18 March 2024

Landscape analysis of large-scale food fortification in Indonesia

Landscape Analysis Large Scale Food Fortification (LSFF) was conducted by UNICEF Indonesia and Bappenas with aim to identify gaps and challenges in the implementation of LSFF in Indonesia. The landscape analysis presents five key findings. First, Indonesia has very limited data on either coverage or impact of fortified food. Second, national requirements for mandatory fortified of salt, wheat flour and palm cooking oil are increasing with Indonesia’s growing population. The national requirement for rice has fallen however as the diet of the population has diversified and wheat flour consumption has increased. A majority of salt and wheat flour are now consumed as processed foods. Third, weaknesses and gaps in the current regulatory monitoring system. It includes the excessive and duplicative facility and product inspections by Food Drug Administration and the Ministry of Industry with lack of coordination between the two, insufficient accredited and authorized agencies to undertake all the required inspections in a timely manner, over reliance on product testing and market surveillance, no system for ensuring the use of fortified ingredients in processed foods and no solution for small scale salt processors that are unable to achieve SNI certification. Fourth, high level of interest in large scale fortification of rice in Indonesia recognizing that rice is the staple food of the country and Indonesia is almost self-sufficient in rice. However logistical, technical, and financial constraints have limited large scale rice fortification. Fifth, weak coordination, management and oversight on LSFF programme, where lack of communication on fortification between sectors and even within ministries was evident. Although Coordination platform for Salt Iodization was established in order to guide mandatory salt fortification in the early years, it has not been functional for several years. Meanwhile comparative structures for wheat flour and oil fortification have never existed. 
29 January 2024

Mid-Upper Arm Circumference (MUAC) tapes guidelines

One in 12 Indonesian children under five years is estimated to be wasted (too thin compared to their height/length). Wasted (moderate wasting and severe wasting) children are three times more likely to become stunted, with those with severe wasting having almost 12 times greater risk of dying than a healthy child. Detecting child wasting before children develop complications is essential to easily treat the condition.  Simple colour-coded bands, known as mid-upper arm circumference (MUAC) tapes, can be easily used at both the community and health facility level and even within households, to detect wasting and refer children in need of wasting treatment. The World Health Organisation (WHO) and Ministry of Health (MoH) updated guidelines recommend that MUAC measurements be used as a screening tool to detect child wasting in the community, and at a health-facility level, as an independent criterion, in addition to weight-for-height and bilateral oedema (nutritional swelling), for admission to wasting treatment programmes. Global and local evidence has found that communities, including caregivers, can be easily trained, and equipped with MUAC tapes to screen for wasting, detect child wasting early, and appropriately refer children at risk to health facilities when needed.  Additionally, Integrated Health Outpost (Posyandu) and Early Childhood Development (ECD) center are also important platforms for early identification of wasted children and referral for timely treatment and nutritional care.
11 December 2023

Healthy retail food environments

Overweight and obesity are on the rise in Indonesia, accompanied by an increase in diet-related conditions such as diabetes, hypertension, and heart disease. Key contributors to this trend include shifts in the country's food landscape, notably the expansion of modern food retailers like convenience stores. While these outlets offer a wider array of food choices, they can also promote the consumption of unhealthy ultra-processed foods rich in fats, sugar, and salt. Recognizing the pivotal role of the retail environment in influencing purchasing decisions, food retailers in Indonesia have a unique opportunity to foster environments that motivate individuals to choose and consume healthier foods and beverages, all without compromising profitability. In fact, such initiatives can lead to increased sales and profits while enhancing consumer perceptions of the retailer's brand. This socially responsible approach can have a positive impact on the dietary habits and overall well-being of Indonesian children. Since 2020, UNICEF and Deakin University have collaborated on the Healthy Food Retail project, focusing on Indonesia, Chengdu City (China), the Philippines, and Thailand. The project aims to build evidence, facilitate stakeholder engagement, and support retailers in promoting healthier food environments for children. This brief summarizes the Healthy Food Retail project and urges Indonesian F&B retailers to participate in fostering healthier food environments for children in the country.
14 November 2023

Maternal nutrition in Indonesia

Maternal nutrition starts from preconception, carries through the ante and postpartum periods and continues throughout the reproductive period and the transformative years from the foetal stage to adolescence. Indonesia has a high prevalence of maternal malnutrition coupled with high rates of maternal and neonatal mortality. According to Riskesdas 2018, 1 in 2 pregnant women are anaemic, 1 in 6 are thin, 1 in 3 are short stature. Many maternal health programs have been implemented in Indonesia, including routine iron and folic acid (IFA) and postpartum vitamin A supplementation, supplementary feeding for undernourished pregnant women and nutrition education and counselling. It is important to periodically review these programs to ensure alignment with the most up to date evidence and global recommendations, to address barriers and bottlenecks and to adjust programming for maximum impact. Against the backdrop, this landscape analysis seeks to better understand the current state of maternal nutrition programs in Indonesia. It aims to provide a systematic identification of barriers – from the policy level to program implementation – of maternal nutrition interventions in Indonesia, and their alignment with the 2016 WHO recommendations on antenatal care for a positive pregnancy experience (as well as the relevant WHO nutrition recommendations for menstruating women and postpartum women). Additionally, the analysis also aims to understand the direct and indirect impact of the COVID-19 pandemic and the preparedness of the health systems in dealing with uncertainties due to the impact of the pandemic. Findings are summarized according to the intended beneficiary during three distinct stages: before pregnancy (adolescent girls and women of reproductive age); during pregnancy (pregnant women); and after pregnancy (postpartum women) and recommendations were provided as a set of priority (short-term), medium-term and long-term actions.