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Book
The Double Burden of Malnutrition in East Asia and the Pacific : Evidence and Lessons for a Multisectoral Response.
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Year: 2016 Publisher: Washington, D.C. : The World Bank,

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Abstract

Global trends indicate that overlapping burdens of undernutrition and overnutrition-the double burden of malnutrition (DBM)-are the new normal (IFPRI 2014); indeed, most East Asia and Pacific (EAP) countries now have a DBM problem. This report explores the nature of nutrition problems affecting EAP countries to understand the sectoral and system-wide actions necessary for a coordinated approach to improving nutrition. The report (i) synthesizes evidence related to the burden of malnutrition in EAP, (ii) identifies the rationale for a multisectoral approach to DBM practitioners working across sectors in EAP, and (iii) provides an overview of the types of actions and interventions needed to address the DBM in a coordinated fashion across the life course. Actions across health and nonhealth sectors-ranging from implementation of national-level policy measures and complemented by interventions at the community and individual levels to support behavior change-are needed to prevent escalation of overweight and obesity. Among sectoral priority actions, the health sector plays an important role in monitoring health and nutrition outcomes, preventing and treating infectious and noncommunicable diseases associated with malnutrition, and providing interventions that affect individuals' nutrient intakes. Similarly, nonhealth sectors have expertise and resources to deliver interventions related to the underlying causes of malnutrition. Further, systems-strengthening efforts are needed to support an environment that addresses the DBM across the life course, including increasing DBM-sensitivity of policy frameworks; leadership, coordination, and accountability; workforce capacity; and knowledge and evidence. Reducing the DBM is fundamental to sustainable development in EAP. EAP countries must shift from dichotomized policies addressing either undernutrition or overnutrition and develop coherent frameworks to address malnutrition in all forms for all life stages. Integrated preventive and curative interventions for undernutrition and overnutrition-implemented across the life course by multiple sectors-can forestall massive economic and human development consequences for future generations.


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Improving the Quality of Frontline Nutrition Services in Indonesia's Health Sector

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In the past two decades, Indonesia significantly improved its economic growth, poverty, and maternal and child health outcomes. Despite these notable achievements, the country's rates of stunting and malnutrition are among the highest in the world and threaten early childhood development as the stepping-stone of human capital formation. Though government guidelines, standards, and training have helped improve nutrition services in the health sector, there continues to be considerable variation in service quality across districts, between urban and rural areas, and among public and private facilities, with many mothers and children being provided suboptimal services. Malnutrition is a multisectoral issue that is not the "problem" of the health sector alone. However, many of the high-impact health interventions known to improve nutrition outcomes for children are not being implemented in Indonesia, calling for a higher-quality health system to produce better nutrition outcomes. This report analyzes the opportunities to improve the quality of frontline nutrition interventions in Indonesia's health sector as an element of achieving the National Strategy to Accelerate Stunting Prevention (2018-2021) (StraNas Stunting) goals. It uses a framework adapted from the Lancet Global Health Commission's report on High-Quality Health Systems in the Sustainable Development Goals Era, which explains that improving the quality of nutrition health care requires system-wide action. In specific, high-quality nutrition services necessitate both process and foundational reforms at the macro, meso, and micro levels. The paper outlines the challenges and proposes recommendations to improve quality nutrition care and services in the country. These are related to strong leadership, harmonized guidelines and targets, and robust regulatory and quality improvement mechanisms; improved monitoring and evaluation and data use; predictable, adequate, and timely financing; platforms for care; competent health workers and a sound supportive supervision system; adequate supplies and functional equipment; and systems that respond to clients' health needs and expectations.

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