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  • 1. MINISTRY OF NATIONAL DEVELOPMENT PLANNING/ NATIONAL DEVELOPMENT PLANNING AGENCY (BAPPENAS) SCALING UP NUTRITION (SUN) MOVEMENT IN INDONESIA Brussels, January 8, 2014 NINA SARDJUNANI Deputy Minister for Human Resources and Cultural Affairs, Ministry of National Development Planning/BAPPENAS 1
  • 2. I. Malnutrition in Indonesia: status, causes and concerns II. Towards scaling up nutrition in Indonesia III. Monitoring and evaluation 2 OUTLINE
  • 3. Malnutrition in Indonesia status, causes and concerns 3
  • 4. Malnutrition in Indonesia is high compared to other countries in Southeast Asia
  • 5. Indonesia’s Situation for number of malnourished children MillionofChildren Prevalence data: RISKESDAS, 2013 Population: Pusdation Projected Population, 2011
  • 6. Stunting is an issue in every province Prevalence of stunting 40+ 30-39 20-29 <20 Source: BKP/WFP using RISKESDAS 2007 data 6
  • 7. 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 7
  • 8. Recent success in reversing the downward trend in exclusive breastfeeding Source: IDHS, 1994, 1997, 2002-3, 2007 and 2012 8
  • 9. 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) 9
  • 10. Towards scaling up nutrition in Indonesia 10
  • 11. 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 11
  • 12. 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) 12
  • 13. • Soft Launching by Coordinating Minister for People’s Welfare, attended by Minister of National Development Planning, Minister of Health, Minister for Woman Empowerment and Child Protection, and other stakeholders from Central and Local level, September 19, 2012. • Advocacy, Consultation, and Workshops have been held by Government, Professional Organization (Nutritionist and Public Health Society), UN Agencies, at national and sub-national level to galvanize support for the movement. One of which is the National Workshop on October 28, 2013 by Coordinating Minister for People’s Welfare. • Grand Launching by the HE Susilo Bambang Yudhoyono, President of the Republic of Indonesia, on October 31, 2013 during World Food Day with theme “Optimalization of Local Recourses through Food Diversification to Reach Food Self-sufficiency and Community Nutrition Improvement” 13
  • 14. Use of various advocacy materials to disseminate information of the national movement to accelerate nutrition improvement. 14
  • 15. Putting Policies in Place • Policy Framework for the first 1,000 days movement is the central policy document for SUN movement. It identifies six nutrition goals that cover stunting, wasting, over weight, low-birth weight and exclusive breastfeeding • Guidelines for Program Planning is a reference for stakeholders for planning and budgeting as well as for implementing, monitoring and evaluating the progress of SUN movement 15
  • 16. • Food and Nutrition Action Plan 2011-2015 (National & Provinces) – Developed as a guideline and direction in implementing food and nutrition development at national, provincial, district levels, not only for government but also for other related parties involved in the food and nutrition improvement. – All relevant ministries such as the ministry of health, agriculture, industry, home affairs, education, religious affairs, food and drug control, marine and fisheries, and bappenas (developmen & planning agency) are ready and are committed to act – In progress: aligning indicators with SUN Policy Framework (specific and sensitive nutrition intervention) 16
  • 17. Major opportunities in Indonesia • Extensive community network of cadres and posyandu to reach children and women close to where they live • Social protection platforms that target the most vulnerable children and women are in the process of being scaled-up and can be designed in way that impact more effectively on nutrition: – PNPM (National Program for Community Empowerment) Generasi and 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 harnessed appropriately and in-line with government regulations to protect children’s rights to breastfeed. • Parent’s desire for their children to do well at school – parents are our most important ally but need to understand how important nutrition is in early life. 17
  • 18. 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. 18
  • 19. Critical components for SUN scale-up • Build capacity of provincial and district governments to deliver nutrition services • Assign clear accountabilities for each stakeholder in all relevant sector and at all levels. • Collect nutrition-relevant data at regular intervals to track progress, identify needs and improve accountability. • Support civil society groups to generate and disseminate data at subnational level to make the undernutrition problem visible and to improve the coverage and quality of service delivery. • Protect nutrition funding in national and subnational budgets and mobilise alternative sources of funding. • Ensure effective mechanisms to reach community members including network of motivated and skilled community based workers. 19
  • 20. Monitoring and Evaluation 20
  • 21. 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) 21
  • 22. • 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 22
  • 23. • 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 23
  • 24. • Growth Monitoring (monthly) • Twice a year Vitamin A Supplementation for 6-59 months (February and August) • Exclusive breastfeeding (monthly) • Pilot: Twice a year height measurement during Vitamin A Supplementation on February and August Routine Data Collected-Nutrition (Community Level) 24
  • 25. Monitoring & Evaluation Mechanism • Identification of the results showing progress of implementation of each activity using agreed progress indicators; • Conduct monitoring and evaluation using available mechanism to collect data on key program indicators; • Monitoring of results for output and outcome indicators through data/report collected from supervision, survey or special study developed to monitor and evaluate the outcome of the movement. • At Central Level, a monitoring and evaluation team will be established using existing structures and it will be supervised by the technical team which is under the oversight of Bappenas. • At Sub-National level, similarly, such an M&E team will be established using existing structures and it will be supervised by the technical team which is under the oversight of Bappeda. 25
  • 26. • Results related to Inputs and Process indicators will be collected every semester (twice a year), while results of outputs and outcomes related to nutrition specific and sensitive interventions will be gathered either annually or every three years. • At national level, the Chairman of the Task Force will report implementation progress of the Movement to the President on a regular basis that is, at least once a year or at any time if necessary. • At sub-national level, the governor, regent/mayor will report progress of implementation of the Movement in their respective areas to the Chairman of the Task Force with a copy to the Minister of Home Affairs ior at regular intervals of at least once a year or at any time if necessary. 26 Monitoring & Evaluation Mechanism
  • 27. THANK YOU 27