y2y youth innovation fund fy19 final report height charts

Y2Y Youth Innovation Fund FY19 Final Report

Height Charts to Support Stunting Prevention and Reduction in East Nusa Tenggara, Indonesia

1 PDS Checkpoint Template Version: 1.9 (as of August 2018.)

Project Name: Height Charts1 to Support Stunting Prevention and Reduction

in East Nusa Tenggara, Indonesia

Country: Indonesia

TTL (please indicate), Mentor,

Project Manager, and YIF Team

Members:

Steisianasari Mileiva (TTL)

Social Protection Specialist, Social Protection & Jobs (SPJ) Global

Practice, Africa Region

[email protected]

Juul Pinxten

Social Protection Specialist, SPJ Global Practice, East Asia and the

Pacific (EAP) Region

[email protected]

Zack Petersen

Director of Operations, “The 1000 Days Fund”

[email protected]

YIF Focus Areas: Health; Gender Equality

Project Start Date January 1-July 29, 2019

Amount planned $ 25,000

Total Project Cost $ 25,800

Climate/Sustainability components On overall program sustainability, the team has ensured that the

intervention will be carried forward once the YIF financed activity itself

ends. Also, by training the Village Health Team (VHT)2 we are investing

in long-term change. On average, VHT will stay on as part of the

integrated village health post (Posyandu) for five years. If and when they

leave their role, they are still member of the community where their

knowledge and acumen will continue to create lasting change at the

village level.

Innovation Element Designed “by moms-for-moms,” the height chart measures an invisible

problem – the high rate of stunting3 in Indonesia and especially in the

location of the height chart project, East Nusa Tenggara Province – in an

effort to make the problem and array of solutions more visible in the

mind of mothers (caregivers) and village4 officials.

During implementation, the team also developed: (a) script charts (in the

form of a desk calendar, see Figure 2, 5) that utilizes images to

equip VHT) when communicating key information on ways to prevent

and reduce stunting to caregivers (mothers, fathers, grandparents, others

in the house); and (b) smart blankets5 (baby blanket with measurements,

1 See Figure 1, Page 14. The height chart is a life-sized and simple tool that provides parents with a visual and easy to understand indicator to

measure their children’s height versus the expected height range for children of the same age, disaggregated by gender. The height chart was

developed and designed “by moms for moms,” through a series of focus group discussions in both rural and urban villages in Indonesia, includes

easy-to-follow guidelines for parents regarding optimal child-rearing behavior during critical period of first 1,000 days of life. 2 Village health team (VHT) is a terminology being used in the YIF Height Chart Project that included village midwives, community-based

health workers (Kader) and other health volunteers. 3 Stunting is a condition of impaired growth (low-height-for-age, relative to World Health Organization’s Growth Standards) and development

experienced by chronically malnourished children. The stunting rate in East Nusa Tenggara Province 43 percent) is above the national level (31

percent) (Riskesdas, 2018). 4 In Indonesia, the local government consists of several levels: Province –> District –> Sub-District –> Village 5 This is under prototype phase.

mailto:[email protected]

mailto:[email protected]

https://www.1000daysfund.org/





see Figure 3, Page 15) to start sensitizing caregivers early on about

critical period of first 1,000 days to prevent stunting.

- Linkage to Operation

- Partnership with country offices/in-

country organizations

- Mobilization of other funding

sources alongside YIF

Linkage to World Bank Operation:

a) The height chart project (the Project) is inspired by the US$400

million PforR on Investing in the Early Years that promotes multi-

sectoral approaches to address the stunting “crisis” in the country.

Among others, the operation introduces the use of length mat to

reactivate the critical role of local health facilities (Posyandu). The

length mat is designed for children between 0-9 months, while the

height chart is designed for children between 9-24 months and for

use in homes directly instead of only in Posyandu.

b) The height chart (as designed and tested through the YIF) can also

be used by facilitators of the country’s flagship Conditional Cash

Transfer Program (Program Keluarga Harapan - PKH) as part of the

provision of the Health Module on essential life skills and health

behaviours in the Family Development Sessions (FDS) activities

with the CCT beneficiary mothers.

Partnership with in-country organizations and mobilization of other

funding sources alongside YIF:

a) The Project was supported by approximately $12,000 from a

member of the Asia Philanthropy Circle.6 The funds were used for

height chart prototyping, travel and staff management costs.

b) The Project worked closely with the East Nusa Tenggara’s district

health center with regard to data sharing as well as having two staff

members joined the Project team in the field for a total of 10 days.

c) From the private sector side, Reckitt Benckiser, the parent company

of Dettol soap, provided 240 bottles of soap to be distributed during

workshops in the village.

d) Kick Andy, an award-winning primetime television show, joined the

Project team to East Nusa Tenggara to profile the height charts and

local health care workers (including midwives) as part of their talk-

show program highlighting remarkable people making a difference

throughout the country. The show aired in June 2019 (YouTube

links provided in Annex 1).

e) As a result of being featured on Kick Andy, Angkasa Pura, a state-

owned-enterprise7, pledged to donate IDR100 million ($7,000) to the

Project’s local partner (The 1000 Days Fund/TDF) to continue the

activities in the three villages (Komodo, Messah and Rinca) and

other villages, including through testing other innovative tools and

approaches to increase awareness and promote behavior change.

6 A consortium of philanthropists working jointly on public health, education, climate change and other issues pertinent to prosperous and

sustainable communities. APC is headquartered in Singapore with team members housed under The 1000 Days Fund (TDF), an NGO based

in Jakarta, Indonesia. 7 Responsible for the management of airports in Indonesia.




Project Overview

1.1. Project Objective To collect evidence in order to learn whether the distribution of height charts improves mothers' knowledge of

positive behaviors to reduce stunting and help midwives communicate the often-complex causes and

preventative measures for stunting from a woman's pregnancy to her child's second birthday.

In the short term, the Project wants to learn whether the distribution of height charts served as an effective tool

to nudge mothers toward an improved understanding of stunting and the critical importance of first 1,000-day

care8. In the long term, the Project sought to position midwives, alongside healthcare providers and other

community health workers (VHT), as frontline actors serving as respected, village-level fonts of knowledge

and focal points of stunting and 1,000 days care knowledge across Indonesia.

1.2. Project Summary Stunting, or low height for age, is caused by insufficient nutrient intake, poor hygiene and frequent infections

— and is associated with terrible disadvantages. On average; stunted kids will surrender 10 IQ points, and miss

half a year of schooling due to illness (being 10 times more susceptible to sickness like pneumonia and

diarrhea)9. And, almost half of preventable infant death is related to malnutrition. That is as many as 70,000

child deaths in Indonesia every single year.10 It is also an economic disaster. As adults, stunted kids will go on

to earn a wage more than one-fifth lower than their peers.

Indonesia, a G20 nation and Southeast Asia's largest economy, is home to provinces like East Nusa Tenggara,

where the stunting rate stands at a staggering 43 percent.11 If you speak with people in the villages in East Nusa

Tenggara islands, however, stunting is not top-of-mind. Worse, the problem seems to be invisible, because

being “short” is seen as normal.

Almost three quarters of Indonesia’s population receive prenatal counseling at the (integrated) health facility,

or Posyandu. Posyandus are local, volunteer-run health facilities, and more than 300,000 Posyandus serve more

than 30 million mothers across the world’s largest archipelago12. However, there is significant variation in the

quality of healthcare services provided through this traditional model, with many Posyandus and volunteer

health workers lacking the training and critical skills needed to recognize or properly attend to the issues

contributing to high stunting rates.

The Project team set out to fill this information gap and to make the problem more visible by: (a) distributing

height charts through home visits; and (b) holding workshop for village health teams (VHTs) in Komodo,

Messah and Rinca Villages in East Nusa Tenggara, while collecting evidence (pre- and post- surveys) as to

whether the distribution: (i) improves mothers’ knowledge of positive behaviors to prevent stunting; and (ii)

helps village midwives communicate the often-complex causes and the preventative measures for stunting.

The Project was implemented for six months, between January to June 2019, as per the YIF’s implementation

parameters. Young staff from the World Bank and the local NGO partner designed and implemented the Project.

8 Maternal prenatal nutrition and child's nutrition from conception to 2-years-old (or first 1,000 days) are crucial factors in a child’s

neurodevelopment and lifelong mental health. 9 Morris SS, Cogill B, Uauy R. 2008 Maternal and Child Undernutrition Study Group. Effective international action against undernutrition:

why has it proven so difficult and what can be done to accelerate progress? Lancet 16;371(9612):608-21. 10 Committing to Child Survival: A Promise Renewed: https://www.unicef.org/publications/files/APR_2015_8_Sep_15.pdf 11 These numbers are on par with Sub-Saharan Africa—countries like Zambia, Ethiopia, South Sudan and Rwanda. 12 Rokx, Claudia; Subandoro, Ali Winoto; Gallagher, Paul. 2018. Aiming high: Indonesia's ambition to reduce stunting. Washington, D.C.:

World Bank Group. http://documents.worldbank.org/curated/en/913341532704260864/main-report

https://www.unicef.org/publications/files/APR_2015_8_Sep_15.pdf

https://www.unicef.org/publications/files/APR_2015_8_Sep_15.pdf




A total of 159 households received the height charts—installed in a prominent place in what is sometimes the

only room in the home. The same number of people (caregivers, mostly mothers) participated in interactive

one-on-one counseling on how to use the height chart to measure their children and on key behaviors to prevent

stunting. Another 22 VHTs participated in workshops to improve their knowledge of stunting prevention and

reduction, including the importance of the first thousand days in child development. In addition, to support

continued uptake of the knowledge and practices after the end of the Project, the team met with village heads

to motivate resource allocations for activities that support stunting prevention and reduction in the three villages.

Simple growth or height charts installed in homes allow parents to see what could have been invisible – whether

their child has a normal height for their age. The hope is that it would further prompt action in the event of a

short-fall and provides targets at regular age-intervals. More important that the act of measurement means

having families repeatedly exposed to the messages, carried in written and symbolic form, on the top of the

charts. The messages are reinforced by in-home visits, using the charts as a center-piece of the conversation.

The families then associate messages on the charts with the in-home visit, and are constantly reminded of the

messages when they see the charts. Recent research regarding growth charts found that its introduction and use

led to 22 percentage points reduction of stunting rates among malnourished children.13

Key Findings

• The Project installed 159 height charts and trained 22 VHTs across three villages (Komodo, Messah and

Rinca) in East Nusa Tenggara Province. Endline results indicate that 65 percent of caregivers could define

stunting. More importantly, 48 percent of those same caregivers could explain why stunting is important

and 62 percent said that having the height chart in the home led to positive behavior change, including more

in depth and frequent interactions with VHTs, as well as better hygiene and health practices. At baseline

(January 2019), only 35 percent of VHTs (8 out of 22) felt confident explaining: what stunting is, why it is

important to prevent stunting, and the key stunting prevention messages found on height charts. After five

months (i.e. in June 2019), this number had doubled to 73 percent.

• In addition, meetings with village heads and buy-in from the sub district health facility allowed the height

charts and data from the villages to be presented to district heads and all three villages now have additional

budget allocations to finance activities aligned with prevention and reduction of stunting. Some planned

activities are: more creative and engaging deliveries of health counseling (including on stunting), monthly

cooking demonstrations, and nutritious meals for mothers and children at the health check-ups.

“Now we can see the changes in terms of the height of our children and what happens when we give

them nutritious meals. Before, I only gave my child snacks”—Mother, Messah Village.

“Now more mothers come to the Posyandu for monthly check ups for their kids under five years

old”—Village Health Team, Komodo Village.

“Because of the height chart I am more concerned with what I feed my child and sanitation. And now

my daughter is not sick as much as she used to be”—Mother, Komodo Village.

“Now I wash my hands often and I can see the weight and height of my child increasing”—Mother,

Rinca Village.

13 Günther Fink, Rachel Levenson, Sarah Tembo, Peter C Rockers; Home- and community-based growth monitoring to reduce early life

growth faltering: an open-label, cluster-randomized controlled trial, The American Journal of Clinical Nutrition, Volume 106, Issue 4, 1

October 2017, Pgs 1070–1077, https://doi.org/10.3945/ajcn.117.157545. This important study should be built upon by work with larger

sample sizes and longer evaluation periods.

https://doi.org/10.3945/ajcn.117.157545

https://doi.org/10.3945/ajcn.117.157545




Key Interventions

• Caregivers (mothers, fathers and other caregivers at home) in the three villages received a height chart

installed by the YIF team, an in-depth demonstration (using emotional demonstration techniques14), and

direct home counseling. All home interventions focused on educating mothers/caregivers about the

importance of the first 1,000 days of a child’s life to prevent stunting, growth of their child as well as to

motivate them to take appropriate action to maintain or improve it.

• VHTs are trained through workshop set-up in an effort to give them the confidence needed to serve as fonts

of stunting knowledge in the village. At the end of the workshop series, they put together Village Action

Plan to prevent and reduce stunting.

• The Project worked with and via VHTs and local experts on the ground to listen and learn what worked in

their village, and facilitate conversations meant to turn practices introduced into a village-owned stunting

prevention program.

Key Learnings

• Ownership: Height Charts are more likely to be an effective communication tool about anti-stunting

behavior when they are designed in consultation with health workers (including VHTs) and workshops are

designed to be more interactive and provided information not previously taught. This helps VHTs then take

ownership and lead the height chart installation program.

• Frequency: Height Charts are more likely to trigger interaction between caregivers and health workers

when implementers commit to a schedule of regular monthly visits to frequently remind caregivers of the

importance of using the height chart and understanding the key messages printed on the height chart on the

importance of first 1000 days care to prevent and reduce stunting. Also, when health workers are regularly

trained leading to having confident in their ability to provide in-home and Posyandu counseling on stunting.

• False assumptions on health workers and men/fathers: Initially, the YIF Height Charts team was going

to focus only in providing tool (height chart) and knowledge to mothers. Two important lessons were: (i)

the fact that members of the VHTs also has limited understanding about stunting, and (ii) that men (fathers)

were also interested to hear about stunting and child measurement. Therefore, the YIF activities were

adjusted to also include training/workshop to the village health team and doing the home visits in the

afternoon to allow men to take part in the counseling upon returning from work.

• Low literacy rate: The initial design of the height charts had more words than the final product. It turned

out that villagers tend to not read and absorb written information on a daily basis. The final height chart

design is less about reading messages and more about seeing colorful images that trigger the remembrance

of that messages, inspired by how one associates the swoosh with Nike or the golden arches with

McDonalds.

Bank Group Contribution

• The Project was selected as a recipient of the FY19 World Bank’s Youth Innovation Fund (YIF)

competition and received US$25,000 to finance field activities between January to June 2019.

• Two World Bank staff contributed their time (on top of their main deliverables) to implement as well as

supervise the implementation of the Project and producing the final report. This is aligned to the YIF

14 Emotional demonstrations (emo-demos) is behaviour-centred design to trigger behaviour changes, such as handwashing with soap, by

creating disgust and shame he Emo-Demo technique of triggering emotions associated with behaviors was pioneered by the London School

of Hygiene and Tropical Medicine (LSHTM) for hand-washing programs.




concept that provides an opportunity for young Bank staff to design and implement youth development

projects in client countries.

Partners

• The Project partnered with the Asia Philanthropy Circle and “The 1000 Days Fund (TDF)” (see footnote 5

for more details), as well as with the East Nusa Tenggara’s district health center.

Implications for the Future

• The Height Charts intervention package (with the VHT workshop and other innovative approaches

to be developed) would be deployed to other villages. In fact, TDF has received private sector funding

to expand the pilot to 38 Posyandus. TDF is seeking funds from other donors to scale up this YIF Height

Charts project’s approaches to other villages, and it plans to submit an official request to the Ministry of

Health for the continued use and official adoption of the tested approaches. The team will continue

exploring social and cultural issues that influence women and midwives’ role in society and on childbearing

with specific attention to the devastating effects of stunting. These lessons will continue feeding into the

design and implementation of household height charts with the hope that the government promotes and

adopts these for distribution at the national level.

• Focus on caregivers/mothers and village health workers: Indonesia’s President, Mr. Joko Widodo, in

2018 set a target of 20 percent reduction in the number of stunted children by 2025. Preventing stunting in

Indonesia requires governments to put in place policies that would create the conducive environment

needed, but more importantly it requires grassroots change at the village level. This entails investment in

the village health workers and volunteers who interact with the community on a daily basis. The Project

reaffirmed that filling gaps in knowledge and errors in measurement among caregivers and village health

workers has the potential to trigger broader awareness about pertinent development challenge such as

stunting prevention and reduction. Given the newfound confidence of the VHTs as the direct provider of

information and care to households vulnerable to stunting, it is critical to think about how they can expand

on their role in the village ecosystem. This could include VHTs leading discussions with religious leaders,

teachers and school-age children.

• Stunting ambassadors in the villages: As a result of frequent visits to the three target villages, interactive

home visits and workshops for village health team, a number of individuals approached the YIF team to

serve as “stunting ambassadors” in their respected villages. The next step would be to hold meetings with

sub-village heads and gather nominations of “ambassadors/champions” to further solidify efforts to create

a village ecosystem that will eventually lead to “Stunting-Free” pledges taken by village leaders and citizens

in the three villages.

• Further tracking of project outcomes: TDF plans to explore a system to track whether the training

increases the rate of referrals from the target villages to the sub-district hospitals. This will be done by

cross-referencing VHT members who attended the training with those referring patients to the hospital.

Early signs of progress have been noted – within two weeks of completing the workshop, two VHT

members referred patients to the National Hospital. They both identified themselves as project participants

and stated that they would not have recognized that their patients were in danger had it not been for their

recent training.




1.3. Implementation Approach

Pre-Implementation (December 2018):

Prior to traveling to the three villages the Project team prepared the questionnaires (see Annex 2) to collect necessary

data and the field work agenda.

Implementation (January to June 2019):

Implementation consists of multiple field works in the three target villages in East Nusa Tenggara Province and

regular email updates following each fieldwork. In between field works, the team conducted meetings to discuss

the data collected and revise the implementation plan as needed. Also, video footages and beneficiary feedback

were gathered to produce a 3-minute video summary of activities in the field. Please see the three pillars of the field

activity as described below under Implementation Details.

Throughout implementation, the Project team kept the sub-district health office apprised, leading to the participation

of two staff members of the health office to do field work in the three villages in the second half of project

implementation.

Post-implementation (July 2019):

The Project team had the opportunity to present the height chart to the World Bank CEO Ms. Kristalina Georgieva

at a Y2Y happy hour event and prepared the final report as per template provided by the YIF.

Implementation Details:

Village Health Team (VHT) Workshop— The Project strived to position the VHT as sustainable fonts of

knowledge, giving them the confidence to nudge mothers and caregivers toward better decisions and stunting

prevention behaviors. The Project supported health workers in the three villages through the provision of workshop

sessions that include the following: (a) familiarization on village stunting data and the graphs in the Ministry of

Health’s distributed maternal and newborn health book; (b) practical use of data and graphs to improve

understanding of local conditions and make better informed decisions such as identification children who had the

potential to be stunted; (c) Discussions on the importance and use of height charts as tools to monitor growth of

children between during first 1,000 days and provide early warning in the case of lower height-for-age; and (d)

preparation of Village Action Plan15 to prevent and reduce stunting. See photos immediately below from one of the

workshop sessions (left) and the VHT and Project team showing their Village Action Plan (right).

Interactive Home Visit—The Project distributed height charts to houses with pregnant mothers and/or children

under the age of 2 years old. While visiting the houses, the Project team conducted: (a) short interviews to fill out

15 Proposed action items include cooking demonstrations, village gardens, door-to-door distribution of Vitamin A for children under 2-year

of age, and close monitoring of children at risk of being stunted.




the baseline/midline/endline questionnaires; (b) height chart installation and children’s measurement; and (c) one-

on-one counseling with mothers and/or primary caregivers (grandmother and/or father in some instances) on the

ways to prevent stunting, as visualized on the upper part of the height chart and an emotional demonstration (emo-

demo) of why stunting prevention is critical during the first 1,000 days of a child’s life with regard to cognitive and

immune system development. See photos immediately below where the Project team conducted counseling using

emo-demo tools (left) and a mother helped her daughter to stand to be measured against the height chart that was

just installed at her home (right).

Village Buy-In—In addition to VHT workshops and installation of the height charts inside target houses

(interactive home visit), the Project team also met with village heads and district health officials to provide updates

of the activities, share data and motivate leaders to focus attention and resources on stunting prevention and

reduction. At one of the meetings, the Project team highlighted the Village Action Plan that was prepared by the

VHTs to garner support from decision-makers regarding resource allocation.

Approach:

• Caregivers (mothers, fathers and other caregivers at home)16 in the three villages received a height chart

installed by the YIF team, an in-depth demonstration (using emotional demonstration techniques17), and

direct home counseling. All home interventions focused on educating mothers/caregivers about the

importance of the first 1,000 days of a child’s life to prevent stunting, growth of their child as well as to

motivate them to take appropriate action to maintain or improve it.

• VHTs are trained through workshop set-up in an effort to give them the confidence needed to serve as fonts

of stunting knowledge in the village. At the end of the workshop series, they put together Village Action

Plan to prevent and reduce stunting.

• The Project worked with and via VHTs and local experts on the ground to listen and learn what worked in

their village, and facilitate conversations meant to turn practices introduced into a village-owned stunting

prevention program.

16 The Project considered Gender Equality by working with and benefiting mothers through the provision of information regarding stunting

and ways to prevent stunting. In addition, as discussed under Key Learning (page 5), men (fathers) were also interested and thus project

activities were adjusted by doing home visits in the afternoon allowing men to take part in the counseling upon returning from work. 17 Emotional demonstrations (emo-demos) is behaviour-centred design to trigger behaviour changes, such as handwashing with soap, by

creating disgust and shame he Emo-Demo technique of triggering emotions associated with behaviors was pioneered by the London School

of Hygiene and Tropical Medicine (LSHTM) for hand-washing programs.




1.4. Project Implementation Timeline (briefly describe the progress in each quarter)

All activities are completed. Breakdown by month is provided below:

1.5. Cost Breakdown

Categories

Initial amount

requested to

YIF

Actual amount

used from YIF

Detailed Description (e.g.

venue for training, etc.)

Additional

resources used

from other sources Total

Goods/Equipme

nt (Vendor)

$2,080 $ 860.00 Printing height charts, revising

height charts, and

consumables and tools for

VHT workshops and

Interactive Home Visit

$2,000 from Asia

Philanthropy Circle

for height chart

prototyping

$2,860.00

Travel $ 14,500 $ 18,475.79

Travel costs: flights, boats, in

and out transfers,

accommodations

$653 from Asian

Philanthropy Circle

for travels

$19,128.79

Services (STC) - - - - -

Services

(Vendor)

$8,400

$6,500.00

Graphic designers (for height

chart and script chart),

videographer, workshop

facilitator, financial and

administration management,

monitoring and evaluation

$9,000 from Asian

Philanthropy Circle

for staff payment

$15,500.00

Total $24,980 $ 25,835.79 - $11,653 $37,488.79

18 These numbers are taken from SAP based on actual amount disbursed at a certain date; therefore, there were time lags between the “size”

of the activities to the “size” of the amount disbursed.

Month Jan Feb Mar Apr May June

Activities

Fieldwork:

pre-testing

the fieldwork

strategy, first

half of the

baseline

interviews,

height charts

installation,

questionnaire

s revision

Fieldwork:

remaining

baseline

interviews, VHT

Workshop,

Interactive Home

Visit, meetings

with village

officials (Village

Buy-In)

Fieldwork:

midline

interviews, VHT

Workshop,

Interactive Home

Visit, and Village

Buy-In

Fieldwork:

follow up visit to

check and

troubleshoot any

problems,

meetings with

village officials,

joining the Kick

Andy team for

video recording

Desk work:

interim data

assessment,

budget review

and

reconciliation,

script chart

and stunting

blanket

Fieldwork:

endline

interviews, VHT

Workshop,

Interactive

Home Visit,

Village Buy-In,

video

finalization;

report writing

Notes

Amount

Disbursed

($)18

660.81 5,181.72 2,501.15 4,543.90 7,288.30 5,659.91




Results

2.1. Results

• At baseline (January 2019), 4 percent of caregivers (mothers and fathers) could define stunting. At endline

(June 2019), 65 percent of caregivers could do so. More importantly, 48 percent of those same caregivers could

explain why stunting is important. While it is meaningful to know what stunting is, the knowledge of why

stunting is must be prevented (see Section 1.2) is a crucial piece to promote positive behavior change.

• At baseline, already about a third of the beneficiaries (34 percent) understand the importance of exclusively

breastfeeding their child for the first six months of life. This is a positive behavior to prevent stunting and the

fact that some level of knowledge already exist was a welcomed finding. At endline, the share increased to

almost 60 percent.

• Between midline and endline there was increased understanding of how to use the height chart to measure

children’s height correctly. However, only about 40 percent of the beneficiaries took note of their child’s

measurements in the table provided on the height chart. This may be linked to the relatively low literacy levels

in the villages. See more in Section 2.2 below.

• At baseline, only 8 out of 22 VHT members (35 percent) felt confident explaining: what stunting is, why it is

important to prevent stunting, and the key stunting prevention messages found on height charts. At endline, this

number had doubled to 73 percent. While a large part of our focus was on mothers, it is important to note that

the sustainability of the Project’s interventions hinges on well-trained and confident health workers and

volunteers who serve as the “ujung tombak” (the colorful Indonesian metaphor which literally means “tip of

the spear”) of the fight against stunting. The knowledge and awareness of these village health workers is

critically important, considering that a large majority of Indonesians will never visit a formal health facility and

only interact with the local midwife and village health volunteers.

• This newfound confidence is crucial for village health workers. They will not only be able to pass that

knowledge on to mothers and caregivers, but be able to speak up at village meetings and request support for the

village health facility (Posyandu). These budget commitments were displayed prominently at the three villages

– they now have operational budgets of over US$3,000 for 2019-2020, which they will use to conduct monthly

cooking demonstrations and provide nutritious meals for mothers and children at the health check-ups.

Results Framework:

No. Indicator Baseline*

(%)

Midline*

(%)

Endline*

(%)

Caregivers’ Knowledge of Stunting19:

1. Share of beneficiaries (parents) who can explain what stunting is 4 31 65

2. Share of beneficiaries (parents) who can explain why it is important to

prevent stunting

0 0 48

Use of Height Chart:

3. Share of beneficiaries (parents) who can demonstrate and explain how a child

should stand20 when being measured with the Height Chart

0 40 58

4. Share of beneficiaries (parents) who know the difference between pink and

blue sections on the Height Chart

0 35 75

19 At endline, almost all respondents (94 percent) had heard of stunting, indicating that the Project helped introducing a new term in the

villages 20 Feet flat and against the wall




5. Share of beneficiaries (parents) who know the meaning of the “standards” for

each age range on the Height Chart

0 37 53

6. Share of beneficiaries (parents) with Height Chart on the wall, who know and

understand the importance of exclusively breastfeeding their child for the first

six months of life21

34 66 58

7. Share of height charts with measurements recorded in writing 0 45 42

Village Health Team’s Knowledge of Stunting: 22

8. Share of village health team’s members who can explain with confidence:23

- What is stunting

- Why stunting is important

- Key elements of stunting prevention during the first 1,000 days

N/A 35 73

* Baseline: January 2019 | Midline: March 2019 | Endline: June 2019

• In addition to the above indicators in the results framework, the Project measured Net Promoter Score (NPS),

calculated based on a score from 1-10** from VHT members about the likelihood that they would recommend

three activities listed below as approaches in other villages. The results indicated VHT’s positive reactions

toward the Height Chart Project, with an average of 83 percent likelihood to recommend the Project’s activities

to be conducted in another village.

Net Promoter Score:

No. NPS Questions Number of

Respondents

NPS Raw

Score

Final NPS

Score

1. Recommendation score for installing height charts in another village 22 17 77

2. Recommendation score for using media “emotional demonstration” or

“demonstration images” as a way to prevent and reduce stunting in

another village

22 18 82

3. Recommendation score for replicating stunting interactive home visit

in another village

22 20 91

** Conversion Scores:

Score 9/10 equals to “+1”

Score 7/8 equals to “0”

Score 1-6 equals to “-1”

All scores were added and divided by the number of respondents, then multiplied by “100”

21 There are two different elements to this question: (1) knowledge that the child should be exclusively breastfed for first 6 months, and (2)

knowledge of why exclusive breastfeeding is important. *In the midline survey we asked "What should a baby consume during the first six

months of life?” and 66 percent said ASI (breastfeeding) exclusively. As part of the endline we asked, "In your opinion, do you only give a

child ASI exclusive during 0-6?" and 58 percent answered that ASI is the best thing to give a baby. 22 The baseline for the VHTs was taken in March 2019 because originally the focus of the Project was the mothers, but we learned that VHTs

played a key role and yet some have limited understanding and not always confident about their knowledge of stunting (see Section 1.2 under

Key Learnings). 23 This was a self-assessment to test individual level of knowledge by presenting statements with regard to stunting and asking the village

health team’s members to choose from the following: (a) I have never heard the term; (b) I don't understand; (c) I understand but don't feel

comfortable to explain to mothers; (d) I understand and feel somewhat comfortable to explain to mothers; and (e) I understand and feel very

comfortable to explain to mothers.




2.2. Qualitative Feedback and Lessons Learned

Learnings (in addition to Key Learnings on Page 5)

• Through focus group discussions (FGDs), both mothers and village health teams stated that there had been

behavior changes in the villages as a result of the height charts and the other Project’s activities. For

example, 64 percent of beneficiaries (mothers) with children under 2, indicated that having a height chart

in the home led to positive behavior change such as increased frequency of visiting the Posyandu. Then,

some others (58 percent) reported increases in diversity of mothers’ food intake and improved hygiene

(WASH) behaviors (25 percent). The latter anecdotal improvement is important, if insufficient, given that

the 2018 Indonesian National Health Survey findings indicated that more than 85 percent of respondents in

the district (Manggarai Barat) did not wash their hands properly. However, the discussions also gathered

that during Project implementation, minimal changes took place with regard to intake of iron and folic acid

(IFA) tablet, Vitamin A, deworming pills and children’s immunization. Anecdotally, these indicated that

information provision through interventions such as those done under the Project may need to be

accompanied with other approaches – including those that address supply side constraints24 – and longer

intervention time, if behavior changes are the ultimate targets.

• The Endline FGDs introduced new tools, including: (a) script chart, which works as a portable presentation

in the form of a desk calendar (see Figure 2, Page 16) that utilizes images to equip VHT members when

communicating key information on ways to prevent and reduce stunting to caregivers; and (b) smart blanket

which holds the same stunting prevention messages as the height chart, but is meant for measuring children

under 9 months. Children who receive blankets before birth will eventually “graduate” to height charts

when they are old enough to stand, thus covering measurements for the entire 1,000 days, from conception

to 2-years-old. These new tools were greeted with enthusiasm, and TDF team looks forward to working

with these villages in order to continually improve the script chart and smart blanket.

Areas Where Results Suggest Room for Improvement

• Although 80 percent of Height Charts are still both in good condition and remain in prominent and visible

positions in the household, this is a little lower than expected (against more than 90 percent, 10 months

later, in the Gates-funded Zambian study). The risk is that it is the poorest and least educated households

with the greatest risk of stunting, where height charts were obscured by cabinets or other furniture because

the importance of the tool was not explained properly and therefore was not see as something that could be

covered or obscured.

• Only 42 percent of installed height charts had multiple recorded height measurements, although only 8

percent had monthly measurements recorded. Anecdotal reports indicate that in many cases where there

were no written height measurements, parents expressed that they had a fairly accurate idea of the height

of their child. Parents may be using the height chart to measure their children, but did not record the

measurements in the table on the height chart. Although the filled-in table was meant to nudge parents to

use the height chart and read/see the messages on the height chart and then to monitor the behavior, it may

not be the best approach. Future design of the height chart may need to consider this strategy for the context

of low literacy beneficiaries.

Areas With Clear Shortcomings

24 Such as provision of health supplies, health workers and facilities.




• During implementation of the Project, the team thought of doing an experiment with sending SMS on

stunting prevention messages on the height chart to listed mobile phone numbers of beneficiaries. The

purpose was to send a reminder to the beneficiaries in order to increase knowledge and/or nudge positive

behaviors of stunting prevention during first 1,000 days of child’s life. However, it was unsuccessful. Only

5 percent reported both receiving and understanding the messages. The failure seemed to be contributed by

the following: incorrect phone numbers listed in the survey forms, beneficiaries’ mobile phones cannot

receive SMS/broken, poor reception network in the villages, low literacy among beneficiaries, and

husbands or children are the main users of beneficiaries’ phones. This does not mean that this intervention

will always fail – progress in mobile phone technology might make this more viable in the future.

• Communications about the first 1,000 days, as opposed to stunting, was largely ineffective. Only 18 percent

of respondents seemed to adequately understand the concept and importance of the first three years of life.

This may be because it is an abstract concept and requires too many stages of new thinking (it is quite a

large number that requires translation to the notion of conception until two year of age).

Lessons Learned/Reflections specific to World Bank Young Staff:

• There is an ancient yet relevant quote that goes “I hear, and I forget, I see, and I remember, I do, and I

understand.” In my case25, the YIF provided the opportunity to do – to identify a development challenge

(high stunting rate in East Nusa Tenggara, Indonesia) and to act on it by preparing and implementing a

(time-bound and relatively small) project. I believe that I went above and beyond my responsibilities in

the office where I am currently a task team member to leading a team (including the challenge and

dynamics of doing it remotely from Washington DC), making day-to-day decisions, representing the

Project, and ensuring accountable use of World Bank financial resources to achieve the development

objective. I recognized the area where I needed strong support from others, i.e. administration such as

documents management/recording, budgeting and accounting. Furthermore, I enjoyed the opportunity to

learn more about designing results framework and monitoring and evaluation instruments.

• In my experience26 providing support to YIF project lead and TDF team in one of the monitoring trips and

guiding the reporting phase, I was most struck by the impact well planned field visits themselves can have.

While from the base and mid line, recollection of key messages related to the first 1,000 days of child’s

life and stunting where very low. Through the reiteration of these messages, accompanied by VHTs, and

often again at the end of the trip in a wider village level meeting I felt was an important driver of some of

the increases found at the end line. I surmise, as heard in theory working on behavioral change

communication (BCC), that the value of the behavioral interventions become more pronounced when they

echoed several times and from multiple angles and are well and understandably explained.

25 Steisianasari Mileiva 26 Juul Pinxten




3. Additional Documents

Figure 1. Height Chart

Bahasa Indonesia Version:

English Version:




Figure 2. Script Chart

Figure 3. Stunting Blanket




Annex 1. Links to Videos, Newspaper Articles, Website and Some Social Media Updates of the Project

https://www.youtube.com/watch?v=yVEfsW_8jWg

\

https://www.youtube.com/watch?v=p8x5duikiIY&t=159s








https://www.youtube.com/watch?v=iP0atX0tP7k&t=3s

https://www.thejakartapost.com/news/2019/07/18/stunting-indonesia-s-most-neglected-issue.html








https://jakartaglobe.id/context/vicepresidential-debate-serves-as-perfect-opportunity-to-talk-about-

stunting

Website: https://www.1000daysfund.org/

https://jakartaglobe.id/context/vicepresidential-debate-serves-as-perfect-opportunity-to-talk-about-stunting









https://www.facebook.com/KantorStafPresidenRI/?pageid=206588216425327&ftentidentifier=7568630

24731174&padding=0

https://jokowidodo.app/post/detail/hari-anak-nasional-23-juli-tingkatkan-kualitas-pelayanan-posyandu-

dalam-upaya-pencegahan-stunting

https://www.facebook.com/KantorStafPresidenRI/?pageid=206588216425327&ftentidentifier=756863024731174&padding=0




https://jokowidodo.app/post/detail/hari-anak-nasional-23-juli-tingkatkan-kualitas-pelayanan-posyandu-dalam-upaya-pencegahan-stunting







Annex 2. Instruments and Forms Used in the Field

a) Survey form for mothers who are pregnant and with children under two years old




b) Survey form for village health teams (VHTs)




c) Rundown of the Interactive Home Visit

Halo Ibu, selamat [pagi/siang/sore]. Kita tadi yang jumpa di puskesmas. Perkenalkan, nama saya […] dan ini teman

saya […] Kami datang kesini untuk menempel poster tinggi badan, jadi nanti Ibu biar sewaktu-waktu bisa

memakainya dan mengukur tinggi badan anak Ibu ya. Kira-kira cocoknya ditempel di mana ya Bu? Jadi biar

nanti Ibu juga gampang memakainya, dan nanti kalau misalnya anak Ibu atau temannya anak Ibu bisa coba

mengukur tinggi badannya di sini.

Sambil teman saya menempelkan posternya, kita ngobrol dulu ya Bu. Ibu, sambil kita mengobrol saya sambil

mengisi data-data boleh ya?

Ibu, kita nonton video dulu yuk, saya mau kasih lihat video tentang kesehatan anak, ibu mau lihat?

Setelah melihat video itu, perasaan ibu bagaimana? Yang ibu ingat dari video itu apa, bu?

--bertanya tentang questioner-

Oke sekarang poster sudah terpasang, saya jelaskan ya supaya bisa bermanfaat.

Nah, sekarang kita mau diskusi juga, kira-kira yang bisa dilakukan agar tinggi badan anak Ibu bisa sesuai dengan

target, atau bahkan melebihi target. Di poster tinggi badan ini, ada 10 cara yang bisa dilakukan untuk mencegah

anak-anak tidak stunting.

Tadi kan sudah dengar tentang stunting ya Bu, nah menurut Ibu stunting itu anak yang seperti apa sih yang

sudah terkena stunting? Kalau Ibu tidak tahu tidak apa-apa juga ya. Yuk kita baca sama-sama.

Ibu apakah bisa membaca? [Kalau tidak] tidak apa-apa, saya bacakan ya. Nanti kalau misalnya Ibu ada

kesulitan membaca lagi bisa minta tolong suami atau anaknya yang sudah bersekolah ya Bu. Tapi tidak apa-apa

sekarang saya bantu bacakan lalu nanti kita diskusikan ya Bu.

Nah jadi ternyata anak yang stunting itu anak yang apa tadi? Ya, yang kurang gizi ya Bu. Jadi yang pertama,

[...], menurut Ibu apa yang harus kita lakukan? Yang kedua, [...], berdasarkan ini, berarti Ibu harus ngapain? Yang

ketiga, .. dst. sampai yang kesepuluh.

Oke berarti yang akan Ibu lakukan setelah pertemuan kita ini apa? Ya, menyediakan makanan-makanan yang

bergizi ya Bu. Jadi anak nya gak apa-apa makan telur sehari 2 butir sehari. Terus sayur-sayurannya juga jangan lupa

ya Bu. Iya sih Bu kalau di pulau sayur-sayurnya susah ya Bu. Tidak apa-apa Bu, kalau di pulau kan banyak daun

kelor, nah, daun kelor itu bisa kok dikonsumsi oleh anak-anak. Terus buah-buahan juga.

Terus apa lagi Bu yang akan Ibu lakukan setelah pertemuan kita? (Ke puskesmas).

Jadi anak Ibu kalau misalnya belum minum obat cacing yang harus dilakukan apa? (Ke pustu) Nah Ibu kalau

misalnya ke pustu tanya ke ibu bidan atau bapak mantri untuk obat cacing. Jadi sekali dalam 6 bulan anak Ibu harus

minum obat cacing juga. Jadi misalnya anak Ibu sudah minum obat cacing di bulan Desember. Kita hitung ya,

berarti nanti di bulan Juni Ibu harus kasih anaknya obat cacing lagi. Jadi Ibu gak apa-apa sering-sering ke pustu.

Jadi kalau ada informasi-informasi kesehatan atau perkembangan bayi Ibu bisa dapatkan setiap hari. Jadi ke pustu

bukan hanya kalau ada acara saja atau karena dipanggil oleh petugas kesehatan.

Jadi tadi ketika kita lihat tinggi badan anak ibu dan ternyata dia belum sesuai target, yang Ibu harus

lakukan tadi apa saja? [Ibu ulangi]




Nah kalau nanti misalnya Ibu lupa tidak apa-apa, bisa minta tolong dibacakan ya. Ibu bisa pakai poster tinggi badan

ini setiap hari boleh, setiap minggu boleh. Kalau misalnya nanti ada pertanyaan atau Ibu kebingungan, Ibu harus

kemana nih kalau mau tanya? [Ke pustu]

Terus kalau ASI eksklusif itu di posternya sampai anaknya umur berapa Bu? Seperti itu dulu ya Bu. Jadi

mulai besok, Ibu silahkan datang ke pustu untuk tanyakan obat cacing atau untuk vitamin yang lainnya, karena Ibu

masih menyusui. Jadi boleh tanya-tanya ke pustu, boleh minta di pustu, dan itu semua [harusnya] gratis.

Nah jadi kalau dilihat dari hasil tinggi badan anak Ibu ini, anak Ibu ternyata belum sampai di tinggi rata-rata anak

untuk umurnya.Ibu, setelah posternya terpasang dan tadi kita telah ukur anak ibu, Jadi menurut Ibu, anak Ibu seperti

apa kalau begini? Jadi misalnya anak Ibu ini umurnya [1/1.5/2/...] tahun. Nah kalau 2 tahun kan untuk anak [laki-

laki/perempuan] harusnya ada di mana ya Bu? Iya, yang [biru/pink] ya Bu. Nah, jadi ada targetnya. Garis hijau ini

menandakan anak baiknya ada disini, kalau ada digaris merah atau dibawah garis merah, ibu bisa ketemu dengan

bidan atau Pak Mantri.

--- jika anak tinggi sesuai, berikan tepuk tangan dan pujian---

Nah sedangkan anak Ibu berada di berapa senti dari yang diharapkan? Tapi Ibu tidak perlu sedih, karena

anak Ibu masih di bawah 2 tahun, jadi untuk bisa mencapai tinggi badannya yang ideal Ibu belum terlambat lho.

Dan lakukan hal-hal yang tadi telah kita baca, pasti anak kan tumbuh sehat.

Ada pertanyaan Bu? Kalau tidak ada kami pamit dulu ya Bu, dan Ibu semoga sehat-sehat, anaknya juga sehat-

sehat. Terima kasih Bu.




d) Rundown of the Village Health Team Workshop

SCRIPT DAY 1

8:00-8:10 Intro-Overview of the Day Administer “Kuesioner Pemahaman”

Selamat pagi ibu, bapak sekalian. Terima kasih atas waktunya pagi ini. Sebelumnya boleh perkenalan diri, dan dari

saya juga akan memperkenalkan diri karena ada teman-teman baru.

Ini kali ketiga kami kesini, sudah beberapa kali pasang poster bersama Ibu Bidan, Kader, Mantri dan berbicara

mengenai stunting (3 hal utama: apa itu stunting, penyebab, kenapa stunting itu penting, dan cara mencegahnya)

Supaya kami bisa memahami lebih baik pengetahuan ibu bapak tentang stunting, boleh bantu isi kuesioner yang

dibagikan? Ditulis aja sejujurnya, tidak ada benar salah. Saya bantu baca ya.

- Terima kasih telah mengisi, ini nanti menjadi masukan buat kami

Kedatangan kami ini bermaksud mau mengajak ibu-bapak, teman-teman sekalian untuk mengurangi angka stunting

di Messah dan anak-anak jadi lebih cerdas dan sehat. Tentunya, yang lebih paham situasi masyarakat adalah teman-

teman semua. Semoga dengan kepedulian bapak ibu, kami dari 1000 hari mau membantu dan menunjukkan

komitmen kami. Kedepannya kami akan datang tiap bulan untuk mendukung program yang akan dijalankan oleh

teman-teman sekalian.

Acara pertemuan pagi ini adalah :

1. Membahas status stunting yang ada di Messa dan bagaimana cara memantau dengan menggunakan buku

PINK (KIA).

2. Kami mau minta masukan kalau kami mau memperagakan permainan edukasi pada Ibu ketika pasang

poster, apakah bisa dimengerti atau tidak.

3. Kami juga bawa tikar panjang dan mau menunjukkan cara pakai, sehingga anak yang belum bisa berdiri

sudah bisa mulai diukur. Selain itu, poster tinggi badan sudah kami benahi menjadi 7 hal sehingga lebih

mudah diingat, nanti kita lihat sama-sama

4. Nanti sore kami akan pasang poster baru di rumah yang belum ada poster. Ada 3 tim yang akan jalan supaya

lebih cepat.

Sedangkan untuk besok acaranya adalah diskusi sama-sama & perencanaan tindakan nyata bulan depan untuk

menurunkan stunting. Dari sini, kita komitmen bersama menjalankan program yang sudah dibuat.

8:10-9:00 Discussion of Village Statistics and Status of Stunted Children

Acara pertama hari ini melihat data anak yang telah kita ukur bersama. Pak Mantri sudah ukur 68 anak, ini adalah

nama-nama anak. Terima kasih ya Pak atas inisiatifnya.

Selanjutnya Emma akan memfasilitasi diskusi ini.

Emma needs:

1. Provide pink books (one between 2 or 3 participants is sufficient)

2. Bring data about which children have height charts in their homes

3. Support facilitation, clarify instructions if they are unclear, ensure participants understand the task.

9.00 -9.15 EMO DEMO




Ibu, bapak, saya mau bertanya, dan minta masukannya, Bagaimana kalau Saya dan teman-teman menunjukan

permainan ini kepada ibu-ibu. Apakah mudah dimengerti apa tidak?

Saya mulai ya. ----- permainan dimulai---

1) What do you think was good/what did you like about the emo demo?

2) What could be improved/what didnt you like about the Emo-demo?

3) menurut bapak/ibu, bagaimana respon orang tua jika ditunjukkan emodemo?

4) Bagaimana jika kami melakukan ini nanti sore ketika pemasangan poster?

9.15 – 9.45 Revisit Height Charts & Introduction to Length Mats.

Masih semangat yah ibu-ibu? Ini kami bawa tikar ukur. Jadi untuk anak yang belum bisa berdiri dengan baik, pakai

tikar lebih mudah.

Tujuannya: supaya ibu bisa mulai peduli terhadap tinggi badan sebagai indikator kesehatan.

Penting untuk mengukur bayi dari awal.

Tikar ukur ini model terbaru dari Jakarta.

Tikar ini seperti poster tinggi badan, untuk indikasi dan penting untuk mengubah perilaku hidup sehat,

Poster ini kita bikin yang baru, ada sedikit perbedaan berdasarkan masukan dari ibu bapak. Perubahannya gambar

lebih besar, lebih sederhana kata-katanya. Untuk isi piringnya sudah ada ikan supaya lebih sesuai.

Saya akan tunjukkan cara menggunakan tikar ukur ya.

• Rentangkan tikar pada lantai yang datar dan rata. • Pastikan ujung-ujungnya tidak tergulung • Pastikan papan

akrilik tidak bengkok atau patah dan membentuk sikusiku tegak lurus • Pastikan umur anak. Pengukuran

panjang/tinggi badan dilakukan untuk setiap baduta ketika berusia tepat 3, 6, 9, 12, 15, dan 18 bulan. • Baringkan

anak terlentang di bagian yang sesuai dengan jenis kelaminnya (laki-laki atau perempuan) • Pastikan kepala anak

menempel rapat dengan papan akrilik • Pastikan kepala anak tidak memakai topi atau pita, atau ikat rambut sehingga

menghalangi pengukuran yang tepat • Posisikan agar tubuh anak berbaring selurus mungkin • Pastikan bagian

bawah lutut menempel pada tikar (lutut tidak menekuk)

• Jika memakai popok tebal harus dilepas agar tidak menghalangi pengukuran • Tumit dalam keadaan tertekuk dan

jari kaki menghadap ke atas. Lihatlah di bagian mana tumit kaki anak berada, cocokkan dengan usia anak. Lihat

apakah tumit ada di bagian merah, tepat di garis kuning, atau mencapai bagian hijau dari tikar ini? Jika di bagian

hijau berarti tumbuh dengan baik, jika dibagian garis kuning berarti anak masih tumbuh normal namun berisiko

stunting dan jika di bagian merah berarti anak memiliki gangguan pertumbuhan panjang/tinggi badan. • Catat hasil

pengukuran panjang/tinggi atau panjang badan anak 0-23 bulan dengan Karpet Pertumbuhan pada Formulir 4.

Pemantauan Layanan Pengukuran Panjang/tinggi Badan. (Petunjuk pengisian lihat lampiran Buku Monitoring).

(2) Selanjutnya, bersama Kader Posyandu dan atau Bidan lakukan konsultasi hasil pengukuran Panjang/tinggi

Badan kepada orang tua dan atau pengasuh anak yang diukur tersebut.

Ada yang mau ditanyakan ibu/ bapak? Ada yang tidak dimengerti?

Debrief and Discuss afternoon schedule Break Until 15:15

Sekarang kita istirahat, nanti ketemu lagi jam 15.15. Kita mau tempel poster.




Ada 3 tim yang akan ditemani oleh kader/ibu ya.

Internal: Langkah-langkah yang dilakukan sebelum memasang poster tinggi badan

1. Introduction (1mins)

2. Installation of the height chart or latest version (2mins)

3. Emo Demo (8mins)

4. Q Baseline or follow-up (5mins)

5. Comparison of Jan data if applicable (1mins)

6. Practice of child standing against the height chart (1mins)

15.15 – 17.15 Height Chart Review and Installation

DAY 2

8.00 – 9.35 Action Plan Co-Created by Village Health Team

Halo selamat pagi, kita ketemu lagi! Tujuan hari ini adalah untuk diskusi mengenai aksi/ tindakan utama untuk

setahun kedepan dan untuk membangun rencana tindakanyang bisa terukur bulan depan, baik untuk teman-teman

kesehatan disini dan juga untuk 1000 hari.

Kita evaluasi kegiatan pelatihan kemarin dulu ya :

1) What do you think was good/what did you like about kemarin – length mat, emo demo?

2) What could be improved/what didnt you like dari pelatihan kemarin?

(10 min)

Kalau menurut ibu-bapak, para kader disini, apa penyebab utama yang berpengaruh terhadap stunting?

(berdasarkan catatan kemarin, kunjungan ke rumah, berdasarkan pengalaman bapak ibu selama di sini)

Bisa coba dituangkan dalam 1 gambar yang menurut pendapat kalian sendiri, yang jadi penyebab utama?

(bersama-sama)mengidentifikasi faktor yang sama. (30 min)

Bagaimana kita menanggulangi faktor penyebab ini?

Discuss in 2s and 3s to begin with then brainstorm as a group: what we can do over the next year across 3 levels;

the household, Posyandu and village. (30 mins)

➔ Dimana perlu menunjukan menu sebagai ‘pemantik ide’ jika mereka bingung.

Langkah-langkah apa yang bisa kita lakukan bulan depan?

Apakah data pelatihan kemarin berguna, demo sambil bermain? Kenapa?

Apakah ini mau dilakukan lagi?

Kira-kira apa yang mau kita lakukan bulan depan, bentuk tindakan apa yang bisa dilakukan dan yang bisa dilakukan

oleh 1000 hari untuk membantu?

Masalah utama penyebab

stunting

Kegiatan/ ide Dukungan yang

dibutuhkan

Bisa diukur bulan

Maret?

Kesimpulan??

1.

2

3.




e) FGD guide for gathering beneficiaries’ feedback at the end of the Project

Script FGD

15.00 – 17.30 FGD

1. Welcome & introduction

2. Background

3. Background rules

4. Opening questions

Selamat datang, terima kasih banyak atas waktunya.

Saya Sisi dari 1000 Hari, disini ada juga xxx/ xxx/ xxx. Senang bisa berkumpul kembali bersama ibu-ibu semua

disini. Kami mengundang Ibu untuk diskusi mengenai kegiatan kami selama ini tentang stunting, terutama

mengenai poster tinggi badan, dan juga kunjungan ke rumah. Tujuannya supaya nantinya kegiatan kami lebih baik

lagi. Kita akan berbicara dan melihat lagi kegiatan yang telah terjadi mulai dari Januari sampai April kemarin

sebelum Puasa.

Saya pastikan yang ibu-ibu katakan hari ini adalah rahasia. Nama Ibu tidak akan digunakan dalam laporan., silakan

jawab spontan saja ketika menjawab pertanyaan. Tidak ada yang benar atau salah. Karena orang punya pemahaman

yang berbeda. Diskusi ini akan berlangsung selama 1 jam kurang lebih.

Ada beberapa aturan sebelum kita mulai diskusi : boleh matikan hp,

Apa sudah jelas? Ada pertanyaan?

Bisa kami mulai untuk diskusi? Saya ingin merekam pembicaraan ini supaya tidak ada yang terlupa dan catatan

yang kami punya tepat. Boleh saya rekam?

IF YES, START RECORDING.

Sekarang mari kita perkenalan. Beritahukan Nama Ibu,

Kita akan berdiskusi dalam kelompok. Kita bagi 1 kelompok 3 orang ya.

Disini ada 2 kertas, kertas yang warnanya xxx untuk di tulis 3 hal yang ibu sukai dari poster tinggi badan,

Kertas warna xx apa yang tidak disukai dari poster tinggi badan atau apa yang bisa ditingkatkan?

- Tanya kenapa? (tulis dibagi 2 dalam kertas besar)

-

Saya bertanya seputar poster tinggi badan:

1. Bagaimana teman-teman dari 1000 hari menjelaskan poster tinggi badan ketika berkunjung ke rumah? Apakah

mudah dimengerti atau tidak? Apa yang sulit?

2. Menurut Ibu, apakah bagian kalender untuk menuliskan tinggi badan anak ini berguna? Kenapa/ kenapa tidak?

3. Menurut Ibu, bagaimana jika poster ini ditempel di desa lain? Mengapa perlu dilakukan di desa lain?

Sekarang saya bertanya mengenai kunjungan ke rumah:

Coba sekarang kasih jempol – kalau ibu percaya diri dan memahami stunting dan bisa menjelaskan ke orang lain-,

jempol ke samping- tidak begitu yakin, dan jempol ke bawah – jika tidak yakin/ tidak percaya diri.

Apa yang membuat ibu bingug?

Bagaimana penjelasan tentang stunting bisa ditingkatkan (atau seberapa sering penjelasan bisa ditingkatkan?)

4. Menurut ibu, penjelasan stunting harusnya dilakukan bagaimana? Apakah dengan kunjungan ke rumah atau

lebih baik dilakukan saat Posyandu?




5. Menurut ibu, ketika berkunjung ke rumah : siapa yang lebih tepat untuk menjelaskan? 1000 hari atau teman-

teman kader dan bidan?

6. Bagaimana perasaan ibu ketika dikunjungi teman-teman dari 1000 hari untuk diberikan penjelasan mengenai

stunting?

Terkait gambar / alat untuk menjelaskan stunting (flipchart)

1. Ibu lihat, saya sekarang punya gambar supaya bisa menjelaskan stunting lebih mudah, boleh kita coba yah

ibu?

2. Jika dibandingkan dengan penjelasan yang sebelumnya ibu terima di rumah ketika menempel poster?

Bagaimana menurut ibu?

3. Apakah ini bisa membantu ibu-ibu di desa lain jika kita menjelaskan stunting?

Kesimpulan: dari apa yang telah dikatakan, apa yang penting dari diskusi hari ini?

Assistant moderator summary : follow up questions / give very short summary

Baik, terima kasih ibu atas waktunya menjawab pertanyaan-pertanyaan dari kami. Apakah dari Ibu ada yang mau

disampaikan kepada kami?

Jika tidak ada, kita tutup diskusi hari ini, terima kasih. Semoga kedepannya anak-anak kita menjadi anak sehat

cerdas-terbebas stunting dan pada akhirnya anak-anak tersebut menjadi tabungan hari tua kita di surga.