counseling

▪ Growth monitoring & Promotion

▪ Vitamin A supplementation

▪ Provision of iodized salt

▪ Complementary Feeding

▪ Iron fortification and provision of Taburia

▪ Zinc for diarrhea management

▪ Controlling of Deworming

• Nutritional counseling

• Nutrition services

• Reproductive health

• Nutrition counseling

• Iron folate tablet

supplementation

• Health Screening

• Monthly Immunization

• School Health Improvement

• Supplementary feeding

• Controlling school food

vendor

▪ Iron folate tablet

supplementation

▪ Supplementary feeding

▪ Prevention of Deworming

▪ Supplementation of

Calcium

GOVERNMENT

PrivateSector

Academia &Civil Society

Shared

Social Value

of communities

9

SYNERGY AND HARMONIZATIONIN NUTRITION AND HEALTH DEVELOPMENT

Health Program Multisectoral

Family ApproachHealthy Community

Movement (GERMAS)

Implementation of Healthy Paradigm

a systematic collective action from all stakeholders to raise awareness, capacity

and ability of the community to live healthy for better quality of life

STRENGTHENING OF PROMOTIVE-PREVENTIVE MEASURES THROUGH

HEALTHY LIFE COMMUNITY MOVEMENT

(GERMAS)

Goals

Nudging the

community

behavior to

Live Healthy

Be Productive

Create Healthy Environment

Minimizing Health Care Cost

GOVERNMENT LEADERSHIP ON NUTRITION

• SUN Movement in Indonesia

• Indonesia joined the Global SUN Movement in 2011

• Policy Framework and Implementation Guidelines developed in 2012

• Presidential Decree on 1000 Days of Live in 2013 and launching of the National Movement (1000 HPK)

• Multi-sector and multi-stakeholder coordination structures established, and stakeholder networks

• Tracking of budget allocations for nutrition.

MULTI-SECTORAL APPROACHES TO SYNERGIZE EFFECTS AND MULTIPLY CHANNELS FOR NUTRITION IMPROVEMENT

MULTI-SECTOR NUTRITION POLICY FRAMEWORKS & PLANS reflect International Commitments

NUTRITION-SENSITIVE SOCIAL PROTECTION PROGRAMMES(PKH AND PNPM)

• Infant & Young Child Feeding (IYCF) COUNSELLING PACKAGE WASH/IYCF INTEGRATION

• IYCF PACKAGE FOR AGRICULTURAL EXTENSION WORKERS FOCUSING ON COMPLEMENTARY FEEDING

• INTEGRATED ECD PACKAGE (EDUCATION, CHILD PROTECTION, HEALTH AND NUTRITION)

• Integration of the

first 1000 days of

live Movement

into CSO

program

• Strengthening

CSO

engagement with

the government

• Advocacy to

support the

Movement of first

1000 days of life,

• Supporting

nutrition as a

national and

local government

priority issue

• Encourage

cooperation

between

countries

• Cooperation and

technical

assistance

Development

Partners

Social

institutionsBusiness

sectorProfessional

Organizations & Academics

• Implementation of

“Tri Dharma

Perguruan Tinggi”

in improving

nutrition

• Increasing the

quality of the

ProfesSional

Nutrition Service

• Provide input

based on research

results

• Facilitating the

business sector in

the Movement of

1000 HPK

• CSR for Nutrition

improvement

• Exchange

experiences

including the use

of innovation

technology

13

THE ROLE OF STAKEHOLDERS IN

ACCELERATION OF NUTRITION IMPROVEMENT

Collaboration with Development Partners in NTT:

• Nutrition International (NI) Indonesia : Micronutrient Supplementation for Reducing Morbidity and Mortality in

Indonesia program (MITRA) by anemia prevention activities for young women through Fe tablets.

• UNICEF : Community-Based

Nutrition Program (PGBM)

• Program in Gorontalo

District to reduce Stunting

which is funded by village

cooperatives and self-

supporting communities

such as Posyandu,

Posbindu & Saung germas

• PKPU's support in the

Ambassador Program of

1000 HPK through

monitoring program

activities (by Midwives and

Posyandu cadres) to

mothers and children during the first 1,000 days of life

• APPNIA & GAPMMI:

Support the Ministry

of Health in

Adolescent Nutrition

Campaign

• Faculty of Medicine, Hasanuddin University: 1 student accompanies 1 pregnant mother program, until the baby is born and the baby reaches the age of 2 years

• Poltekkes students in Gorontalo District, accompanies and educate mother from the beginning of pregnancy until giving birth and “Arisan Donor Darah” (Si DORA)

THE ROLE OF STAKEHOLDERS IN

ACCELERATION OF NUTRITION IMPROVEMENT

Development Partners Social Institutions Business sector Professional Organizations & Academics

12

TERIMA KASIH – THANK YOUTHANK YOU –KOB KHUN KRAB

15

SALAMINDONESIA

Working together for Indonesia prosperity