Hasan talks about the relationship between sanitation and stunting

Ending stunting in a major Asian economy

  • Jun 20, 2016

Despite being one of the largest economies in Asia, Indonesia has an incredibly high rate of stunting: children who fall at least two standard deviations below median height for age. Not having the correct nutrition within the first 1,000 days of life can lead to lifelong challenges. Children’s minds and bodies may not fully develop.

Iwan Hasan, IMA World Health’s team leader for Indonesia, supervises the Millennium Challenge Account’s National Nutrition Communications Campaign project for IMA World Health. The three-year program aims to address the root causes of stunting by working with Indonesia’s national and district governments to achieve behavioral change.

Q: What is the aim of NNCC campaign?

The campaign has three main objectives. The first is to create awareness about stunting issues in Indonesia and the long-term implications of stunting on children, families, communities and the country. The second objective is to gain commitment from various stakeholders, like the local and central governments as well as community leaders, to reduce stunting. The third is to cultivate behaviors or practices that can reduce stunting.

Q: What is the most important lesson you have learned so far?

It is very important for all partners, counterparts and stakeholders to be on the same page and to be very clear about what everyone should be doing. This creates harmony and makes it easier to make a big impact on the communities who need our help most.


Timeframe: 2014-2017

Funding level: $4.1 million (US)

Donor: Millennium Challenge Corporation, Indonesia

IMAs Role: Lead Agency

“More than one-third of Indonesians under 5 years are stunted.” – Iwan Hasan


Hasan talks about the long-term effects of stunting on children and the country as a whole

Q: Why is this campaign so important?

Most people are not aware that stunting is a huge issue in Indonesia. More than one-third of Indonesians under 5 years are stunted and that is a big problem. For a country like Indonesia, which is a member of the G20 and has an economy that is bigger than the Netherlands, Turkey and Saudi Arabia, when it comes to stunting prevalence, we are comparable to countries like Timor-Leste, Laos and Cambodia.

People are also not aware of the long-term implications of stunting and the tremendous effect it can have on a person’s life. A child’s future is significantly affected by nutrition in their first 1,000 days from conception to 2 years. Educating parents about the importance of this issue can have a big impact on their children’s lives and we want them to know that improving a child’s nutrition is very simple. It does not take a huge investment to reduce stunting as a parent and a community, it just takes focusing on some basic practices such as exclusive breastfeeding, making sure that pregnant mothers have good nutrition, washing hands with soap, using a proper toilet and making sure that parents feed their kids with nutritious, diversified food after 6 months of age.

Q: What are some of the challenges you have found when it comes to behavior change?

Behavior change needs time for it to have a real impact. You can’t expect a two-year campaign to immediately change behavior when it comes to infant feeding, sanitation and hygiene, but it does provide an avenue to educate parents and influence some basic, social and cultural norms that give people the desire to make real changes in their children’s lives. The biggest challenge is changing people’s perceptions and combating cultural myths. For example, people still think a child’s height is entirely genetic and has little to do with nutrition. So if you have a short kid under 5 years, people assume that is because their mom or dad is short, while we know scientifically it is also influenced by good nutrition during the first 1,000 days.

Q: What are some of the key things you are doing that are making a difference?

The first is that we are engaging very closely and continuously with local counterparts and local governments. I cannot emphasize enough how important this part of our work is. By engaging them and working with them we are not only collaborating with them but we are educating them on stunting and advocating for stronger support. Once they are aware of the issues and realize how important they are, they become our allies and partners. They will be supportive of our campaign and programs and that has been our first approach in our campaign. The second key thing we are trying to do is to create a dialogue with the community through mother classes and mother support groups. This is done through health workers and volunteers with mothers and communities. We encourage them to talk about important, yet simple, things like how to breastfeed their babies exclusively up to 6 months, and give them tips because we know that every mother’s breastfeeding challenges are unique. We want to encourage dialogue to answer problems like how to make sure that kids are fed properly and adequately after they reach the age of 6 months. Unfortunately, these dialogues rarely happen at the community level. More often than not, the interaction between the health providers and the community and mothers is just professionalized. So you give the service, they receive the service, and that’s it. There are no interactions or dialogue. Our third approach is working with faith leaders whether their congregations are Muslim and/or Christian because they are pillars in the communities, are very important sources of information and have a powerful influence on social norms. 

Q: What has been the most rewarding part of this project so far?

Hasan answers questions following a presentation to staff members at IMA’s headquarters in Washington, D.C.

Hasan answers questions following a presentation to staff members at IMA’s headquarters in Washington, D.C.

To see some early signs of fruition of our work. For instance, we had an event that was opened by the head of the district and instead of us or nutrition professors talking about the issue, he was the one who spoke to his district about the effects of stunting. He took our role and that is the kind of result we want. It means that our work has actually made a difference as the leaders of the communities are the ones who will be taking these messages to the people. When the leaders realize how big the impact of child malnutrition is, they realize that it is something they have to work on and contribute to. That is one of the most rewarding parts of our work.

Q: What are you hoping to achieve with this campaign in the long term once it is completed?

I would be pleased if, for example, parents have a different and improved attitude towards child care. I want them to have the attitude that my children’s futures have to be better than mine, and that it comes through improving health and nutrition as well as giving children a clean environment. That is my dream. It’s not a big dream, but if they have that attitude then it is already an accomplishment.