Generasi works to empower local communities in poor, rural sub-districts in provinces covered by the project to increase their use of health and education services. The project provides an incentivized, participatory block grant system to meet the health and education needs of women and children in poor, rural areas, as well as financing for capacity building activities at the village level.
The project targets three Millennium Development Goals in which Indonesia’s performance is lagging:
Utilizing agreed-upon targets for 12 health and education indicators, the project promotes community participation in decision-making to identify and implement local solutions to health and education challenges.
The prevalence of stunting in young Indonesian children has caused alarm at the highest levels of government. In 2013, 37.2 percent of Indonesian children under 5 years of age (almost 9 million children) were stunted, 19.6 percent were underweight, and 11.9 percent were either overweight or obese. Stunting is caused by chronic malnutrition and repeated illnesses in childhood. It can be measured by comparing young children’s heights with the WHO Growth Chart Standard.
The government launched a National Strategy to accelerate Stunting Prevention in August 2017 and as part of this initiative, the Human Development Workers pilot. HDWs support villages and local service providers to bring together stunting-reduction services in the health, water and sanitation, social protection and early education sectors for households with pregnant women and children under two years old.
Public awareness of stunting and its causes is still low. Salmiah, a mother of three in Central Lombok, was devastated to learn that her 2-year-old daughter was stunted. She recalled how her pregnancy was difficult and that she didn’t have access to nutritious food.
“Due to a lack of healthy food during my pregnancy, my daughter was born underweight and at the age of two she was stunted,” said Salmiah, a teacher at an Islamic elementary school.
Although Salmiah has been a member of her local integrated health service post (posyandu) since 2000, she decided to learn from about stunting after learning that her daughter was stunted. She found that in her village, 25 percent of children under five, or 225 children, were stunted. In 2017, she became a Human Development Worker (HDW) for Generasi Sehat dan Cerdas (Healthy and Smart program), a program initiated by the Government of Indonesia and the World Bank.
“I know about stunting now and I am determined to provide good, nutritious food and maintain a clean environment, so that my daughter can grow optimally,” Salmiah said.
"As an HDW, it is my duty to ensure that pregnant mothers have regular prenatal check-ups at the posyandu, take Iron supplements, consume healthy, nutritious food and have access to clean water”.
Salmiah met fellow Human Development Workers in Jakarta at a training organized by the Central government and the World Bank – an experience that made her more determined to help her community fight stunting. She and fellow HDWs were also trained to use the Length Mat, a simple and innovative tool to detect stunting early.
"Upon my return from the training, I shared more information about stunting with the community, particularly its impacts and how to overcome it. I spoke to community members, religious leaders and village leaders. I am grateful that 30 percent of the Village Fund is now allocated to prevent stunting,” Salmiah said.
Salmiah works closely with other facilitators and village representatives from the health post, early childhood center, the conditional cash transfer program for families (Program Keluarga Harapan or PKH) as well as from the water and sanitation program (Pamsimas). By strengthening coordination between these service providers, she wants to ensure that all targeted beneficiaries receive the complete service delivery package. Salmiah developed a village convergence social map which helped identify 11 households with stunted children which are operating without latrines and clean water. She worked with water and sanitation facilitators to ensure that clean water and latrines are provided to these households in 2018.
The challenge, however, is to convince families who are in denial that their children are stunted. “It takes great effort,” Salmiah said, “to raise awareness on supplementary nutrition, and good sanitation practices.”
Salmiah’s hardwork has paid off already. In the past 15 months, the number of stunted children aged two or less decreased from 86 to 58.
“Insya Allah (God willing), there will be no poor families and every child in our village will grow to be tall and smart,” Salmiah said.
Source of data: 2013 National Health Survey (RISKESDAS) and interviews.
The atmosphere was festive as staff at the Permata Bunda integrated health post (posyandu) in Manahan, Surakarta awaited Vice President Jusuf Kalla on Monday, 12 March. The posyandu is a key component of the national stunting prevention program led directly by President Joko Widodo and Vice President Jusuf Kalla. The one in Manahan serves 42 under-five-years-old children and four pregnant women.
At Permata Bunda health post, Vice President Kalla witnessed the launch of an innovative tool -- a portable “Length Mat” -- initiated by Generasi, the Ministry of Health and the Ministry of Villages, Disadvantaged Regions and Transmigration to measure the height of children under two years of age.
Between 6-15 February 2018, this innovative tool was trialed in 13 villages in four priority districts – Cianjur, Gorontalo, Maluku Tengah, and Ketapang. The trial involved 232 people, including parents of children under two years of age, health post workers, and human development workers. Generasi and the Ministry of Villages will expand the pilot to 3,105 villages in 31 districts in 2018.
Height, a critical benchmark of child growth, must be measured every three months for children less than two years old. The Length Mat gives health workers and parents a visual cue to see if a child is the right height for her/his age, and can be used to differentiate between female and male children. It is used by posyandu to detect stunting early and rapidly identify children who need special attention.
The Length Mat is made from durable plastic and is practical as it can be carried door to door by community health workers in remote areas, making it easier for them to detect stunting, and promote better health and nutrition practices. The mat is expected to motivate caregivers to change behaviors to promote child growth. Since community level height measurements may not be highly accurate, measurements taken with the length mat should primarily be used to raise awareness for behavioral change, not as hard data.
The length mat has been introduced in stunting prevention initiatives in Bolivia, Guatemala, Zambia and Cambodia. The use of growth charts in Zambia has reportedly helped reduce stunting by 22 percent over a one year period. Initial reviews of length mat use in Cambodia and Guatemala showed that mothers felt the height visualization on the mat has helped them understand their children’s growth.
The VP reiterated the urgency of addressing malnutrition and stunting in Indonesia. “Without sufficient nutrition and a healthy environment, our young generation is in peril,” the Vice President said in a written statement on March 12th. He explained that if the situation persists, it would affect the country’s development performance in economic growth, poverty, and inequality. According to the VP, “Indonesia is in critical situation in terms of stunting, as warned by the WHO. Therefore, people must play (an) active role to protect our children”.
The National Report on Basic Health Research (RISKESDAS) 2013 estimates that almost 9 million children in Indonesia or a third of all children under five years of age are stunted. The Government of Indonesia is committed to reducing the prevalence of stunting through cross-ministerial, national and subnational anti-stunting programs.
The National Report on Basic Health Research (RISKESDAS) 2013 estimates that almost 9 million children in Indonesia or a third of all under-five children are stunted. The Government of Indonesia is committed to reducing the prevalence of stunting through cross-ministerial, national and subnational anti-stunting programs.
Indonesia’s National Development Planning Agency (Bappenas) hosted a two-day Stunting Bootcamp on March 26-27, bringing together 26 district and city governments to reduce rates of stunting to 28 percent by 2019. In an all-out effort to combat stunting, 19 government ministries and institutions came together for the event, as did UNICEF, MCA-I, DFAT and the World Bank. The Stunting Bootcamp is the second of eight planned events to bring the anti-stunting movement to 1,000 villages in 100 districts and cities in 34 provinces. The government plans to expand the coverage to 1,600 villages in 160 districts in 2019.
Through the Bootcamp, the national government aimed to build local governments’ capacity and commitment to plan, implement, monitor and evaluate convergence interventions to reduce stunting. Such interventions would include advocacy campaigns to raise awareness about the importance of reducing stunting and improve interpersonal communication to enhance collaboration across stakeholder groups.
Pungkas Bahjuri Ali, Director of Health and Nutrition at Bappenas, said that local governments were expected to share the national government’s commitment to reduce stunting, and to demonstrate their commitment by planning for and funding anti-stunting programs.
“We will share best practices from global, national, and village experiences, strengthen the coordination between the national and local governments, and improve the effectiveness of the program,” he said in his opening remarks at the Borobudur Hotel in Central Jakarta. He emphasized that adequate nutrition, disease prevention and good parenting were at the core of the movement to reduce stunting. “The role of the ministries and government institutions is focused on those three,” he said.
Subandi Sarjoko, Deputy Minister of Bappenas who also serves as the Head of Human, Community, and Cultural Development, revealed that government mapping initiatives found 19 districts and cities that have launched anti-stunting interventions without success in reducing stunting rates. “It was found that each area does not receive all aspects of the integrated intervention. For example, Village A, provides good nutrition but doesn’t have adequate clean water supply. Village B is the other way around. In fact, all aspects of the integrated intervention should be received by the target communities,” he said.
Villages Minister Eko Putro Sandjojo urged villages to reduce stunting rates by using Village Funds to finance infrastructure such as water and sanitation facilities, health clinics, and early education centers to improve villagers’ quality of life. “We must educate people about stunting. Even wealthy districts have stunting cases due to a lack of knowledge and widespread myths on nutrition,” he said during the Bootcamp. “Only 5 districts across Indonesia are free from open defecation. It affects the stunting rate as it’s not only about nutrition. Villages should build clean water facilities using Village Funds - it’s not expensive.”
The stunting reduction movement has the backing of Indonesia’s highest executive office. President Joko Widodo is committed to reducing stunting as evidenced by the Presidential Instruction No. 1/2017 on Healthy Community Movement (Germas); and Presidential Regulation No. 83/2017 on Strategic Policy on Food and Nutrition. The National Coordination Meeting 2018 for Generasi Sehat Cerdas, the National Village Congress and the Stunting Summit, all held in the week of March 25, further reflect the President’s commitment to accelerate the efforts to reduce stunting.
“Stunting reduction will be included in the government’s work plan every year, in line with the commitment to meet the SDGs by 2030,” Subandi said. “In 2018, the government’s priority is to improve education on nutrition, conduct nutritional surveillance, and provide nutritional food. 12 ministries and institutions directly contribute to interventions against stunting, and these efforts must be synergized.”
Tuesday, Mar 20, 2018 Author: Hera Diani
The sweltering heat subsided as the sun moved closer to the west that afternoon in early August. For a farmer group in Haikatapu Village, Rindi Subdistrict in Sumba Timur, East Nusa Tenggara, that only meant one thing: watering and weeding the nutrition gardens.
The gardens occupy a total of 2,000 square-meter and a 1,200 square-meter of village lands that are close to one another, surrounded by rice fields and close to a spring. A group of eight farmers have managed the gardens since 2012, when the Generasi program handed out five sachets of vegetable seeds per person and 100-kilogram of onion seeds, as part of the initiative to improve people’s nutrition. The farmers tend the gardens every morning and afternoon, and they work on their own farms in between.
“We produce plenty of vegetables now, from cabbage and spinach to lettuce, eggplant and sweet potato, as well as papaya,” said Ninda Halawulang, member of the farmers group.
The situation is very different compared to a couple of years ago. The dry season, which can last up to eight months, makes Sumba Timur dry and difficult for people to grow vegetables to meet their daily needs. This has contributed to nutrition issues in the community.
The management of the farms were also not as organized. Those who lived near the water source used to manage their own farms, which were usually quite small. Inadequate public transport made it difficult for them to obtain seeds, which are sold only in the district capital about 1.5 hours’ drive away. Therefore, most community members relied on grocery sellers, that passed through their area, to obtain vegetables.
These issues were discussed in a village meeting, which the Generasi Cerdas Sehat (Generasi) team attended. Responding to the problem, the village community empowerment cadre, which was part of the Generasi team, assisted the community to identify the type of seeds needed and a budget plan to obtain them.
The local health post cadres in Rindi Sub-district has also been very proactive among the community. Following Generasi conducted cadres training, the cadres worked with the community to establish nutrition gardens in each village.
Today, the gardens help ensures families meet their daily nutritional needs. Some of the produce is also given to seven integrated health service posts (posyandu) in the area (whose cadres received Generasi training) as supplementary food for toddlers. Moreover, the gardens also serve as income source, as the communities sell the produce in the market.
“The money helps pay for our children’s schooling and household expenses,” Ninda said, smiling.
Generasi, in coordination with the Health Agency, facilitated nutrition gardens in three other villages in the area. The nutrition gardens have improved people’s nutrition, testified farmers group who managed a garden in Lukuhippa Hamlet near Haikatappu.
The garden was started in 2016, when Generasi provided seeds worth Rp 20,000 for every pregnant woman. Managed by a group of six farmers, the garden has earned Rp 10 million so far, mostly from the sales to employees of a sugar cane plantation.
“Most of the produce are sold and the money is for each member of the farmers group. The rest of the produce is for community needs, like if we have community meeting,” said Jeara Pay, daughter of the Lukuhippa hamlet head who helps with the garden.
The success of the nutrition gardens has urged village government, that are integrated with Generasi programs, to discuss the initiative in their village development planning deliberative meetings. The purpose is to allocate funds from Village Budget to support the sustainability of the initiative.
One recent scorching afternoon, a display of colorful squat toilets welcomed curious visitors in the main park of the city of Mataram, in Indonesia’s West Nusa Tenggara province.
These visitors were not looking to buy new toilet bowls, nor were they working on home improvement projects. They were among 350 villagers who went ‘shopping’ for ideas and innovations to improve basic services and infrastructure in their home villages.
The 2017 Village Innovation Festival was organized by the provincial government of West Nusa Tenggara, in collaboration with the Generasi Cerdas dan Sehat Program. Support came from the World Bank, the Government of Australia and Millennium Challenge Account Indonesia. The festival highlighted innovative solutions to address some of the most pressing development challenges faced by village communities.
At the heart of the festival was the implementation of the Village Law (Law No. 6 of 2014 on Villages), which governs the disbursement of village funds in more than 74,000 villages. The law increases the authority and responsibility of the communities on how to spend their village funds. Many believe the village law has the potential to address rural inequality in Indonesia.
Visitors exchanged ideas and know-how on ways to use village funds more effectively to meet their needs, particularly in improving basic social services, and in addressing poverty and inequality.
As I went stall hopping, I was impressed by the creative ideas and the villagers’ dedication to overcome the various constraints they face for public services.
Cutting edge technology may not be the festival’s buzzword but the gathering was not short on solutions that were simple, creative, and applicable to their needs.
I met health worker Sri Santiani, who set up the Maternity Savings Fund (Tabulin), after witnessing how many mothers and expecting mothers experienced the burden paying for the cost of maternity and child care services.
Sri got the idea of a savings program after seeing that many mothers do not have government health insurance, or that they do could not afford to pay insurance premiums. Tabulin helps mothers save up for maternity services. Women can also tap into the savings program for other needs.
The crowd’s favorite was the ‘Contract Midwife’ initiative. The idea was coined by Nonong Muhaemin, a health worker whose village had struggled with high incidences of maternal deaths due to lack of health facilities. The nearest community health center from his Tokolok Village is about 25 kilometers (15.5 miles) away through difficult terrain.
After Nonong’s village revived the health post service (posyandu) and recruited a midwife exclusively for their village, there were no more cases of maternal deaths during childbirth, and the number of high-risk pregnancies and severely underweight babies/toddlers have also significantly decreased.
Initially the midwife’s salary was paid through the Generasi program, but after seeing the benefits, they now use their own village fund.
Meanwhile, in Mekarsari Village in Suela District, Lombok Timur Regency, an elementary school principal, Sabirin, came up with the idea of a ‘school without walls’.
His village did not have a junior high school. With the nearest being 10 kilometers (6 miles) away, many families could not afford the transportation cost to send their kids to school. Without the prospect of secondary education, many children got married after graduating from elementary school, but got divorced soon afterwards – financial and job insecurity being the main reasons.
Sabirin asked the children if they would continue their education if there was a junior high school in the village and he was met with enthusiasm. Subsequently, SMPN Satu Atap (One Roof Junior High School) opened in 2012, a simple thatched-roof hut built through a collective donation from the community, and with support from Generasi.
Providing free tuition to all students, the new school’s impact on the incidence of child marriage is significant. In 2016, no children has gotten married after graduating from elementary school, compared to 10-12 child marriages in previous years. The school is currently still funded by local community.
Back to the toilet bowl stalls. For the record, it was not there to offer new technology on toilets, rather an invitation for financial institutions to fund credit schemes to own toilet bowls in Indonesia, where about 32% of the total population still practice open defecation.
I’d say that’s a neat idea.
The Rempek Village Maternal Health Post (Polindes) in the hamlet of Gelumpang Sanyar (which has 248 inhabitants), in the village of Rempek, Gangga, North Lombok was built using Rp 160 million (US$11,865) in village funds. Supplies such as cabinets, tables, and chairs were purchased using the village funds, while the medical equipment and medicines were provided by the sub-district community health centre (puskesmas) with support from Ministry of Villages, Development of Disadvantages Regions and Transmigration and the National Family Planning Board.
The Polindes provides a range of basic services for women and children, including antenatal care, childbirth, and contraception. The midwife lives on site, therefore she is always on call and available. Before the clinic was built, expectant mothers usually had to travel to a facility in the neighbouring hamlet, which is more than a kilometre away.
The Generasi program actively conducts a number of initiatives throughout the community, which has significantly increased awareness of mother and child healthcare. The construction of the facility was proposed at a hamlet-level community meeting consisting entirely of women. The women’s proposal was then put forward at a village-level meeting.
To accommodate accompanying family members, the community also proposed the construction of a gazebo, which was accepted by the village government and built using Rp 18 million (US$1,335) allocated from the village funds in 2015. According to the village head, “In 2016, we allocated almost 50 percent of the total value of the village funds we received for the development of education and health services facilities.”
In 2014, the community in Sengkol Mantang village, Batukliang sub-district in Central Lombok District lobbied the village government to allocate a portion of the village funds to support Nurul, who was born with a disability that affected her legs. The village government accepted the community proposal and allocated a portion of the 2014 village funds to provide her with crutches. In 2016, the village government provided additional support in the form of transportation to school. With the support of the community and the village government, Nurul now has the same opportunities to study as all other members of the community.