Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Independent consultant, Banda Aceh, Indonesia.
Int J Soc Determinants Health Health Serv. 2023 Jul;53(3):354-362. doi: 10.1177/27551938231156024. Epub 2023 Feb 14.
Previous stunting-related studies focus more on causes or determinants of stunting. Little is known about factors contributing to the success of stunting reduction programs. This study aims to fill those gaps using a case study from Ende District, Province of Nusa Tenggara Timur, Indonesia. A group model-building workshop with stunting-related stakeholders was conducted in November 2021. The system dynamic approach in the form of a causal loop diagram was used. Five variables related to the stunting reduction program were included in the analysis: the budget for the stunting reduction program; stunting-related stakeholder's cooperation and coordination; sufficient water supply; the ability of the related stakeholders to execute the program; and water, sanitation, and hygiene-related behavior. We found that the budget for the program and the cooperation and coordination between stakeholders were the most influential variables in the system. The feedback loop between these 2 variables was also the most prominent in the system, suggesting that sufficient funding and strong collaboration between stakeholders could lead to successful stunting reduction programs. Finally, this study implies that the stunting reduction programs in developing countries should be seen holistically and improvement should be conducted in all aspects, including financial, institutional, environmental, technical, and social.
以往与发育迟缓相关的研究更多地关注发育迟缓的原因或决定因素。对于导致发育迟缓减少计划成功的因素知之甚少。本研究旨在通过印度尼西亚东努沙登加拉省恩徳区的案例研究来填补这些空白。2021 年 11 月,与发育迟缓相关的利益相关者进行了一次群体模型构建研讨会。采用因果关系图形式的系统动力学方法进行分析。分析中包括与减少发育迟缓计划相关的五个变量:减少发育迟缓计划的预算;与利益相关者的合作与协调;充足的供水;相关利益相关者执行计划的能力;以及与水、环境卫生和个人卫生相关的行为。我们发现,该计划的预算以及利益相关者之间的合作与协调是系统中最具影响力的变量。这两个变量之间的反馈循环在系统中也最为突出,这表明充足的资金和利益相关者之间的紧密合作可以促成成功的减少发育迟缓计划。最后,本研究表明,发展中国家的减少发育迟缓计划应全面看待,应在财务、机构、环境、技术和社会等各个方面进行改进。