Early Successes in Indonesia's Fight Against Stunting
Jakarta’s skyscrapers, high-end shopping malls and expensive restaurants signal a country on the rise, with an increasingly large and affluent middle class and exciting prospects for Indonesia’s future growth. But just half a day’s journey away, young mothers with infants in Nusa Tenggara Timur province were recently waiting at a supplementary feeding center to free receive fortified foods and micronutrients.
At first, some of these mothers and infants appear relatively healthy—but in reality, they suffer from micronutrient deficiency. It’s a widespread problem: About 7 million infants and children, or about one-third of all Indonesian children under 5 years old, have experienced stunted growth. And stunting can have a major impact on the rest of their lives.
A lack of vitamin A, iron, zinc, and other nutrients during early childhood puts children at higher risk of experiencing chronic disease, delayed cognitive development, delayed enrollment in school, and reductions in academic achievement and future earnings.
The $131.5 million Community-Based Health and Nutrition to Reduce Stunting Project—part of the Millennium Challenge Corporation’s five-year, $600 million compact with Indonesia— aims to reduce and prevent low birth weight and childhood stunting and malnourishment of children in project areas, and to increase household income through cost savings, productivity growth and higher lifetime earnings. The project will target about 7,000 villages in provinces where rates of stunting and low birth weight in infants and children up to 2 years old are higher than national averages.
And as implementation of this project begins, it is already having an important effect in Indonesia.
“Nutrition has been a development issue in Indonesia since 1967, but it was not until new evidence emerged about the impact that stunting could have on economic growth that our focus shifted to tackling this epidemic,” said Nina Sardjunani, Indonesia’s deputy minister for development planning. “The physiological connections between diet and physical development have been known for a long time, but we are making the point that a child’s health will impact their skills development, their productivity and income, and ultimately the economic growth potential of the country.
“This is why nutrition, and stunting in particular, is a critical development issue for Indonesia.”
A new approach to tackle stunting
With MCC support, the Government of Indonesia is piloting a multi-dimensional approach, founded on the latest evidence about the most effective nutritional and sanitation interventions, to address stunting. MCC’s Community-Based Health and Nutrition to Reduce Stunting Project aims to improve both awareness about feeding practices and prevention of illness as well as access to proper nutrition and healthcare services.
One of the aims of Indonesia’s decentralization push was to bring the delivery of social services closer to the communities where they were most needed, but not all local governments empowered to implement this delivery had the capacity to do so effectively. The Government of Indonesia is tackling the problem of local government capacity through training of health and sanitation service providers and a complementary stunting-focused communications campaign, but it is recognized that making services available will not be enough to solve health problems like stunting. There must also be an understanding of the need within communities themselves and a willingness to demand these services from their governments.
Encouraging this demand requires a level of community organization and empowerment, as well as a demonstration of trust in the communities’ own decision-making abilities. The project will combine community education to improve awareness and deliver a variety of tools needed to improve access; it will also work with the private sector to provide a long-term, sustainable solution to the underlying causes of this problem, which are known to include a lack of proper nutrients in food and a lack of access or improper use of supplements during pregnancy and in the first two years of a child’s life.
Part of a USG—and worldwide—movement
Through initiatives like Feed the Future and the 1,000 Days partnership, the U.S. Government is promoting the cost-effectiveness of investing in maternal and child nutrition from conception to a child’s second birthday. It engages the private sector, NGOs and civil society to partner and invest in efforts to improve maternal and child nutrition and build collaboration and partnership across sectors.
Former Secretary of State Hillary Rodham Clinton lauded this approach when she signed the MCC compact with Indonesia in 2011. In her speech at the event in Bali, she drew the connection between the MCC-funded nutrition project in Indonesia and the multi-lateral Scaling Up Nutrition (SUN) movement, the latter of which “helps countries target under nutrition more effectively and reach more people by coordinating investments, resources and programs.”
Today, Indonesia is a leader within the SUN movement, and Sardjunani has been appointed by United Nations Secretary-General Ban Ki-moon to represent Indonesia as a member of the multilateral SUN Lead Group.
And what did Indonesia choose for its SUN flagship project? MCC’s Community-Based Health and Nutrition to Reduce Stunting Project.
“Now that we are a lower middle income country, Indonesia needs to start sharing information with the rest of the world,” Sardjunani said. “Our challenge is not only to be accountable to the U.S. Government as our development partner, but for us to prove that these interventions are effective and then share that knowledge.
“Let’s prove to the beneficiaries that we can deliver on our promises to them. We are really accountable to them, and we believe this will make a real difference in their lives.”