| dc.description.abstract | The increase in stunting nutrition problems has negative implications for health status and even potential economic losses that impact development performance. The geographical environment of the archipelago was another challenge that required clear methods and mechanisms at every administrative and operational level. The difficulty of convergence and coordination across government sectors at various administrative and operational levels has resulted in poor development programs, including the food and nutrition sector. Stunting national and regional policies must be implemented and operationalized within an integrated institutional framework.
With various stunting interventions that have been identified and implemented by the government, this study develops a framework that considers the categorical dimensions and social organization of the food and nutrition security system. The research focuses on stunting interventions at the meso and micro social organization levels and immediate and underlying determinants. This study aimed to evaluate the implementation of stunting policies and develop an institutional strategy model and a stunting responsive index. The stages of this research are divided into four sequences. The first stage is a qualitative evaluation study on targeting that is operationalized using the Korten Conformity Model to answer the question: Have the targets or beneficiaries of the program been appropriately defined? The second stage is an implementation effectiveness evaluation study that answers the main question, is the intervention successful? Furthermore, if successful, is the intervention feasible? The third stage is the institutional strategy modeling stage for the multi-criteria decision-making approach, namely the Analytic Network Process (ANP). The fourth stage is developing a stunting intervention evaluation model, namely the stunting responsive index.
This study assesses the suitability of the three elements of implementing food and nutrition policies in stunting interventions at the research sites (Bangka and West Bangka), namely the program itself, implementing organizations, and program beneficiaries. The suitability of the program output in this study is based on the perceived benefits of the target group. Program implementing organizations, especially those in charge of nutrition-specific interventions, demonstrate the ability to carry out the required tasks. The stunting intervention policy or program at the research location certainly still requires continuous improvement, especially the resources of the implementing organization, namely implementing officers and financing. Evaluating the impact of food and nutrition programs, especially on beneficiaries, is crucial to saving resources and is also helpful in redefining the program to meet its following objectives. Program implementers need to be trained and motivated, and beneficiaries provide information about program benefits and mechanisms for accessing the program.
Nutrition program intervention is a complex process that needs to be harmonized. Financing is one of the obstacles that occur in the research location that can create competition for regional apparatus organizations to obtain sources of financing. Multisectoral convergence is needed to avoid competition for resource allocation. The results of the cost-effectiveness analysis conducted in this study noted that the cost of stunting-sensitive interventions was higher than the costs of stunting-specific interventions in the two research districts. The characteristics of the effectiveness of the social environment-sensitive intervention program in the Bangka Regency are more cost-effective because the additional costs incurred per one percent reduction in stunting are lower by IDR 1.2 billion compared to other nutrition-sensitive intervention groups. West Bangka Regency has a more cost-effective intervention in the food environment because it requires an additional cost of IDR 63.2 million per one percent reduction in stunting compared to other sensitive interventions. As the region that feels the most budgetary constraints in this study, West Bangka Regency needs to consider priorities for more cost-effective interventions.
The basis for setting priority interventions may include economic reasons and an analysis of the cost-benefit and comparative effectiveness of the choice of intervention type. The Multi-Criteria Decision Making (MCDM) approach with the Analytic Network Process (ANP) method used in this study is an alternative for determining priorities. This approach's relative priority scale is an alternative for local governments. As part of a sensitive intervention, the food environment cluster is a priority to be implemented. Non-Cash Food Assistance (NCFA) is the cluster's top priority strategy for low-income families. Diversification of family food according to local wisdom and utilization of the yard is one of the successful practices with this program. The sensitive intervention in the social environment cluster that is a priority to be implemented is nutritional counseling for parents or caregivers regarding feeding practices, cognitive parenting, and early stimulation. The role of cadres as social workers must be strengthened in their capacity and role to support these interventions. Prioritizing the health and living environment to ensure access to adequate water and sanitation is a comprehensive strategy with the previous two interventions as there is ample evidence in developing countries of the practice's success.
The results of the stunting index modeling confirm that several regions in eastern Indonesia, namely the provinces of Papua, West Papua, East Nusa Tenggara, Maluku, and North Maluku, have low stunting index (SI) values. The research variables from the SDGs development pillars, namely the Economic Development Pillar and the Environmental Development Pillar, contribute to the low index value. In Indonesia, the low socioeconomic status of households in poor urban and rural communities reduces access to quality food and adequate sanitation and water facilities. | id |
