THE EFFECTS OF SOCIAL ASSISTANCE PROGRAMS ON STUNTING PREVALENCE RATES IN INDONESIA
Background: Social assistance, such as Non-Cash Food Assistance (BPNT) and the Family Hope Program (PKH), is among the instruments used to eradicate stunting in the short and long term. Therefore, it is important to ensure that individuals effectively use it.
Aims: This study aimed to review the effect of social assistance on stunting prevalence rates in Indonesia.
Methods: This research employs a quantitative approach, utilizing numerical measurements and statistical analysis. The data is secondary and sourced from the Central Bureau of Statistics and the Ministry of Finance. The specific method applied is the generalized method of moments (GMM) dynamic panel regression. The research sample encompasses panel data from 34 provinces from 2015 to 2021. This study utilizes the indicator of very short height for children less than five years of age as a proxy for stunting. Furthermore, low height in children is adopted as a measure of stunting. Furthermore, this study adopted a measure of low height in children to indicate stunting.
Results: The results showed that social assistance negatively affected stunting, supported by various other indicators such as the proportion of proper sanitation, the average length of schooling, protein consumption, and drinking water sources. Meanwhile, excessive calorie consumption increases stunting in a certain period.
Conclusion: In this condition, government social assistance was urgently needed since access to the lowest decile households increased stunting rates. The practical implications for policy derived from these findings involve optimizing the efficiency of social assistance initiatives, emphasizing the significance of addressing environmental factors in programs aimed at preventing stunting, integrating health and nutrition initiatives, and implementing educational campaigns within communities to raise awareness about calorie consumption.
Keywords: child health, social assistance, stunting, toddlers
Introduction
Parents are expected to anticipate exceptional growth and development of their children. However, the expectation is not achieved due to malnutrition-related challenges. In a study conducted by the Ministry of Health, 10.2% of Indonesian children weighed less than 2500 grams, 19.6% exhibited abnormal weight indicative of malnourishment, while 32.2% experienced stunting(Health, 2018). The developmental delays were experienced due to malnutrition, and the impact resulted in stunting. According to the World Health Organization (WHO) definition, stunting is manifested when the height of children is minus two standard deviations of the growth median for their age(W.H.O., 2022). Consequently, stunting children are shorter than their peers of the same age group.
The Indonesian Nutrition Status Survey (SSGI) showed that the prevalence of stunting decreased from 24.4% in 2021 to 21.6% in 2022(Health RI, 2023). Even though a decrease was experienced in 2022, the condition remained a severe problem for children health.(Wardani et al., 2022)stated that stunting causes a decline in cognitive, language, and motor functions as well as several degenerative diseases. This statement was supported by President Joko Widodo at the BKKBN National Work Meeting, where the condition was reported to be dangerous for children’s development, leading to poor learning abilities, mental retardation, and chronic diseases(Communication & Service, 2023).(Tampy & , 2020)stated that normal children could improve their cognitive abilities. Therefore, the condition can affect the quality of human resources in the future.
The causes of stunting are very complex and previous studies showed that there was the influence of maternal factors such as height, age during pregnancy, duration of breastfeeding, dietary nutrition during pregnancy, and maternal education level on the increased risk(Beal et al., 2018);(Nurbiah et al., 2019);(Tyas & Setyonaluri, 2022);(Wardani et al., 2022). Furthermore, stunted mothers with low education increase the likelihood of stunting(Widyaningsih et al., 2022). A large number of children living at home under age five and the lack of mothers attending antenatal care services can also increase the risk(Titaley et al., 2019).
In another study,(Kandpal et al., 2016)examined the Conditional Cash Transfer (CCT) program, one of which was Pantawid for stunting in the Philippines. The program had a significant effect on reducing stunting by using cross-sectional data and providing cash transfers to poor households for education, children’s health, and maternal health services. Meanwhile,(Muhtar et al., 2022)showed that social assistance programs, as measured through the Family Hope Program (PKH) and the Staple Food Program, reduced stunting in Blora, Central Java.
In several previous studies, stunting has often focused on socioeconomic factors and household characteristics(Source Title, 2021), as well as maternal(Beal et al., 2018);(Nurbiah et al., 2019);(Tyas & Setyonaluri, 2022);(Wardani et al., 2022)and environmental factors(Irianti et al., 2019);(Cameron et al., 2021);(Nizaruddin & Ilham, 2022). Furthermore, there are studies linking stunting to food prices(Ilman & Wibisono, 2019). While only a few studies have directly linked cases of stunting to cash assistance programs like Indonesia's PKH, the program does contain elements that can potentially contribute to addressing stunting. Though not specifically designed to tackle stunting, PKH provides financial assistance to households, which can improve their access to nutritious food and essential health services. Therefore, the impact of direct assistance on stunting in Indonesia was examined. This study contributes to the reduction of stunting and provides an overview of the importance of direct cash assistance to improve children’s nutritional status, impacting health and decreasing the condition.
Variable | Acronym | Definition | Unit | Source | |
|---|---|---|---|---|---|
Dependent | Stunting | 𝑆𝑡𝑢𝑛𝑡𝑖𝑛𝑔𝑖𝑡 | The prevalence of (very short) in children under 5 years/children | Percentage | BPS |
Independent | Social Assistance | 𝑆𝐴𝑖𝑡 | Realization of social assistance funds for each province | Percentage | Ministry of Finance |
Sanitation | 𝑆𝑎𝑛𝑖𝑡𝑎𝑡𝑖𝑜𝑛𝑖𝑡 | Households by province and have access to proper sanitation | Percentage | BPS | |
Sanitary Proportion | 𝑆𝑎𝑛𝑖𝑡𝑎𝑟𝑦_𝑃𝑟𝑜𝑝𝑖𝑡 | Proportion of households that have access to proper sanitation services | Percentage | BPS | |
Mean Years School | 𝑀𝑌𝑆𝑖𝑡 | The average number of years spent by residents aged 15 and over | Years | BPS | |
Prevalence of Undernourishment | 𝑃𝑜𝑈𝑖𝑡 | An estimate of the proportion of a given population, for which the usual daily energy consumption from food is not sufficient to meet the required energy level | Percentage | BPS | |
Average calorie consumption | 𝐶𝑎𝑙𝑜𝑟𝑖𝑒𝑖𝑡 | Average calorie consumption for each province | Percentage | BPS | |
Average protein consumption | 𝑃𝑟𝑜𝑡𝑒𝑖𝑛𝑖𝑡 | Average protein consumption for each province | Percentage | BPS | |
Internet access | 𝐼𝑛𝑡𝑒𝑟𝑛𝑒𝑡_𝑢𝑟𝑏𝑎𝑛𝑖𝑡 | Households that have accessed the internet in 3 last month in urban | Percentage | BPS | |
𝐼𝑛𝑡𝑒𝑟𝑛𝑒𝑡_𝑟𝑢𝑟𝑎𝑙𝑖𝑡 | Households that have accessed the internet in 3 last month in the rural | Percentage | BPS | ||
Source of drinking water | 𝑆𝐷𝑊𝑖𝑡 | Households with an adequate source of drinking water in urban and rural | Percentage | BPS | |
𝑆𝐷𝑊_𝑢𝑟𝑏𝑎𝑛𝑖𝑡 | Households with an adequate source of drinking water in urban | Percentage | BPS | ||
𝑆𝐷𝑊_𝑟𝑢𝑟𝑎𝑙𝑖𝑡 | Households with an adequate source of drinking water in rural | Percentage | BPS |
Method
In this study, a quantitative method was used with a stochastic model to consider the existence of variables with a probability distribution(Gujarati, 2004). In addition, Generalized Method of Moments (GMM) was used to estimate parameters in dynamic panel data and overcome autocorrelation as well as heteroscedasticity problems. GMM equated the moment from the sample condition to the population. Robustness check was
Aizawa, T. (2020) ‘Joint Impact of the Conditional Cash Transfer on Child Nutritional Status and Household Expenditure in Indonesia', Journal of Human Capital, 14(1), pp. 122–164. https://doi.org/10.1086/708093
Akbar, M.T., Mahardhika, D.W. and Sihaloho, E.D. (2021) ‘Stunting in Eastern Indonesia : Determinants and Solution from Indonesian Family Life Survey', Cita Ekonomika, 15(1), pp. 1–13. https://doi.org/https://doi.org/10.51125/citaekonomika.v15i1.3230
Arellano, M. and Bond, S. (1991) ‘Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations', The Review of Economic Studies, 58(2), pp. 277–297. https://doi.org/10.2307/2297968
Arellano, M. and Bover, O. (1995) ‘Another look at the instrumental variable estimation of error-components models', Journal of Econometrics, 68(1), pp. 29–51. https://doi.org/https://doi.org/10.1016/0304-4076(94)01642-D
Bagcchi, S. (2015) ‘India's poor sanitation and hygiene practices are linked to stunting in children, study finds', BMJ : British Medical Journal, 350, p. h1564. https://doi.org/10.1136/bmj.h1564
Beal, T., Tumilowicz, A.,Sutrisna, A., Izwardy, D. and Neufeld, L.M. (2018) ‘A review of child stunting determinants in Indonesia.', Maternal & Child Nutrition, 14(4), p. e12617. https://doi.org/10.1111/mcn.12617
Bureau of Communication and Public Service (2023) Prevalensi Stunting di Indonesia Turun ke 21,6% dari 24,4%, SehatNegeriku. Available at: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20230125/3142280/prevalensi-stunting-di-indonesia-turun-ke-216-dari-244/
Cameron, L., Chase, C., Haque, S., Joseph, G., Pinto, R. and Wang, Q. (2021) ‘Childhood stunting and cognitive effects of water and sanitation in Indonesia', Economics & Human Biology, 40, p. 100944. https://doi.org/https://doi.org/10.1016/j.ehb.2020.100944
Casale, D., Espi, G. and Norris, S.A. (2018) ‘Estimating the pathways through which maternal education affects stunting: evidence from an urban cohort in South Africa', Public Health Nutrition. 2018/02/19, 21(10), pp. 1810–1818. https://doi.org/DOI: 10.1017/S1368980018000125
Chowdhury, T.R., Chakrabarty, S., Rakib, M., Winn, S. and Bennie, J. (2022) ‘Risk factors for child stunting in Bangladesh: an analysis using MICS 2019 data', Archives of Public Health, 80(1), p. 126. https://doi.org/10.1186/s13690-022-00870-x
Ernalia, Y., Utari, L.D., Suyanto and Restuastuti, T. (2018) ‘Different Intakes of Energy and Protein in Stunted and Non-stunted Elementary School Children in Indonesia', KnE Life Sciences, 4(4). https://doi.org/10.18502/kls.v4i4.2318
Gizaw, Z., Yalew, A. W., Bitew, B. D., Lee, J. and Bisesi, M. (2022) ‘Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia', Scientific Reports, 12(1), p. 19293. https://doi.org/10.1038/s41598-022-23981-5
Gujarati, D.N. (2004) Basic Econometrics, 4th edn. New York.
Gupta, A.K. and Santhya, K.G. (2020) ‘Proximal and contextual correlates of childhood stunting in India: A geo-spatial analysis', PLoS ONE, 15(8 August), pp. 1–20. https://doi.org/10.1371/journal.pone.0237661
Huo, S., Wang, K., Liu, Z., Yang, Y., Hee, J. Y., He, Q., Takesue, R. and Tang, K. (2022) ‘Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program', JMIR Public Health Surveill, 8(4), p. e33394. https://doi.org/10.2196/33394
Ilman, A.S. and Wibisono, I.D. (2019) ‘Reducing Stunting through Trade Reforms: Analysis of Food Prices and Stunting Prevalence in Indonesia', Center for Indonesian Policy Studies [Preprint]. Center for Indonesian Policy Studies. https://doi.org/10.35497/276145
Irianti, S.,Prasetyoputra, P., Dharmayanti, I., Azhar, K. and Hidayangsih, P.S.. (2019) ‘The role of drinking water source, sanitation, and solid waste management in reducing childhood stunting in Indonesia', IOP Conference Series: Earth and Environmental Science, 344(1), p. 12009. https://doi.org/10.1088/1755-1315/344/1/012009
Jibril, M., Puspitarini, R.C. and Nawangsih, V.S.A. (2022) ‘Efektivitas Family Development Session (FDS) Program Keluarga Harapan (PKH) Dalam Upaya Menurunkan Angka Stunting Pada Anak', Jurnal Sosial Politik Integratif, 2(2), pp. 140–154. Available at: https://jisip.org/index.php/jsp/article/view/67/38
Kandpal, E., Alderman, H., Friedman, J., Filmer, D., Onishi, J. and Avalos, J. (2016) ‘A Conditional Cash Transfer Program in the Philippines Reduces Severe Stunting', The Journal of Nutrition, 146(9), pp. 1793–1800. https://doi.org/10.3945/jn.116.233684
Logarajan, R.D., Nor, N. M., Ibrahim, S., & Said, R. (2023) ‘Social determinants of stunting among malay children below five years in malaysia', Nutrition, 111, p. 112030. https://doi.org/https://doi.org/10.1016/j.nut.2023.112030
Ministry of Health (2018) Cegah Stunting itu Penting. Available at: https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Warta-Kesmas-Edisi-02-2018_1136.pdf
Ministry of Health RI (2023) Buku Saku Hasil Survei Status Gizi Indonesia (SSGI) 2022. Available at: https://www.badankebijakan.kemkes.go.id/buku-saku-hasil-survei-status-gizi-indonesia-ssgi-tahun-2022/
Ministry of Social Affairs (2021) Modul 6 Pemanfaatan bantuan sosial dalam pemenuhan gizi anak usia dini & ibu hamil (3 JP), Tanoto Foundation. Available at: https://ppkhsragen.com/wp-content/uploads/2021/05/Modul-6-Pemanfaatan-Bantuan-Sosia-dalam-Pemenuhan-Gizi-Anak-Usia-Dini-dan-Ibu-Hamil.pdf
Muhtar, Pudjianto, B. and Habibullah (2022) ‘Social approach to stunting prevention in Blora, Central Java, Indonesia', Simulacra, 5(2), pp. 13–28. Available at: https://journal.trunojoyo.ac.id/simulacra/article/view/15909/7354
Mzumara, B., Bwembya, P., Halwiindi, H., Mugode, R. and Banda, J. (2018) ‘Factors associated with stunting among children below five years of age in Zambia: Evidence from the 2014 Zambia demographic and health survey', BMC Nutrition, 4(51), pp. 1–8. https://doi.org/10.1186/s40795-018-0260-9
Nizaruddin, N. and Ilham, M.I. (2022) ‘The Effect of Sanitation on Stunting Prevalence in Indonesia', Populasi, 30(2), pp. 34–51. Available at: https://journal.ugm.ac.id/populasi/article/view/80186
Nurbiah, Rosidi, A. and Margawati, A. (2019) ‘The potency of socio-economic family and cultural factor in affecting stunting of Muna ethnic in Batalaiworu, Southeast Sulawesi', IOP Conference Series: Earth and Environmental Science, 292(1), p. 12015. https://doi.org/10.1088/1755-1315/292/1/012015.
Nurhidayati, V.A. and Riyadi, H. (2022) ‘Quality of Water Sources, Sanitation, and Hygiene in Households with Stunted Children in Rural and Urban Areas in West Java', Amerta Nutrition, 6(1), pp. 13–18. Available at: https://e-journal.unair.ac.id/AMNT/article/view/39803/23614.
Pratiwi, I.G.A.P.E., Irawan, R. and Hidayat, B. (2019) ‘Hubungan antara kalori total, protein, rasio protein: Kalori pada makanan pendamping ASI dan pola pemberian susu dengan stunting pada anak usia 6-24 bulan di Kenjeran, Surabaya, Indonesia', Medicina, 50(3), pp. 576–581. https://doi.org/10.15562/medicina.v50i3.627.
Rah, J.H., Sukotjo, S., Badgaiyan, N., Cronin, A. A. and Torlesse, H. (2020) ‘Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age.', Maternal & Child Nutrition, 16 Suppl 2(Suppl 2), p. e12741. https://doi.org/10.1111/mcn.12741
Rahayu, A. Yulidasari, F., Anggraini, L., Rahman, F., Laily, N., Sari, A.R., Noor, M.S., Puteri, A.O., Rosadi,D. and Anhar V.Y. (2020) ‘Energy and Protein Intake-Related Risks Affected the Occurrence of Stunting Among Young Children', in 4th International Symposium on Health Research, pp. 330–336. https://doi.org/10.2991/ahsr.k.200215.063
Rizal, A., Haya, M. and Maigoda, T.C. (2022) ‘Faktor Faktor yang Berhubungan dengan Anak Balita Stunting pada Keluarga Nelayan di Wilayah Kecamatan Teluk Segara Kota Bengkulu', Jurnal Mitra Rafflesia, 14(1), pp. 155–165. Available at: https://jurnal.stikesbhaktihusada.ac.id/index.php/MR/article/view/155-165
Sunardi, N., Insani, C.S.D., Martini, E., Sagala,E,D., Surahman, M. and Munawaroh, M. (2021) ‘Strategi Manajemen Untuk Mewujudkan Kemandirian Yayasan Islam Nurul Amal Melalui Program Wirausaha', Jurnal PADMA: Pengabdian Dharma Masyarakat, 1(4). https://doi.org/10.32493/jpdm.v1i4.13498
Talib, R.A., Jumuddin, F.A., Ramlan, W.M., Hamzaid, N.H., Koon, P.B., Wee, W.L., Jamil, S.M., Lian, D.K. and Safii, N.S. (2021) ‘Health communication medium and nutrition knowledge to reduce stunting among residents of people's housing project in Kuala Lumpur, Malaysia: a preliminary finding', Journal of Education and Social Sciences, 18(2), pp. 59–66. Available at: https://www.jesoc.com/wp-content/uploads/2022/01/JESOC18.ISU-2_33.pdf
Tampy, S.T. et al. (2020) ‘The Associations between Anemia, Stunting, Low Birthweight, and Cognitive Ability in Indonesian Children: An Analysis from Indonesian Family Life Survey', Journal of Maternal and Child Health, 5(4), pp. 402–412. Available at: https://thejmch.com/index.php/thejmch/article/view/451.
Titaley, C.R., Ariawan, I., Hapsari, D., Muasyaroh, A. and Dibley, M. J. (2019) ‘Determinants of the Stunting of Children Under Two Years Old in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey', Nutrients, 11(5). https://doi.org/10.3390/nu11051106
Tyas, A.P. and Setyonaluri, D. (2022) ‘Association between Maternal Mental Health and Child Stunting in Indonesia', Kemas, 17(3), pp. 381–388. https://doi.org/10.15294/kemas.v17i3.27813
Wardani, D.W.S.R., Wulandari, M. and Suharmanto, S. (2020) ‘Hubungan Faktor Sosial Ekonomi dan Ketahanan Pangan terhadap Kejadian Stunting pada Balita', Jurnal Kesehatan, 11(2), pp. 287–293. https://doi.org/10.26630/jk.v11i2.2230
Wardani, I.M.K., Nurrochmah, S. and Mawarni, D. (2022a) ‘Determinants of Stunting in the Eastern Indonesia Region Based on Indonesian Family Life Survey 5 Data BT - Proceedings of the 3rd International Scientific Meeting on Public Health and Sports (ISMOPHS 2021)', Atlantis Press, pp. 189–194. https://doi.org/10.2991/ahsr.k.220108.033
Wardani, I.M.K., Nurrochmah, S. and Mawarni, D. (2022b) ‘Faktor Maternal sebagai Determinan Stunting di Kawasan Timur Indonesia: Analisis Data Indonesian Family Life Survey 5', Jurnal Penelitian Kesehatan Suara Forikes, 13(1), pp. 229–233. Available at: https://forikes-ejournal.com/index.php/SF/article/view/sf13144.
WHO (2022) Stunting prevalence in children aged < 5 years (%) (Health Inequality Monitor). Available at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3328
Widyaningsih, V., Mulyaningsih, T., Rahmawati, F. N. and Adhitya, D. (2022) ‘Determinants of socioeconomic and rural–urban disparities in stunting: evidence from Indonesia', Rural and Remote Health, 22(1). https://doi.org/https://doi.org/10.22605/RRH7082
Copyright (c) 2024 Siti Munawaroh, Moh Najikhul Fajri, Shochrul Rohmatul Ajija
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. As an author you (or your employer or institution) may do the following:
- make copies (print or electronic) of the article for your own personal use, including for your own classroom teaching use;
- make copies and distribute such copies (including through e-mail) of the article to research colleagues, for the personal use by such colleagues (but not commercially or systematically, e.g. via an e-mail list or list server);
- present the article at a meeting or conference and to distribute copies of the article to the delegates attending such meeting;
- for your employer, if the article is a ‘work for hire', made within the scope of your employment, your employer may use all or part of the information in the article for other intra-company use (e.g. training);
- retain patent and trademark rights and rights to any process, procedure, or article of manufacture described in the article;
- include the article in full or in part in a thesis or dissertation (provided that this is not to be published commercially);
- use the article or any part thereof in a printed compilation of your works, such as collected writings or lecture notes (subsequent to publication of the article in the journal); and prepare other derivative works, to extend the article into book-length form, or to otherwise re-use portions or excerpts in other works, with full acknowledgement of its original publication in the journal;
- may reproduce or authorize others to reproduce the article, material extracted from the article, or derivative works for the author's personal use or for company use, provided that the source and the copyright notice are indicated.
All copies, print or electronic, or other use of the paper or article must include the appropriate bibliographic citation for the article's publication in the journal.
2. Requests from third parties
Although authors are permitted to re-use all or portions of the article in other works, this does not include granting third-party requests for reprinting, republishing, or other types of re-use.
3. Author Online Use
- Personal Servers. Authors and/or their employers shall have the right to post the accepted version of articles pre-print version of the article, or revised personal version of the final text of the article (to reflect changes made in the peer review and editing process) on their own personal servers or the servers of their institutions or employers without permission from JAKI;
- Classroom or Internal Training Use. An author is expressly permitted to post any portion of the accepted version of his/her own articles on the author's personal web site or the servers of the author's institution or company in connection with the author's teaching, training, or work responsibilities, provided that the appropriate copyright, credit, and reuse notices appear prominently with the posted material. Examples of permitted uses are lecture materials, course packs, e-reserves, conference presentations, or in-house training courses;
