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Lombok, Indonesia, June 26, 2018 ¨C Salmiah thought she had learned all that she needed to know about raising a healthy child, being a community health worker in Batukliang, Central Lombok, since 2000. But the mother of three was devastated when she found out that her 2-year-old daughter had not grown normally.

¡°Due to lack of healthy food during my pregnancy, my daughter was born underweight and at the age of 2 she was stunted,¡± says Salmiah, who also works as a teacher at an Islamic elementary school.

Stunting prevention: a national commitment

Stunting ¨C the failure to reach one¡¯s potential for growth ¨C is caused by chronic malnutrition and repeated illness during childhood. It can permanently limit a child¡¯s physical and cognitive capacity and cause livelong damage. Globally, nearly a quarter of children under 5 are malnourished.

Indonesia¡¯s stunting rates are staggering. In 2013, 37% of Indonesian children under the age of 5, or almost 9 million children, were stunted, according to the National Health Survey.

In 2017, Indonesian Vice President Jusuf Kalla called for a National Strategy to Accelerate Stunting Prevention. The strategy, supported by the World Bank, was built on Indonesia¡¯s experience and global lessons, particularly Peru¡¯s success cutting its stunting rate by half in just seven years. 

¡°Stunting among children under the age of 5 is a reflection of Indonesia¡¯s future,¡± said Sri Mulyani Indrawati, Minister of Finance. ¡°The issue is now a government priority.¡±

Indonesia¡¯s national commitment to reduce stunting entails stronger collaboration among many stakeholders, say officials.

¡°Stunting must be tackled together,¡± said Nila Moloek, Minister of Health. ¡°There should be better collaboration between government agencies at the national and regional level. Also with the private sector, civil society and academics.¡± 

Converging services to prevent and reduce stunting

To combat the problem, pregnant mothers and children under the age of 2 need to simultaneously access key services. These services include: basic immunization, breastfeeding, dietary diversity, drinking water and sanitation, early childhood education, food insecurity measurements where they live, and a birth certificate to make sure they are in the system. Convergence of these key services is low in Indonesia.

By establishing a national strategy, Indonesia aims to strengthen all these services and drive the convergence of national, regional, and community programs. It commits 22 ministers and an estimated US$14.6 billion to converge priority nutrition interventions. The strategy targets 100 districts with high stunting rates in 2018, and will be scaled up to 160 districts and cities in 2019, to 390 in 2020, and eventually all 514 districts and cities by 2021.

Human development workers

A vital part of the government¡¯s stunting reduction program is the Human Development Worker pilot ¨C a collaboration between the government and the World Bank. The pilot will contract 3,105 human development workers tasked to ensure the delivery of interventions to address stunting. The workers will help identify gaps in the services while at the same time encourage community members to use those services more often.

¡°The human development workers help us a lot,¡± said Zaenal, head of Mantang village in Lombok. ¡°By having them participate in the community-health centers, we now know more about our community¡¯s health.¡±

Salmiah, who is also a health development worker, supports the convergence of services in her village by ensuring that pregnant mothers have regular prenatal check-ups, take iron supplements, consume healthy, nutritious food and have access to clean water.

She found that in her village, 25% of children under age 5, or 225 children, were stunted. Many parents, however, were in denial about their children¡¯s condition. It took great effort to raise awareness on supplementary nutrition and good sanitation practices, she said. Salmiah participated in training on  how to use the Length Mat, a simple and innovative tool that communities and health workers can use to detect stunting early.  

"Upon my return from the training, I shared more information about stunting with the community, particularly its impacts and how to overcome it. I spoke to community members, religious leaders and village leaders. I am grateful that 30% of the Village Fund is now allocated to prevent stunting,¡± Salmiah said.

Salmiah works closely with other facilitators and village representatives from the health post, early childhood center, the conditional cash transfer program, as well as from the water and sanitation program. By strengthening coordination between these service providers, she wants to ensure that all beneficiaries receive the complete service package.

Her hard work has paid off. In the past 15 months, the number of stunted children under the age of 2 decreased from 86 to 58.

¡°God willing, there will be no poor families and every child in our village will grow to be tall and smart,¡± Salmiah said.