Contributing to the fight against stunting in Indonesia—raising awareness at the household level

Indonesia has emerged as a force to be reckoned with, growing to be the fourth most populous country in the world and more than halving poverty from the turn of the century until today. However, it is faced with rising income inequality, of which two-thirds is explained by inequality of opportunities[1].

The World Bank’s Human Capital Index shows that a child born in Indonesia today is likely to attain just 53 percent of the full value of human capital they could achieve if the child received the full set of health and education.[2]  In other words, the risks of attaining low health and education are high and the lack of both access to and investment in these services compound over time, making it harder for individuals to compete in a world of work that is changing.

A key component of low human capital is driven by the prevalence of stunting, defined as a child having a low height for its age. The condition of being stunted renders significant negative developmental and cognitive effects on a child and when roughly a third of Indonesian children – or about 8 million - are stunted, it is a national emergency.[3] The Government has recognized this issue and has launched a national stunting reduction strategy which the World Bank supports both through technical assistance and results-based financing. [4]

Initiatives to address stunting have been on the rise. Countless multi sectoral initiatives have been undertaken by ministries and agencies at all levels of government and civil society. We, two young World Bank staff, also wanted to take part, and not only through our ongoing work program.

In East Nusa Tenggara, a stunning tourism destination that is also home to the Komodo Dragon, the stunting rate stands at 43 percent – far above the national average. However, when you go and ask the villagers about stunting, they do not know about it.[5] It came to our realization that there is a need to support the government in raising awareness about stunting at the household level – the day-to-day people whose children may be stunted.  

We came across the FY19 Youth Innovation Fund (YIF)’s call for proposal and put forward an idea to collaborate with a local organization, the 1000 Days Fund to distribute Height Charts to villagers’ homes to discuss about stunting and measure their children.

We believe that innovation is not only about new technological tools, but also about simple tools delivered differently and especially adapted to the end users. The Height Chart – or as the locals in East Nusa Tenggara call it Poster – consists of height measurements for children between 9-24 months and practical ways to prevent stunting. It went through several design revisions by listening to and gathering inputs from mothers and health workers.

The project idea won the YIF Pitch Competition in December 2018 and received US$25,000 for implementation from January to June 2019. The project team installed the height charts in 159 homes in three island villages in East Nusa Tenggara Province. During installation, we conducted one-on-one counseling with caregivers (mostly mothers) on how to use the height chart to measure their children and on key behaviors to prevent stunting. In addition, 22 village health workers, locally known as kader and nakes, participated in workshops designed to improve their knowledge of stunting prevention and reduction, including the importance of the first thousand days care and child development[6]. Finally, to support continued uptake of knowledge and sustainability, the team met with village heads to motivate resource allocations for activities that encourage stunting prevention and reduction in the three villages.

After about six months of implementation, 65 percent of caregivers were able to define stunting and 48 percent were able to explain why stunting is important – major increase from a baseline of 4 percent. More importantly, 62 percent of caregivers said that having the height chart in the household led to positive behavioral changes. On the village health workers side, while at the baseline only 35 percent felt confident explaining key aspects of stunting and stunting prevention, this figure doubled to 73 percent. In addition, the continuous follow up and community level meetings convened by village heads and the project team, contributed to all three villages rendering additional budget allocations to finance activities aligned with the prevention and reduction of stunting.

At the end of the implementation period, the team found that ownership, ensuring village health workers took part in revising the height charts design, frequency, ensuring that key messages are reiterated through monthly visits, broadening access, that is including both fathers and mothers in installation and explanation of the height chart, were key principles that foment success in raising awareness and delivering change from the ground up in the fight against stunting.

While this initiative was just a small part of larger national effort to combat stunting, it has garnered attention sufficient to propel the intervention to more villages, spearheaded by the 1000 Days Fund and supported by the private sector as well as local governments.