D

espite its initial successes, Indonesia continues to struggle with malnutrition in children under the age of five, partly due to a lack of appropriate nutrition counseling in the country.

Although it is seen as a key to promoting a healthy diet, nutritional counseling and advice receives minimal attention compared to other activities at integrated health posts (Posyandu).

“In most cases, nutrition counseling carried out in the community-based health posts doesn’t work well, although experts have long considered it as the most crucial stage of nutrition monitoring activities for children,” said Candra Wijaya, the health team leader at World Vision Indonesia (WVI) who also leads the organization’s nutrition counseling program for kids, known as PMBA.

Without proper counseling, growth monitoring efforts were unlikely to be sufficient in helping improve the nutritional status of children under the age of five, he said.

Under the PMBA program, pregnant women and mothers of toddlers under the age of two get counseling on proper nutrition. Candra said the education participants received was focused on the prevention of chronic malnutrition, which can lead to stunting in children.

“In the counseling, they learn how to prepare healthy dishes using local food resources taken from their own yards and gardens,” Candra said.

The program provides counseling in several of WVI’s working areas, such as Central Sulawesi, East Nusa Tenggara, Maluku, Papua, Southeast Sulawesi, Sumatra, West Kalimantan and West Sulawesi.

“The counseling is performed by health cadres in the form of house visits, peer group discussions and counseling at the Posyandu,” Candra said, adding that the program also trained healthcare workers on nutrition counseling.

This specific type of education and advice is the fourth of five steps in child nutrition monitoring activities delivered at local Posyandu. Other steps are registration, weighing and measuring the baby, filling in health records and performing basic healthcare services such as immunizations.

First initiated in 1986, Posyandu aims to promote the health and wellbeing of children by monitoring their growth and development.

Based on the work of unpaid volunteers, the Posyandu system has been praised for playing a crucial role in reducing the proportion of malnourished children under the age of five to 17.9 percent in 2010. To meet Millennium Development Goals (MDGs) targets, the figure should further decline to 15.5 percent by 2015.

“We have managed to prevent a worsening of malnourishment among children under five years old partly thanks to the volunteers, mostly housewives, who have focused relentlessly on providing childcare services in the Posyandu,” said Health Minister Nafsiah Mboi.

Around 14 million or 71 percent of the country’s children under the age of five visit the Posyandu every month, she said, citing the ministry’s latest data.

Yosellina, a maternal and child health specialist at WVI, said providing advice on follow-up needed to improve a child’s nutrition remained a difficult task for many Posyandu volunteers throughout the country, and that the opportunity to prevent chronic malnutrition only occurred within the first two years of a child’s life. That was why, she continued, the helped train Posyandu volunteers as well as parents.