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Jakarta Post

The next Indonesian government should focus on reducing stunting

  • Widjajanti Isdijoso Suharyo and Nils Grede

    The Jakarta Post

Jakarta   /   Mon, October 20, 2014   /  10:24 am

With the imminent change in the national leadership, 2014 is in many ways a watershed year for Indonesia, the world'€™s fourth-largest nation and its third largest democracy.

The year 2014 also marks the gradual introduction of universal health care and an expected decrease in the number of people living below the poverty line to 11 percent of the people.

However, other statistics are worrisome. Eight million Indonesian children under five grow up stunted and maternal mortality is still high at 359 per 100,000 live births, far behind Indonesia'€™s MDG (millennium development goal) target of 102. This puts Indonesia far behind much poorer Asian nations such as India, Pakistan and Cambodia as well as many African nations.

While Indonesia according to its constitution spends 20 percent of its budget on education, much fewer funds go toward three areas that are as critical for development: health, food and nutrition security and social protection.

Despite the roll-out of Universal Health Care (UHC) for 86.4 million of the nation'€™s poor, the 1 percent of Gross Domestic Product (GDP) invested in health remains one of the lowest in the world, on par with poorer neighboring countries such as Laos, Cambodia and the Philippines, but behind Malaysia and Brunei with 2 percent, and Vietnam and Thailand, both with 3 percent.

Overall Indonesia only spends about 1 percent of GDP on social safety nets, much less than other middle income countries, but what is more surprising is that three times as much goes to fuel and agricultural subsidies.

Fuel subsidies, however, have been shown to benefit largely the wealthy and the middle class. 35 percent of the fuel subsidies benefit the top 10 percent income earners in Indonesia. So it does not come as a surprise that inequity has risen sharply in Indonesia in recent years with the GINI coefficient going from 0.31 in 1999 to 0.41 in 2012 (a higher number means less equitable distribution of wealth).

Limited investments in these areas have contributed too little to curbing Indonesia'€™s stunting problem. Stunted growth, i.e. the failure of a child to reach their full growth potential, reflects chronic malnutrition, which is a function of multiple factors including access to nutritious food and to quality health services.

As we now know from one of the world'€™s most renowned medical journal, the Lancet, the first 1,000 days of life from pregnancy to the age of two constitute a window of opportunity that determine whether children will grow up stunted or not.

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Indonesia needs to reinforce accountability and strengthen governance for food and nutrition matters.


Failing to use this window of opportunity means that stunting will have an irreversible impact on Indonesia'€™s development path with tremendous consequences for human capital formation.

First, nearly half of global child mortality has been attributed to malnutrition. So, stunting kills.

Second, due to suboptimal cognitive capacities, stunted children achieve less in school, drop out earlier and have lower paying jobs.

Third, they also pass stunting on to the next generation, as stunted mothers give birth to low birthweight babies.

It is important to realize that investments in food security and nutrition are complements to investments in education.

Without health and proper nutrition, the returns to investments in schooling are suboptimal. A 2013 study published by the International Food Policy Research Institute (IFPRI) '€” a renowned research centre on food policy '€” makes a strong economic argument to invest in stunting reduction.

The study looks at 17 high burden countries, Indonesia among them, and finds that for every dollar Indonesia invests today in measures to prevent stunting, it can expect a payback of US$48. So there is a huge opportunity here for the next administration to put all its efforts into ensuring the next generation does not grow up stunted.

First, Indonesia needs to reallocate its budgetary priorities if it wants to reverse the trend toward rising inequity where the bottom of the wealth pyramid gets trapped in poverty.

Less fuel subsidies, more health, food and nutrition security and pro-poor social safety nets.

Second, it needs to help Indonesians improve their diets by moving beyond just rice, Indonesia'€™s favorite staple food, which however is poor in nutrients.

Indonesia can do so in two main ways: 1) by working toward changing mindsets on nutrition; and 2) by reforming existing programs such as rice for the poor which are not yet optimally targeted and efficient.

For changing mindsets, there are children who grow up in households with plenty of purchasing power, but where parents do not yet make the right, informed decisions, which are optimal for their child'€™s nutrition. Public awareness campaigns need to be expanded and some of the existing safety nets can be used as platform to improve knowledge and change behaviors.

Schools could also be leveraged as platforms to educate about healthy nutrition including. hygiene. Healthy school meals could be used as a way to reinforce teaching with concrete action.

As for the safety nets, many of these were designed many years ago and their objectives and mechanisms are not aligned with the overall goal of reducing stunting.

For example, the rice-for-the poor program (Raskin), which reaches over 15 million poor or near poor households every year with subsidized rice, was created after the Asian financial crisis, long before there was any awareness what the true cost of stunting for an economy is and how '€” more importantly '€” it can best be addressed.

Third, Indonesia needs to reinforce accountability and strengthen governance for food and nutrition matters.

Decentralization is important, but is also a challenging process as in many areas we have seen how it strengthens local input and decision-making, but also at times can become an obstacle to implement national policies.

A new ministry or agency for food and nutrition security would have to focus on bringing together actors from the agriculture, fisheries, health and poverty reduction areas in order to elaborate a master plan of how to get serious about reducing stunting and it would have to have the budgets and authority to be able to do so with '€œcarrots and sticks'€.

Lastly, the government cannot do it alone. One out of four children grows up stunted even among the top wealth quintile. This means that behaviors need to change including among those who have purchasing power and could afford adequate diets.

Studies show that properly formulated, age specific food is often not widely available or affordable and at times it lacks some critical nutrients. In this area, the government needs to rely more on the private sector to do its part.

The new president has his work cut out. It is important to remember that coping with stunting would unleash the dormant potential of Indonesia'€™s human capital and accelerate Indonesia'€™s growth.

As renowned economists have shown, investing more money and effort now in reducing stunting, will have a very handsome payoff in the not too distant future. It is not a cost to the economy; it is an investment into Indonesia'€™s future.

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Widjajanti Isdijoso Suharyo is deputy director for research and outreach at Smeru. Nils Grede is deputy country director at World Food Programme Indonesia.

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