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Project status: Completed
District governments in Indonesia have principal responsibility for managing health interventions, including improving the nutritional status of women and children, under the health decentralisation policy framework in Indonesia (Law Number 32, 2004 on Regional Autonomy, the Ministry of Health Decree number 1107/2000 on the Authority of the Provincial Level of Government and the Minimum Authority of the District Government in Indonesia). In part, decentralisation is intended to allow decision-makers to be more responsive to the needs of local communities and to develop solutions tailored to take advantage of local resources and expertise.
This process involves decision-makers integrating locally generated evidence into a policy framework that may still be dominated by national concerns, such as improving economic indicators. Preliminary research indicates that there are barriers to the effective integration of locally generated evidence into District policies and programs (Yoganingrum, 2008).
In particular, proposals that the district government develop dietary diversification strategies adapted from local foods (the local food of ganyong in Gunungkidul was processed and developed by the Indonesian Institute of Sciences (LIPI) to be an additional food supplementation for children in 2000), rather than imported food supplements, have not been adopted, despite showing some success in alleviating malnutrition.
Using a case study of maternal and child nutritional policies, programs, and interventions in the Bantul and Gunungkidul Districts (Kabupaten) we intend to: 1) evaluate the extent to which evidence-based decision making is used to inform health policy in Bantul and Gunungkidul; 2) identify barriers to integrating evidence based public health research into public health programs in Indonesian District health systems; 3) In collaboration between LIPI and the District Governments of Bantul and Gunungkidul make policy proposals to enhance the governance of district level public health programs. None of the major nutritional surveys provides a description or evaluation of district-level government policies, programs and interventions and how expert evidence is integrated into this process (The regional nutritional surveillance system in Indonesia (Bloem, 1998); the National Indonesia Socio-Economic Household Survey (Indonesia Ministry of Health, 2002); and the Indonesia Family Life Survey (Frankenberg et al, 1999)).
The proposed research will contribute to filling this gap in knowledge and to enhancing government's capacity in the field of public health through strengthening processes to enable evidence-based decision making at the district level.