* Corresponding Author
Policy Triangle Analysis of Stunting Issues in Urban Areas: A Case Study of Yogyakarta City
https://doi.org/10.22146/jkap.86489 Maria Wigati(1*), Ceria Ciptanurani(2)
(1) Universitas Gadjah Mada
(2) Universitas 'Aisyiyah Yogyakarta
(*) Corresponding Author
Abstract
Stunting reduction is one of Indonesia’s major projects. While one-size-fits-all regulations were no longer promoted, understanding the characteristics of each region imposed a strong policy foundation. Many studies had been conducted in rural areas, but the analysis of urban areas was scarce. A study was conducted in Yogyakarta City to understand the characteristics of stunting intervention, despite the high human development index, education level, and access to health facilities. This made it important to examine the characteristics of stunting reduction efforts, based on the analysis of the contents, contexts, processes, and actors involved, in Yogyakarta City, to help with its ambition for zero stunting. A desk review and focus group discussion were conducted involving four local government staff, consisting of the Regional Planning and Development Agency, Health Office, and Office of Women's Empowerment, Child Protection, and Population Control and Family Planning, which were elaborated with literature following the policy triangle framework. A total of 13 open-access official documents and dashboards were obtained for analysis. Decrees from the local government showed a strong commitment to ending malnutrition. While most intervention packages were similar to those across Indonesia, targeted interventions for specific subjects were needed to support people who were unable to be covered by general services. Furthermore, Yogyakarta City has smaller open spaces than other districts in the province, a contradictory low nutrition awareness despite high school participation, and other factors were cross-linked with its culture in the community, implementer, to the authority levels. Stunting reduction programs were multisectoral, involving not only government offices but also non-government, mass media, community, private sectors, and academia. This study is expected to provide lessons learned for decision-makers, private sectors, academia, and public health practitioners to implement good collaboration in stunting reduction efforts.
Keywords
Full Text:
PDFReferences
Abimbola, S., Baatiema, L., & Bigdeli, M. (2019). The impacts of decentralization on health system equity, efficiency and resilience: A realist synthesis of the evidence. Health Policy and Planning, 34(8), 605–617. https://doi.org/10.1093/heapol/czz055
Beynon, M. J., Crawley, A., & Munday, M. (2016). Measuring and understanding the differences between urban and rural areas. Environment and Planning B: Planning and Design, 43(6), 1136–1154. https://doi.org/10.1177/0265813515605096
BKKBN. (2021). Recapitulation of families at village level. Retrieved April 2, 2022, from Pendataan Keluarga website: https://portalpk21.bkkbn.go.id/laporan/tabulasi/STUNTING2/Tabel4
BPS-Statistics of Yogyakarta Municipality. (2022). Yogyakarta Municipality in figures 2022. Yogyakarta City.
Brownson, R. C., Chriqui, J. F., Stamatakis, K. A. (2009). Understanding evidence-based public health policy, 99(9), 1576-1582.
Carey, R., Caraher, M., Lawrence, M., & Friel, S. (2016). Opportunities and challenges in developing a whole-of-government national food and nutrition policy: Lessons from Australia’s National Food Plan. Public Health Nutrition, 19(1), 3–14. https://doi.org/10.1017/S1368980015001834
Central Statistic Bureau of Yogyakarta City. (2021). Regional statistics of Yogyakarta City. Yogyakarta. In Bahasa Indonesia
Central Statistics Bureau of Indonesia. (2021). Stunting handling special index report 2019-2020. In Badan Pusat Statistik. Retrieved from https://www.bps.go.id/publication/2021/09/08/3b622d713a80363685aef508/laporan-indeks-khusus-penanganan-stunting-2019-2020.html. in Bahasa Indonesia
De Onis, M., Borghi, E., Arimond, M., Webb, P., Croft, T., Saha, K., et al. (2019). Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutrition, 22(1), 175–179. https://doi.org/10.1017/S1368980018002434
De Silva, I., & Sumarto, S. (2018). Child malnutrition in Indonesia: Can education, sanitation and healthcare augment the role of income? Journal of International Development, 30(5), 837–864. https://doi.org/10.1002/jid.3365
Department of Education and Sports of Yogyakarta City. (2021). Government agencies performance report. Yogyakarta City. in Bahasa Indonesia
Department of Environment of Yogyakarta City. (2021). Government agencies performance report. Yogyakarta City. in Bahasa Indonesia
Department of Health of Yogyakarta City. (2021). Health profile of Yogyakarta City. in Bahasa Indonesia
Department of Population and Civil Registration of Yogyakarta City. (2021). Population development profile year 2021. Retrieved from https://dindukcapil.jogjakota.go.id/assets/instansi/dindukcapil/files/profil-kependudukan-2021-10470.pdf. in Bahasa Indonesia
El-Jardali, F., Fadlallah, R., Daouk, A., Rizk, R., Hemadi, N., El Kebbi, O., Farha, A., Akl, E.A. (2018). Barriers and facilitators to implementation of essential health benefits package within primary health care settings in low-income and middle-income countries: A systematic review. International Journal of Health Planning and Management, 34(1), 15-41. https://doi.org/10.1002/hpm.2625
Essa, W.Y., Nurfiandarti, E., Ruhyana, N.F. (2021). Strategies for handling stunting in Bandung City. Jurnal Bina Praja, 13(1), 15-28.
Global Nutrition Reports. (2022). The global burden of malnutrition at a glance. Retrieved January 5, 2023, from https://globalnutritionreport.org/resources/nutrition-profiles/
Gurning, F. P., Sari, R. Y., Astuti, R. W., & Sinambela, U. B. M. (2021). Implementation of the stunting prevention and control program in the work area of the Medan City Health Office in 2020. Jurnal Kesehatan, 10(1), 36–42. https://doi.org/10.37048/kesehatan.v10i1.325. in Bahasa Indonesia
Helmyati, S., Dipo, D. P., Adiwibowo, I. R., Wigati, M., Safika, E. L., Hariawan, M. H., et al. (2022). Monitoring continuity of maternal and child health services, Indonesia. Bulletin of the World Health Organization, 100(2), 144-154A. https://doi.org/10.2471/BLT.21.286636
Hudoyo, K. S. (2018). Support for the utilization of Special Operational Assistance funds in stunting prevention. Retrieved from https://kesmas.kemkes.go.id/assets/upload/dir_60248a365b4ce1e/files/PPT-BOK-STUNTING-PERNAS-2018_horison_1226.pdf. in Bahasa Indonesia
Kustanto, A. (2021). The prevalence of stunting, poverty, and economic growth in Indonesia: A panel data dynamic causality analysis. Journal of Developing Economies, 6(2), 150. https://doi.org/10.20473/jde.v6i2.22358
Lestari, W., Kristiana, L., Paramita, A. (2018). Stunting: Study of social constructions in rural and urban communities related to infant’s nutrition and nurture in Jember Municipality. Aspirasi: Jurnal Masalah-Masalah Sosial, 9(1). https://doi.org/10.22212/aspirasi.v7i1.1084
Mahmudiono, T. (2016). Child stunting in households with double burden of malnutrition: Applications of behavioral epidemiology (Kansas State University). Dissertation.
Marquardt, J. (2017). How power affects policy implementation: lessons from the Philippines. Journal of Current Southeast Asian Affairs, 36(1), 3–27. https://journals.sagepub.com/doi/pdf/10.1177/186810341703600101
Marwiyah, S., Devi, N. U. K., & Jailani, M. (2022). Implementation of the Welijo Cares for stunting program as a community empowerment effort in the work area of the Tongas Health Center (study in Sumendi Village, Tongas District, Probolinggo Regency). JISIP (Jurnal Ilmu Sosial Dan Pendidikan), 6(3), 10374–10379. https://doi.org/10.58258/jisip.v6i3.3410. in Bahasa Indonesia
Ministry of Health of Indonesia. (2020). Public Health Program Indicators in the National Medium-Term Development Plan and the Ministry of Health's 2020 Strategic Plan-2024. In Kemenkes RI. Retrieved from https://kesmas.kemkes.go.id/assets/uploads/contents/others/e-book.pdf. in Bahasa Indonesia
Ministry of Health of Indonesia. (2021). Results of the Indonesian Nutrition Status Study (SSGI) at the national, provincial and regency/city levels in 2021. Badan Litbangkes Kemenkes RI dan Litbangkes Kemenkes RI. in Bahasa Indonesia
Ministry of Health of Indonesia. (2022). Pocket book results of the 2022 Indonesian nutrition status survey (SSGI). Badan Kebijakan Pembangunan Kesehatan Kemenkes RI. in Bahasa Indonesia
Ministry of National Development Planning of Indonesia. (2019). Health sector study of nutrition development in Indonesia. In Kementerian PPN/Bappenas. Jakarta: Kementerian PPN/BAPPENAS. in Bahasa Indonesia
Ministry of National Development Planning of Indonesia. (2021a) Decree of the Minister of National Development Planning/Head of the National Development Planning Agency concerning Determination of District/City Expansion Locations of Integrated Stunting Reduction Intervention Focus Year 2022. KEP.10/M.PPN/HK/02/2021 (2021). in Bahasa Indonesia
Ministry of National Development Planning of Indonesia. (2021b). Locations of stunting reduction intervention focus. Retrieved February 22, 2023, from https://cegahstunting.id/intervensi/intervensi-terintegrasi/lokasi-fokus-intervensi-penurunan-stunting/. in Bahasa Indonesia
Ministry of National Planning and Development/National Planning and Development Agency. (2018). Guidelines for implementing integrated stunting reduction interventions in districts/cities. Retrieved from http://tnp2k.go.id/filemanager/files/Rakornis 2018/Pedoman Pelaksanaan Intervensi Penurunan Stunting Terintegrasi Di Kabupaten Kota.pdf. in Bahasa Indonesia
Mohseni, M., Aryankhesal, A., & Kalantari, N. (2019). Prevention of malnutrition among children under 5 years old in Iran: A policy analysis. PLoS ONE, 14(3), 1–14. https://doi.org/10.1371/journal.pone.0213136
Napier, T. E. D. L. (1973). Rural-urban differences: Myth or reality? Retrieved from https://core.ac.uk/download/pdf/159582457.pdf
Novianto, H., Mufti Azis, M., & Mudrika Arini, H. (2022). Analysis of changes in the Yogyakarta City air quality system during the COVID-19 pandemic. Jurnal Rekayasa Proses, 16, 1–14. https://doi.org/10.22146/jrekpros.71888. in Bahasa Indonesia
O’Brien, G. L., Sinnott, S. J., Walshe, V., Mulcahy, M., & Byrne, S. (2020). Health policy triangle framework: Narrative review of the recent literature. Health Policy OPEN, 1, 100016. https://doi.org/10.1016/j.hpopen.2020.100016
Ohly, H., Crossland, N., Dykes, F., Lowe, N., & Hall-Moran, V. (2017). A realist review to explore how low-income pregnant women use food vouchers from the UK’s Healthy Start programme. BMJ Open, 7(4), e013731. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28432063/
Parkhurst, J. O. (2017). Evidence-based policymaking: an important first step and the need to take the next. In The Politics of Evidence.
Pasuhuk, H. (2022, October 1). Yogyakarta tourism has emerged from the pandemic. Dw.Com. in Bahasa Indonesia
Permanasari, Y., Permana, M., Pambudi, J., Rosha, B. C., Susilawati, M. D., Rahajeng, E., et al. (2020). Challenges of implementing convergence in stunting prevention programs in priority districts. Media Penelitian Dan Pengembangan Kesehatan, 30(4), 315–328. https://doi.org/10.22435/mpk.v30i4.3586. in Bahasa Indonesia.
Presidential Decree No 72 Year 2021 about the Acceleration of Stunting Reduction.
Purwanti, I., Mahfoedz, I., & Wahyuningsih, W. (2016). Knowledge about nutrition is related to anemia status in pregnant women at the Sewon II Health Center, Bantul, Yogyakarta in 2012. Jurnal Gizi Dan Dietetik Indonesia, 2(2), 62–67. Retrieved from http://ejournal.almaata.ac.id/index.php/IJND/article/view/286. in Bahasa Indonesia
Putri, D.R.A., & Rahman, A. (2023). Analysis of the implementation of stunting policy at Public Health Centers in Makassar City. PINISI: Journal of Art, Humanity & Social Studies, 3(2), 277-280.
Rokx, C., Subandoro, A., & Gallagher, P. (2018). Aiming High: Indonesia’s Ambition to Reduce Stunting. Washington DS.
Shahid, M., Cao, Y., Ahmed, F., Raza, S., Guo, J., Malik, N. I., et al. (2022). Does mothers’ awareness of health and nutrition matter? A case study of child malnutrition in marginalized rural community of Punjab, Pakistan. Frontiers in Public Health, 10(February), 1–11. https://doi.org/10.3389/fpubh.2022.792164
Sinharoy, S. S., Clasen, T., & Martorell, R. (2020). Air pollution and stunting: a missing link? The Lancet Global Health, 8(4), e472–e475. https://doi.org/10.1016/S2214-109X(20)30063-2
SUN Movement. (2018). Monitoring, evaluation, accountability and learning system country dashboard 2018: Indonesia. Retrieved from http://bit.ly/sunmeal.
Suryaningrum, M. A., Afrilda, Y., & Susanti, I. C. (2021). Guide to healthy kitchens to overcome stunting in quality family villages (DASHAT). Jakarta. in Bahasa Indonesia
The Government of Banyuasin. (2022, August 31). Banyuasin is the 1st best in South Sumatra Province in the performance assessment of 8 convergence actions to reduce stunting in 2022. Bappeda-Litbang.Banyuasinkab.Go.Id. Retrieved from https://bappeda-litbang.banyuasinkab.go.id/banyuasin-menjadi-terbaik-1-se-provinsi-sumsel-penilaian-kinerja-8-aksi-konvergensi-penurunan-stunting-tahun-2022/. in Bahasa Indonesia
The Government of Kepulauan Riau. (2022, August 31). Assessing the performance of the stunting reduction convergence action in 2022, Batam City won the best award in the Riau Archipelago. Mediacenter.Batam.Go.Id. Retrieved from https://mediacenter.batam.go.id/2022/08/31/penilaian-kinerja-aksi-konvergensi-penurunan-stunting-2022-kota-batam-raih-penghargaan-terbaik-se-kepri/. in Bahasa Indonesia
The Government of South Kalimantan. (2022). Report on the implementation of the accelerated reduction of stunting. South Kalimantan. in Bahasa Indonesia
The Government of Tanah Bumbu. (2022, August 31). Tanah Bumbu is the third best in South Kalimantan for stunting reduction convergence. Mc.Tanahbumbukab.Go.Id. Retrieved from https://mc.tanahbumbukab.go.id/tanah-bumbu-terbaik-ketiga-se-kalsel-aksi-konvergensi-penurunan-stunting/. in Bahasa Indonesia
The Government of Yogyakarta City. (2020, June 20). Optimizing the posyandu program during the COVID-19 pandemic with health volunteers. Retrieved from https://warta.jogjakota.go.id/detail/index/10741. in Bahasa Indonesia
The Government of Yogyakarta City. (2021). Executive summary of regional environmental management performance information. https://doi.org/10.1787/a26f6edb-id. in Bahasa Indonesia
The Government of Yogyakarta City. (2022a, February 10). The 2023 Yogyakarta City Government work plan prioritizes economic recovery. Warta.Jogjakota.Go.Id. in Bahasa Indonesia
The Government of Yogyakarta City. (2022b, October 11). Larung COVID-19, prayer for the hope that the pandemic will end. Jogjaprov.Go.Id. in Bahasa Indonesia
The National Institute of Health Research and Development. (2008). National report on basic health research 2007. In Kementerian Kesehatan Republik Indonesia. https://doi.org/1 December 2013. In Bahasa Indonesia.
The National Team for the Acceleration of Poverty Reduction. (2017). 100 priority districts/cities for stunting intervention. Retrieved from http://www.tnp2k.go.id/images/uploads/downloads/Buku Ringkasan Stunting.pdf. in Bahasa Indonesia
The National Team for the Acceleration of Poverty Reduction. (2018). Guide to convergence of programs/activities to accelerate stunting prevention. In TNP2K sekretariat wakil presiden Republik Indonesia. Retrieved from http://tnp2k.go.id/filemanager/files/Rakornis 2018/Panduan Konvergensi Program Kegiatan Percepatan Pencegahan Stunting.pdf. in Bahasa Indonesia
Tomaszewski, L.E., Zarestky, J., & Gonzalez, E. (2020). Planning qualitative research: Design and decision making for new researchers. International Journal of Qualitative Methods, 19, 1–7. https://doi.org/10.1177/1609406920967174
UNICEF. (2022). Child malnutrition. Retrieved January 5, 2023, from https://data.unicef.org/topic/nutrition/malnutrition/
UNICEF. (2021). UNICEF conceptual framework on maternal and child nutrition. Retrieved September 29, 2023, from https://www.unicef.org/media/113291/file/UNICEF%20Conceptual%20Framework.pdf
UNICEF/WHO/World Bank. (2021). Levels and trends in child malnutrition UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates Key findings of the 2021 edition. In World Health Organization. Retrieved from https://www.who.int/publications/i/item/9789240025257
Universitas Gadjah Mada. (2022, December 5). Pentahelix synergy for Yogyakarta free from stunting. Fkkmk.Ugm.Ac.Id. Retrieved from https://fkkmk.ugm.ac.id/sinergi-pentahelix-untuk-yogyakarta-bebas-stunting/. in Bahasa Indonesia
Wagino. (2022, September 12). Funding for stunting reduction programs. Www.Djkn.Kemenkeu.Go.Id. Retrieved from https://www.djkn.kemenkeu.go.id/artikel/baca/15355/Pendanaan-Program-Penurunan-Stunting.html. in Bahasa Indonesia
Walt, G., & Gilson, L. (1994). Reforming the health sector in developing countries: The central role of policy analysis. Health Policy and Planning, 9(4), 353–370. https://doi.org/10.1093/heapol/9.4.353
World Food Programme. 2016. Urban nutrition: Reducing the triple burden of malnutrition. Retrieved from: https://documents.wfp.org/stellent/groups/public/documents/communications/wfp287654.pdf
World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization. https://apps.who.int/iris/handle/10665/258734
World Health Organization. (2018). Stunted growth and development: Context, causes, and consequences. In Stunted Growth and Development. Geneva.
Wray, N., Markovic, M., & Manderson, L. (2007). "Researcher Saturation": The impact of data triangulation and intensive-research practices on the researcher and qualitative research process. Qualitative Health Research, 17(10), 1392–1402. https://doi.org/10.1177/1049732307308308
Yasri, A., & Yusran, R. (2022). Implementation of the Laskar Nagari Care for Food and Nutrition (LNPPG) program in preventing stunting in Padang Pariaman Regency. PUBLICNESS: Journal of Public Administration Studies, 1(1), 30–35. https://doi.org/10.24036/publicness.v1i1.4. in Bahasa Indonesia
DOI: https://doi.org/10.22146/jkap.86489
Article Metrics
Abstract views : 1879
| 
views : 1539
Refbacks
- There are currently no refbacks.
Copyright (c) 2023 JKAP (Jurnal Kebijakan dan Administrasi Publik)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.