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‘Kecil-kecil cabe rawit’, stunting and 1,000 days

The 2018 Riskesdas (Basic Health Survey) estimated that 31 percent of Indonesian children under 5 were destined to a life devastated by stunting.

Julia Suryakusuma (The Jakarta Post)
Jakarta
Thu, October 29, 2020

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‘Kecil-kecil cabe rawit’, stunting and 1,000 days

C

em>Cabe rawit (bird’s eye chili) are much smaller in size than regular chili peppers, but try chewing one, it could make you run to the nearest fire hydrant to douse the fire in your mouth! 

That is why in Indonesia kecil-kecil cabe rawit refers to someone who is small in stature, but who can pack a punch, whether in smarts, bravery or some other special ability, talent or character. Gandhi (1.64 m), Genghis Khan (1.55 m), Lady Gaga (1.55 m) and Kamala Harris (1.57 m) are examples of kecil-kecil cabe rawit people. In Indonesia, our third president, B.J. Habibie (1.62 m) was the shortest, but purportedly also the smartest.

Indonesia is not short of short people, unfortunately most do not belong to the kecil-kecil cabe rawit category who are small due to genetics, but because they are under-fives and they are stunted.

Stunting is caused not just by chronic malnutrition, repeated illness and infections and inadequate psychosocial stimulation, but also by the mother’s health during her pregnancy. Also, lack of access to basic services such as “basic immunization, breastfeeding, dietary diversity, drinking water and sanitation, early childhood education, food insecurity measurements where they live, and a birth certificate to make sure they are in the system”.  There has to be a convergence of these key services, and in Indonesia, it is low.

The effects of stunting are devastating for the individual child, the family, community and indeed the nation. It means not only that a child is short, but also that he or she will be a lightweight, in body mass, and even worse, it will permanently limit the child’s physical and cognitive capacity. The ramifications will be felt lifelong, in terms of health, education, employment and earnings, creating a vicious cycle of underdevelopment and poverty that created the stunting in the first place. Once stunting has occurred, it is irreversible.

In 2018, 13 million children under 5 were stunted and 4.5 million were wasted in East Asia and the Pacific. The 2018 Riskesdas (Basic Health Survey) estimated that 31 percent of Indonesian children under 5 were destined to a life devastated by stunting.

Wow! That is already a staggering number but in certain areas it is even higher. There are 10 areas identified as having the worst prevalence of stunting - East and North Nusa Tenggara, West Sulawesi, Gorontalo, Aceh, Central, South and West Kalimantan, and North and Central Sulawesi – up to 48 percent and possibly higher.

On Oct 12, I was again reminded of the seriousness of stunting when I followed a webinar called “Multisectoral Partnership for Stunting Reduction in Indonesia”, with speakers from the government, Roche Pharmaceuticals and the 1,000 Days Fund, an NGO with its headquarters in Jakarta. It was created in 2018 “as a bold approach to invent and test innovative, cost-effective solutions to help end stunting in Indonesia”.

Health Minister Terawan Agus Putranto gave a video address saying that in order to achieve the reduction of stunting to 14 percent in 2014, certain strategies needed to be adopted.

The other speakers elaborated on what the minister said, but what really caught my attention was the presentation by the 1,000 Days Fund. The webinar opened with a two-minute video (youtube.com/watch?v=tuZwSrb8THc&t=3s) made by the 1,000 Days Fund on the smart charts that they use to measure the height of infants, which are also used as an educational tool. Zack Petersen, the lead strategist of the 1,000 Days Fund stated that “so far we have found that installing smart charts in homes has been the most cost-effective tool.” 

The name of the NGO is derived from “the first 1,000 days of an infant’s life - the time spanning roughly between conception and one’s second birthday - is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.” It is a narrow window of opportunity that if missed, is irreversible.

The 1,000 Days Fund works by partnering with local midwives and government-backed community healthcare centers to distribute information about nutrition during pregnancy and during the first 1,000 days of a child's life.  

It has also set up a Stunting Center of Excellence in East Nusa Tenggara (NTT), which serves as a centralized training hub, where selected midwives and public health officials are trained and equipped with evidence-based tools before returning to their hospitals and health facilities to act as surrogate instructors, distributing knowledge, tools and technology directly to village health volunteers and their community.

Reading up on stunting in Indonesia, I was shocked to see the figures. In the late 1970s I worked in a community development NGO, which was also involved in nutrition for under-fives.  In forty years, the situation is still that bad?

Now with COVID-19 and the baby boom resulting from people staying at home with no access to contraceptives, it’s a disaster not simply waiting to happen, it is happening already.  No wonder stunting has been called “Indonesia’s least-known health catastrophe”.

A friend of mine who has also worked on stunting programs in the past says she blames the big funding agencies for wasting so much money as they merely care about how their portfolio appears and do not really care about the quality of the program and the situation in the field. She also feels that despite the government’s good intentions, the weak link is with government agencies. Jokingly she said, “If I had Rp 10,000 for every time I have had to hear ‘convergence’ and ‘multisectoral’ we would have saved 1 million kids from stunting”. Is she being harsh? Well, why has the situation still not improved then?

On the other hand, the 1,000 Days Fund, which works in the field, has achieved a lot. When it started it reached four islands, four integrated health services posts (Posyandu) and one community health center (Puskesmas), had trained 20 community-based health workers, distributed 158 smart charts and reached 158 children and women by its trained heath workers.

After two years it has reached 28 islands, 618 Posyandu and 114 Puskesmas, trained 2,500 health workers, distributed 43,000 smart charts and reached 62,000 mothers and children.

In Labuan Bajo, Flores, Zack claims that in two years they have reduced stunting by 9 percent. But he quickly adds, “For me it's not about the numbers, it's about the moms who now know how important the first 1,000 days of life are for the happiness and wellbeing of their child [...] we do everything not to see people as statistics.”

So dear readers, how about a little crowd funding to help prevent Indonesian kids from stunting? A little goes a long way. You would also be contributing to their future and to the future of the nation. Now that is big, way bigger than cabe rawit!

Please donate to 100 days fund. https://1,000daysfund.give.asia/campaign/10-000-height-charts-for-national-children-s-day#/

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The writer is the author of Julia’s Jihad

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