Collaborative efforts are key to reducing stunting in Indonesia, as the COVID-19 pandemic may worsen the already high prevalence of stunted children, experts have warned.
Endang Laksminingsih, a professor at the University of Indonesia’s School of Public Health, said the involvement of all stakeholders was necessary given the multiple factors that caused stunting.
“Indonesia should prioritize programs based on evidence and [stunting] pathways above all, which consist of inadequate daily intake and infection,” Endang said in her presentation for The Jakarta Post’s Jakpost Up Close webinar, “Putting children first: Policy development in reducing stunting in Indonesia”.
The webinar was held in a partnership between the Tanoto Foundation and The Jakarta Post Foundation to mark National Children’s Day, which falls on July 23.
In order to reach the same goal, she called for a national directive with clear division of authority at all levels, as well as a similar framework and evaluation-monitoring system.
With the United Nations International Children's Emergency Fund (UNICEF) estimating that Indonesia could see 4 million births in the nine months since the COVID-19 pandemic began -- as social restrictions keep couples at home -- fears of potential stunting have increased.
Globally, the number of malnourished children under the age of 5 is predicted to increase by about 15 percent this year as a result of the pandemic, if no swift response efforts are made, according to UNICEF.
In Indonesia, the situation is likely to be exacerbated, with Statistics Indonesia (BPS) recently saying that about 1.63 million Indonesians fell into poverty between September 2019 and March this year. The number of poor households is expected to further rise because of the pandemic, which still shows no signs of abating.
World Bank senior social development specialist Samuel Thomas Clark said the pandemic could pose a threat to stunting-reduction efforts, as parents struggle with loss of income.
He said state-sponsored social aid could help families financially impacted by the pandemic, but attempts to reduce stunting would lose ground without a wider intervention from the government and the participation of all stakeholders. He cited examples of efforts made in Peru, a country that achieved a 15 percent stunting prevalence rate decline in eight years.
“Peru has put stunting [eradication] as a national priority. [...] The country has multisectoral convergence nutrition programs and allocated funding only to programs deemed effective,” Clark said. "The government also promotes behavioral change communication to people of all walks of life, including parents, local figures, regional leaders, even chefs, to understand the importance of this issue."
Better comprehension of stunting and preventive measures should be applicable at the grassroots level, particularly in poor households, the group most susceptible to major health problems, said Fasli Jalal, professor of public health and rector at YARSI University. Hence, the government needed to scale up Posyandu (community health posts), he suggested.
“Posyandu workers were once touted as heroes, but the trend is now changing. Each region should have been able to find a suitable formula to revitalize the Posyandu,” Fasli said.
Despite the country having reduced the stunting prevalence in children under 5 years old from 37.2 percent in 2013 to 27.7 percent last year, the rate remains high as more than a quarter of Indonesian children are stunted.
Furthermore, President Joko “Jokowi” Widodo has set a rather ambitious target to reduce the rate to 14 percent by 2024.
“We need to work hard and all stakeholders must participate,” Fasli said, urging municipalities and regencies to cooperate with universities in stunting-reduction programs.
Eddy Henry, the head of early childhood education and development at the Tanoto Foundation, an organization that is involved in programs aimed at improving life quality among communities, suggested private stakeholders also join the cause. The foundation recently started its #BulanPeduliStunting (stunting care month) campaign.
Eddy said that the private sector could contribute to stunting reduction by conducting stunting-related studies to support evidence-based policies, providing funding, helping with the implementation at the grass roots and facilitating collaboration with various sectors.
The government has already put stunting reduction at the top of the country's agenda but flaws remain during implementation, said Bambang Widianto from the National Team for Accelerated Poverty Reduction (TPN2K).
He said that 18 government institutions had allocated nearly Rp 30 trillion (US$2.05 billion) for stunting reduction last year.
“In terms of budget and human resources, we have it. But the biggest challenge is how to reach ‘convergence’ [among institutions and regional governments],” Bambang said. “The fact is, regional administrations cannot handle it alone. Therefore, we need help from many stakeholders.”
Bambang said the pandemic had indeed hampered the government’s efforts at reducing stunting but the government was determined to continue them.
“Posyandu have gradually reopened with health protocols, but still obstacles remain for certain services,” he added.