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.