The Jakarta Post
Despite Indonesia's economic growth over the past several years, malnutrition issues, especially stunting, remain major concerns, which, unless they are resolved, will affect future generations. Collaborative efforts involving the private sector are urgently required to solve the issue.
Indonesia has maintained its high economic growth rates in recent years. While its growth rate reflects an achievement that deserves praise, there is a fundamental issue that the country must address seriously: malnutrition.
In a recently published Global Nutrition Report 2014, Indonesia is listed among 17 countries with the three most problematic nutritional issues, namely stunting, wasting and obesity in children under five.
A tough job, however, faces the government in its efforts to reduce stunting.
Minister of Health Nila Moeloek disclosed during the recent National Congress of Persagi (the Indonesian Nutritionist Association) that based on Basic Health Research in 2013, there were 8.8 million under-five children suffering stunted growth.
'Unless addressed immediately, the stunting problem will become a burden on the country's development, particularly during the demographic bonus period in 2020-2030. The development will lose its meaning if Indonesian human resources are not of good quality,' said Nila.
Furthermore, as quoted on the Ministry of Health website, Nila explained that according to some research, children with low birth weights and stunting have three times greater potential to suffer from heart disease and other degenerative diseases as well as a shorter life expectancy.
To improve the nutrition of the Indonesian people, the Indonesian government has been carrying out a program called 'Seribu Hari Untuk Negeri' (First 1,000 Days for the Country), which focus on providing better nutrition for human in their first 100 days in early life.
The program starts from the first day of fetus life inside the womb until the child is two years old. A person's nutrition intake in the first 1,000 days of their life greatly effects their future growth, both physically and intellectually, the Health Ministry says.
Impact of chronic malnutrition
According to the World Food Program (WFP), stunting, caused by chronic malnutrition, is a growth failure in a child over time, resulting in a young child who is short for their age. But chronic malnutrition is not just about height. The less visible impacts of chronic malnutrition are much more devastating. It also permanently affects brain development, immunity and health.
On its website, the WFP states that stunted children are more likely to become ill and they have a higher risk of premature death. Their school performance is lower than that of their properly nourished counterparts, including completing fewer grades thereby lowering their income-earning potential later on.
Stunting is the direct result of a gap between nutrient need and nutrient intake during the first 1,000 days of a child's life, from conception until two years of age, which is a period of rapid growth and development.
Scaling up nutrition
With Indonesia's economic growth surging, the government has begun to recognize the investment that is represented by ensuring every child in the country reaches his or her full potential.
In 2010, the government announced its commitment to the Scaling Up Nutrition (SUN) project, a global movement that pushes for action on maternal and child nutrition. The Ministry of Health claims that it allocates Rp 700 billion ($77.7 million) annually to combat child malnutrition.
The government has committed to reducing the prevalence of stunting among children aged under five years by 5 percent and reducing the prevalence of underweight children to less than 15 percent. The UN in Indonesia has congratulated the government on its commitment to making nutrition a top priority, and stands by its efforts to scale up nutrition as a way of accelerating the nation's long-term development goals.
'Malnutrition is a multifactorial problem linked to poor diet and hygiene practices, childhood infections and inadequate care. It is also closely associated with poverty and deprivation and addressing this requires a coordinated multi-sectoral approach' said Nina Sarjunani, the deputy minister for human resources, development and culture at State Planning Agency BAPPENAS, that lead SUN implementation plan in Indonesia.
Global support has been given to combat malnutrition issues in many countries. The WFP, for instance, is a firm supporter and an integral part of the SUN Movement, which supports national governments in efforts to scale up nutrition through country-led national plans and multi-sectoral partnerships.
The respective government is expected to address the issue of micronutrient deficiencies that include treatment of moderate and acute malnutrition for children aged 6-59 months and pregnant and lactating women; prevention of acute malnutrition for children aged 6-23 months and pregnant and lactating women; prevention of stunting targeting children aged 6-23 months and adolescent girls and treatment and prevention of micronutrient deficiencies targeting children aged 6-59 months.
Against child hunger (REACH)
Established by the United Nations Food and Agriculture Organization (FAO), the WHO, UNICEF and the WFP, REACH supports the SUN initiative by assisting governments of countries with a high burden of child and maternal under-nutrition to accelerate the scale-up of food and nutrition action.
Jose Graziano da Silva, director general of the FAO, said that global problems needed global solutions, and that is part of the rationale behind the holding of a high-level intergovernmental international conference such as ICN2.
'Nutrition is and needs to be treated as a public issue, not a private one because of its global price tag of up to 5 percent of global income due to loss of productivity and health care, and a complexity that touches upon many different sectors,' he said.
'There is still much we can and should do to meet the food security, nutrition levels and sustainable development challenges we face,' he said.
The WFP and UNICEF and UNHCR have signed a memorandum of understanding on their respective roles and commitments on tackling malnutrition-related issues. The WFP is responsible for the treatment of moderate acute malnutrition (MAM) while UNICEF (or UNHCR) is responsible for the treatment of severe acute malnutrition (SAM)
Preventing chronic malnutrition
Malnutrition as well as frequent illness during this critical window of opportunity undermines child growth, with the effects of stunting being intergenerational. Poorly nourished women give birth to poorly nourished babies who are then more likely to become stunted. Girls who are stunted and later become pregnant are at an increased risk of giving birth to a small for gestational age and/or low birth weight baby.
In addition, pregnant women who were stunted as children run a greater risk of birth complications due to a narrower pelvis, a factor associated with maternal and newborn mortality.
New research on Indonesia related to nutrition has shown that $1 spent on nutrition could be worth $160 in the long term.
In a paper quoted by The Wall Street Journal recently, a team of economists commissioned by a think tank called the Copenhagen Consensus Center looked at where money could be invested in development to ensure the biggest impact.
'It finds that every dollar invested in better nutrition in Indonesia could yield benefits of $166. In the Philippines it is $153, followed by India at $134,' the paper said.
To determine the cost-benefit ratio, the economists compared how much it would cost to improve nutrition against the benefits healthy children could provide to a country's economy in the future, in the form of higher wages, for example.
Nutritional development programs include providing iron supplements and other vitamins to infants and pregnant women, nutritional education, treatment for severe malnutrition and additional food. 'The costs are based on a 2013 Lancet study on nutrition that reviews actual costs from development programs,' it said.
The estimated returns, say economists, are based on increases in wages accruing to non-stunted children, who have been proven to have higher cognitive skills and complete more education.
Rome Declaration on Nutrition
Indonesia, a UN member country, has accepted the Rome Declaration on Nutrition, which reaffirms:
1. The elimination of malnutrition is an imperative for health, ethical, political, social and economic reasons
2. Nutrition policies should promote a diversified, balanced and healthy diet at all stages of life
3. Coordinated action needs to be supported through cross-cutting and coherent policies, programs and initiatives
4. Food should not be used as an instrument for political or economic pressure;
5. Volatility of prices of food and agricultural commodities can negatively impact food security and nutrition;
6. Improvements in diet and nutrition require relevant legislative frameworks
7. Nutrition data and indicators need to be improved
8. Empowerment of consumers is necessary
9. National health systems should integrate nutrition
10. Special attention to women and empower women and girls
Given the importance of having stronger generations in the future, investment in nutrition under the development framework plays a crucial role in tackling malnutrition issues, particularly stunting.
With many pregnant women and breast-feeding mothers lacking highly required nutrition consumption levels, intensive efforts should be made to ensure that they consume sufficient nutrition, with the programs starting from period when the fetus is inside the womb.
However, given the complexity of malnutrition issues, the government cannot work alone in this regard. To solve the malnutrition problem effectively, the government needs to collaborate with other parties, including the private sector.
If all of the aforementioned points can be undertaken well, then this will not only reduce costs for health but also enhance people's productivity and constantly boost economic growth.
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