Handling Malnutrition Children by OMABA (ojek makanan balita : Todler Food Taxibike) And Cooking C
Health Office of Bandung City (Dinas Kesehatan Kota Bandung)

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The increasing cases of malnutrition of poor people caused by economic factors, social, level of knowledge or because of concomitant disease causes high mortality. Recorded in 2013 in the region of UPT Puskesmas of Riung Bandung, it was found 29 cases of malnutrition, 21 infant deaths, while for cases of malnutrition the highest one is in the village of CisarantenKidul where as many as 17 cases scattered in various neighbourhood far apart. It showed that the issue of high rate of malnourished toddler is a major problem that must be addressed immediately. Statistic of 2013 found there were approximately 35.85% of poor families (KK). Card ownership of JAMKESMAS (Social Health Security) of poor people was 38.91%, while poor people who did not have JAMKESMAS card were 61.09%, in addition to the many seasonal residents, which led to bias data record. After reviewing things above, we believe there was a need for an effort to provide PMT-P and sustainable recovery in the form of prepared foods. Besides, the other issue was the locations of malnourished children under five are far apart asCisarantenKidul village area was very spacious (due to Bandung city expansion) so it was very difficult for volunteers in the neighbourhood to distribute PMT-P and recovery in the form of prepared foods. Given these conditions, it took strategic innovative effort in order for these malnourished infants living scattered to be given PMT-P and recovery in the form of prepared foods, which are managed by a centralized food processing centre in one place who then distributed the products by delivering healthy food services every day to the malnourished children.

B. Strategic Approach

 2. What was the solution?
OMABA was a distribution strategy of extrahealthy food (PMT-P) for Recovery supplies, which was prepared by cooking centre and was intended for malnourished children under five to be well targeted and to ensure the food was really consumed by them. This program was a collaboration between Public Health Service Unit (UPT) of Community Health Centre (Puskesmas) of Riung Bandung, Health Committee of Sub District CisarantenKidul of District Gedebage, and National Oil Company, Pertamina’s CSR.

 3. How did the initiative solve the problem and improve people’s lives?
OMABA program was inspired by Cooking Centre program of Plumpang KOJA of North Jakarta and with help from Nutritionist student job training students of Bandung Health Polytechnic (Poltekkes)who volunteered in Public Health Service Unit (UPT) of Community Health Centre (Puskesmas) of Riung Bandung, who participated in providing education nutritious about nutritious foods for toddlers. The limited source of funds had touched the Head of Public Health Service Unit (UPT) and Sub District Head of CisarantenKidulwho then submitted a proposal to National Oil Company ,Pertamina Ltd. This proposal was intended to anticipate if the state budget for the first phase of extra healthy food (PMT-P) for Recovery supplies ran out within three months, as well as for sustaining these programs, to make sure there are no more cases of malnutrition in Sub District CisarantenKidul. Basically, the central government and the local government annually allocate budget for PMT-P and recovery program for malnourished children to every health center, with the purpose of the fund could be allocated appropriately in the form of prepared foods. But in reality, not all health center can perform this procedure because usually this case of malnutrition scattered in several neighbourhoods (RukunWarga: RW) which had pockets of poverty. These conditions complicated the operational volunteers of PMT –P and Recovery program in making self-prepared food every day and simultaneously distribute it to the distance places. On September 1, 2013 using Bandung Municipality budget, PMT-P and recovery concept in the form of prepared foods that were managed by Cooking Center was materialized. With the creativity of the Family Welfare Education (TP-PKK) ladies together with the community core team ladies of 11TH Neighbourhood (RW), who could cook and chaired by Mrs. Vita Fatimah, this very unique program was run. The distribution of these PMT-P extra healthy food for recovery supplies was conducted by two volunteers. Because the distribution of the PMT-P foods used motor cycles, the CSR Committee chairman of Pertamina took initiative to call it OMABA (OjekMakananBalita: Toddler food Taxi Bike). This activity went on and developed until 2014 when malnourished children cases reduced from 29 to 11, which were usually accompanied by infections and other diseases. CSR funds from Pertamina in 2015 as well as the national budget (BOK/APBN) of 2014 and 2015, which were allocated for malnutrition eradication at the amount of Rp10,000.00 (1 US$ )/target, eventually succeeded again in reducing malnutrition and in turn gradually became good nutrition. Malnutrition management, ranging from malnourished children tracking, malnourished children validation, PMT –P supply and its distribution, was done together with officials and volunteer who joined the Cooking Centre. Distribution strategy and the food supply delivery services everyday were done directly by OMABA to the houses of toddler targets for three consecutive months , with the aim of ensuring that supplementary foods were consumed by toddler targets. In addition, there were also training activities of cooking and nutritional counseling for volunteers in every neighbourhood to improve the nutritional knowledge. In term of the toddler food menu, an evaluation was always held once a month so that the provision of PMT-P can be optimally advantageous.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Some of the things that make the adaptation of this program unique and creative are: 1. The implementation of Cooking Centre system to ensure nutrient intensive and food hygiene compliant with standards with a varied menu utilizing the existing natural resources. 2. OMABA (ToddlerFood Taxibike) is ready to deliver a balanced nutritional meal every day for three consecutive months and give the food directly to infants immediately after the food was delivered by OMABA volunteers. This is to facilitate access for the poorest and vulnerable groups to the quality of nutrition services in accordance with the purpose of the first Sustainable Development Goals (SDG). 3. In order to educate public about nutritional awareness, this program continues to grow with the availability of DARLING (Mobile Kitchen). 4. OMABA Kitchen itself was also trained by institutions, such as Bandung Nutrition Polytechnic campus, Master Chef and other cooking experts to increase the quality of nutrition knowledge. 5. This program introduced mechanisms of participation and consultation, so that people could express their wishes and needs and took part in shaping their responsibilities or deliver public services by implementing the concept of ATM (Amati/Observe, Tiru/Follow, Modifikasi/Enhance).

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The owner of this program is the Health Committee Team of Sub District CisarantenKidul, District Gedebage of Bandung as the main implementer of OMABA program. TBBM Bandung Group, as a funding channel of Pertamina’s CSR, continued to provide support and useful inputs for every innovation launched by Public Health Committee Team. This program was directly felt by CisarantenKidul communities with population of 13,047 or 3,887 families, 1,238 infants and 3,914 poor people.
 6. How was the strategy implemented and what resources were mobilized?
Some of the things that make this program adaptation unique from others are that the program had a cooking centre which in its implementation had the workflow as follows 1. The management of food resources through nutritional gardens/farms of Sub District CisarantenKidul’s PKK, which activities consist of seeding, maintenance or fertilizing and harvesting. 2. Processing in Cooking Centre, its activities ranging from groceries /ingredients, reception, processing and packing. Implementation of Cooking Centre ensures nutrient intensive and hygienic foods according to the standards with a varied menu and utilized the existing and simple natural resources like the manufacture of tempeh nuggets and meatballs cassava. 3. Distributions OMABA was ready to deliver a balanced nutritional meal every day for three consecutive months, as well as fed these foods directly to toddlers immediately after the food was delivered by OMABA volunteers. 4. Evaluation and monitoring was carried out by Cooking Centre volunteers along with nutrition personnels of UPT Puskesmas of Riung Bandung. 5. Cooking Centre Development Program In order to educate public about nutritional awareness, this program continued to grow with the availability of Darling (Mobile Kitchen), which was the cooking demonstrations of healthy and nutritious food in every Integrated Service Unit (Posyandu), WarungSehati (WarungSehatAnakTercintadanIbu: Small store for beloved child and mother). 6. Training in nutrition and how to process food were coached by trainers from institutions such as the Bandung Nutrition Polytechnic, Master Chef and others to increase the quality of nutrition knowledge and also to develop capabilities in terms of economy and healthy refined and nutritious refined which were products processed by Cooking Centre. These refined products were utilized not only by malnourished children but also by society as a whole,in particular those who children under five years old and school children. The capacity improvement of women members of Cooking Centre and OMABA was facilitated by ICDC (Innovation for Community Development Centre). 7. That eradication of malnutrition is a matter to be resolved together.It was proved by the fact that its causes are so complex. Starting from the knowledge, health status, and most importantly is the economic problem. Cross-sector cooperation by involving various elements of the community is needed.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The main OMABA program stakeholders was the Head of UPT Puskesmas of Riung Bandung, who was the first chairman of the Health Committee of Sub District CisarantenKidul, District Gedebage of Bandung, period 2012 - 2015 and its innovator and creator. Currently the program was held by the chairman of the same committee for period of 2015 - 2018 and supported by Head of Sub District CisarantenKidul as regulator and motivator in participation in the society. Moreover, the functional staff who managed nutrition program and health promotion UPT Puskesmas of Riung Bandung took roled as monitoring and evaluating agents, while Head of administration as administrative manager. Other officers were the entire staff of health centres that hold related programs, such as KIA and others. Discussions with team of experts from the Society for Promotion and Education of Public Health of Indonesia (PPKMI) of West Java were done in order to obtain directions and strategies which were scientifically measurable. Cross-sector counterparts consisted of District Gedebage, all Sub Districts of District Gedebage, Departemen of Bandung health Polytechnic campus and, volunteers of Nutrition Department graduates from Bandung Health Polytechnic that assisted in monitoring and evaluating the OMABA program. Other organizations involved were the ICDC, Print Media, Electronic Media and Healthy Bandung Caring Forum (Forum RembugPeduli Bandung Sehat). Citizens who directly related to these activities were especially the volunteers from the 11th Neighbourhood (RW 11), Sub District CisarantenKidul, Cooking Centre volunteers, and all volunteers of Posyandu in CisarantenKidul, families of malnourished and nutrition deficiency children and surrounding communities of UPT Puskesmas of Riung Bandung. Also participated was the Chief Medical Officer of Bandung, who was always monitoring and doing evaluation of the health programs, which in this regard were the nutrition programs.

 8. What were the most successful outputs and why was the initiative effective?
From this activity the following output was resulted 1. The availability of human resources for nutrition volunteers who were skilled in preparing meals and doing nutrition counseling as many as 11 people, 19 volunteers of nutrition , and 393 active volunteers of Posyandu 2. The availability of human resources for nutrition officers who were skilled in the handling nutrition management system. 3. The improvement of public participation aspects of toddler weighed at Posyandu over target toddler was (D/S): from 74.3% (2013) to 75.46% (2015) 4. The improvement of program effectiveness of toddler’s weight increase over target toddler (N/D): from 63.35% (2013) to 69.80% (2015) 5. The improvement of nutritional status of malnourished toddlers from 29 (2013) to 4 (2015) 6. The enhancement of Extra healthy foods (PMT- penyuluhan )in Integrated health center Posyandu : from instant food (2013) innovated to healthy prepared/refined foods (2015) 7. The establishment of the cooperation relationship with Pertamina’s CSR covering a contract for 5 years since 2012 to 2016 8. The implementation of Extra healthy food (PMT- Pemulihan) recovery supplies distribution system that can reach people with malnutrition in some areas. 9. The availability of healthy foods that met the nutritional needs of the toddlers among the poor people This initiative was effective, because it could 1. Make all malnutrition objects, especially among poor people, gain access to improve their nutritional status so that cases of malnutrition decreased very significantly 2. Establish healthy eating behaviours in households of CisarantenKidul

 9. What were the main obstacles encountered and how were they overcome?
Some of the obstacles encountered during the running of the program were 1. Lack of financial support which hampered OMABA program when the fund from Pertamina’s CSR had not been materialized. To facilitate this OMABA program the fund from National Budget (BOK/APBN) was utilized in advance 2. Lack of human resources. Limited resources for nutrition volunteers happened so that in these programs some elements of society, such as the PKK volunteers, integrated health services (Posyandu) volunteers and Community Leaders (TOMA), were involved 3. The number of seasonal residents in CisarantenKidul increased which complicated data collection effort targeting PMT-P recovery program recipients. For that, we do data affectivity by applying criteria limits to the population of less and more than 6 months of residency, which were visitors (less than 6 months) and permanent resident of CisarantenKidul (more than 6 months), in addition to the availability of infants database system which made data collection easier 4. The occurrence of Confronting Structural disadvantage, that was the disadvantage change in social structure of society. It required patience and good communication skills and good leader from this Health Committee team so that people want to follow a series of public nutrition improvement activities.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The impacts of this OMABA program were as follows: The most significant defferences was change in nutrient status and reduces in number of malnutrition . The most importance was collaboration of all elements of society in dealing with malnutrition in the area of Riung Bandung community health services, especially in CisarantenKidul village. The most Important benefit of The OMABA Cooking center Program was society empowerement to address the issue of public health , especially eradication of malnutrion. Toddlers suffering from malnutrition can be treated comprehensively in Riung Bandung Community Health center. Not merely by supplementary feeding, but by providing the education so that malnutrition very significantly decreased. Transformation in organization and working procedursinto goal-oriented services head occurred. CSR programs in the health sector, was effective and well targeted. Improvement of Public Health (declining rates of malnutrition, morbidity and mortality of infants). Besides, other creative programs could be established such as DARLING (mobile kitchen), WARUNG SEHATI (mother and child healthy food stall ), OMASA (Child school food taxibike) and delivery services sales of product from OMABA kitchen.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This initiative may prove the integrity and accountability in the public service through cooperation of Pertamina’s CSR with the Health Committee as executor of Pertamina’s CSR in the health sector resulted in the existence of a relationship that is mutually beneficial. CisarantenKidul Health Committee could carry out various health programs with proper budget well targeted and appropriate, since it could be accountable for all budgets allocated properly. It could be seen from the results of the independent auditor of Pertamina Ltd., which statesdthe use of Pertamina’s CSR budget by the Health Committee CisarantenKidul and UPT Puskesmas of Riung Bandung as its patron met acceptable/qualified status without exception (WTP) in three consecutive years, as well as of the indicators of activity results that could be achieved in the form of a decrease in cases of malnutrition in CisarantenKidul.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
During the running of the OMABA program, there were scientific measurements done through students’ research on gauging the extensiveness of the program in which people had benefited from it. Society's most advantaged elements by this program were toddlers and women of poor families who had poor access to good nutrition services. The assessment of the public and media were widely available at 1. regional.kompas.com 2. https://m.tempo.com 3. news.detik.com 4. www.pikiran-rakyat.com 5. https://www.youtube.com 6. www.voanindonesia.com 7. Photo.sindonews.com 8. Majalahkartini.co.id 9. https://korpri.id/tag/ojek-makananbalita 10. www.republika.co.id 11. www.tribunnews.com 12. www.antaranews.com 13. https://twitter.com 14. www.metronews.com 15. https://www.facebook.com 16. www.pertamina.com 17. www.depkes.go.id 18. https://wwwscrib.com

Contact Information

Institution Name:   Health Office of Bandung City (Dinas Kesehatan Kota Bandung)
Institution Type:   Local Government  
Contact Person:   Sonny Sondari
Title:   Head of Riung Bandung Public Health Center  
Telephone/ Fax:   +62 81394690052
Institution's / Project's Website:  
E-mail:   sonnysondari@yahoo.com  
Address:   Riung Purna St., No. 20
Postal Code:   40295
City:   Bandung
State/Province:   West java

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