Vol. 5, No. 5, May 2024

E-ISSN: 2723-6692

P-ISSN: 2723-6595

http://jiss.publikasiindonesia.id/

Jurnal Indonesia Sosial Sains, Vol. 5, No. 5, May 2024 1182

Public Policy Analysis in Stunting Reduction: A Review of

National Programs and Strategies

Mila Yusnita, Iwan Kurniawan Subagja,

Azis Hakim

Universitas Krisnadwipayana, Jakarta, Indonesia

Email: milayusnita25@gmail.com, iwankurniawan@unkris.ac.id, dr_azishaki[email protected].id

Correspondence: milayusnita25@gmail.com

KEYWORDS

ABSTRACT

Stunting; Stunting Policy;

Stanting Implementation

Stunting remains a severe problem in public health, including in

Indonesia, and tackling it requires cross-sectoral efforts and

integrated public policies. This study analyzes public policies on

stunting reduction, especially national programs and strategies in

Indonesia. The research method used is public policy analysis,

including identifying, describing, and evaluating existing policies

and factors influencing their implementation. The study collected

data from various sources, including policy documents and

academic literature. The results of the analysis show that the

Indonesian government has implemented various national

programs and strategies to reduce stunting. These programs include

nutrition interventions, maternal and child health services, health

education, and community empowerment. The national strategy

adopted includes a cross-sectoral approach, active community

participation, increased accessibility, and health system

strengthening. Nevertheless, implementing public policies to stunt

reduction is faced with various challenges. These challenges include

budget constraints, suboptimal cross-sectoral coordination, public

awareness, and environmental factors affecting child nutrition. In

addition, evaluation of the impact and effectiveness of the program

is also an essential focus in improving the success of stunting

reduction efforts. The study suggests several policy

recommendations to improve the effectiveness of stunting

reduction in Indonesia. The recommendations include increasing

budget allocations for nutrition programs, improving cross-sectoral

coordination through establishing more effective coordination

mechanisms, increasing community participation through a

community-based approach, and strengthening regular program

monitoring and evaluation.

Attribution-ShareAlike 4.0 International (CC BY-SA 4.0)

1. Introduction

Stunting is a condition of stunted child growth caused by chronic nutritional deficiencies,

recurrent infections, and limited access to nutritious food and adequate health care (Abeway et al.,

2018). Although there has been a decline in stunting rates in various countries, especially in Southeast

Asia, stunting remains a severe public health problem, especially in developing countries. Poverty,

lack of access to nutritious food, low education, and environmental factors are some of the leading

causes of stunting. The implications are profound, as stunting contributes to long-term health

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problems such as low productivity, immune system weakness, and the risk of chronic diseases in

adulthood (Morales et al., 2023; Trihono et al., 2015). Therefore, stunting reduction is a top priority

on the global and national development agenda.

At the global level, various agencies such as the World Health Organization (WHO), the UN

Children's Fund (UNICEF), and the UN Food and Agriculture Agency (FAO) have recognized the

importance of stunting reduction in the achievement of the Sustainable Development Goals (SDGs),

especially SDG 2 which emphasizes "Hunger Eradication, Food Security Achievement, Nutrition

Improvement, and Sustainable Agriculture Promotion." (Mugambiwa & Tirivangasi, 2017) At the

national level, many countries have formulated programs and strategies to address the problem of

stunting (Hossain et al., 2017). This includes developing public policies focusing on stunting

prevention, increased access to nutritious food, and improved public health services (Shekar et al.,

2017). However, the effectiveness of these policies is often debated, given the complexity of the

stunting problem, which involves many aspects, ranging from cultural economy to other related

matters.

Indonesia is one of the countries with a relatively high stunting rate; data shows the results of

the 2023 Indonesian Health Census (SKI); the national stunting prevalence rate is 21.5%, and it only

decreases by around 0.1% when compared to 2022. The government has taken several steps by

issuing presidential regulation no. 72 of 2021 concerning the acceleration of stunting reduction as a

legal basis for the implementation of stunting reduction in Indonesia, as well as the appointment of

the National Family Planning Population Board (BKKBN) by the President of the Republic of

Indonesia as the implementing coordinator between relevant ministries/institutions in stunting

reduction. In translating Presidential Regulation 72 of 2021 (2021), BKKBN has taken comprehensive

technical steps in implementing the acceleration of stunting reduction which is translated through

programs and activities by dividing roles between the central government, provincial regional

governments, district and city governments up to the village/village government level through the

regulation of the National Population and Family Planning Agency number 12 of 2021 concerning the

national action plan for accelerating the reduction of Indonesia's stunting rate in 2021-2024 (2021).

In taking severe steps to reduce stunting, relevant ministries/agencies have prioritized stunting in

the government work plan (RKP) for each ministry/institution

Programs such as the community-based water supply and sanitation program, otherwise

known as PAMSIMAS carried out by the Ministry of PUPR, the Posyandu program and supplementary

feeding and giving blood-added tablets carried out by the Ministry of Health, as well as the marriage

guidance program (Binwin) involving religious counselors by the Ministry of Religious Affairs and

other Ministries/Institutions programs according to the primary duties and functions of the

ministry/institution (Kemenko PMK, 2022).

However, despite efforts made at both the global and national levels, several challenges still

need to be overcome to tackle stunting. One is the accessibility and affordability of public health

services, especially in remote and marginalized areas. In addition, economic and social disparities

exist and are obstacles to improving children's nutrition. In addition, it is essential to consider cross-

sectoral approaches in stunting reduction. Many factors affect stunting, including health, education,

the economy, sanitation, and the environment. Therefore, coordination among government agencies

and cooperation with the private sector and civil society organizations are vital in addressing this

issue holistically.

Public policy analysis can provide valuable insights into evaluating the effectiveness of

programs implemented to reduce stunting. By analyzing existing policies, we can identify each

program's strengths and weaknesses and recommend policy changes needed to improve outcomes.

By understanding more deeply how these policies are formulated, implemented, and evaluated, we

can develop more effective strategies to combat stunting and improve the well-being of children

around the world.

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2. Materials and Methods

This research uses secondary data analysis to design and evaluate existing policies through

qualitative descriptive data collection methods commonly used in qualitative descriptive research.

This research aims to describe an event or occurrence that exists. It tends to be exploratory and

prioritizes a deep understanding of the context.

3. Result and Discussion

Efektivitas Program dan Strategi Nasional

In the national strategy document, five main pillars in handling stunting are described,

including: (2023)

1) Leadership Commitment and Vision

Handling stunting is not only carried out temporarily, but it must be sustainable because of the

relationship with child nutrition services and monitoring pregnant women, including preparing

brides-to-be to become healthy prospective couples of childbearing age, which is characterized

by no lack of hemoglobin (HB) before going on a honeymoon with a couple. The implementation

of programs and activities targeting pregnant women, toddlers, and brides-to-be must be

supported by the commitment and vision of regional leaders through budgeting for financing

related to stunting and other health. Committed leadership places stunting reduction as a non-

negotiable priority. They understand that stunting is a health problem and are concerned with

economic growth and social development. With a strong commitment, leaders can mobilize all

relevant parties, including government, non-governmental organizations, the private sector, and

the general public, to work together in joint efforts. At the same time, the leadership vision is a

guide in designing targeted and sustainable public policies. A clear vision of a stunting-free

society lays the foundation for setting concrete goals and directing strategic measures. Leaders

with a broad vision can see the problem of stunting as part of a bigger picture of overall human

development. They can integrate stunting reduction programs into the broader national

development agenda.

2) National Campaigns and Behavior Change,

The causes of stunting children are indeed very complex factors, one of the most significant

contributors to children becoming stunting is family care in caring for children under five, this

can be explained where a family that does not care about the development and growth of

children, families that have limited access to information and minimal behavior will be the most

important points that must be improved so that children are healthy and following growth and

its development. The government has launched various national programs and strategies

designed to support the implementation of national campaigns and behavior change in stunting

reduction. These programs include health education for pregnant women, promotion of exclusive

breastfeeding, increased access to adequate nutrition, and improved environmental sanitation.

The national strategy also includes inter-sectoral collaboration, coordination among government

agencies, and active community participation in health-related decision-making.

3) Convergence of Central, Regional and Village Programs

Discussing convergence, the Ministry of Home Affairs of the Republic of Indonesia has compiled

8 convergence actions as an instrument in the implementation and evaluation of local

government programs and activities for stunting alleviation, the 8 actions include situation

analysis, activity plans, stunting discussion, regent/mayor regulations on the role of villages,

KPM development, data management systems, stunting measurement and publication and

annual performance reviews. The action is expected to be used as a reference for local

governments in the implementation of stunting and how local governments can carry out a

comprehensive program with policy support for villages as a basis for implementing services at

the village level.

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4) Food Security and Nutrition,

The food security program is one of the national priorities in the 2020-2024 RPJMN because it is

a priority and the village is one of the guidelines for villages, the Minister of Villages and PDTT

issued PDTT Village Minister Regulation Number 8 of 2022 concerning the priority of using

Village Funds in 2023 and Village Minister Decree number 82 of 2022 concerning Guidelines for

Food Security in Villages. In 2022, twenty percent of the total village funds, or IDR. 13.6 trillion

will be used to support food security. This policy will continue in 2023 as the Government's

commitment to anticipate the food crisis.

5) Monitoring and Evaluation.

In the implementation of activities, monitoring, and evaluation are needed to observe the

progress of activities that have been planned, whether by the plans compiled or by regulations

and policies that have been issued by the central government and local governments, as well as

providing input and recommendations on obstacles found at the field level, these obstacles can

be given solutions according to the level of existing constraints. Since 2022, the Ministry of FMD,

by its role has carried out with ministries/agencies related to integrated assistance for provincial

and district/city governments in assisting the strengthening of stunting reduction activities in

the regions, this assistance has provided many suggestions and recommendations for provincial

and regional governments to improve and evaluate the implementation of activities that are

being or will be implemented.

Supporting and Inhibiting Factors

Some supporting factors that can be analyzed from handling stunting are as follows:

1. Availability of resources: Sufficient funds, personnel, and infrastructure to support the

implementation of stunting reduction programs.

2. Strong leadership: Political leaders and other stakeholders must be highly engaged and

committed to supporting and implementing public policy.

3. Community involvement: Participating actively in stunting prevention programs can improve

effectiveness and sustainability.

4. Strong Data Provisioning: Policies backed by valid data are more likely to succeed.

5. Cross-sector cooperation: Collaboration between various government departments and agencies

and non-government partners can improve program efficiency and effectiveness.

Meanwhile, several inhibiting factors can be analyzed in handling stunting as follows:

1. Challenges in funding and adequate budget allocation for stunting programs.

2. Imbalance of infrastructure and access to health services in rural areas.

3. Limitations in the capacity and quality of human resources involved in program implementation.

4. Cultural and social factors affecting children's diet and health practices.

5. Unfavorable environmental conditions include poor sanitation and limited access to clean water.

Discussion

The Indonesian government has focused on stunting handling for almost seven years, several

steps have been taken to reduce children under five (stunted) due to chronic malnutrition for long

enough so that children's growth becomes stunted since 2021 BKKBN as the coordinator of stunting

handling, has carried out and made policies to concentrate on stunting prevention. This prevention

targets upstream, wherein the upstream sector, interventions must be carried out to prevent

stunting; this prevention is quite massive through policies related to the assistance of brides and

grooms through the Elsimil application (electronic ready-for-marriage and pregnancy) before

marriage. Through the focus on the bride-to-be, BKKBN wants brides-to-be to check their health first

before marriage so that they can be monitored regarding the health condition of the bride and groom,

if they find unhealthy can, through blood deficiency indicators, it is recommended that the bride and

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groom take blood-added tablets and postpone pregnancy first until the condition of hemoglobin

levels is sufficient. In terms of provincial and local governance, 8 convergence actions are the basis

for stakeholders in the implementation of programs and activities, and this implementation is

monitored continuously by the Ministry of Home Affairs.

Critical Analysis of Policy Implementation

1. Governance Analysis

a) Not all district/city governments have issued regulations related to the obligation to check

the health of prospective brides and fill out the Elsimil application as an instrument for

monitoring the health of prospective brides.

b) Various village government policies still translate interventions to reduce stunting at the

village level into priority village programs and activities.

c) There is still a lack of stakeholders utilizing data from family updates in the BKKBN data

collection application as a basis for intervention for families at risk of stunting.

d) Regional regulations related to the obligation for brides-to-be to have a medical examination

before being given a marriage cover letter have not maximized the dissemination of

information related to PPS in the sub-district, village governments, and other technical

personnel.

e) The implementation of integrated assistance still focuses on improvements and evaluations.

However, related parties still do not routinely monitor the results of recommendations,

whether they have been implemented or not.

2. Analysis of Service Strengthening, Mobilization, and IEC

a) It is necessary to move pregnant women to be willing to check their pregnancy at least six

times with two times examined by a specialist.

b) Specific services for children 0-23 months need to be strengthened to monitor growth and

development at Posyandu.

c) Strengthening TPK assistance for families with baduta moving to posyandu is necessary.

d) It is necessary to strengthen convergence in referral services for children who do not gain

weight, are underweight, undernourished toddlers, and malnourished toddlers to be

provided services by the nutrition needed.

Causes and Impact of Stunting

Stunting, a global public health problem, results from chronic nutritional insufficiency in the

growing years. A study by Black, Alderman, et al. (2013) highlights various factors that cause stunting,

including inadequate nutrition, poor sanitation, and lack of health services. The impact of stunting is

not only limited to physical health but also affects cognitive and economic development later in life

(Hoddinott et al., 2011).

Public Policy Analysis in Stunting Reduction.

Tackling stunting through public policy requires a comprehensive and coordinated approach.

Various countries have implemented national programs and strategies to address stunting. A study

by Fanzo et al. (2018) analyses national initiatives in developing countries and highlights the

importance of integrating nutrition interventions with other sectors such as agriculture, sanitation,

and education.

Review of National Programs and Strategies

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National programs and strategies for stunting reduction have been the focus of attention at both

national and international levels. For example, the study by Bhutta et al. (2013) evaluates the

effectiveness of national programs in several countries and highlights factors that influence the

success or failure of their implementation. In-depth analysis of these programs can provide valuable

insights for policy planners in designing effective and sustainable strategies.

4. Conclusion

Some conclusions that can be conveyed from the policy to accelerate stunting reduction are the

need to strengthen technical policies within the scope of local and village governments in the

implementation of stunting programs and activities to respond to the needs of the community

according to the dynamics that exist in the community, as well as the need for continuous monitoring

related to follow-up plans for the results of the mentoring process that has been carried out by the

central government to local governments and strengthening stakeholder commitment The

importance of supporting programs and activities that have been listed in the annual government

activity plan so that stunting becomes a priority activity at the central, regional and village levels

which are outlined in the short and medium term development plan with a target stunting prevalence

rate of 14% in 2024.

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