SUN Movement experiences in Indonesia
By Nina Sardjunani and Endang L. Achadi
Nina Sardjunani is the SUN Lead Group member and was previously Deputy Minister of Ministry of National Development/National Development Planning Agency.
Endang L. Achadi is a Professor in the Faculty of Public Health, Universitas Indonesia
What we know: Indonesia joined the Scaling Up Nutrition (SUN) Movement in 2011.
What this article adds: Joining the SUN Movement has strengthened political and policy commitment to nutrition across multiple sectors in Indonesia. The existing Strategic Policies and Action Plan on Food and Nutrition has aligned with the SUN Common Results Framework, with proactive advocacy and engagement across multiple ministries. Costing the nutrition-sensitive and nutrition-specific components of nutrition plans is well underway, albeit with some challenges. SUN-inspired networks and working groups (specific to Indonesian needs) have been developed. While Indonesia remains firmly committed to scaling up nutrition, challenges to putting plans into action include national constraints in food production and variety; emerging double burden of malnutrition; maintaining interest and securing commitment of stakeholders; regional capacity (related to decentralisation) and availability of resources.
When Scaling Up Nutrition was raised by UN Secretary General Ban Ki-Moon in 2010, the SUN approach was highly relevant to the prevailing nutrition context in Indonesia. While undernutrition rates were still high, reflected particularly by prevalent stunting in children under five years old, overnutrition was increasingly becoming a significant concern. On 22 December 2011, the Republic of Indonesia joined the global SUN Movement with a letter of commitment from HE Endang Rahayu Sedyaningsih, the late Minister of Health, to the Secretary General of the UN. At the time, with support from the Ministry of Health and the Coordinating Ministry of People’s Welfare, Indonesia began the First 1,000 Days of Life Movement and Bappenas (the Indonesian Ministry of National Development Planning) began to formulate a SUN Policy Framework to create the political and policy commitment. The resulting policy framework includes objectives adopted from the World Health Assembly 2025 targets on nutrition, strategies and implementation phases of the Movement, as well as partnership in the Movement. The framework also regulates the monitoring and evaluation of the First 1,000 Days of Life Movement. In line with the SUN Policy Framework, Guidelines for Programme Planning were also formulated for local government, since nutrition-specific and nutrition-sensitive interventions are already decentralised in Indonesia.
SUN Movement in Indonesia
To obtain political and policy commitment from relevant ministries, the Coordinating Ministry of People’s Welfare, Bappenas, and the Ministry of Health drafted the Presidential Decree on the National Movement to Accelerate Nutrition Improvement within the Framework of the First 1,000 Days of Life Movement, which was eventually approved by the President in 2013. Presidential Decree No. 42/2013 was launched by the President in conjunction with the commemoration of World Food Day in West Sumatra in October 2013.
The Government of Indonesia develops a five-yearly National Medium Term Development Plan (RPJMN), in which each sector proposes its programme planning and budget. For RPJMN 2015-2019, all of the SUN principles are included as cross-sectoral issues. Currently, the National Action Plan on Food and Nutrition (RANPG), with its multi-sectoral approach, is in line with RPJMN 2015-2019 and is being finalised. For 2015-2019, the RANPG has been renamed the National Strategic Policy and Plan of Action on Food and Nutrition (KSRANPG). The RANPG has been developed every five years since 2001. The latest RANPG, KSRANPG, is aligned with the SUN Common Results Framework (CRF). In the KSRANPG, the First 1,000 Days of Life policies and programmes are included as a priority area of focus.
From the outset, we were aware that nutrition needed to go beyond the health and agriculture sectors. Therefore the multi-sectoral approach of the RANPG engaged 13 ministries and two national boards/agencies, namely the Ministry of Home Affairs, Ministry of Health, Ministry of Agriculture, Ministry of Marine and Fisheries, Ministry of Education and Cultural Affairs, Ministry of Industry, Ministry of Trade, Ministry of Youth and Sports Affairs, Ministry of Communication and Information, Ministry of Women Empowerment and Child Protection, Ministry of Public Works and Public Housing, Ministry of Man Power, Ministry of Village and Regional Development, National Family Planning Coordination Board, and National Agency of Drugs and Foods Controls. Two ministries also coordinate the Action Plan. These are the Coordinating Ministry for Human Development, Society, and Cultural Affairs and the Coordinating Ministry for Economy and Maritime Affairs.
The difference between the current and previous RANPGs is that the current RANPG encourages all relevant sectors to work together to specifically address food and nutrition issues. This multi-sector, nutrition-sensitive approach was advocated in advance of the RANPG’s development. Meetings and workshops were called by the Deputy Minister for Human Resources and Cultural Affairs of Bappenas, as Chair of the Technical Team. Advocacy meetings were held at least five times due to challenges in convening the right persons from all sectors at the same time. The series of meetings began with introductions and ‘getting to know everyone’. This was followed by meetings with clusters of sectors to establish effective processes and ended with a final meeting comprising all sectors. The process has broadened sectors’ understanding about multi-factoral causes of malnutrition and multi-stakeholder roles in improving nutrition.
In general in the RPJMN 2015-2019, each of the 15 sectors/agencies engaged already had programmes that were nutrition-sensitive, but were not recognised as such by the sectors until the advocacy meetings took place. For example, the Ministry of Public Works and Public Housing has a programme to build water and sanitation facilities; the Ministry of Industry and Ministry of Trade is in charge of food fortification programmes; the Ministry of Agriculture and Ministry of Marine and Fishery have programmes to ensure the availability and accessibility of agriculture and marine products, while the Ministry of Trade is in charge of stabilisation of food prices. In these cases, the ministries are not required to change the programme but now recognise the nutrition-sensitive aspect. For example, a subsidised rice programme for poor households has been implemented since 1998 and is now recognised as nutrition-sensitive. Sectors work together to identify indicators related to nutrition and agree which of these are key performance indicators to be monitored. For example, the Ministry of Agriculture determines food diversity and food access as its indicators; the Ministry of Social Welfare uses coverage of National Social Security; the Ministry of Public Works and Public Housing uses improvement to sanitation and access to clean water indicators; and the Ministry of Education uses women’s education as its indicator.
Stakeholder Networks of the Indonesia SUN Movement are already established under the SUN technical team. The UN Country Network, especially UNICEF, has been involved in the development of the KSRANPG (CRF). Other networks – the SUN Business Network, Civil Society Alliance, and the Donor and UN Country Network on Nutrition – were informed about the KS-RAPG 2015-2019.
Based on the Presidential Decree, the SUN Movement secretariat has been established and is based in Bappenas. The secretariat has been working with ministries and agencies to analyse the costs of national nutrition plans. Both nutrition-specific and nutrition-sensitive interventions in the food and nutrition programme plan are costed. First, the secretariat worked with the ministries to identify the relevant nutrition-specific and -sensitive programmes and activities. To ensure programme budgets were correct, data verification was conducted through multi-sectoral meetings using the SUN list of key words to determine specific and sensitive programme categories and associated costs identified. The programmes in question were discussed with each sector and a weighting scale agreed, based on the significance of the programme to nutrition improvement and using the SUN guidance in this regard. The weighting scale was used to adjust the cost of the programme (see www.scalingupnutrition.org for methodology details). Secondly, the Sector Development Matrix of RPJMN 2015-2019 was formulated that included each programme budget allocation. Finally, the Sector Development Matrix of RPJMN 2015-2019 was integrated into the National Action Plan. A common challenge is that nutrition-related activities are not stated in the national annual work plan document (RKP) and RPJMN. In such cases, the specific budget allocation for nutrition-related interventions is traced in the budget documents, and the programme and budget allocation adjusted when necessary.
Engaging other ministries on nutrition-sensitive planning
Presidential Decree No. 42/2013 mandated the establishment of a coordinating mechanism for a multi-stakeholder, high-level Task Force led by the Ministry of People’s Welfare. This Task Force consists of multiple stakeholders and 13 line ministries at national level. The Decree led to the issuance of The Minister for People’s Welfare Decree No. 11/2014 on the establishment of a Technical Team to facilitate coordination at the national level. This Decree mandated the Deputy Minister for Human Resources and Cultural Affairs of Bappenas as Chair of the Technical Team. The Decree of the Deputy Minister for Human Resources and Cultural Affair Bappenas No. 37/2014 mandated the establishment of six Working Groups (Campaign, Advocacy, Training, Planning and Budgeting, Partnership and Environmental Risk Factor Study), supported by an Expert Team with stakeholders from Government, Business sectors, UN agencies, international development partners, community and social organisations, professional organisations, academia and mass media. Each working group convenes meetings to discuss their strategies and programme. Bappenas also convenes coordinating meetings to ensure the activities proposed are in line with the SUN Policy Framework. The chairperson of the technical team in Bappenas is responsible for reporting annually to the Chairperson of the Task Force. Both Networks and Working Groups exist in Indonesia. The Networks reflect the SUN approach: government, UN, donor agencies and international agencies are grouped as one network; civil society organisations comprised of academia, professional organisations and NGOs as a second; and business as a third network. The Working Groups speak to the Indonesian context and function with support from the networks.
Certain sectoral activities, such as agriculture and public works, are categorised as important nutrition-sensitive activities. However, challenges in engaging other sectors on nutrition can occur when the SUN Movement is viewed as a new project with new or additional budget allocation needed. What can be difficult to get across is the idea that the SUN Movement aims to both improve coordination of what exists, as well as rollout and scale up new nutrition interventions or modified existing nutrition-sensitive programming, with a view to combatting all forms of malnutrition. Another considerable challenge is that nutrition problems are often invisible. Therefore, to obtain more support for nutrition programming, strong advocacy strategies are needed, particularly to convince the nutrition-sensitive sectors that change is necessary.
Putting plans into action
Although the RANPG is a comprehensive document, several challenges remain in putting the plan into action, including:
- Domestic food production capacity is increasingly limited due to land conversion, preponderance of small-scale farmers and fishermen, dominance of traditional technology and limited access to capital. This limits food availability and diversity;
- The process of food production and food consumption diversification has been slow in Indonesia, which has led to dependence on certain food types. In addition, food access – which is still poor due to the decline in purchasing power caused by poverty and unstable food prices – has led to inadequate food consumption for many. Nutritional problems are inter-generational and the consequences are trans-generational. Therefore nutrition interventions must be coordinated across demographic groups;
- Indonesia is experiencing a double burden of malnutrition as evidenced by the increase in non-communicable diseases (NCDs). NCDs are not only the result of lifestyle, but more importantly are a consequence of malnutrition in the first 1,000 days of life and pre-pregnancy malnutrition. Low consumption of fruits and vegetables, high consumption of sugar, salt and high-fat food, coupled with low levels of physical activity in society, especially in urban areas, lead to increases in overweight and obesity prevalence;
- Lack of knowledge leads to inadequate childcare and feeding practices, as reflected in the very low rate of exclusive breastfeeding among infants aged 0-6 months (38%); and
- Lack of access to clean water and lack of a healthy environment contribute to communicable diseases that cause malnutrition.
While dialogue with other networks has been progressing, it is not clear yet what activities these networks intend to promote and instigate. This is especially so for the SUN Business Network and the Civil Society Alliance. Networking efforts need to be accelerated.
In 2016, the Ministry of Health is planning to conduct the fourth Basic Health Survey (Riskesdas), which will include a number of nutrition indicators, i.e. stunting, wasting, overweight of children under five, undernutrition, anaemia, low birthweight and exclusive breastfeeding prevalence. The results of the survey will be used to inform and help improve programme implementation.
Commitment to the National Action Plan on Food and Nutrition at central level has not been replicated fully in all districts; it should be reflected in the Regional Action Plan on Food and Nutrition. Bappenas continues to develop the Guidelines for the Development of the Regional Action Plan on Food and Nutrition in order to assist local government to develop its own Action Plan, based on a multi-sectoral approach. This is a significant challenge in itself, because:
- The process of the development of the Regional Action Plan on Food and Nutrition requires a similar process to the development of the National Action Plan. This includes sensitising all relevant sectors at regional levels, selection of priority programmes/intervention based on local problem analysis and human resources capacity and other resources availability, creating a coordination and budgeting plan, and monitoring and evaluation;
- The Regional Action Plan on Food and Nutrition needs approval from the parliament; and
- There are over 500 districts/cities in Indonesia that need assistance from the central Government.
Conclusions and recommendations
The Government of Indonesia has taken the SUN Movement seriously. The Movement’s launch corresponded with recognition of the current double burden of malnutrition situation in Indonesia. This response is evidenced by the release of the Presidential Decree, the launch of the SUN programme by the President himself, the development of relevant national documents and other actions. The multi-stakeholders approach has increased the awareness of all related sectors to their potential role in improving the nutrition situation in Indonesia. However, significant challenges remain, including maintaining interest (some forms of malnutrition are effectively invisible), commitment from all stakeholders, regional capacity and availability of resources.
Addressing malnutrition in Indonesia requires commitment from many stakeholders, so there is a need for strong championship at national level. The role of Parliament should therefore be enhanced, especially its role in developing laws on nutrition and nutrition-related issues and budget decisions. The commitment and coordination of the various interested networks must be intensified, especially the SUN Business Network and Civil Society Alliance, as well as Donor and UN Country Networks on Nutrition.
For more information, contact: Endang L. Achadi
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Reference this page
Nina Sardjunani and Endang L. Achadi (2016). SUN Movement experiences in Indonesia. Field Exchange 51, January 2016. p20. www.ennonline.net/fex/51/sunexperiencesindonesia