2017年-世界发展银行全球_Operationalizing_a_Multi-Sectoral_Approach_for_the_Reduction_of_Stunting_in_Indonesia___An_Application_Using_the_2007_and_2013_Riskesdas_102页_7mb

Summary of the Report: Operationalizing a Multi-Sectoral Approach for the Reduction of Stunting in Indonesia

Core Content

This report explores the effectiveness of a multi-sectoral approach to reduce stunting in Indonesia, using data from the 2007 and 2013 RISKESDAS surveys. It highlights the need for integrated interventions across sectors such as agriculture, education, social protection, and water, sanitation, and hygiene (WASH) to improve child nutrition. The analysis is based on the UNICEF conceptual framework, which identifies food security, care, health, and environment as the four main underlying determinants of child malnutrition.

Main Views

• Stunting remains a major issue in Indonesia, with over one-third of children under five being stunted in 2013, despite a slight increase from 2007.
• The national poverty rate decreased from 16.6% to 11.4% between 2007 and 2013, but this did not lead to improved child nutrition, indicating that economic growth alone is insufficient for better nutritional outcomes.
• A multi-sectoral approach is necessary to address the complex and interdependent factors that contribute to stunting. This includes both nutrition-specific (direct interventions targeting malnutrition) and nutrition-sensitive (sectoral interventions that indirectly improve nutrition).
• The SUN movement and initiatives by the World Bank emphasize cross-sectoral collaboration and coordinated efforts to enhance nutrition outcomes through improved access to the four key determinants.

Key Findings

• Access to the four drivers of nutrition (care, health, environment, and food security) has improved over time, but significant inequalities persist between urban and rural areas, and across wealth quintiles.
• Adequate access to care was the least prevalent, with only 7% of children having access to all components in 2013.
• Adequate access to environment was the most prevalent, with 56% of children having access to both improved sanitation and basic drinking water.
• Only 1% of children had access to all four determinants of nutrition simultaneously in 2013, indicating a low level of integration between sectors.
• Children with access to two or more determinants had a lower likelihood of being stunted, suggesting that simultaneous improvements across sectors are more effective.
• Rural and low-wealth children are the most vulnerable, with less access to adequate nutrition determinants and higher stunting rates.

Policy Considerations

• Multi-sectoral programs must be tailored and targeted to specific age groups, locations, and wealth levels to be more effective.
• Better coordination between sectors is crucial for enhancing the success of nutrition interventions.
• Data collection gaps exist in the current surveys, particularly regarding dietary diversity, calorie and protein consumption, and child care practices.
• A more coordinated data collection approach is needed to close these gaps and improve the monitoring and evaluation of nutrition-related policies.
• Clear objectives and responsibilities among sectors should be established to ensure efficient and effective multi-sectoral interventions.

Conclusion

The report underscores the importance of a holistic, multi-sectoral strategy in combating stunting in Indonesia. It recommends a systematic approach to monitoring progress, targeted interventions, and improved coordination across sectors. The findings suggest that without addressing all four determinants simultaneously, the impact of nutrition interventions may be limited, and sector-specific programs may not achieve the desired outcomes unless they are integrated with broader efforts.

Key Indicators and Definitions

• Adequate Care: Includes mother's hand washing, smoke-free households, and breastfeeding practices.
• Adequate Food Security: Based on dietary diversity and consumption of fruits and vegetables.
• Adequate Health: Defined by prenatal checkups, skilled birth attendance, postnatal checkups, and immunization.
• Adequate Environment: Includes access to improved sanitation, basic drinking water, and safe water management.

Data Sources

• RISKESDAS surveys (2007 and 2013) were used to measure access to the four nutrition determinants.
• Wealth quintiles were calculated using polychoric principal components analysis by the NIHRD.

Recommendations

• Improve data collection to better understand the interdependencies among the four nutrition drivers.
• Enhance cross-sectoral coordination to ensure that interventions are effective and sustainable.
• Tailor programs to specific demographics and geographic regions.
• Promote integrated approaches that address all four determinants simultaneously.