MINISTRY OF NATIONAL DEVELOPMENT PLANNING/NATIONAL DEVELOPMENT PLANNING AGENCY (BAPPENAS)

SCALING UP NUTRITION (SUN) MOVEMENT IN INDONESIA

Brussels, January 8, 2014

NINA SARDJUNANIDeputy Minister for Human Resources and Cultural Affairs,

Ministry of National Development Planning/BAPPENAS

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I. Malnutrition in Indonesia: status, causes and concerns

II. Towards scaling up nutrition in Indonesia

III. Monitoring and evaluation

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OUTLINE

Malnutrition in Indonesia status, causes and concerns

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Malnutrition in Indonesia is high compared to other countries in Southeast Asia

Indonesia’s Situation for number of malnourished children

Mill

ion

of

Ch

ildre

n

Prevalence data: RISKESDAS, 2013Population: Pusdation Projected Population, 2011

Stunting is an issue in every province

Prevalence of stunting

40+

30-39

20-29

<20 Source: BKP/WFP using RISKESDAS 2007 data6

Rising inequities in stunting

Source: RISKESDAS 2007 & 2010

Reduction in stunting in children in highest wealth quintile

Increase in stunting in children in lowest wealth quintile

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Recent success in reversing the downward trend in exclusive breastfeeding

Source: IDHS, 1994, 1997, 2002-3, 2007 and 2012

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What causes undernutrition in Indonesia?

• Only 36% children 6-23 months consume a “minimum acceptable diet” (IDHS, 2012)

• 14% of children have suffered diarrhea in the last 2 weeks (IDHS, 2012)

• 24% defecated in the open (JMP, 2013)

• 14% do not have access to an improved water source (JMP, 2013)

• Only 42% children less than 6 months are exclusively breastfed (IDHS, 2012)

• 12% are below the national poverty line (SUSENAS, 2012)

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Towards scaling up nutrition in Indonesia

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Bringing People Together

• Presidential Decree No. 42/2013 on National Movement to Accelerate Nutrition Improvement within the Framework of the First 1000 Days of Life– Provide authority to the Coordinating

Ministry of People’s Welfare to oversee the coordination of the SUN Movement in Indonesia

– Identify coordinating structures to convene multiple stakeholders and sectors at national and sub national level

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Coordinating Structure

TASK FORCE(Coordinating Minister

of People’s Welfare)

Advisory Team

(Coordinating Minister of People’s Welfare)

Technical Team

(Deputy Minister of Human Resources Development & Cultural Affairs- Bappenas)

Campaign

Advocacy

Training

Partnership

Planning & Budgeting

Environmental, Safety Health

Team of Experts (Supporting Technical

Team)

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• Soft Launching by Coordinating Minister for People’s Welfare, attendedby Minister of National Development Planning, Minister of Health,Minister for Woman Empowerment and Child Protection, and otherstakeholders from Central and Local level, September 19, 2012.

• Advocacy, Consultation, and Workshops have been held byGovernment, Professional Organization (Nutritionist and Public HealthSociety), UN Agencies, at national and sub-national level to galvanizesupport for the movement. One of which is the National Workshop onOctober 28, 2013 by Coordinating Minister for People’s Welfare.

• Grand Launching by the HE Susilo Bambang Yudhoyono, President ofthe Republic of Indonesia, on October 31, 2013 during World Food Daywith theme “Optimalization of Local Recourses through FoodDiversification to Reach Food Self-sufficiency and Community NutritionImprovement”

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Use of various advocacy materials to disseminate information of the national movement to accelerate nutrition improvement.

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Putting Policies in Place

• Policy Framework for the first 1,000 daysmovement is the central policy document forSUN movement. It identifies six nutritiongoals that cover stunting, wasting, overweight, low-birth weight and exclusivebreastfeeding

• Guidelines for Program Planning is areference for stakeholders for planning andbudgeting as well as for implementing,monitoring and evaluating the progress ofSUN movement

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• Food and Nutrition Action Plan 2011-2015 (National& Provinces)

– Developed as a guideline and direction inimplementing food and nutrition development atnational, provincial, district levels, not only forgovernment but also for other related parties involvedin the food and nutrition improvement.

– All relevant ministries such as the ministry of health,agriculture, industry, home affairs, education, religiousaffairs, food and drug control, marine and fisheries,and bappenas (developmen & planning agency) areready and are committed to act

– In progress: aligning indicators with SUN PolicyFramework (specific and sensitive nutritionintervention)

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Major opportunities in Indonesia

• Extensive community network of cadres and posyandu to reach childrenand women close to where they live

• Social protection platforms that target the most vulnerable children andwomen are in the process of being scaled-up and can be designed in waythat impact more effectively on nutrition:

– PNPM (National Program for Community Empowerment) Generasiand MCA Indonesia in 11 provinces, 64 districts, 499 sub-districts,5206 villages

– PKH Prestasi (Conditional Cash Transfer)

– National Insurance Program coverage

• Thriving business sector which can contribute enormously, if harnessedappropriately and in-line with government regulations to protectchildren’s rights to breastfeed.

• Parent’s desire for their children to do well at school – parents are ourmost important ally but need to understand how important nutrition is inearly life.

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Critical components for SUN scale-up

• Leadership and champions for nutrition, starting from the

highest political level, to help raise public awareness and protect

funding allocations.

• Effective coordination of nutrition actions with strong political

support to coordinate efforts among key sectors and stakeholder

groups at national and subnational level.

• Nutrition on goals and targets are in included in national

development plans and sector-specific strategies and plans

• Laws, regulations and standards in place and enforced at

national and subnational level to protect the rights of children

and women to good nutrition.

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Critical components for SUN scale-up

• Build capacity of provincial and district governments to delivernutrition services

• Assign clear accountabilities for each stakeholder in all relevantsector and at all levels.

• Collect nutrition-relevant data at regular intervals to trackprogress, identify needs and improve accountability.

• Support civil society groups to generate and disseminate dataat subnational level to make the undernutrition problem visibleand to improve the coverage and quality of service delivery.

• Protect nutrition funding in national and subnational budgetsand mobilise alternative sources of funding.

• Ensure effective mechanisms to reach community membersincluding network of motivated and skilled community basedworkers.

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Monitoring and Evaluation

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Monitoring & Evaluation Framework(IMPACT Level)

• M&E and information system to monitor progress:

• Basic Health Research (Riskesdas)- every 3 years

• IDHS/SDKI – every 5 years

• Social Economic Survey/Susenas)- annually (core)/3 years(specific)

• Nutrition Indicators Collected (Impact Level):

– In line with the WHA global nutrition targets

• U-5 Stunting (Riskesdas)

• U-5 Wasting (Riskesdas)

• U-5 Over Weight (Riskesdas)

• Low Birth Weight (Riskesdas/IDHS)

• 0-6 months Exclusive Breastfeeding (Riskesdas/IDHS)

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• Nutrition Indicators Collected:– Nutrition Specific

• 4+ food groups 6-23 months (IDHS)

• Children 3 IYCF 6-23 months (IDHS)

• Zinc treatment (IDHS)

• 4+ ANC for pregnant mother (Riskesdas/IDHS)

• Deworming (IDHS)

• Vitamin A (Riskesdas/IDHS)

• Iron Folate Supplementation (Riskesdas/IDHS)

• Presence of Iodized Salt in HH (Riskesdas)

Monitoring & Evaluation Framework

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• Nutrition Indicators (cont.):

– Nutrition Sensitive

• Access improved water %pop (IDHS)

• Access improved sanitation %pop (IDHS)

• Access to primary school enrollment (SUSENAS)

• Un-met need for family planning (IDHS)

• Birth Rate (IDHS)

• % births attended by SBA (IDHS)

• Poverty Rate- %pop living below poverty line (SUSENAS)

Monitoring & Evaluation Framework

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• Growth Monitoring (monthly)

• Twice a year Vitamin ASupplementation for 6-59months (February and August)

• Exclusive breastfeeding(monthly)

• Pilot: Twice a year heightmeasurement during VitaminA Supplementation onFebruary and August

Routine Data Collected-Nutrition

(Community Level)

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Monitoring & Evaluation

Mechanism

• Identification of the results showing progress of implementation ofeach activity using agreed progress indicators;

• Conduct monitoring and evaluation using available mechanism tocollect data on key program indicators;

• Monitoring of results for output and outcome indicators throughdata/report collected from supervision, survey or special studydeveloped to monitor and evaluate the outcome of the movement.

• At Central Level, a monitoring and evaluation team will beestablished using existing structures and it will be supervised by thetechnical team which is under the oversight of Bappenas.

• At Sub-National level, similarly, such an M&E team will beestablished using existing structures and it will be supervised by thetechnical team which is under the oversight of Bappeda.

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• Results related to Inputs and Process indicators will be collectedevery semester (twice a year), while results of outputs andoutcomes related to nutrition specific and sensitive interventionswill be gathered either annually or every three years.

• At national level, the Chairman of the Task Force will reportimplementation progress of the Movement to the President on aregular basis that is, at least once a year or at any time if necessary.

• At sub-national level, the governor, regent/mayor will reportprogress of implementation of the Movement in their respectiveareas to the Chairman of the Task Force with a copy to the Ministerof Home Affairs ior at regular intervals of at least once a year or atany time if necessary.

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Monitoring & Evaluation

Mechanism

THANK YOU

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