Stunting Reduction Not Yet Centralized

KOMPAS/SAMUEL OKTORA

Sulis Pattimura, 10, a young girl from Latu village, Amalatu district, West Seram regency, Maluku, suffers from malnutrition. She was laid down by her mother Fatima Dano, 55, to the bed at the Masohi Regional General Hospital, Central Maluku Regency , Maluku, on Friday (21/12/2018). Her heart disease worsened the condition of Sulis\' body.

TANGERANG, KOMPAS – Efforts to reduce child stunting due to chronic undernutrition have not been centralized, while stakeholders are yet to cooperate in tackling the core problems of the condition. Consequently, stunting reduction has not had any significant impact. Systematic and measured reform involving all parties is necessary.

On the sidelines of the 2019 Working Meeting on Health on Wednesday (2/13/2019) in Serpong, Tangerang, Health Ministry public health director Doddy Izwardy said that many relevant parties, including regional administrations, had gained an adequate understanding of stunting. However, stunting prevention programs remained ineffective because of a lack of a convergence of individual programs.

“Convergence is the key to tackling stunting. This is the focus of our regional trainings. Regents and mayors must understand the localized causes of stunting. This is being prioritized to resolve the core problems and to focus budgeting,” Doddy said.

Specificity

Many factors can caused stunting, and thus requires the determination of specific causes and the correct measures in addressing each case. According to Doddy, studies show that stunting in Indonesia is primarily caused by poor socioeconomic status, premature births, poor maternal nutritional status, maternal age at childbirth and poor parental education. Poor sanitation, unclean drinking water and inadequate healthcare services may also contribute to stunting.

Regional administrations must be aware of the local causes of stunting in order to provide proper treatment and care. All regional work units must coordinate in a centralized manner to address the issue. “This will prove the commitment of regional administrations to prioritizing stunting [reduction]. Several regions have started adopting stunting as a priority issue,” said Doddy.

One such region is Banggai regency in Central Sulawesi. The region’s stunting rate has decreased from 35.6 percent in 2013 to 31.5 percent in 2018. The administration also has a focus program on stunting reduction for residents who have not reached marriageable age.

Banggai Health Agency head Anang S. Otoluwa said that the commitment of regional leadership was the key to success in stunting reduction. All stunting reduction initiatives were a priority.

One of its focus programs was the pre-reproduction posyandu (integrated health posts). These posyandu monitor the reproductive health of female patients from pre-marriage counseling to prenatal care, during childbirth and parental guidance. “Stunting prevention must begin in the upstream, with expectant mothers,” Anang said. The local administration also encouraged young married couples to delay having children. It explained the risks of young pregnancy to help couples understand the potential dangers.

It also held targeted outreach programs, such as through a WhatsApp group comprising 200 young and expectant mothers as well as experts to provide direct consultations on health and nutrition.

“We are working with religious affairs offices [KUA] to ensure that brides and grooms are ready for marriage and having children. We ensure that mothers-to-be have adequate nutritional intake so that they can give birth to healthy babies,” said Anang.

Budgeting

The central government said it would focus primarily on improving the quality of health and education programs to improve human resource quality. “The budgetary allocation remains the same, as it has enough room. We are focusing more on improving the quality of the programs,” Finance Minister Sri Mulyani Indrawati said on Wednesday following a limited Cabinet meeting at Merdeka Palace.

President Joko Widodo has shifted the focus of the national development program from infrastructure to human capital, particularly to improve health and education.

Sri Mulyani said that the budgetary allocation would be enough for the short term. What was necessary was to improve the quality and focus of technical programs under the relevant ministries. In health, such improvements would target basic healthcare services, such as at puskesmas (community health centers), and equal distribution of healthcare professionals. (TAN/PDS/LAS)