Peran Mitra Pembangunan dalam
Penanggulangan Triple Burden Malnutrition
Dr. Elvina Karyadi, MSc, PhD
Senior Health Specialist
Persatuan Ahli Gizi Indonesia XVI- Temu Ilmiah Gizi dan
Kongres Nasional Kursus Penyegar Ilmu Gizi (KPIG)
Medan, 20 November 2019
Outline
• Global overview of nutrition problem
• Overview of triple burden malnutrition in Indonesia
• Stunting in Indonesia: what is the progress?
• Obesity and NCDs
• What is the gap?
• Summary
Global Overview of
Nutrition Problem
Source: Global Nutrition Report, 2017
Meeting Target: Where are we now?
Overview of
Nutrition Problem in Indonesia
Stunting is a national emergency
Proportion of Overweight and Obesity Among
Adults > 18 years, 2007-2018
Sources: Riskesdas 2007, 2013 and 2018
Proportion of Anemia among Pregnant Women
Source: Riskesdas 2013 and 2018
CONSEQUENCES OF STUNTING
LOW LOW POVERTY LOST
COGNITIVE WAGE ECONOMIC
DEVELOPMENT EARNING
ACTIVITY
AND
POTENTIAL
SCHOOLING
ATTAINMENT
11
DRIVERS OF TRIPLE BURDEN MALNUTRITION
- Epidemiological transition
Health and biological environment - Changing lifestyle and habit
- Low physical activity
Physical/build Environment - More street vendors and
meals outside home
- Limited access to healthy
food
- Food system and supply
Economic and Food environment - Fast-food
- Urban life environment
Socio-cultural Environment - Early married before 18 years
- Advertisement targeted toward
children
- Gender gaps
STUNTING IN INDONESIA:
what is the progress?
Windows of Opportunity to prevent irreversible loss in
cognitive function is short during early childhood
The prevalence of
stunting increases
steadily up to the
first 2 years of life
Stunting damages brain development in irreversible ways
Normal Stunted
Impaired brain cells
Limited branching
Typical brain cells Abnormal, shorter
Extensive branching branches
Adequate nutrition in first 1000-days is imperative
16
Access to convergence nutrition service
children 0-2 years
Service Coverage Convergence service coverage
35
Imunisasi dasar 35.6
30 28.7
ASI Eksklusif 60.2 25.4
25
Keragaman konsumsi 32.5
18.8
20
Air minum 74.2
15 12.4
Sanitasi 68 8.5
10
PAUD 8.4 4.3
5
0.1 1.2
Skor kerawanan pangan 11.9 0
Akte kelahiran 83.1
0 20 40 60 80 100
Source: World Bank staff calculations based on SUSENAS 2017.
National Government Committment
Priorities
Indonesia’s Stunting Rate –
Scenario-based Projections
Indonesia's Stunting Rate - Scenario-based Projections
35.0
Scenario 1: Conservative. Reduction of
stunting prevalence as business as usual
(BAU)
29.4 29.0
29.0
30.0 28.5
Scenario 2: Stranas Stunting-Realistic,
28.6
28.1 reduction of stunting about 1.5%/year
27.7
27.3
26.7
Scenario 3: Stranas Stunting –
Stunting Rate
28.2 25.2
25.0
27.4 24.3 Optimistic, Service Coverage (nutrition)
23.4 is 90 %. Prevalence of stunting will be
24.5 reduced about 2 % per year.
22.1
20.0
20.6
19.4
15.0
2019 2020 2021 2022 2023 2024
Axis Title
BAU (Business As Usual) Baseline NatStratRealistic NatStratOptimistic
23
OBESITY AND NCDs
BEHAVIORAL RISK FACTORS OF NCDs
IN INDONESIA
INDONESIA PROFILE
NATIONAL POLICIES FOR NUTRITION AND NCDs
YES
WHAT IS THE GAP?
?
THE
ROLES
SEKTOR PRIVAT
MITRA PEMBANGUNAN
Nutrition
and NCDs INGO/NGOs
AKADEMIA
MEDIA
SHARING RESPONSIBILITY
❖ ADVOCACY: PARTNERSHIP, LEADERSHIP & MANAGEMENT
o Building on current initiatives through SUN networks
o Consider ways to ensure that both the future National Plan for Development (RPJMN) and National
Action Plan for Food and Nutrition (RANPG) adequately contemplate the triple burden malnutrition
o Regulations (food standards, food labelling, taxation)
❖ HEALTH SYSTEM STRENGTHENING
o Enhancing primary health care to deliver health and nutrition intervention, detect NCDs, diagnosis
and case management, providing guidelines
❖ HEALTH PROMOTION AND BEHAVIOR CHANGE COMMUNICATION THROUGH LIFECOURSE
o Nutrition Education and healthy food promotion, develop the curriculum
o “Health message” for salt, sugar and oil intake
❖ ENHANCING RESEARCH, DATA BASE COLLECTION AND WEB-BASED SURVEILLANCE SYSTEM
o Explore the potential for and possibilities of introducing taxes on imported food commodities
o Economic and fiscal impacts of triple burden malnutrition
o National Nutrition Survey
SUMMARY
• Indonesia will face a “bonus demography” (2030-2040) and tackling
triple burden malnutrition should be a priority for improving the HCI
• Ensure adequate investments in nutrition-specific and
nutrition-sensitive programs (including food security)
• Incentivizes coordination, collaboration, alignment & accountability
across ministries & levels of government and multi-stakeholders
• Improve delivery of key programs and quality of services
• Drive performance and better spending by improving the collection
and publication of data on expenditure, intervention coverage, and
indicator health and nutrition outcomes
• Use technology to strengthen capacity of sub-national to implement
multi-sectoral interventions, and empower citizens to monitor progress
and demand delivery
http://documents.worldbank.org/curated/en/
913341532704260864/pdf/128954-REVISED-
WB-Nutrition-Book-Aiming-High-11-Sep-
2018.pdf
