Scaling up child wasting prevention and treatment in the context of stunting prevention in Indonesia
This is a summary of a Field Exchange field article that was included in issue 67. The original article was authored by Blandina Rosalina Bait, Angela Kimani, David Colozza, Julia Suryantan, Dhian Probhoyekti, Pungkas Bahjuri Ali, Sidayu Ariteja, Nurul Azma Ahmad Tarmizi, Evi Fatimah, Yuni Zahraini and Jee Hyun Rah.
Blandina Rosalina Bait works for UNICEF, Jakarta, Indonesia.
Angela Kimani is a Food Systems and Nutrition Consultant at OptimAdept Consult.
David Colozza works for UNICEF, Jakarta, Indonesia.
Julia Suryantan works for UNICEF, Jakarta, Indonesia.
Dhian Probhoyekti works at the Ministry of Health, Government of Indonesia.
Pungkas Bahjuri Ali works at the Ministry of Health, Government of Indonesia.
Sidayu Ariteja works at the Ministry of National Development Planning, Government of Indonesia.
Nurul Azma Ahmad Tarmizi works at the Ministry of National Development Planning, Government of Indonesia.
Evi Fatimah works at the Ministry of Health, Government of Indonesia.
Yuni Zahraini works at the Ministry of Health, Government of Indonesia.
Jee Hyun Rah works for UNICEF, Jakarta, Indonesia
Indonesia provides a successful example of how child wasting and stunting can be addressed together through large-scale programmes that deliver essential nutrition actions.
- The Government of Indonesia successfully leveraged political momentum to accelerate child stunting reduction to simultaneously tackle child wasting.
- Under the National Strategy to Accelerate Stunting Prevention, the Government of Indonesia scaled up an essential package of nutrition-specific and nutrition-sensitive interventions, strengthened national and subnational capacity to deliver essential nutrition services and enhanced intersectoral collaboration.
- Continued efforts are needed to scale up stunting prevention measures that also directly contribute to preventing child wasting.
Background
Despite progress in reducing malnutrition in Indonesia, the challenge of undernutrition in children under five years of age remains. The Government of Indonesia (GoI) has committed to tackling stunting and wasting together and aims to reduce the prevalence of stunting to 14% and wasting to 7% by 2024. The GoI's strategy is outlined in their 2017 National Strategy to Accelerate Stunting Prevention which includes plans to scale up child wasting prevention and treatment. The GoI has set a goal of providing treatment to 90% of severely wasted children and having at least 60% of primary healthcare centres providing integrated management of acute malnutrition (IMAM) services by 2024.
The National Stunting Prevention programme
Under the 2017 National Strategy to Accelerate Stunting Prevention, the GoI established a nationwide stunting prevention programme. Following the programme's launch, the GoI solidified its commitment to scaling up action against stunting by leveraging multiple funding sources to support the programme at all levels. The stunting reduction programme is multi-sectoral involving stakeholders across sectors at both national and sub-national levels with different coordination structures and focuses for each. The programme targets interventions between conception and the child's second birthday, including pregnant and lactating women and adolescent girls.
At the national level, efforts are focused on delivering a set of evidence-based nutrition-specific and nutrition-sensitive interventions with high coverage and quality. At the sub-national level, intensive efforts are being made to support programme convergence through strengthening multi-sector coordination and the capacity of local government authorities, healthcare and non-healthcare workers and frontline workers.
Addressing child wasting in the context of the stunting reduction programme
A set of evidence-based nutrition-specific and nutrition-sensitive interventions was selected to be scaled up across the country to support the national stunting prevention programme. Specifically, the prevention and treatment of moderate and severe child wasting were included as two of the eight critical nutrition-specific interventions prioritised. The nutrition-sensitive interventions included various areas such as home food gardening and improvements in water and sanitation services.
Accordingly, the GoI scaled up the IMAM programme across all 514 districts in 34 provinces. To facilitate the scale-up, the Ministry of Health, with support from UNICEF, developed and disseminated national IMAM guidelines and an accompanying training curriculum (adapted in light of the COVID-19 pandemic). IMAM services were also integrated into health systems, including community screening in all provinces and integrating screening and treatment data into the national health and nutrition information system. Furthermore, since 2019, the GoI and UNICEF have been working to support the local production of ready-to-use therapeutic food (RUTF) in collaboration with the Scaling Up Nutrition (SUN) Business Network. An acceptability and efficacy study of local RUTF recipes was conducted through this partnership and completed in December 2021.
Successes, challenges and lessons learned
Successes
National level
- An enabling environment for implementing joint child stunting and wasting programmes has been created through changes at policy level.
- There is substantial support from the national level to sub-national authorities in designing interventions for stunting reduction that also include the management of wasting.
- Addressing child stunting and wasting together has been supported by the integration of IMAM services into the existing health system and improvements to national nutrition data management systems.
- In 2021, the GoI, with support from UNICEF and other United Nations agencies, developed and endorsed the Global Action Plan on Child Wasting and an Operational Roadmap. Given the strong inter-linkages between child wasting and stunting, the roadmap is also expected to contribute to the reduction of child stunting in Indonesia.
Sub-national level
- There has been increased capacity of sub-national government authorities to implement and monitor the national stunting reduction acceleration programme and the adaptations made for their local context.
- There have been increased commitments from other government institutions and community health systems in supporting stunting and wasting interventions.
- The village authority's capacity has been strengthened so it can play a leading role in prevention activities at the village level.
- At the village level, village stakeholders such as village authorities, community health volunteers and women's empowerment organisations conduct mapping activities and develop joint work plans and budgets based on the identified causes of stunting and wasting in their specific villages.
- Advocacy efforts led to the GoI substantially increasing the budget allocations for stunting and wasting treatment and prevention. As of 2021, 19 government ministries and institutions have committed a total budget allocation of approximately USD2.5 billion for nutrition-sensitive and nutrition-specific interventions and coordination.
Challenges
- Scaling up IMAM in a highly decentralised and culturally diverse country and ensuring that authorities at multiple sub-national levels of government can address both stunting and wasting remains a key challenge.
- Data management issues persist, particularly ensuring sufficient resources to enable quality data management.
- Health facilities need to be further strengthened to fully integrate IMAM services, including community mobilisation, local RUTF availability and monitoring and evaluation.
- Substantial gaps remain in integrating and upscaling nutrition-sensitive interventions including home food production, water and sanitation and social protection.
- There is a need for more stakeholders to become involved in implementing child wasting services.
- Challenges have been exacerbated by disruption to nutrition services and a reduction in the budget of wasting programmes due to the COVID-19 pandemic.
Conclusion
Indonesia provides a successful example of how child wasting and stunting can be addressed together through large-scale programmes that deliver essential nutrition actions including:
- Continued advocacy for sustained political commitment to, and awareness of, addressing child stunting and wasting together at all levels.
- Strengthening IMAM services for the early detection, referral and treatment of children with wasting.
- Prioritising local production of RUTF to improve the supply and affordability of nutrition commodities.
- Strengthening the coordination of nutrition-specific and nutrition-sensitive interventions (and inter-sectoral collaboration) related to the prevention of wasting and stunting.
- Improving the data management capacity of sub-national teams so that there is quality data to track progress and inform decisions.
The national strategy to accelerate stunting prevention outlines the interventions that can be undertaken to prevent stunting. However, continued efforts are needed to scale up those stunting prevention measures that also directly contribute to preventing child wasting.
For more information, please contact Blandina Rosalina Bait at bbait@unicef.org