improving quality of care in partnership with governments and communities_michelle inkley_5.8.14

Indonesia Community-based Nutrition Project

CORE Group Presentation

May 8, 2014

MCC in 2 minutesReducing poverty through economic growth

•Competitive selection– Good governance– Economic freedom– Investment in citizens

•Country-led solutions– Economic and social analysis

•Country-led implementation– The MCA and implementing partners– 5-year Compacts and Threshold Program

•Focus on results

Indonesia

• 246.9 million people

• 17,000 islands across 3200 miles

• Largest Muslim democracy (86% Muslim)

• 140 million people live on less than $2/day

• Over one-third of children under five years of age experience stunted growth

This chart uses WHO data from different years as available and is presented for comparison purposes only

Children Under 5 Years Stunted (%)

37% of all Indonesian children under age 5 are stunted

Why focus on stunting

Stunting affects:

•Survival

•Long-term health

•Cognitive development

•Family resource utilization

•Long-term productivity

Conceptual Framework

Project Overview• The Indonesian government’s implementation of

Scaling Up Nutrition (SUN)

• Aims to reduce and prevent low birth weight, childhood stunting, and malnourishment of children

• Targets approximately 5400 villages in 11 provinces where stunting and low birth weight are higher than national averages

• $129.5 million

• 16.5% ERR

• In Year 2 of 5-year Compact

Project Activities• Component 1 (Demand Side): block grants and

participatory planning technical assistance to communities ($81.6 M)

• Component 2 (Supply Side): training and capacity building for health and sanitation providers, anthropometric equipment, micronutrient provision, and private sector response ($34 M)

• Component 3: national stunting awareness campaign and project management support ($13.9M)

– Demand Side – PNPM Generasi

PNPM Generasi Implementation Cycle

PNPM Generasi Project Locations

PNPM Generasi Indicators as a Community Incentive

1. Each pregnant women attends four prenatal care visits

2. Each pregnant woman receives iron supplements during pregnancy

3. Each delivery assisted by trained professional

4. Each mother attends two postnatal care visits

5. Each infant is fully vaccinated

6. Each child under 5 is given vitamin A supplements

7. Each child under 5 years of age is weighed once a month

8. Each child increases their weight

9. Each child aged 6-59 months receives Vitamin A two times per year

10.Each mother and father attends a monthly nutrition counseling session

11.Each primary-school-age child attends school

12.At least 85 percent of secondary-school-age children attend school

– Supply Side – Supplying Services and

Resources Demanded by Communities

Capacity Building

• Ministry of Home Affairs, Ministry Health and Sanitation

• Training– Over 20,000 staff and volunteers– Cascaded training model– Didactic and on-the-job– Maternal, child, and young child feeding;

growth monitoring; sanitation and hygiene

Sanitation and Hygiene

Helping Communities to Become Open Defecation-free

•Community-led Total Sanitation (CLTS)– Sanitation triggering– Community action plan– Monitoring and technical assistance– ODF declaration

•Service provider incentives (RBF)

Micronutrient Powders and the Private Sector

• Government of Indonesia policy to provide MMN powders to bottom 2 quintiles

• Supplemental feeding and nutritious food options

• Role of the private sector

Media Campaign

• Formative research

• Reaching the village level

Impact Evaluation

• Random assignment to treatment and control

• Testing entire package

• Reduction of stunting as a key outcome

• Public availability of data

Challenges and Opportunities

• Number of stakeholders

• “The Handshake”

• Budget tradeoffs

• Geographic scope

• On-the-job performance

• Distribution and compliance

Organizational oversight