PPT berisi program penguatan kelembagaan public health nutrition workforce

2. Indonesia Experience in
Strengthening Nutrition Capacity
Session 2: Public Health Nutrition Capacity for Stunting Reduction
Trias Mahmudiono, PhD
Lecturer/Researcher of FKM Universitas Airlangga
2

3. Capacity for nutrition is defined
as the ability to assess and
analyse the problem of
malnutrition and design,
implement, manage, and
monitor appropriate actions
Gillespie, 2001

4. 205.8
273.7
234.1
219.8
248.2
261.5
0
50
100
150
200
250
300
2000 2005 2010 2015 2020 2025
Jumlah
Penduduk
(juta
jiwa)
Source: Proyeksi Penduduk Indonesia 2000 – 2025, BPS – BAPPENAS - UNFPA
Indonesian Population Continue to Rise

5. McKinsey (2012)
Prediction
5

6. Indonesia Demographic Pyramid
75+
70 - 74
65- 69
60 - 64
55- 59
50 - 54
45- 49
40 - 44
35- 39
30 - 34
25- 29
20 - 24
1
5- 1
9
1
0 - 1
4
5- 9
0 - 4
Laki- laki Perempuan
0 2 4 6 8 1
0 1
2
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
80 60 40 20 0 20 40 60 80
1
150 100 50 0 50 100 150
0-4
10,000 8,000 6,000 4,000 2,000 0,000 2,000
1
35 28 21 14 7 0 7 14 21 28 35
0-4
2,4 1,8 1,2 0,6 0,0 0,6 1,2 1,8 2,4
1
1
2 1
0 8 6 4 2 0
75+
70 - 74
65- 69
60 - 64
55- 59
50 - 54
45- 49
40 - 44
35- 39
30 - 34
25- 29
20 - 24
15- 19
10 - 14
5- 9
0 - 4
Laki- laki Perempuan
0 2 4 6 8 10 12
0-4
5-9
1
0-1
4
1
5-1
9
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
12 10 8 6 4 2 0
2000 2025
Source: Proyeksi Penduduk Indonesia 2000 – 2025, BPS – BAPPENAS - UNFPA

7. Projected Population Pyramid in 2030
Indonesia
Malaysia
USA Japan
Golden
opportunity!

8. The Prevalence of Child Stunting in Indonesia 2007-2013
by Province
36.8
37.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Kep.Riau
DIY
DKI
Kaltim
Babel
Bali
Banten
Sulut
Jabar
Jatim
Sumsel
Jateng
Riau
Indonesia
Jambi
Kalbar
Gorontalo
Sumbar
Bengkulu
Papua
Maluku
Sulsel
Malut
Sulteng
Kalteng
Aceh
Sumut
Sultra
Lampung
Kalsel
Pabar
NTB
Sulbar
NTT
2007 2010 2013

9. 9
MALNUTRITION
17.7% undernutrition
30.8% stunting
48.9% anemic pregnant
women
8% obese children
28.9% obese adults (>18
years)
IN
NUMBERS
Riskesdas, 2018

10. 10
EXCLUSIVE
BREASTFEED WEIGHT HEIGHT
EXCLUSIVE
BREASTFEED
NUTRITION PROGRAM INDICATOR AND
RESULTS IN 2013 AND 2018

11. Burden of Disease Change in Indonesia
Sumber data: Global burden of diseases (2010) dan Health Sector Review (2014)
Rank 1990 2010 2015
1 ARI (ISPA) 1 Stroke 1 Stroke
2 Tuberkulosis 2 Tuberkulosis 2 Road Accident
3 Diarrhea 3 Road Accident 3 Ischemic Heart Disease
4 Stroke 4 Diarrhea 4 Cancer
5 Road Accident 5 Ischemic Heart Disease 5 Diabetes Melitus
6 Birth Complication 6 Diabetes Melitus 6 Tuberkulosis
7 Anemia 7 Low Back Pain 7 ARI (ISPA)
8 Malaria 9 ARI (ISPA) 8 Depression
13 Ischemic Heart Disease 12 Birth Complication 9 Asphyxia
16 Diabetes Melitus 26 Malaria 10 Chronic Lung Disease (PPOK)

12. Source: Rigdway et al., 2019

13. Golden Window of Opportunity
Indonesia 2020-2035
"Demographic Devident"
Assumption: Human Resources Are Well Educated
Source: Menko Perekonomian, 2010

14. Education Level of Indonesian Workforce
Education 2001 2006 2010
No Schooling or Elementary (SD) 63.0% 55.5% 51.5%
Junior High School (SMP) 17.7% 20.2% 18.9%
Senior High School (SMA) 10.3% 12.7% 14.6%
SMK 5.5% 6.2% 7.8%
Diploma I,II,III 1.6% 2.2% 2.7%
University 1.8% 3.2% 4.6%
Source: BPS, 2010

15. ISUES
Limited
in
number
Unequal
Distribution
Education
Qualification
below DIII
Insufficient
Quality
PROBLEM IN HEALTH WORKFORCE IN INDONESIA

16. Source: Delisle et al, 2017 Adapted from Shrimpton et al, 2014

17. Human Resource in Indonesia in Puskesmas 2017
Standar ketenagaan Minimal di PuskesmasberdasarkanPMK75/2014 tentang Puskesmas
Sumber: BPPSDM,31 Desember 2016
NO Health Personnel
Number of
PUSKESMAS
Current Condition STANDAR Maldistribution DEFICIT
1 Medical Doctor
9.756
16.527 13.152 6.954 3.579
2 Dentist 6.618 9.756 1.520 4.658
3 Nurse 98.864 58.968 49.698 9.802
4 Midwife 120.091 49.212 78.953 8.074
5 Pharmacist 10.171 9.756 4.175 3.760
6
PublicHealthSpecialist
12.136 9.756 7.247 4.867
7
Sanitarian
9.246 9.756 3.225 3.735
8 Nutritionist 9.331 13.152 2.169 5.990
9
Medical Laboratory
Technician
6.481 9.756 1.892 5.167
T
OT
A
L 289.465 183.264 155.833 49.632

18. Source: Ellahi et al, 2014

19. Courses Offered Under Master’s Program in Nutrition
Capacity Assessment Framework
Source: Khandelwal et al., 2014

20. Public Health
and Nutrition
Program in
Indonesia
Source: SINTA, 2019
20
Diploma in Nutrition (Vocational Study/D33
years)
44 institutions
Diploma in Nutrition (Vocational Study/D44
years)
22 institutions
Bachelor in Nutrition (Undergraduate4 years) 85 institutions
Master in Nutrition Science (2 years) 4 institutions
Doctor in Nutrition (3-4 years) 2 institutions
RD 4 institutions
Bachelor in Public Health (4 years) 184 institutions
Master in Public Health (2 years) 44 institutions
Doctor in Public Health (3-4 years) 7 institutions

21. Public Health Nutrition Intervention Management
Practice Cycle
Source: Bailie et el., 2008

22. Four-Tyre Hierarchy of Capacity Building Needs

23. Capacity Building Conceptual Framework
Source: Bailie et el., 2008

24. Source: Shrimpton et al., 2016
Multi-layered Public Health Nutrition (PHN) Workforce
Development

25. Source: Laar et al., 2017
Partners of Ghana Scaling Up Nutrition

26. Source: Laar et al., 2017

27. Source: Black et al., 2013

28. Nutrition community programs
in Indonesia:
28
GOVERNMENTS by Ministry of Health
Specific Interventions Sensitive Interventions
1) PMT for malnutrition pregnant mom 1) Sanitation and clean water
2) TTD for anemic pregnant women 2) Food security
3) Iodize salt consumption
3) Family planning and health
insurance
4) Exclusive breastfeeding 4) Parental education in child-care
5) Immunizations 5) Nutrition education in community
6) Supplementation and fortification
6) Sexual and nutrition education in
adolescents
Indonesian Ministry of Health, 2019

29. Kemen
dikbud
Kem
PU&PR
Kemen
perin
Kemtan
Kemsos
BPOM
BKKBN
Kemenag
Clean water &
sanitation
Food security
Program
Gizi Anak Sekolah
(PGAS)
Fortification
Food safety
Reproductive health
Pre-marital education
Food aids
SPECIFIC
SENSITIVE
Supplementation
and fortification
Balanced-nutrition
campaign
Exclusive
breastfeeding
Maternal health
class
School-based
program

30. SEAMEO RECFON
PROGRAM
30
Capacity Building
for Teachers
School Based
Nutrition
Intervention
SEAMEO STAR
Village
School Garden
for Nutrition,
Literacy, and
Enterpreneurship
Nutrition
Competition

31. NGO programs in Indonesia:
31
NGO
Specific Interventions Sensitive Interventions
1) PMT for malnutrition pregnant mom 1) Sanitation and clean water
2) TTD for anemic pregnant women 2) Food security
3) Iodize salt consumption
3) Family planning and health
insurance
4) Exclusive breastfeeding 4) Parental education in child-care
5) Immunizations 5) Nutrition education in community
6) Supplementation and fortification
6) Sexual and nutrition education in
adolescents
Indonesian Ministry of Health, 2019

32. 32
GLOBAL ALLIANCE for
IMPROVED NUTRITION
INDONESIA
Country focused. Directly support
policies and actions at a national level
Context driven. Consider the needs and priorities
of the government of Indonesia as the starting point
in guiding our work. Assess the nutrition situation,
examine what other stakeholders are doing, and
identify areas where can add value, working with
others.
Alliance strengthening. Aim to build and work
in alliances, because overcoming malnutrition in a
sustainable way requires contributions from all
corners of society.
Critical engagement. Engage critically with all
stakeholders, including businesses.
Skills. Staff skillset is fit for purpose with technical
experience in nutrition, food systems, business, and
program delivery, monitoring, and management.
Gender sensitive. Recognize that power
asymmetries within the food system often run along
gendered lines.

33. 33
EMO- DEMO

34. 34
Nutrition International (NI)
Priority Objectives and Program
With Good Nutrition
She’ll Grow Into It”
campaign
to Reduction
Anaemia among
Adolescent School
Girls
Changing
behaviours for an
anaemia-free
pregnancy in
Indonesia

35. 35
JAPFA FOUNDATION
PROGRAM
Nutrition
Counseling in
School
NutriTEEN
Program

36. 36
Capacity Building of Posyandu
Cadres

37. Government and University
Partnership

38. Innovation based on Biscuit from
Supplementary feeding program

39. Redesign of PHN Curriculum to Include
1000 days of early life approach

40. Nutrition Education Course

41. Nutrition Related Society in Indonesia

43. Source: Shrimpton et al., 2013
Dimension of a Nutrition Capacity Assessment Framework

44. Source: Delisle et al, 2017

45. Lesson Learn ▪Partnership is the key for sustainable capacity building in
nutrition
▪ Through political will, stunting reduction became
common goals and national priority
45
▪Despite many nutrition related study program in Indonesia open in
hundreds of institutions, nutrition workforce is still lacking in
numbers.
▪Interprofessional collaboration will likely be the short answer to the
lack of manpower in nutrition (such as through midwife, nurse, cadre
etc.)
▪Public health nutrition workforce will be at the core of the capacity
building efforts, therefore inclusive strategy for public health nutrition
education or training are warranted.

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