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Forewords

Global Nutrition Report (GNR) - 2014

On Jan 9, 2015 GNR-2014 was launched at Bappenas, Jakarta. It was opened by Coordinating Minister for Human Development and Culture, Puan Maharani; Minister of National Development Planning (BAPPENAS),Andrianof Chaniago; Director General of Nutrition, Maternal and Child Health Ministry of Health, Anung Sugiantono; and attended by Lawrence Haddad, Co-Chair GNR,

IFRI, Washington; and US Ambassador for Indonesia, Robert O. Blake, Jr.The following are the takeaways from Prof Lowrence Haddad after attending the launching GNR in Jakarta.

Jakarta, April 2015Prof. Soekirman (Em.), Bogor Agriculture University (IPB), Chairman of KFI

MY TAKEAWAYS (From Jakarta): (Prof. Lawrence Haddad)

“* Shock. Many in the audience were floored by the fact that Indonesia was one of only 17 countries with high levels of under 5 stunting, wasting AND overweight. Stunting rates are high (36% from a 2013 government survey), static, and, for the poorest quintile, are actually increasing. One of the senior government officials said it was a “disaster”. The Indonesia Nutrition Country Profile gives more details.

* Decentralization. It is clear that while most of the power for improved nutrition lies with the +500 Districts, there does not seem to be a plan for getting them to focus on nutrition. This could be done through regulation, investment (in capacity) or incentives, but while each District has an action plan, there is

no action plan for dealing with the Districts.

* Potential. The potential for a big change in malnutrition seems high. The economy is booming, poverty is falling, cash transfers are in place, a new law is being introduced that would raise the age of marriage to 18 from 16, there is tons of up to date data, and the central government seems committed (ranked 7th in the nutrition component of the HANCI).

* Think tanks. The gap between government and research seemed quite significant. Nutrition in Indonesia needs something like a SMERU and Prof. Soekirman announced a new such think-tank, the IGI (Institud Gizi Indonesia), launched in October last year. This will help link existing and new research to policy making and vice versa. It should keep the issue in the media, help governments use existing data and become better consumers of evidence and help researchers to pose more relevant questions.

* Leadership. It is pretty clear that nutrition leaders in Indonesia need to be extraordinarily adept—excelling in horizontal coordination (across sectors and stakeholders at the same level) and in vertical coordination (from national to sub district). This requires so much more skill than knowledge of nutrition. It requires people to stick their necks out to make decisions that might not please key constituencies, make a compelling case and build relationships outside their comfort zones. None of this is easy, but it has to be done.

* New Plans. New plans for nutrition improvement are being drafted for 2015-2019 and they are going to be multisectoral, not just focusing on food and health. In principle this is very good, but in practice it makes it even more demanding to implement, so capacity investments will have to accompany the changes. Also the proposed name, Food and Nutrition Plan, needs to change to something like Multisector Plan for Nutrition. Food is important, but so are the other sectors. The proposed name would privilege one sector over the others and often food is not the main constraint to improved nutrition.

In sum, all the ingredients are in place for a rapid reduction in malnutrition in Indonesia. We just need a few adventurous cooks with the keys to the kitchen who can develop, articulate and implement plans for nutrition. If Indonesia wants to lock in enhanced economic performance in the future, it needs to invest in nutrition now. “

Photo: Gallery KFI

Volume 11April 2015 -

NewsletterFortifikasi Pangan untuk Perbaikan Gizi

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KFI NewsLetter April 2015 - Volume 11

kegemukan, yang membuat jantung dan paru-paru “stress” berat sepanjang hari. Akibatnya penyakit diabetes, tekanan darah tinggi, stroke dan kanker mengancamnya. Masalah gizi menyebabkan negara kehilangan 11% pendapatan nasionalnya akibat tingginya angka kematian, kurangnya kemampuan belajar disekolah, upah yang rendah, dan sering bolos sekolah dan bekerja karena sakit. Ibu yang kurang gizi dan mengandung akan cenderung melahirkan bayi dengan berat badan rendah (BBLR). Keadaan ini memperburuk keadaan karena memperpanjang rantai kemiskinan generasi berikutnya. Singkatnya masalah gizi menggerogoti tubuh, menghambat kemajuan ekonomi dan kemajuan masa depan bangsa. Ambisi untuk mencanangkan pembangunan berkelanjutan (sustainable) dapat dilumpuhkan oleh sikap pembiaran atau tidak peduli terhadap maraknya masalah gizi (kekurangan dan kelebiha gizi).

GIZI DAN PEMBANGUNAN MENURUT IFPRI (GLOBAL NUTRITION REPORT-2014)(IFPRI Issue BRIEF, November 2014)

Gizi baik adalah fondasi dari pembangunan bangsa yang sehat, kuwat, bertahan hidup dalam segala keadaan, dan menjadi sumber pembangunan ekonomi yang tangguh. Tanpa pembangunan gizi, SDM akan tidak mampu bersaing dan mudah “ambruk” seperti bangunan yang dibangun diatas pasir. Anak pendek (stunting) tidak dapat tumbuh dan berkembang dengan normal, karena ada kerusakan dan gangguan pada proses perkembang otak dan sistem kekebalan tubuh (sistem immunitas). Ibu hamil dan WUS (Wanita Usia Subur) yang kurang zat besi dalam makanannya, tidak dapat memenuhi kebutuhan fungsi darah dan ototnya. Disamping itu banyak orang dewasa yang membawa beban berat badan karena

Minister of National Development Planning (BAPPENAS) Andrinof Chaniago.

Dirjen Gizi KIA Kementrian Kesehatan Pada acara Launching GNR-2014 DI BAPPENAS (DG Nutrition, MCH, MOH).

GNR Launching in Jakarta(January 9, 2015)

Coordinating Minister for Human and Cultural Development Puan Maharani.

“High quality Human Development with typical Indonesian character requires good nutrition.”

“Human Development is a central problem of national development. It has three main dimensions: intellectual, physical health and mental health. All comprises the dimensions of national development.”

Photo: Gallery KFI Photo: Gallery KFI

Photo: Gallery KFI

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KFI NewsLetter April 2015 - Volume 11

FINANCIAL RESOURCES AND POLICY, LEGISLATION, AND INSTITUTIONAL ARRANGEMENTS

www.globalnutritionreport.org2014 Nutrition Country Profile

ECONOMICS AND DEMOGRAPHY

CHILD ANTHROPOMETRY

ADOLESCENT AND ADULT NUTRITION STATUS

IndonesIa

WORLD HEALTH ASSEMBLY INDICATORS: PROGRESS AGAINST GLOBAL WHA TARGETSUnder-5 stunting, 2013 Under-5 wasting, 2013 Under-5 overweight, 2013 WRA anemia, 2011

Currently off course Currently off course Currently off course Currently off course

Source: WHO 2014.Notes: Currently it is only possible to determine whether a country is on or off course for four of the six WHA targets. The year refers to the most recent data available; on/off-course calculation is based on trend data. WRA = women of reproductive age.

INCOME INEQUALITY

Gini index, 2011 38Source: World Bank 2014.Note: 0 = perfect equality, 100 = perfect inequality.

POPULATION

Population (000) 246,864 2012

Under-5 population (000) 24,622 2012

Urban (%) 50 2010

> 65 years (%) 5 2012

Source: UNPD 2013.

CHILD ANTHROPOMETRY

Number of children under 5 affected (000)

Stunting a 8,906 2013

Wasting a 3,303 2013

Overweight a 2,814 2013

Percentage of children under 5 affected

Wasting a 14 2013

Severe wasting a 7 2013

Overweight a 12 2013

Low birth weight b 9 2007

Sources: a UNICEF/WHO/WB 2014; b UNICEF 2014.

ADOLESCENT AND ADULT ANTHROPOMETRY (% POPULATION)

Adolescent overweight a 10 2007

Adolescent obesity a 2 2007

Women of reproductive age, thinness b NA NA

Women of reproductive age, short stature b NA NA

Sources: a WHO 2014; b DHS 2014.Note: NA = not available.

MICRONUTRIENT STATUS OF POPULATION

Women of reproductive age with anemia a

Total population affected (000) 15,308 2011

Total population affected (%) 23 2011

Vitamin A deficiency in preschool-age children (%) b 20 NA

Population classification of iodine nutrition (age group 6–12) c

Mild iodine deficiency 1996

Sources: a Stevens et al. 2013; b WHO 2009; c WHO 2004.Note: NA = not available.

CHANGES IN STUNTING PREVALENCE OVER TIME, BY WEALTH QUINTILE

Data not available

Source: DHS surveys 1990−2011 adapted from Bredenkamp et al. 2014.

PREVALENCE OF UNDER-5 STUNTING (%)

29

40 3936

2013201020072004

Source: UNICEF/WHO/WB 2014.

POVERTY RATES AND GDP

1990 2000 2010 2011 2013

US$1.25/day (%) US$2/day (%) GDP per capita PPP ($)

54

18 16

85

46 43

4,2955,552

8,027 8,4389,254

Source: World Bank 2014.Note: PPP = purchasing power parity.

UNDER-5 MORTALITY RATE

Deaths per 1,000 live births

84

52

34 31

2012201020001990

Source: UN Inter-agency Group for Child Mortality Estimation 2013.

METABOLIC RISK FACTORS FOR DIET-RELATED NONCOMMUNICABLE DISEASES, 2008 (%)

Raised blood pressure Raised blood glucose Raised blood cholesterol

Both sexes Male Female

38

7

3933

7

4336

7

41

Source: WHO 2014.

PREVALENCE OF ADULT OVERWEIGHT AND OBESITY, 2008 (%)

Both sexes

Male

Female

Obesity (BMI ≥ 30)Overweight (BMI ≥ 25)

257

163

215

Source: WHO 2014.Note: BMI = body mass index.

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KFI NewsLetter April 2015 - Volume 11

Credits:Concept: Prof.(Em.) Soekirman Creative: Habibie Yukezain Writing: Ifrad DDS Picture Editor: Adityo Rachmanto Published By:Indonesian Nutrition Foundation for Food Fortification (KFI), Address: KFI c/o Komplek Bappenas A1, Jl. Siaga Raya Pejaten, Jakarta 12510, Indonesia, Phone: +62 21 7987 130, Fax: +62 21 7918 1016, Website: www.kfindonesia.org, Email: info@kfindonesia.org

The KFI Newsletter is part of KFI-GAIN project.

Supported by: SAFO - GFP

INTERVENTION COVERAGE AND CHILD-FEEDING PRACTICES

UNDERLYING DETERMINANTS

FINANCIAL RESOURCES AND POLICY, LEGISLATION, AND INSTITUTIONAL ARRANGEMENTS

ECONOMICS AND DEMOGRAPHY

CHILD ANTHROPOMETRY

ADOLESCENT AND ADULT NUTRITION STATUS

2014 Nutrition Country Profile

For complete source information: www.Globalnutritionreport.org/about/technical-notes. © 2014 International Food Policy Research Institute

IndonesIa

INTERVENTION COVERAGE (%)

Severe acute malnutrition, geographic coverage a NA NA

Vitamin A supplementation, full coverage b 73 2012

Children under 5 with diarrhea receiving ORS b 39 2012

Immunization coverage, DTP3 b 64 2012

Iodized salt consumption b 62 2007

Sources: a UNICEF/Coverage Monitoring Network/ACF International 2012; b UNICEF 2014.Notes: ORS = oral rehydration salts; DTP3 = 3 doses of combined diphtheria/tetanus/pertussis vaccine. NA = not available.

INFANT AND YOUNG-CHILD FEEDING PRACTICES (% 6–23 MONTHS)

Minimum acceptable diet 37 2012

Minimum dietary diversity 58 2012

Source: Indonesia DHS 2012.

GENDER-RELATED DETERMINANTS

Early childbearing: births by age 18 (%) a 7 2012

Gender Inequality Index (score*) b 0.500 2013

Gender Inequality Index (country rank) b 103 2013

Sources: a UNICEF 2014; b UNDP 2014.Note: *0 = low inequality, 1 = high inequality.

POPULATION DENSITY OF HEALTH WORKERS PER 1,000 PEOPLE

Physicians 0.204 2012

Nurses and midwives 1.383 2012

Community health workers NA NA

Source: WHO 2014.Note: NA = not available.

POLICY AND LEGISLATIVE PROVISIONS

National implementation of the International Code of Marketing of Breast-milk Substitutes a

Many provisions law

2014

Extent of constitutional right to food b Medium-high 2003

Maternity protection (Convention 183) c Partial 2011

Wheat fortification legislation d Mandatory NA

Undernutrition mentioned in national develop-ment plans and economic growth strategies e

Rank: 43/832010–2014

Sources: a UNICEF 2014; b FAO 2003; c ILO 2013; d FFI 2014; e IDS 2014.Note: NA = not available.

AVAILABILITY AND STAGE OF IMPLEMENTATION OF GUIDELINES/PROTOCOLS/STANDARDS FOR THE MANAGEMENT OF NCDs

DiabetesAvailable, partially

implemented2010

HypertensionAvailable, partially

implemented2010

Source: WHO 2014.Note: NCDs = noncommunicable diseases.

CONTINUUM OF CARE (%)

88

83

29

77

13Unmet need for family planning, 2007b

Continued breastfeeding at 1 year, 2012a

Initiation of breastfeeding within 1 hour after birth, 2010a

Skilled attendant at birth, 2012a

Antenatal care (4+ visits), 2012a

Sources: a UNICEF 2014; b UNPD 2014.

RATE OF EXCLUSIVE BREASTFEEDING OF INFANTS UNDER 6 MONTHS (%)

40

32

42

201220072002–2003

Source: UNICEF 2014.

FOOD SUPPLY

Undernourishment (%): data for 1991, 2000, 2010, 2014

Available calories from nonstaples (%): data for 1991, 2000, 2009

Availability of fruits and vegetables (grams): data for 1990, 2000, 2010, 2011

1991 2000 2010 2014

2220

119

27 28

33

138186

266298

Source: FAOSTAT 2014.

FEMALE SECONDARY EDUCATION ENROLLMENT (%)

43

7984

2012201020001990

Source: UNESCO Institute for Statistics 2014.

GOVERNMENT EXPENDITURES (%)

1990 2000 2010 2012

Health

Education

Social protection

Agriculture

2.4 1.7

9.1

4.9

7.5

7.6 2.3

Source: IFPRI 2014.

SCALING UP NUTRITION (SUN) COUNTRY INSTITUTIONAL TRANSFORMATIONS, 2014 (%)

44Bringing people into a shared space for action

50Ensuring a coherent policy and legal framework

35Financial tracking and resource mobilization

44Total weighted

48Aligning actions around a common results framework

Source: SUN 2014.

IMPROVED DRINKING WATER COVERAGE (%)

1990 2000 2012

Piped on premisesOther improved

UnimprovedSurface water

9 15 21

6063

64

24 18 136 4 2

Source: WHO/UNICEF JMP 2014.

IMPROVED SANITATION COVERAGE (%)

1990 2000 2012

Improved facilitiesShared facilities

Unimproved facilitiesOpen defecation

35 47 597

810

1814

940 31 22

Source: WHO/UNICEF JMP 2014.

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