Newsletter Fortifikasi Pangan untuk Perbaikan Gizi
April 2015 -
Forewords
Volume 11
no action plan for dealing with the Districts.
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 2015 Prof. Soekirman (Em.), Bogor Agriculture University (IPB), Chairman of KFI
MY TAKEAWAYS (From Jakarta): (Prof. Lawrence Haddad)
Photo: Gallery KFI
“* 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
* 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. “ 1
KFI NewsLetter April 2015 - Volume 11
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
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).
GNR Launching in Jakarta (January 9, 2015) Coordinating Minister for Human and Cultural Development Minister of National Development Planning (BAPPENAS) Andrinof Chaniago. Puan Maharani.
Photo: Gallery KFI
Photo: Gallery KFI
“High quality Human Development with typical Indonesian “Human Development is a central problem of national character requires good nutrition.” development. It has three main dimensions: intellectual, physical health and mental health. All comprises the dimensions of national development.”
Photo: Gallery KFI
Dirjen Gizi KIA Kementrian Kesehatan Pada acara Launching GNR-2014 DI BAPPENAS (DG Nutrition, MCH, MOH).
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KFI NewsLetter April 2015 - Volume 11
2014 Nutrition Country Profile
www.globalnutritionreport.org
IndonesIa ECONOMICS AND DEMOGRAPHY UNDER-5 MORTALITY RATE
POVERTY RATES AND GDP US$1.25/day (%)
US$2/day (%)
85
8,438
8,027 54
46
4,295
18
1990
2000
POPULATION 52 34
2011
2013
Source: World Bank 2014. Note: PPP = purchasing power parity.
38
84
9,254
16
2010
Gini index, 2011 Source: World Bank 2014. Note: 0 = perfect equality, 100 = perfect inequality.
43
5,552
INCOME INEQUALITY
Deaths per 1,000 live births
GDP per capita PPP ($)
1990
2000
31
2010
2012
Population (000)
246,864
Under-5 population (000)
24,622
2012 2012
Urban (%)
50
2010
> 65 years (%)
5
2012
Source: UNPD 2013.
Source: UN Inter-agency Group for Child Mortality Estimation 2013.
CHILD ANTHROPOMETRY PREVALENCE OF UNDER-5 STUNTING (%)
CHILD ANTHROPOMETRY Number of children under 5 affected (000) Stunting a
8,906
2013
Wasting a
3,303
2013
Overweight
2,814
a
40
CHANGES IN STUNTING PREVALENCE OVER TIME, BY WEALTH QUINTILE
39
36
29
2013
Percentage of children under 5 affected
Data not available
14
Wasting a
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.
2004
2007
2010
2013
Source: UNICEF/WHO/WB 2014.
Source: DHS surveys 1990−2011 adapted from Bredenkamp et al. 2014.
ADOLESCENT AND ADULT NUTRITION STATUS ADOLESCENT AND ADULT ANTHROPOMETRY (% POPULATION)
MICRONUTRIENT STATUS OF 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
Women of reproductive age with anemia a Total population affected (000) Total population affected (%) Vitamin A deficiency in preschool-age children (%) b Population classification of iodine nutrition (age group 6–12) c
Sources: a WHO 2014; b DHS 2014. Note: NA = not available.
Raised blood glucose
2011
23
2011
20
NA
Mild iodine deficiency
1996
Sources: a Stevens et al. 2013; b WHO 2009; c WHO 2004. Note: NA = not available.
METABOLIC RISK FACTORS FOR DIET-RELATED NONCOMMUNICABLE DISEASES, 2008 (%) Raised blood pressure
15,308
Raised blood cholesterol
PREVALENCE OF ADULT OVERWEIGHT AND OBESITY, 2008 (%) Overweight (BMI ≥ 25)
41
36
43 33
39
Male
7 Both sexes
7 Male
25
Female
38
7
Both sexes
Obesity (BMI ≥ 30)
7
FINA
16 3 21 5
Female Source: WHO 2014. Note: BMI = body mass index.
Source: WHO 2014.
WORLD HEALTH ASSEMBLY INDICATORS: PROGRESS AGAINST GLOBAL WHA TARGETS Under-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.
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IndonesIa 2014 Nutrition KFI NewsLetter April 2015 - Volume 11Country Profile INTERVENTION COVERAGE AND CHILD-FEEDING PRACTICES CONTINUUM OF CARE (%) Antenatal care (4+ visits), 2012
RATE OF EXCLUSIVE BREASTFEEDING OF INFANTS UNDER 6 MONTHS (%)
INTERVENTION COVERAGE (%)
a
88 Skilled attendant at birth, 2012
a
42
40
83
32 Initiation of breastfeeding within 1 hour after birth, 2010 a 29
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.
Continued breastfeeding at 1 year, 2012 a
INFANT AND YOUNG-CHILD FEEDING PRACTICES (% 6–23 MONTHS)
77 Unmet need for family planning, 2007b 13
2002–2003
2007
2012
Minimum acceptable diet
37
2012
Minimum dietary diversity
58
2012
Source: Indonesia DHS 2012.
Source: UNICEF 2014.
Sources: a UNICEF 2014; b UNPD 2014.
UNDERLYING DETERMINANTS FOOD SUPPLY Available calories from nonstaples (%): data for 1991, 2000, 2009
Undernourishment (%): data for 1991, 2000, 2010, 2014
Availability of fruits and vegetables (grams): data for 1990, 2000, 2010, 2011 33
186
138
1991
298
266
20
Gender Inequality Index (score*) b
7
2012
0.500
2013
103
2013
Gender Inequality Index (country rank) b
9
2010
43
Physicians
0.204
2012
Nurses and midwives
1.383
2012
NA
NA
Community health workers
2014
1990
Source: WHO 2014. Note: NA = not available.
Source: FAOSTAT 2014.
84
79
POPULATION DENSITY OF HEALTH WORKERS PER 1,000 PEOPLE
11
2000
Early childbearing: births by age 18 (%) a
Sources: a UNICEF 2014; b UNDP 2014. Note: *0 = low inequality, 1 = high inequality.
28
27 22
FEMALE SECONDARY EDUCATION ENROLLMENT (%)
GENDER-RELATED DETERMINANTS
2000
2010
2012
Source: UNESCO Institute for Statistics 2014.
GOVERNMENT EXPENDITURES (%) IMPROVED DRINKING WATER COVERAGE (%) Piped on premises Other improved 4 18
63
60 9 1990
Improved facilities Shared facilities
Unimproved Surface water
6 24
IMPROVED SANITATION COVERAGE (%)
2 13
31
40 64
15
21
2000
2012
14 8
18 7
1990
Source: WHO/UNICEF JMP 2014.
22 9 10
7.6
59
9.1
2012
2.4
1.7
1990
2000
2.3 7.5
47
35
Social protection Agriculture
Health Education
Unimproved facilities Open defecation
4.9
2000
Source: WHO/UNICEF JMP 2014.
2010
2012
Source: IFPRI 2014.
FINANCIAL RESOURCES AND POLICY, LEGISLATION, AND INSTITUTIONAL ARRANGEMENTS SCALING UP NUTRITION (SUN) COUNTRY INSTITUTIONAL TRANSFORMATIONS, 2014 (%)
POLICY AND LEGISLATIVE PROVISIONS National implementation of the International Code of Marketing of Breast-milk Substitutes a
Bringing people into a shared space for action
44
Ensuring a coherent policy and legal framework
50
Aligning actions around a common results framework
48
Wheat fortification legislation
Financial tracking and resource mobilization
35
Undernutrition mentioned in national development plans and economic growth strategies e
Total weighted
44
Extent of constitutional right to food b Maternity protection (Convention 183) c d
Many provisions law
2014
Medium-high
2003
Partial
2011
Mandatory
NA
Rank: 43/83
2010– 2014
Sources: a UNICEF 2014; b FAO 2003; c ILO 2013; d FFI 2014; e IDS 2014. Note: NA = not available.
Source: SUN 2014.
For complete source information: www.Globalnutritionreport.org/about/technical-notes.
AVAILABILITY AND STAGE OF IMPLEMENTATION OF GUIDELINES/ PROTOCOLS/STANDARDS FOR THE MANAGEMENT OF NCDs Diabetes
Available, partially implemented
2010
Hypertension
Available, partially implemented
2010
Source: WHO 2014. Note: NCDs = noncommunicable diseases.
© 2014 International Food Policy Research Institute
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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:
[email protected]
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The KFI Newsletter is part of KFI-GAIN project.
Supported by: SAFO - GFP
