Speaking with families in the village of Serdang Kulon in October I got a sense of the momentous change currently underway to ensure children across Indonesia get every chance for a healthy and prosperous life. Stunting, caused by undernutrition and frequent infections early in life, has been a persistent issue across the archipelago for decades, but better coordinated action across all levels of government is now supporting families so the first 1000 days of their children’s lives provides the foundation for a brighter future to build Indonesia’s human capital and productivity.
The Indonesian government deserves praise for their leadership and commitment to addressing this issue. Under a 2021 presidential regulation, the National Strategy to Accelerate Stunting Prevention was enshrined into law. The strategy commits 23 ministries and an estimated $3.9 billion per year to coordinating nutrition interventions that address the many underlying causes of stunting. Since the package of activities under the strategy was introduced in 2017, roughly 3.9 million mothers and 10.6 million children under the age of 2 have benefitted across more than 75,000 villages. Between 2018 and 2021 the national stunting rate saw an unprecedented decline, from 30.8% to 24.4%.
A formula to reduce stunting
Indonesia’s efforts to reduce childhood stunting follow closely that of Peru, Senegal, Thailand and Brazil among others, all of which have dramatically reduced stunting rates to below 20%, and some even below 15%. These countries have followed a similar formula: engage the highest level of office to provide leadership and oversight; coordinate the response across ministries and levels of government to deliver a harmonized response to a complex problem; reprioritize public financing to target the communities and families most in need; and ensure there are strong monitoring and data systems to promote continuous adaptation and accountability. With many pieces of this puzzle now coming together, Indonesia’s ambition is to reach a stunting rate of 14% by 2024.
One key element that has been driving the change is the commitment and action from all levels of government – from national to village level – to coordinate and target key activities in health, family planning, community nutrition, early childhood education, water and sanitation, and social assistance to the same households as a complete package of services. More than 73,000 human development workers provide frontline support to these coordination efforts and ensure that the right package of services reaches the right households at the right time. This strengthens primary healthcare through the integration of services and builds system resilience.
In Tangerang District I saw these efforts in person. I was impressed by the way in which the community joined together with support from the district and village government. Families said they were attending the posyandu (village-level) services regularly and were receiving support that encouraged ongoing participation. I also had the opportunity to visit a puskemas (district health center) to see the improved nutrition counselling services for pregnant women and mothers of young children as well as the increased availability of micronutrient supplementation and adolescent health services.
The World Bank is a committed partner in this transformational effort through the Investing in Nutrition and Early Years program, which engages leaders at the national, district and village levels to plan, implement and then monitor evidence-based initiatives to improve the nutrition of people in their communities.
Making progress after COVID
Despite important progress in Indonesia, much remains to be done. Setbacks due to the COVID-19 pandemic have disrupted service availability, particularly at the village level, and can threaten Indonesia’s progress in reducing its stunting rate. Moreover, while the current stunting rate represents a 6% drop in just four years, it is still high and is one reason why Indonesia’s Human Capital Index, which quantiﬁes the contribution of health and education to the productivity of the next generation of workers, is below the average for countries in the East Asia and Pacific region.
Going forward, it is crucial that the collaboration between national government and community that I witnessed in Tangerang District continues so the right resources continue to flow to the right beneficiaries and the quality of services being provided continues to get better. The country’s ambitious national targets can only be achieved through further replication across all of Indonesia’s 514 districts now that the program has been scaled up nationwide. Further attention will be needed to make sure the reductions in stunting are resilient to the lingering impacts of the pandemic, rising global food insecurity and increase in the cost of living. Innovations to reach remote populations, integrate the use of modern technologies for the Posyandu 2.0 program, and increase data availability for the timely monitoring of progress are steps in this direction. Steering the right course will require more of the bold leadership and commitment I have witnessed during my visit. I am confident that this is possible and that it will be an important step so that Indonesia can reach high-income country status by 2045, one hundred years after independence.
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