Recipe to Combat Stunting: Upgraded Resources and Supportive Policies

Imagine you are faced with a critical challenge, but you have limited skill, competence, and support to overcome it. Are you sure you can combat that? You might be able to solve the obstacle, but are you sure it will obtain maximum outcomes? A similar analogy might be implied for one of the most critical health cases in Indonesia: stunting. Are you sure we can combat stunting if our resources have limited skill and competence, as well as an unsupported policy? 

According to the Indonesia Nutritional Status Survey (2022), the province with the highest case of stunting is Nusa Tenggara Timur (NTT). Stunting is more than a short stature. It has a strong connection to the long-term life of a human being. Theoretically, stunting is the impaired growth and development that children experience as a result of inadequate psychosocial stimulation, repeated infections, and poor nutrition. Some of those consequences include poor cognition and educational performance, low adult wages, lost productivity, and when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life. The bad news is that the causes behind stunting are not uncomplicated. However, the good news is that the causes are preventable. Just if we have resources with an upgraded set of skills and competence, as well as a supportive policy. The health care workers, such as village midwives, and the government, such as village heads, play a solid role in making it happen.

Village midwives live closely with the family in the village. They are one of the forerunners of health care services in the village. They provide services to childbearing women, newborn infants, and families across the continuum from pre-pregnancy to pregnancy, birth, postpartum, and the early weeks of life. A midwife’s duty is neither unplanned nor facile. Gampong Ara village in Aceh province, Indonesia, succeeded in reducing the stunting rate in children under two years old. There were 13 cases in 2017, 4 in 2019, and no cases in 2020. The study uncovered that the village midwife has carried out her role as an implementer of stunting reduction by carrying out some tasks such as antenatal care, home visits, cadre trainings, pregnancy classes, emotional support, and health status profiling.

Photo credit to: FMCH Indonesia

Another study in Peru found that strong political commitment and good policies, such as coming from the village level, were the secret behind breaking the cycle of poverty perpetuated by stunting. Since 1989, the Indonesian government has initiated a program called Bidan di Desa, or Midwives in Villages, in which a trained midwife is placed in each village along with the village birth facility called Pondok Bersalin Desa (Polindes) in order to provide maternal health services, including combating stunting cases. Until this date, this program remains in all villages in Indonesia, and one of them is because of the solid role of the village heads.

However, oftentimes, reality speaks differently. The myriad roles of midwives do not mean a good sign. Sometimes it can cause a work overload for midwives because they are the one and only health care workers in the village. “There is a high expectation for the midwives. Oftentimes, they handle a huge range of health issues, not only the maternal health services themselves. Being sad, I feel like it is exploitation,” said Syifa Andina, chairwoman of the Foundation for Mother and Child Health Indonesia (FMCHI). Furthermore, the demands of midwives for their health care services require capacity development over time. In fact, not every local leader in NTT realized the importance of midwives’ roles, including capacity development and work overload. Therefore, aside from generating upgraded village midwives and shunning the work overload, village heads have a robust role in political support.

Firstly, the village heads should allocate a specific expense for the midwife’s capacity development. The Indonesian National Population and Family Planning Agency (BKKBN) proposed that at least 10% of the entire village fund (dana desa) be set aside for stunting cases. This number is reasonable and manageable. Strengthening the idea, the fact is that the Ministry of Finance, through Regulation No. 205/2019, has mandated stunting prevention as one of the annual programs funded by the village fund. Furthermore, one of the required aspects of the funding is community empowerment. As a part of the community itself, midwives are entitled and eligible to participate in the empowerment effort. The head villages can allocate at least 1–2% out of that 10%. In sum, when it comes to spending for development, it is worth every penny. As Benjamin Franklin said, “An investment in knowledge pays the best interest.”

Secondly, the village head should establish partnerships with nonprofits and academics in order to get broader support and distribute midwives’ workload. FMCHI, aside from their intervention in midwives’ capacity building, is also providing health education programs for families, including children, related to maternal health issues. Not merely FMCHI, there are many nonprofits that work on maternal health issues in NTT that can be strategic partners of the village midwives. Further, from the academic side, the village has the possibility of building partnerships with some universities or polytechnics, such as Nusa Cendana University through their medical and public health school or the Health Polytechnic of the Ministry of Health in Kupang. Both campuses are actively seeking partners to implement their community service programs.

Imagine that our midwives live in villages with a significant stunting rate. Nevertheless, this time, they have enhanced their skills and competence and gotten solid support from the village heads through better policies. The stunting case would still exist, obviously. It is not a solo solution. However, there will be a guarantee that the outcomes will be better since there will be a fusion of upgraded resources and supportive policies. It takes a long time, but it is worthwhile.