Improving the Quality of Frontline Nutrition Services in Indonesia's Health Sector

In the past two decades, Indonesia significantly improved its economic growth, poverty, and maternal and child health outcomes. Despite these notable achievements, the country's rates of stunting and malnutrition are among the highest in the world and threaten early childhood development as the stepping-stone of human capital formation. Though government guidelines, standards, and training have helped improve nutrition services in the health sector, there continues to be considerable variation in service quality across districts, between urban and rural areas, and among public and private facilities, with many mothers and children being provided suboptimal services. Malnutrition is a multisectoral issue that is not the “problem” of the health sector alone. However, many of the high-impact health interventions known to improve nutrition outcomes for children are not being implemented in Indonesia, calling for a higher-quality health system to produce better nutrition outcomes. This report analyzes the opportunities to improve the quality of frontline nutrition interventions in Indonesia’s health sector as an element of achieving the National Strategy to Accelerate Stunting Prevention (2018–2021) (StraNas Stunting) goals. It uses a framework adapted from the Lancet Global Health Commission’s report on High-Quality Health Systems in the Sustainable Development Goals Era, which explains that improving the quality of nutrition health care requires system-wide action. In specific, high-quality nutrition services necessitate both process and foundational reforms at the macro, meso, and micro levels. The paper outlines the challenges and proposes recommendations to improve quality nutrition care and services in the country. These are related to strong leadership, harmonized guidelines and targets, and robust regulatory and quality improvement mechanisms; improved monitoring and evaluation and data use; predictable, adequate, and timely financing; platforms for care; competent health workers and a sound supportive supervision system; adequate supplies and functional equipment; and systems that respond to clients’ health needs and expectations.