Stunting in Villages

Kompas/Wisnu Widiantoro

Some mothers accompanying their children that are being treated in the Indonesia Protestant Church hall in Papua, Agats, Asmat regency, Papua, Friday (19/1/2018). As many as 13 inpatient children patients that are suffering malnutrition have had to be moved to the emergency room of the Agats General Hospital to the Indonesian Protestant Church in Papua, Asmat regency, because the hospital was full.

The recent visit of World Bank President Jim Yong Kim highlighted the country’s efforts in reducing stunting in Indonesia. The government and the World Bank are cooperating to reduce stunting in children, especially among poor families in villages.

Malnutrition among Indonesian children has taken place far too long and has caused a sharp increase in childhood stunting. The number of children with inadequate height reached 36 percent in 2010, which increased to 37 percent in 2013. It dropped to 29 percent in 2014-2017. Despite the decline, the number of children with stunting remains high. Three out of 10 children have been found to be short for their age. The estimated total of children with stunting is 7 million.

Short children

In the 17th century, the Sultan of Yogyakarta ordered the people to comb the village for short children. Stunting at the time was considered a shortcut to the divine. Thus, the short men were tasked with walking ahead of the King to preach his divineness to the people.

Efforts to reduce stunting have been ongoing since the New Order. President Soeharto’s speeches at the House of Representatives in the 1980s on an increase of several centimeters in the average height of children often received big applause from the House.

However, childhood stunting received special attention only in the 2000s. Finally, stunting was declared as a major issue in 2017. The government has cooperated with local administrations to reduce stunting. However, the program was not particularly effective, and the figure even increased by 2 percent early this year.

KOMPAS/WISNU WIDIANTORO

President Joko “Jokowi” Widodo (second right, standing) and World Bank President Jim Yong Kim (third right, standing) visit the Posyandu Kenanga 2 integrated community health post at Tangkil 1 Elementary School, Tangkil Village, Caringin District, Bogor Regency, on Wednesday (4/7/2018). The President used the occasion to demonstrate the various efforts being undertaken to address childhood stunting in the country.

The program has apparently been unable to reach its target. The number of children with inadequate height was drawn from a survey, not from a census. National and regional prevalence was found, but it was impossible to locate those who had stunting. Without reliable data, the program’s implementation would deviate from its initial plan.

The stunting data was based on reports from posyandu (integrated community health post) and village midwives at subdistrict puskesmas (community health center). However, the reports were limited to short children that were encountered only during the Posyandu’s monthly activities or when they visited midwifes or puskesmas in the villages.

Indeed, comprehensive information must be obtained through a public census of all households. Unfortunately, this could not be implemented, because the census office was unable to handle the task alone. Questionnaires are deemed complex and costly, and require the involvement of village midwives or medical personnel to check the nutrition of each child in the field.

These technicalities are baseless. The Millennium Challenge Account Indonesia (MCA-Indonesia) has created stunting questionnaires and conducted a stunting census in 100 villages with the help of village midwives and other medical personnel. The census lasted two weeks across villages in Java and up to eight weeks in remote areas outside Java.

The census officials located the children with stunted growth, and then entered the information on Google Maps for public access.

Nutritional problems

It is well known that the causes of stunting are chronic poverty, unhealthy lifestyles and bad parenting. The children are often fed only leftovers. Acute and chronic childhood malnutrition were found in 32 provinces and 452 regencies.

The program for eliminating stunting in villages should be run in two stages: organize a database of patients’ addresses, and then carry out the program collaboratively.

KOMPAS/WISNU WIDIANTORO

Accompanied by a number of Cabinet ministers, President Joko “Jokowi” Widodo (left, foreground) and World Bank President Jim Yong Kim (second right, foreground) look at supplementary foods for pregnant women during their visit on Wednesday (4/7/2018) to Posyandu Kenanga 2, an integrated community health post, at Tangkil 1 State Elementary School in Tangkil village, Caringin district, Bogor regency, West Java.

The Villages, Disadvantaged Regions and Transmigration Ministry, together with Unicef, have experience in conducting a household census for the Community-Based Development Information System (SIPBM). Village counselors trained local activists to record socioeconomic data on the residents. As in a participatory approach, enumerators from within the village were tasked with verifying the data. The census was then discussed in a village meeting to ensure the data’s objectivity.

The field census conducted in these six districts could be extended to 74,954 other villages. A total of 40,000 village counselors, plus 40,000 social workers from the Social Affairs Ministry, can be assigned to record the nutrition data of the villagers for two to eight weeks.

The census’s scope would cover 67 million households, of which 22 million are classified as toddlers. A total of 164,000 village midwives and 800,000 village officials could help implement the stunting census. To reduce the Rp 80 billion needed to print the questionnaire, the questionnaire can be submitted through a mobile application that can be accessed through a smart phone or a computer with an internet connection. This method would eliminate the cost of inputting and processing data.

In fact, each time data is submitted, it should automatically include nutritional information and a recommended solution. The data, which should include names, addresses and the child’s nutritional status, can be uploaded to http://datstunt.kemendesa.go.id. The village counselors can use the database to help children with stunted growth in health, education and financial programs.

The program would involve a large number of workers, and each of them could be given health and smart cards.

Until June 2018, the government has distributed Rp 528 billion in village funds to 1,000 villages with stunting problems. The program absorbed 2,056,119 working days (HOK) and provided Rp 376 billion in total aid. Improving the income of families with stunted children is intended to enable them to obtain basic social welfare services. These are the problems that have been overcome in reducing stunting in villages so far.

Ivanovich Agusta, Rural Sociologist at Villages, Disadvantaged Regions and Transmigration Ministry