Challenges

Indonesia is home to 46 million adolescents, who account for nearly 18 percent of the country’s population. Unfortunately, these adolescents are facing massive nutritional challenges, namely the triple burden of malnutrition including undernutrition, overweight and micronutrient deficiencies, posing a serious threat to their educational performance and the achievement of their full potential. Specifically, approximately one in four adolescents is stunted, 8 per cent are thin, 15 per cent are overweight, and another quarter are anaemic. Poor dietary habits and sedentary lifestyles are among the key factors driving the triple burden of malnutrition. Yet, few policies and programmes are addressing the nutrition challenges among adolescents, who will form the future of Indonesia. There is a need to mainstream nutrition policies and programmes into relevant health and education sectors, to improve nutrition knowledge and behaviours, particularly among schoolgoing adolescents.

Toward a Solution

The United Nations Children’s Fund (UNICEF), in partnership with the Government of Indonesia, initiated an integrated gender-responsive adolescent nutrition programme in schools, called Aksi Bergizi, to address the nutritional challenges identified in the country’s adolescent population.

Aksi Bergizi was designed to tackle the triple burden of malnutrition among adolescents in Indonesia by reducing anaemia prevalence while promoting healthy eating and physical activity behaviours. Aksi Bergizi was first piloted in two selected districts – Klaten (Central Java province) and Lombok Barat (Nusa Tenggara Barat province). The Aksi Bergizi intervention package consists of three components:

• Strengthening weekly iron-folic acid supplementation (WIFS) for girls. This is administered alongside a home-brought breakfast to facilitate tablet absorption and reduce the side effects of the supplement. This also helps establish thehabit of eating breakfast, which many adolescents otherwise do not do on a regular basis;
• Multisectoral nutrition education. This is a weekly interactive and fun nutrition and health awareness session, usually conducted immediately following the WIFS session. The content focuses on nutrition and other health issues including reproductive health, HIV/AIDS, water sanitation and hygiene, mental health, addictive substances, violence and injuries, and non-communicable diseases, while mainstreaming gender across all issues. The session is designed to stimulate adolescent girls and boys to practice essential soft skills in daily life while improving their knowledge on health and nutrition issues;
• A comprehensive social and behaviour change communication (SBCC) intervention to improve healthy eating and physical activity which includes advocacy to national and subnational government, capacity strengthening for district officials, health workers, and teachers, school mobilization activities, and social media engagement.

Educating girls and boys on nutrition and health enables them to develop a deeper understanding of gender issues such as pregnancy, menstruation and differing nutritional needs. School mobilization activities also encourage the participation of both girls and boys, thus dispelling cultural norms of cooking being only for girls and sports for boys. The combination of breakfast with WIFS encourages a sense of community while supporting the consumption of healthy foods and micronutrient supplements. School mobilization activities generate even greater excitement and participation among students and their families. Finally, the adoption of a supportive supervision approach to the monitoring and evaluation of the programme encourages communication, team approaches to problem solving, and non-authoritarian supervision through school visits.

This methodology improves performance and relationships using ongoing data collection, regular follow-up and supportive rather than punitive guidance. The activities were designed in 2016 and implemented from 2018 to 2020. Based on the programme evaluation, Aksi Bergizi showed positive changes in adolescents’ knowledge and behaviours, indicated by a significant increase in the proportion of adolescent girls who consumed WIFS, as well as adolescents who consumed vitamin A-rich fruits and vegetables, did physical activity for 60 minutes every day and had good knowledge of nutrition. In 2020, the Government agreed to scale up the Aksi Bergizi intervention package to all schools nationwide using the Healthy School programme as the platform. The Aksi Bergizi pilot has demonstrated the feasibility of implementing an innovative and informative adolescent nutrition package.

Further, it shows how consultative multisectoral policy engagement can be implemented at programmatic level. This is achieved by delivering a targeted package of complementary interventions through participatory learning and support. By applying the lessons from the pilot phase and implementing appropriate scaling measures, Aksi Bergizi has the potential to positively impact adolescents throughout the country, laying a stronger foundation for Indonesia’s future. Aksi Bergizi is a holistic, one-of-a-kind programme which has paved the way for a successful response to the triple burden of malnutrition among adolescent girls and boys in low- and middle-income countries.

The programme has made Indonesia a frontrunner for adolescent health and nutrition programming and promising efforts are underway to replicate the programmes in other countries in the Southeast Asian Region and beyond. A large collection of publications and communication materials, documenting best practices, case studies and the promising results of the pilot have been disseminated through various online and offline channels and platforms. These materials will inform future endeavours to replicate the programme in other countries and regions through SouthSouth and triangular cooperation.