Stunting Prevention Becomes National Priority

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Serious attention and commitment of Indonesian government in improving nutrition globally was marked by the merger of Indonesia with Scaling Up Nutrition (GS) Global Movement under the coordination of UN Secretary-General to reduce the proportion of people suffering from malnutrition in 2011. It has been implemented through SUN movement in the national movement accelerating nutrition improvement within the first thousand days of life or abbreviated as 1000 HPK Movement. As stated in Presidential Regulation No. 42/2013 concerning the national movement to accelerate nutrition improvement by involving 12 ministries, institutions, academics and community organizations.

The program to accelerate nutrition improvement through the 1000 HPK Movement in Indonesia is one of the efforts to achieve Sustainable Development Goals (SDGs). Achieving the SDGs target can only be done if the policymakers pay attention to the efforts improving nutrition for sustainable development. Based on the National Team for Poverty Alleviation Acceleration (TNP2K), the 1000 HPK Movement still had shortcomings in practice in the field. For example, lack of commitment, integration of planning, budgeting, monitoring and evaluation.

The promotion of exclusive breastfeeding and the correct feeding to infants and children (PMBA) is one strategy to deal with and prevent stunting. Stunting brings consequences to health, human resources and general economic growth. The prevalence of stunting in Indonesia is quite high, at 37%. Regulations and policies related to 1000 HPK especially on exclusive ASI and PMBA regulations are quite a lot both in the form of laws, Government Regulations (PP), Minister of Health Regulations (Permenkes), Decrees of the Minister of Health (Kepmenkes) and Regional Regulations (Perda). They are also stated in Law No. 36 of 2009 concerning Health, PP No. 33 of 2012 concerning Exclusive Breastfeeding, and the Republic of Indonesia Ministry of Health No. 450 / Menkes / SK / IV / 2004 concerning exclusive breastfeeding for infants in Indonesia, and East Java Province Regulation No 11 of 2011 concerning Nutrition Improvement. However, the challenge in implementing these policies and regulations is the complexity of coordination within the health sector and between the health and non-health sectors. Therefore, this study aimed to analyze the relationship between the regulation understanding of health workforce (Nakes) to 1000 HPK (focus on exclusive breastfeeding and PMBA) and their implementation in preventing stunting in urban areas.

This research was an observational study using mixed methods (quantitative and qualitative) conducted in 33 Community Health Centers (Puskesmas) in Surabaya City and 13 Puskesmas in Sidoarjo Regency, with a total of 199 health workers (heads of puskesmas, doctors, nutritionists, midwives, and other health workers). The quantitative study was carried out by conducting surveys to health program planners and practitioners, while qualitative study was conducted through focus group discussion (FGD).

The results of this study indicate that there are 19 regulations from laws to local regulations related to IMD, exclusive breastfeeding and PMBA. Knowledge about exclusive breastfeeding, IMD and MP-ASI regulations varies considerably between health workers in practice. There is a significant connection between knowledge, availability of documents, regulations that are read and the application of exclusive breastfeeding regulations. The most popular regulation related to PMBA is the Indonesian Ministry of Health Regulation No.39 of 2013 concerning infant formula and other baby products. Contingency coefficient test results also indicate a significant connection between knowledge, availability of documents, regulations that were read, and the application of PMBA regulations.

Most health planners and practitioners have a very strong commitment in achieving the objectives of Exclusive ASI, IMD and PMBA program. The commitment to achieve exclusive breastfeeding target was slightly stronger than the commitment to accomplish the IMD and PMBA targets. This condition showed the synergy of cross-professional performance was stronger in achieving the Exclusive ASI target than the PMBA target. A good understanding of regulations related to exclusive breastfeeding and PMBA by health workers was the key to successful collaboration across health professionals to educate the public to prevent stunting. Significant commitment from all health professionals is needed to accelerate the stunting reduction program.

Author: Rian Diana, SP., M.Si

Details are viewed in our article in the Indian Journal of Public Health Research & Development.

Adi AC, Diana R, Devy SR, Qomaruddin B, Damayanti NA, Putri NK. (2019). The Correlation between Regulation Understanding by Inter-Professional first 1000 days of Life Health Workers and the Acceleration of Toddler Stunting Prevention. Indian Journal of Public Health Research & Development, 10(3): 911-916. DOI Number: 10.5958/0976-5506.2019.00618.1

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