Zero to hero: Civil society builds a national movement to end stunting (Story of Change)

This story showcases how five Voice for Change Partnership (V4CP) civil society organisations (CSOs) contributed to the emerging national movement to reduce stunted growth[1] in Indonesia and helped transform a neglected issue into a political priority. It demonstrates how the V4CP programme’s blend of international expertise, local insight and evidence-based advocacy scaled action on stunting horizontally across districts and vertically from provincial to national level.

Building on Story of Change: Improving food and nutrition security in Indonesia in November 2018, this story takes a broader look at the strategic approaches taken by the CSOs in five districts in southern Indonesia, and the consequent scaling effects. It highlights how, within two years, stunting rates across the districts had decreased by an average of 13%, the issue had been prioritised in district government plans, and the food and nutrition security (FNS) budget had been increased by an average of 55.6%.

Today, the Government of Indonesia has recognised that the approach taken by the V4CP programme is genuinely contributing towards improving the health of its citizens and is furthering progress towards the United Nations Sustainable Development Goal (SDG) 2.2, to end all forms of malnutrition by 2030.

Stunting: an overlooked crisis

When the V4CP started working on FNS in Indonesia in 2016, it was one of the first programmes to start raising awareness of stunting in the country. While the Government had been trying to tackle the problem for many years, most people were not familiar with the term ‘stunting’, even though a third of young people[2]  - as many as eight million children - suffered from the condition as a direct result of poor nutrition.

Despite its prevalence, stunting was regarded as a problem that should be confined to the health sector. While the 2011-2015 and 2015-2019 National Food and Nutrition Action Plans (FNAP) and Law No. 18 year 2012 on Food had been devised, the provincial governments largely overlooked stunting prevention because they under-estimated its wide-ranging social and economic impacts.

The V4CP began by focusing on the country’s two worst affected provinces: East and West Nusa Tenggara, where around half of the population had stunted growth[3]. It partnered with five local CSOs – Ayo Indonesia, YPPS[4], Bengkel Appek, Transform and  Consortiums for the Study and Development of Participations (Konsepsi), with the initial aim of convincing the local authorities to implement two national initiatives, the Country Strategic Plan on Food and Nutrition Security and the National Strategy to Accelerate Stunting Prevention 2017-2021.

Sowing the seeds of nutrition: accelerating across districts

Over the ensuing months, the V4CP helped the CSOs to build capacity and to devise the most effective strategies for their focus areas. While their plans varied in approach, they included common themes: applying evidence-based advocacy; championing an inclusive, multi-stakeholder approach to improving nutrition; engaging with the media; and collaborating with a wide range of community stakeholders, including other CSOs, youth groups, women forums, as well as local and international development organisations.

Each CSO tailored its strategy to make it locally relevant, yet they also supported each other and grew together by sharing the lessons learned. For example, Konsepsi lent its research capacity to support YPPS in research on de-worming prevalence among under two children in East Flores. As a result, the V4CP programme managed to raise tremendous awareness amongst district governments in both provinces and helped move stunting to centre stage on Indonesian policy makers’ and other stakeholders’ agendas.

District to provincial: horizontal scaling

With support from the five local CSOs, the V4CP contributed to decreasing stunting prevalence rates. In West Nusa Tenggara they fell from 45.2% in 2013 to 33.49% in 2018, and in East Nusa Tenggara from 51.7% in 2013 to 42.6% in 2018.

News of this success began spread as local media reports filtered out to neighbouring districts and provinces. By 2019, the national TV, newspapers and online news were reporting the burgeoning stunting movement. Not only did this publicity increase the CSOs’ credibility in influencing local governments and other stakeholders, it also helped the stunting movement make impacts at scale.

As the news became ‘viral’, provincial governments increasingly took note. This directly contributed to Transform and Konsepsi scaling up their advocacy and led to them being involved in a number of district and provincial FNS task forces across West Nusa Tenggara.  Konsepsi became the only CSO selected to become part of a committee, and an examiner, in support of the provincial government in assessing the stunting reduction performance across all districts in West Nusa Tenggara. “Of course I know the V4CP, Konsepsi and Transform. I saw your photos and read the news,” said Ridwan Syah, the Provincial Government’s Assistant for Economy and Development.

In addition, the way in which the CSOs shared learning with other district governments also helped scale the movement horizontally by inspiring the adoption of similar approaches to stunting reduction. An example of this can be seen through Ayo Indonesia’s work. Having become well-known in the Manggarai district following media publicity, the CSO decided to engage the East Manggarai government, which soon sought strategic collaboration. It asked Ayo Indonesia to support it with synergising stakeholders on the issue, highlighting the importance of the district FNS action plan, and with leading behavioural change communications and clarifying village roles on stunting reduction. As a result, East Manggarai has now committed to boosting stunting prevention and reduction efforts.

Provincial to national: vertical scaling

On 15 August 2019, East Flores received the accolade of the most innovative district in the East Nusa Tenggara province and won first place for its stunting prevention and reduction efforts. This was a direct result of the success of Foranzi, a food and nutrition discussion forum initiated by YPPS in 2017. Not only was the district’s accolade reported in the regional media, it also featured in national media such as Tempo, Liputan 6, Metro TV, and the Jakarta Post.

Consequently, East Flores has since been invited to share its local innovation at national forums. At the Bappenas event in Makassar, the district was hailed as a national role model for stunting reduction. It was also invited to present Foranzi and its broader local systemic change strategy at a Responsible Business Forum (RBF) event in Jakarta. Held by Bappenas, the United Nations and Global Initiatives, the aim of this event was to share SDG2 initiatives and to produce recommendations for the development of a national action plan for the Government of Indonesia.

Transform’s national profile also started to increase after it initiated a seminar on FNS in 2018. During the seminar, the National Development Planning Ministry and the International Food Policy Research (IFPRI) shared evidence related to stunting in West Nusa Tenggara, which spurred the Vice Governor of the province and the Government of Indonesia to make a public commitment on reducing stunting. This was a key entry point for the CSOs to push for regulation, budget allocation, and better implementation for stunting reduction activity across the country.

"Our movements become increasingly massive when all stakeholders join the force, while Government commits to be the motor. The success of the national seminar has embraced various stakeholders across Indonesia, and most importantly the Government wants to scale up the national seminar to be an international seminar hosted by West Nusa Tenggara’s Regional Secretary," said Suyono, Director of Transform.

Konsepsi is also scaling up its influence. It is particularly focused on aligning district governments with the national Government in order to increase the stunting programme’s budget.

“The national Government established a policy on Special Allocation Fund (DAK). Konsepsi is taking a strategic role as a liaison of district governments and is helping them to access the national Government by making use of the national networks that the V4CP has previously connected us with,” explained Moh Taqiuddin, Director of Konsepsi.

Building a movement: engaging multiple stakeholders

The vertical and horizontal scaling of the movement to tackle stunting did not happen in a vacuum. Its success is largely due to way in which the CSOs engaged the full spectrum of stakeholders required, recognising that stunting is too complex an issue for governments to tackle alone. By sharing their insights and learning with other CSO networks, such as the national alliance for Scaling up Nutrition (SUN) CSO coalitions and a newly established NGO coalition for stunting reduction and prevention platform, as well as youth groups, womens’ forums, and local and international development organisations, they enabled other organisations to scale initiatives.

Also key to success was the CSOs use of evidence to underpin advocacy. To date, 19 surveys have been conducted by the V4CP and local governments to provide evidence for advocacy, and to inform regulations and interventions.

Next steps

Today, the V4CP CSOs are recognised as ‘fathers’ of the stunting movement. They have earned the trust of the district governments, which frequently call on them for technical support on stunting prevention and reduction efforts.

The high levels of commitment on stunting among the districts is demonstrated by the fact that political will has been translated into concrete actions, such as policies, programmes and budgets. So far, as many as five new Regent’s regulations have been passed related to stunting reduction and village fund utilisation in East Lombok, North Lombok and East Flores. In the programme’s five focal districts, budget allocation for FNS has increased by an average of 55.6%.

Although much works still needs to be done to eradicate malnutrition across Indonesia, this story bears testimony to how exemplary progress can be scaled by taking an inclusive, collaborative and evidence-based approach to collective action.

Who we are

The Voice for Change Partnership (V4CP) strengthens the capacities of CSOs to foster collaboration among relevant stakeholders, influence agenda-setting and hold the government and private sector accountable for their promises and actions. It is funded by the Dutch Ministry of Foreign Affairs.

References

[1] Stunting is the impaired growth and development that children experience as a result of malnutrition, repeated infection, and inadequate psychosocial stimulation. Stunting in early life - particularly in the first 1,000 days from conception until the age of two - has adverse functional consequences including poor cognition.

[2] Stunting Prevalence in Provinces of Indonesia according to the Indonesia Basic Health Research (Riskesdas) 2013-2018.

[3] Stunting Prevalence in Provinces of Indonesia according to the Indonesia Basic Health Research (Riskesdas) 2013-2018.

[4] YPPS  - Yayasan Pengkajian dan Pengembangan Sosial.