HEALTH SECTOR REVIEW NUTRITION

HEALTH SECTOR REVIEW NUTRITION JULY 2014 AUTHORS: SUNARNO RANU WIDJOJO SUNAWANG BJORN LJUNGQVIST SRI SUKOTJO HARRIET TORLESSE AIDAN CRONIN DRAJAT ...
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HEALTH SECTOR REVIEW

NUTRITION

JULY 2014

AUTHORS: SUNARNO RANU WIDJOJO SUNAWANG BJORN LJUNGQVIST SRI SUKOTJO HARRIET TORLESSE AIDAN CRONIN DRAJAT MARTIANTO ELVIYANTI MARTINI MARIA CATHARINA MOHAMAD MARJI NILS GREDE

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Acknowledgements This report was prepared jointly by a team comprising Dr. Sunarno Ranu Widjojo (Consultant, UNICEF Indonesia), Dr. Sunawang (Consultant, UNICEF Indonesia), Dr. Bjorn Ljungqvist, (Consultant, UNICEF Indonesia), Sri Sukotjo, (Nutrition Specialist, UNICEF Indonesia), Dr. Harriet Torlesse, (Chief of Nutrition, UNICEF Indonesia), Dr. Aidan Cronin (Chief of WASH, UNICEF Indonesia), Dr. Drajat Martianto (Faculty member in the Faculty of Human Ecology, Bogor Agriculture University IPB and Consultant WFP Indonesia), Elviyanti Martini (National Programme Officer, WFP Indonesia), Maria Catharina (Senior Programme Assistant, WFP Indonesia), Mohamad Marji (Progamme Officer and Consultant, WFP Indonesia) and Nils Grede (Deputy Country Director, WFP Indonesia). The team coordinated closely with, and benefited from, the valuable inputs, reviews, and consultations with: Dra. Nina Sardjunani, MA.(Deputy Minister of Human Resources and Cultural, Bappenas); DR Hadiat (Director of Health and Community Nutrition, Bappenas); Dr. Pungkas Badjuri Ali (Head of Sub-directorate of Community Health); Ir Yosi Diani Tresna, MPM (former Head of Sub Directorate of Health Promotion and Community Nutrition Bappenas); Ir. Entos Zaenal SP, MPHM (Head of Sub Directorate of Health Promotion and Community Nutrition, Bappenas); Ir. Doddy Izwardy, MA (Director of Community Nutrition, Ministry of Health, and staff of the Directorate of Nutrition); Dr. Ir Archmad Suyana (former Director General of the Agency for Food Security, Ministry of Agriculture); Dr. Trihono, MD, MPH (former Head of Health Research and Development Board, Ministry of Health); Ria Soekarno, SKM, MCN (Secretary of Health Research and Development Board, Ministry of Health); Dr. Hapsari (Coordinator for Data Management, Health Research and Development Board, Ministry of Health); V. Sudarjanto Sumito SIP, MSI (Head, Sub-directorate of Social Welfare, Ministry of Home Affairs); Dr. Ir Suwandi (Head of Programme and Area Policy Development, Planning Bureau of the Ministry of Agriculture); Dr. Erman Syamsuddin (Director of Early Childhood Development, Ministry of Education); The Management Team for Program Keluarga Harapan - PKH (Ministry of Social Affairs); Drs Suratmono, MM (Deputy for Food Control, National Agency of Drug and Food Control); Professor Soekirman (Director, Indonesia Nutrition Foundation for Food Fortification); Dr. Minarto (Director of the Community-based Health and Nutrition Program, Millennium Challenge Account-Indonesia); and Dr. Robin Nandy (Chief of Child Survival and Development, UNICEF Indonesia). The guidance and support of Dr. Arum Atmawikarta, MPH (Coordinator, Health Sector Review Secretariat) is gratefully acknowledged, as is the coordination support of the Health Sector Review Secretariat and DFAT-AIPHSS. This study could not have been conducted without the generous support from European Union, UNICEF and WFP.

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Table of Contents Acknowledgements ........................................................................................................................ 3 List of tables ................................................................................................................................... 5 List of figures ................................................................................................................................. 6 Abbreviations and acronyms .......................................................................................................... 7 Executive Summary ..................................................................................................................... 10 1. Achievements so far................................................................................................................. 15 1.1

Introduction ........................................................................................................... 15

1.2

Nutrition outcomes and determinants .................................................................... 16

1.4

Contribution of the health sector ........................................................................... 35

1.5

Contribution of other sectors ................................................................................. 43

2.

Remaining challenges .......................................................................................................... 49

2.1

Nutrition outcomes and determinants .................................................................... 49

2.2

Cross-sector coordination and accountabilities ..................................................... 49

2.3

Contribution of the health sector ........................................................................... 49

2.4

Contribution of other sectors ................................................................................. 51

2.5

Summary .............................................................................................................. 53

3.

New and emerging challenges ............................................................................................. 54

3.1

Double burden of malnutrition ............................................................................... 54

3.2

Decentralization .................................................................................................... 54

3.3.

Universal health coverage..................................................................................... 55

3.4.

Minimum service standards for health ................................................................... 55

3.5

Public-private partnership ..................................................................................... 55

4.

Targets to be achieved by 2019 ........................................................................................... 57

5.

Policy options and strategies ................................................................................................ 59

5.1

Cross-sector coordination and accountabilities ..................................................... 59

5.2

Health Sector ........................................................................................................ 60

5.3

Other sectors ........................................................................................................ 61

6.

Health sector programmes ................................................................................................... 65

7.

Activities and target indicators .............................................................................................. 66

Annex 1: Agriculture and food security ......................................................................................... 71 Annex 2: Social protection ........................................................................................................... 81 Annex 3: Water, sanitation and hygiene ....................................................................................... 90 Annex 4: Education ...................................................................................................................... 96 Annex 5: Calculation of nutrition targets ..................................................................................... 103

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List of Tables Table 1: Prevalence of selected NCDs in adults in 2010 and 2013 (RISKESDAS) .............. 29 Table 2: Prevalence of malnutrition by province in Indonesia (RISKESDAS 2013).............. 30 Table 3: Implementation status of nutrition-specific interventions recommended the 2013 Lancet Series on Maternal and Child Nutrition in Indonesia ................................................ 36 Table 4: Nutrition targets for the Health Sector.................................................................... 57 Table 5: Policy/ strategy recommendations for non-health sectors. ..................................... 61 Table 6: Activities of the Community Nutrition Improvement Programme by strategy .......... 66 Table 7: Annual targets for the indicators of the Community Nutrition Improvement Programme ......................................................................................................................... 68

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List of Figures Figure 1: Framework for actions to improve maternal and child nutrition ............................. 16 Figure 2: Recent trends in underweight, stunting and wasting in children aged less than five years, 2007-2013 (RISKESDAS)......................................................................................... 17 Figure 3: Prevalence of stunting in children aged less than five years by province in 2007, 2010 and 2013 (RISKESDAS) ............................................................................................ 17 Figure 4: Prevalence of stunting in children aged less than five years by wealth quintile in 2007, 2010 and 2013 (RISKESDAS) ................................................................................... 18 Figure 5: Prevalence of stunting by age group in 2013 (RISKESDAS) ................................ 19 Figure 6:. Percentage of pregnant women with low MUAC (