| 4. In which ways is the initiative creative and innovative?
The Child Nutrition Post involve the community in a way that no other nutrition programs have in Sambas District. Generally-speaking, the community is not actively involved and is treated as an ‘object’ to receive information on health and nutrition. Community members are especially not involved in problem identification and problem solving processes, leading to low knowledge and low interest.
Sejangkung Community Health Centre, having previously established a community forum to assist the Centre in its work, decided to explore more participatory and empowering nutrition programs, and came up with the idea for the Child Nutrition Post.
The posts are:
a. Easily and quickly implemented
Posts do not require special facilities, and health volunteers come from the community themselves.
Posts are cheaper to implement than creating therapeiutic feeding center (TFC).
Community members and parents are actively involved in obtaining donations, cooking, and eating.
As the posts empower the community and use community food donations, they can be continued by community members without the support of the Health Centre.
e. Locally-based principles
Posts are based on the founding Indonesian principles of ‘gotong royong’ (mutual help) and empathy for others.
Culturally, the posts are acceptable because they use local food traditions.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The initiative was implemented by Sejangkung Community Health Centre after they took part in an event run by Dompet Dhuafa, a social welfare-focused NGO. Dompet Dhuafa’s event trained health volunteers on nutrition and how to run nutrition programs focusing on children. This training inspired the volunteers to establish a nutrition post of their own, and incorporate locally-appropriate solutions into overcoming child malnutrition.
By 2016, nine Child Nutrition Post were running on a monthly basis in six of the 12 villages in Sejangkung Sub-District. These six villages were chosen because they were ranked as the worst for child malnutrition in 2012. Each post runs for 10 days per month and the routine child health post is run on the 11th day.
589 malnourished children under the age of five took part in the program over the four years it has run so far (2013-2016), averaging 150 children per year. No cases of malnutrition in children under five have been identified since 2015.
| 6. How was the strategy implemented and what resources were mobilized?
The Child Nutrition Post were established in Sejangkung as follows:
1. Sejangkung Community Health Centre staff approached village heads with the proposal to establish a Child Nutrition Post in their village.
2. Sejangkung Community Health Centre staff trained health volunteers for four to six days on how to run the program.
3. Sejangkung Community Health Centre staff gained the commitment of village figures and the community through Village Community Discussion Forums.
4. Sejangkung Community Health Centre staff and health volunteers researched existing good practices to learn what they could replicate in Sejangkung. To begin with, staff visited the homes of local residents with healthy, well-nourished children, to examine eating habits and conduct interviews. They documented this information and used it as the basis of developing the Child Nutrition Post strategy, covering topics such as choosing what to eat, preparing food, cooking food, serving food, and feeding children. The volunteers also incorporated new knowledge about local good practices on cleanliness and health into the strategy.
5. Sejangkung Community Health Centre staff and health volunteers established the first two posts in 2013, one in each of the two villages with the highest rates of child malnutrition. At the posts, held over a 10-day period once a month, volunteers and parents with malnourished children cook and eat together between 10am and 3pm. The posts continue until all children ‘graduate’ and there are no more malnourished children in the village. Food menus are based on what foodstuffs are easily available locally (based on input from poor families with well-nourished children) and refer to nutrition standards for child growth. Menus are developed on a five-day cycle so that families have many options to choose from.
6. Monitoring is conducted during every 10-day Child Nutrition Post session, and focuses on children’s attendance and their ability to finish the food served to them. Children who finish are congratulated. Parents’ food preparation skills are also monitored to ensure they are learning from the post.
7. The Child Nutrition Post are currently being replicated throughout Sejangkung Sub-district. From the original two posts in 2013, two more were added in 2014, and another two in 2015. Seventh, eighth, and ninth posts were established in 2016. The Sambas District Health Office has also shared information on this good practice at the provincial level in 2014 and national level in 2015.
The finances required to develop and implement the Child Nutrition Post in Sejangkung are as follows:
1. Sejangkung Community Health Centre operational funds (2013): IDR 29,843,800 (US$2,250) to contribute to food for the posts and to cover transportation costs for health volunteers and Sejangkung Community Health Centre staff.
2. Sejangkung Community Health Centre operational funds (2014): IDR 21,485,000 (US$1,615).
3. Sejangkung Community Health Centre operational funds (2015): IDR 38,956,600 (US$2,928).
4. Sejangkung Community Health Centre operational funds (2016): IDR 31,355,600 (US$2,357).
Many donations of rice are provided to the Child Nutrition Post by community members who own rice milling factories or by shop owners. Other community members also frequently donated foodstuffs or money, as do the parents of children enrolled in the program.
Villages with Child Nutrition Post contribute to the activities by providing a building that can be used. This is usually a pre-existing multi-use building. Village heads have also allocated money from village budgets to ensure the sustainability of the programs into the future.
Donations of vegetable seeds were also given to the posts by the Sub-District’s Centre for Agriculture, Fisheries, Livestock, and Forestry.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
a. Sambas District Health Office (DHO)
One of the Sambas DHO’s priority areas for 2012-2016 was speeding up the elimination of malnutrition. The DHO contributed to the Child Nutrition Post through their funding of Sejangkung Community Health Centre, and by taking part in replication efforts.
b. Sejangkung Sub-District Office
The Sejangkung Sub-District Office facilitated the establishment of the Child Nutrition Post by coordinating between stakeholders. The Office also conducted awareness raising and monitoring through cross-sectoral mini-workshops at the Sub-District level.
c. Sejangkung Community Health Centre
The Sejangkung Community Health Centre trained and provided health workers and volunteers to run the posts, and financially supported their activities.
d. Village Heads
Village Heads issued circular letters, allocated funds via the village budget, and permitted the use of the multi-purpose building.
Community members donated foodstuffs to the posts, and members even became health volunteers themselves to assist with the activities, especially in contributing their knowledge of healthy cooking. Community members also contributed kitchen utensils and fuel.
| 8. What were the most successful outputs and why was the initiative effective?
1. Decision Letter from the Head of the Sejangkung Sub-District to establish a team to eliminate malnutrition (issued in 2013).
2. Decision Letters from four village heads (the first issued in 2013) to establish Child Nutrition Post in their respective villages.
3. Establishment of nine Child Nutrition Posts in six villages between 2013 and 2016.
4. Monthly programming over 10 days at each post.
5. Tens of health volunteers trained on child nutrition, healthy eating, and healthy lifestyles.
| 9. What were the main obstacles encountered and how were they overcome?
a. The timing of Child Nutrition Post events was difficult to make appropriate for all parents of malnourished children. Most work as rice or rubber tree farmers, and generally work 6-11am and 1-4pm. These hours clash with post operating hours, meaning some parents were unable to attend. The problem was overcome by reminding parents that they could delegate another family member to attend instead, such as grandparents. The running hours of the posts were then discussed with all members to ensure the most appropriate timing.
b. Funding for the posts was limited, especially during the first year. The sole source of funding in the initial stages was from Sejangkung Community Health Centre operational funds. This was overcome by establishing posts over time, village by village, as funds allowed, and by encouraging villages to contribute funds from their own budgets.
c. The third challenge was the low level of understanding of parents about child nutrition. A number of parents with malnourished children did not thoroughly incorporate what they learned at the posts into their daily lives, so the children’s bodyweights did not increase at first. This meant that health workers needed to conduct house visits and frequent monitoring.
d. Some parents initially misunderstood the aim of the program, and thought that the food provided at the posts should be the main meal of the children’s days. In actual fact, this nutrition-rich food was intended to be an extra meal. This was overcome through explanation from the health volunteers.
e. Finally, some parents/guardians did not make their children eat everything because they became frustrated. This was dealt with through further explanation on the importance of good nutrition, and through adding a competition element – all children who grew to their ideal weight and ‘graduated’ from the program won bath equipment.