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

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Abstract

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.


Book
Early Childhood Development : A Review of the Global Evidence
Authors: ---
Year: 2015 Publisher: Washington, D.C. : The World Bank,

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Early Childhood Development (ECD) is a holistic concept that refers to the physical, cognitive, socio-emotional, and linguistic development of young children until the time they transition to primary school. This policy brief highlights that developmental gaps in the early years of a child's life do not narrow by themselves over time, are likely to be particularly severe for children born to teenage mothers, and lead to costly consequences for individuals, families, and societies. In turn, this policy brief also documents that strong evidence exist on the significant benefits that quality ECD interventions yield in both the short and longer terms. Different types of ECD interventions are most relevant and are complementary at different times of a child's development. For example, interventions to promote infant and child health and to reduce malnutrition are most effective in the 1,000-day window from pregnancy to a child's second birthday, and programs that enhance both early stimulation and nutrition are more likely to generate long-lasting impacts than nutrition alone. Strong evidence also exists on the positive impacts of high quality center-based programs for young children (i.e. daycares and preschools), including in low and middle-income countries, and these types of programs can also generate positive impacts for other family members, including caregivers and siblings. Finally, providing cash transfers to families can be an effective way to enhance the ECD outcomes of the poorest children, especially when combined with specific health, nutrition, and early stimulation interventions. In sum, this policy brief provides an overview of why early childhood is a critical period of human development and of the several types of ECD interventions that have been proven effective to improve children's development and life-long prospects.


Book
Reversing the Trend of Stunting in Sudan : Opportunities for Human Capital Development through Multisectoral Approaches
Authors: ---
Year: 2020 Publisher: Washington, D.C. : The World Bank,

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The report is structured as follows: section two provides an overview of the existing literature on undernutrition and its determinants. Section three describes the methodology used in this report, the UNICEF conceptual framework and the MICS data collected in 2010 and 2014. The analysis section (section four) begins by describing the nature of stunting among 0-5-year-old children in Sudan highlighting differences in stunting rates across states, households, gender, and age groups. This analysis is followed by an overview of the extent of inequalities in access to adequate levels of nutrition drivers among 0-23-month-old children. The second part of section four examines the extent to which access to adequate levels of nutrition drivers influences stunting in Sudan. The authors estimate marginal effects of access levels (including individual and joint access) on the probability of being stunted to identify the main nutrition drivers that significantly affect stunting and the heterogeneity of their effects across space, wealth, and gender. Finally, section five concludes by discussing the implications of the results on multisectoral responses to stunting in Sudan.


Book
15 Ways to Support Young Children and Their Families in the COVID-19 Response
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Year: 2020 Publisher: Washington, D.C. : The World Bank,

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As the global COVID-19 (Coronavirus) pandemic continues to unfold, young children will be especially vulnerable. World Bank teams can work with client countries to support early childhood development (ECD) by leveraging a range of interventions and mechanisms that will be part of the COVID-19 (Coronavirus) response in every country. The report has three key messages : The early years are a critical period to build human capital. Young children are disproportionately at risk and must be prioritized in COVID-19 (Coronavirus) responses. We will reach young children by supporting parents and caregivers.


Book
Addressing Malnutrition and Investing in Early Years in Nepal in a Federalized Context
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Year: 2020 Publisher: Washington, D.C. : The World Bank,

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In 2015, the new constitution of Nepal promulgated the country as a federal republic with three autonomous government levels of federal, province, and local, each with an elected assembly. Consequently, numerous policies and plans were formulated as per the new federal system. In line with this change, the government of Nepal (GoN) has formulated Multi-Sector Nutrition Plan-II (MSNP II) (2017-2022) to improve the nutrition status of mothers, adolescents, and children by scaling up nutrition-specific and nutrition-sensitive interventions throughout the country. This study reveals the transitional state of nutrition and early childhood development (ECD) in the country as it is adjusting itself in federal structure and governance.


Book
Operationalizing a Multi-Sectoral Approach for the Reduction of Stunting in Indonesia : An Application Using the 2007 and 2013 Riskesdas.
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Year: 2017 Publisher: Washington, D.C. : The World Bank,

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Stunting is a widespread and persistent condition in Indonesia with more than one-third of young children being stunted. The national stunting rate for under five-year-olds increased slightly from 3.8 percent in 2007 to 37.2 percent in 2013, based on official stunting rates reported by the Ministry of Health of the Government of Indonesia. During the same time period, the percentage of population in poverty reduced from 16. Percent to 11.4 percent (World Bank), suggesting that the increased purchasing power did not translate to better nutritional outcomes for children.


Book
Media and Messages for Nutrition and Health : Assessing Media Appropriateness for Nutrition and Health-Related Social and Behavior Change Communication in Four High Stunting-Burden Provinces of Lao PDR
Authors: --- --- ---
Year: 2020 Publisher: Washington, D.C. : The World Bank,

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The Lao People's Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition-related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.


Book
Multisectoral Nutrition Assessment in Sri Lanka's Estate Sector
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Year: 2017 Publisher: Washington, D.C. : The World Bank,

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This Multisectoral Nutrition Assessment assessed the nutrition situation amongst residents of the estate sector, identified the main causes of nutritional deficiencies, as well as gaps in the provision of key nutrition-related services. The findings and recommendations can be used to inform policymakers and planners who are preparing the Estate Health Strategic Policy and Plan, and thereby implement effective multisectoral nutrition and health interventions. To this end, the two main objectives of the study were to: i) Assess the size, severity, and key determinants of undernutrition in Sri Lanka's estate sector. ii) Examine residents' access to and utilization of nutrition related services and identify the gaps, if any, in institutional and implementation arrangements.The report is organized into six chapters. Chapter second presents the methodology employed (data and framework), Chapter third gives an overview of nutritional status in the estate sector, focusing particularly on maternal and child nutrition. Using a modified UNICEF conceptual framework, Chapter fourth explores the key immediate as well as underlying and basic determinants of undernutrition. Chapter fifth reviews the degree to which nutrition is positioned in the national development agenda and discusses gaps in current nutrition specific and nutrition-sensitive programs, and the last chapter outlines recommendations for the way forward.


Book
Early Childhood Development : Situation Analysis for Zambia
Authors: --- --- ---
Year: 2015 Publisher: Washington, D.C. : The World Bank,

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Teenage pregnancies have potential negative consequences on the next generation. Children born to adolescent mothers are particularly at risk in terms of health, nutrition, cognitive and socio-emotional development. Evidence shows that the early years - especially the first 1,000 days - are crucially important for lifetime health, learning, and productivity. Particularly for the most vulnerable children and families, early childhood development (ECD) is a high return investment. This policy brief presents evidence on the health, nutrition and overall development of children in Zambia with a focus on those born to adolescent mothers. Analysis of issues such as infant and child mortality, malnutrition, incidence of illness, healthcare seeking behaviors, protective practices, late entry for school, pre-school experience and development are discussed.


Book
An Investment Framework for Nutrition in Uganda : Reducing Stunting and Other Forms of Child Malnutrition
Authors: --- --- --- --- --- et al.
Year: 2016 Publisher: Washington, D.C. : The World Bank,

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This paper builds on global experience and Uganda's specific context to estimate costs,benefits, and cost-effectiveness of key nutrition interventions. It is intended to help guide theselection of the most cost-effective interventions as well as strategies for scaling these up. Thepaper considers both relevant "nutrition-specific" interventions, largely delivered through thehealth sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Uganda would require a yearly public investment of USD 68 million. The expected benefits are enormous: annually over 8,000 lives would be saved, while at least 375,000 DALYs and 8,700 cases of stunting among children under five would be averted. Economic productivity could potentially increase by USD 280 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 18 percent. However, because it is unlikely that the Government of Uganda or its partners will be able to find the USD 68 million necessary to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The most cost-effective scenario considered would provide a subset of key interventions in regions with the highest rates of stunting and would cost between USD 19 and USD 60 million, depending on how many regions are covered. We then identify and cost five nutrition sensitive interventions relevant to Uganda for which there is both evidence of positive impact on nutrition outcomes and some cost information. These findings point to a powerful set of nutrition specific interventions and a candidate list of nutrition-sensitive approaches that represent a highly cost-effective approach to reducing child malnutrition in Uganda.

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