”Quo Vadis” in Accelerated Stunting-Reduction Movement
Let’s make the stunting issue the nutritional mainstreaming of development, which has long been administered by the World Bank, especially for poor and developing countries.
Indonesia commemorates the 63rd National Nutrition Day today.
It marks as many years of endeavor Indonesia has gone through to improve public nutrition since it became a nationwide concern. Various efforts have since been pursued to address community nutrition. However, the results have not been encouraging so far.
In the last 30 years, there have been at least five national-scale government programs to improve people's nutrition. In 2010, United Nations then-secretary general Ban Ki-moon initiated the worldwide Scaling Up Nutrition (SUN) movement.
The SUN movement, which involved 63 countries, including Indonesia, was a global push to improve nutrition for people, especially women and children.
Why does the issue of nutrition need a global movement? It is because some countries are considered to be sluggish in addressing malnutrition while it is one of the most serious problems in the world. Malnutrition costs enormous human and economic resources. Malnutrition as one of the causes of nutritional problems is something that can be prevented. What is needed is an integrated and comprehensive effort.
As a follow-up to the SUN movement, the government established a Policy Framework for the National Nutrition Improvement Acceleration Movement in 2013, which sought to improve the maternal and infant health and nutrition within the first 1000 days after childbirth, known as the First Thousand Days of Life (HPK) movement.
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> Reducing Stunting in Rural Areas
The following year, the Health Minister issued Regulation No 23/2014, which put a hundred regencies and municipalities on the priority list for the government’s intervention in malnutrition-related stunting.
The National Team for the Poverty Alleviation Acceleration (TNP2K) also included the stunting-related 100 priority list in 2017 as part of its work program, under direct supervision of the Vice President. The target was that all regencies and municipalities would have implemented the prioritized intervention program over stunting in 2021.
It can also be perceived that by the end of 2021 the regencies and municipalities on the priority list were expected to free themselves from stunting as a public health problem, or reach the prevalence of stunting in children under five to below 20 percent. As also shown in the previous program, the prevalence of stunting was reluctant to go down.
There came a ray of light at the end of a narrow tunnel when the President issued Presidential Decree No. 72/2021 in August 2021, which aimed at accelerating the stunting-reduction movement.
The prevalence of stunting can only be reduced realistically to around 21 percent in 2024.
The essence of the decree is an appeal for all elements of the nation to unite in the anti-stunting movement with the expected goal to reduce the stunting prevalence to 14 percent by 2024. The 14 percent figure will be far below the cutoff point of stunting as a nutrition-related public health problem, which is at 20 percent.
The National Development Planning Agency (Bappenas) proposed the target at 19 percent. But the President persisted. By reaching the target of 14 percent, the President was optimistic that we would be able to be free from child stunting by 2030 as aligned in the UN Sustainable Development Goals (SDGs).
In fact, the targeted figure shows that the President was “very optimistic.” We have only been able to reduce the prevalence of stunting by 2 percent on average per year.
Data at the Basic Health Research shows the prevalence of stunting in Indonesia was at 37.2 percent in 2013 and 30.8 percent in 2018. Meanwhile, the Indonesian Infant Nutrition Status Survey (SSGBI) recorded the stunting prevalence at 27.6 percent in 2019 and at 24.4 percent in 2021. It is evident that without accelerating the efforts, the prevalence of stunting can only be reduced realistically to around 21 percent in 2024.
Practically, we only have less than two years to reach the target of 14 percent as set by President Joko “Jokowi” Widodo. It means we should be able to achieve a 5 percent reduction within less than two years.
This is a tough job considering that Indonesia is entering a politically hectic period this year and in 2024. Nutrition and health issues, especially for children under five, will be potentially pushed to the fringe. The indications have already been on the horizon with the movement in the reduction acceleration of stunting already fading.
"Quo vadis?" in the anti-stunting movement
Our concerns over the anti-stunting movement are reasonable given this nation's past experience in which the handling of public nutrition issues seemed to be lukewarm. Various programs were launched, even seemingly to overlap each other, but it appeared we had done the talking but not the walking.
One and a half years since President Jokowi issued Presidential Decree No 72/2021, the movement to accelerate the reduction of the stunting has been concentrated more on administrative matters. The movement has failed to go beyond promulgation efforts. The stunting problem is associated with consuming behavior and food intake and those are found in the households and society, not in the meeting room.
The presidential decree has actually given not only hope but great optimism in the reduction of the stunting problems. The No 72/2021 decree, among other things, focuses on handling stunting in the households and the community alike. This can be seen from the formation of the Household Assisting Team consisting of midwives, village/subdistrict cadres and family planning cadres.
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> Challenges in Dealing with Stunting in NTT
These three neighborhood elements are assigned to accompany families with stunted infants and those with who are at risk of having stunted infants. The main targets are young brides and grooms, pregnant women and children under five.
Therefore, let's implement the programs without delay. Let’s make sure the young brides and grooms and pregnant women don't have anemia, for example.
Let’s make sure expecting mothers check their pregnancy regularly and we cater to those, especially infants and toddlers, who need extra nutrients.
This can be realized through fully committed efforts and support from stakeholders, especially the local government. Accelerating the reduction of stunting must be seen as priority endeavors at all costs, including budget support.
Let’s make the stunting issue the nutritional mainstreaming of development, which has long been administered by the World Bank, especially for poor and developing countries. Otherwise, we may deservedly suspect the “quo vadis” situation embroiling an accelerated reduction movement in stunting.
Albiner Siagian
Albiner Siagian, A professor in Nutrition at the Public Health School, North Sumatra University (USU) and Chancellor of the Tarutung State Christian Institute (IAKN)
This article was translated by Musthofid.
