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European Journal of Applied Sciences – Vol. 12, No. 6
Publication Date: December 25, 2024
DOI:10.14738/aivp.126.18036.
Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor
Region, East Nusa Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
Services for Science and Education – United Kingdom
Stunting Service Management Model in the South-Central
Timor Region, East Nusa Tenggara, Indonesia
Roslin E.M. Sormin
Nusa Cendana University
Frans Salesman
Citra Bangsa University
Melkisedek Neolaka
Nusa Cendana University
Hendrik Toda
Nusa Cendana University
ABSTRACT
South Central Timor is one of the regions with a high prevalence of stunting in
Indonesia. The programs and policies that have been carried out have been unable
to reduce these health problems effectively. This study resulted in an innovative
service model based on intelligent Governance. The design of this study is a
sequential explanatory model using the mixed method. The research subjects were
226 respondents and 527 midwives in 27 South Central Timor region health
centres. The results of the analysis found that there are factors that inhibit the
management of stunting management services in community health centres in
South Central Timor Regency, including (a) tractability of the stunting problems, (b)
diversity of group behaviour, (c) clarity of policy content, (d) accuracy of allocation
of funding sources, (e) socioeconomic conditions of the community and the level of
technological advancement, (f) official support for stunting prevention policies. The
analysis results have an adjusted R2 (Adjusted R Square) value of 0.436. Service
implementation needs to be carried out collaboratively and participatory,
especially related to data, policies, budgets, coordination, socialization, and
implementation
Keywords: Model, Service, Stunting, Timor.
INTRODUCTION
Stunting is a serious problem experienced by many developing countries, including Indonesia.
Stunting is an indicator of children's well-being and an accurate reflection of social inequality
(de Onis & Branca, 2016). Malnutrition has affected 20% of children under five in developing
countries. Stunting is a form of malnutrition when children have a low height for their age. The
global prevalence of stunting in 2019 was 21.4% (Grantina et al., 2020). Stunting is a syndrome
in which linear growth failure is a marker of various pathological disorders related to increased
morbidity and mortality, loss of physical growth potential, decreased neurodevelopmental and
cognitive function, and increased risk of chronic diseases in adulthood (Thurstan et al., 2022).
A country's high prevalence of stunting will also correlate with the low Human Capital Index
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(HCI) (Salesman & Buoy, 2022). Innovation in stunting management programs is urgently
needed because it will impact a country's future, especially in developing countries (Niragire et
al., 2022). The latest data shows that around 148 million children under the age of five in the
world are stunted; 37% are in Africa, and most (56%) are in Asia (UNICEF, 2023).
Indonesia is the second highest in Southeast Asia after Cambodia, with an HCI indicator of 0.55
(Santoso et al., 2024). Human Capital Index This shows that the prevalence of stunting in every
child born in Indonesia is, only 55% able to use their talents to generate income; the remaining
45% are unemployed and cannot be use (Salesman & Buoy, 2022). The cause of this remaining
capacity is due to malnutrition, growth and development inhibition (stunting), and several
other factors (Salesman et al., 2021). The results of the 2021 Indonesia Nutrition Status Survey
conducted by the Ministry of Health show that the prevalence of ratestuntingin Indonesia in
2021 was 24.4% (Ministry of Health of the Republic of Indonesia, 2021).
East Nusa Tenggara is one of the provinces in Indonesia with a prevalence of stunting with a
high presentation of 37.9% (SKI, 2023); this means that 37 to 38 out of 100 children under five
in East Nusa Tenggara are stunted. The results of several studies have found several
determinant variables, which are the causes of the high prevalence of stunting in N.T.T.
province, including lack of access to quality nutrition, high poverty rate, and lack of knowledge
about healthy eating patterns (Picauly et al., 2019). In addition, environmental factors such as
poor sanitation and lack of access to health services also play a role in stunting cases in this
province (Salesman, 2020); (Suratri et al., 2023).
South Central Timor Regency is one of the areas with the highest prevalence of stunting cases
in NTT, which is as much as 24.1%. A study conducted on a health survey found that the number
of stunting cases in the region reached 48.30% (SSGI, 2022) ) Bapenas, 2019. Low education is
another factor supporting the high prevalence of stunting in NTT Province. The results of a
recent study in the African region, especially in low-income countries, found that the level of
parental education contributes to knowledge of stunting-related interventions, nutrition
management, and mitigation (Tamir et al., 2024). A study based on ecological studies in 22
provinces of NTT found that the correlation between the prevalence of stunting and the poor
population was 0.165 (p = 0.463), with unsuitable latrines of 0.420 (p = 0.052), and with
unsuitable drinking water sources of 0.426 (p = 0.048). This study concludes that there is a
relationship between environmental factors and the prevalence of stunting, so it is expected to
prioritize interventions in areas with poor environmental health conditions in East Nusa
Tenggara Province (Nashriyah, 2023).
Joint efforts are needed between the government, the community, and related parties to
overcome this stunting problem and improve the welfare of the people of NTT (Syarif et al.).
Other determinants that also affect the high prevalence of stunting in NTT Province include low
per capita income, low Human Capital Index (HCI) figures, and a high percentage of the
population that is included in the poor category (Alfy et al., 2024), central statistical data shows
that the percentage of poor people in NTT province reaches 19.96%).
The Government of Indonesia has taken strategic steps to improve the health and quality of life
of the community, including handling stunting. Programs to increase access to quality nutrition,
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Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor Region, East Nusa
Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
URL: http://dx.doi.org/10.14738/aivp.126.18036
education about healthy diets, and providing nutritional supplements for children in need have
been massively carried out. However, the implementation of the program and the resulting
outputs have not contributed to reducing stunting in the South Central Timor region.
The quality of human resources also dramatically affects the field of health public services (de
Onis & Branca, 2016). Professional personnel in the health sector will significantly support a
public service. Midwives are street-level bureaucrats who are at the forefront of handling
stunting. Midwifery is a profession that is recognized nationally and internationally by several
practitioners around the world. The definition of a midwife, according to the International
Confederation of Midwife (ICM) in 1972, is a person who has completed a midwife education
program recognized by the state and has obtained qualifications and been given permission to
practice midwifery in the country and the context of stunting prevention in TTS Regency,
midwives must be able to provide supervision, care and advice needed by women during
pregnancy, childbirth and the postpartum period, leading labour and care for newborns and
toddlers (Sumiaty et al., 2021)
Looking at the description of the health problems above, it is necessary to develop a program
innovation through Smart Governance based on the collaborative concept from the perspective
of midwifery as street-level bureaucrats on handling stunting and using the latest concepts of
Governance as a function of inter-organizational linkages (Malodia et al., 2021). This
understanding is not only about the involvement of public institutions in policy formulation
and implementation but also about the connection of various organizations to carry out public
goals. Optimizing the concept of Smart governance on stunting problems will focus on the vital
role of midwives in taking a governance approach to health challenges to reduce the prevalence
rate of stunting in TTS Regency strategically in five dimensions, through (1) collaboration; (2)
attachment; (3) regulations; (4) independent institutions and expert bodies; and (5) adaptive
policies, resilient structures and forward-looking will be discussed in more depth using
qualitative methods (Sumiaty et al., 2021).
Health services are an essential component of the health system, designed to improve the
population's health, focusing on specific regional problems. The service sector includes
individuals, groups, and communities that contribute to improving, expanding, providing, and
utilising health services through effective Governance for public health. Effective health
management involves implementing government strategies to address health challenges
related to the prevalence of stunting in the South Central Timor region. These strategies include
collaboration, training, regulation, independence, sustainability, and adaptive measures
referred to as intelligent governance concepts.
Smart Governance signifies collaboration between various actors to overcome challenges and
form new forms of human collaboration to achieve better outcomes and more open governance
processes (Kickbusch & Gleicher, 2014); (WHO, 2021). Governance in healthcare refers to the
role of governments or other actors in influencing society, nation, or group as a whole in
promoting health and healthcare services as a common goal (Gordon et al., 2020); (Junaid et al.,
2022). Good Governance involves using financial, material, and human resources to provide
timely and quality services and involve them in decision-making, provision, and management
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processes (Sari, 2023). Effective Governance requires government structures with adequate
administrative and technical skills to manage health and programs (Khosravi et al., 2023).
Midwifery care is an integral part of the health service system provided by midwives, and it can
be done independently, collaboratively, or by referral. Midwifery services are an integral part
of health services, which are directed to realize family health according to the authority to
achieve a happy and prosperous small family. The results of a study in one of Indonesia's
regions have provided evidence that continuous midwifery care for pregnant women (p=0.017)
and exclusive breastfeeding education (p=0.009) are significantly correlated with the reduction
of stunting prevalence in the Mapane region, Central Sulawesi (Nurfatimah et al., 2021). The
findings of the study also support findings in other countries, which found that the role of
midwives in providing nutrition education, as well as the provision of antenatal care services,
is one of the determinants (OR 1.51; 95% CI 1.18-1.92) in the prevalence of stunting in the
Bhutanese region (Aguayo et al., 2015). Optimization of midwifery care in Smart Governance
for Health is about how the government, through midwives, takes a governance approach to
health challenges to reduce the prevalence rate stunting in TTS Regency strategically in five
dimensions, through; (1) collaboration; (2) attachment; (3) regulations; (4) independent
institutions and expert bodies; and (5) adaptive policies, resilient structures and foresight.
METHOD
This research is a Sequential explanatory using a combination of models where the first stage
of the research was carried out using the quantity method(John et al., 2024) and the second
stage was carried out by qualitative methods. The population in this study is all midwives in
South Central Timor Regency who contribute to the decrease in the number of stunting, which
totals 521 people and is spread across 37 health centres. The study involved 267 sample
respondents who met the inclusion criteria and used Cluster sampling. The data was
quantitatively analyzed based on multivariate regression using IBM SPSS Version 25 software.
RESULT
Management of Stunting Management Services at Health Centers in South Central Timor
Regency
Collaboration:
This study found that descriptive statistical analysis for the variable "Collaboration" showed
variations in respondents' perception of the collaboration aspect in the context of stunting
activities. The average overall score for this variable is 20.62, with a value range between 9 to
29 with an SEM of 0.237 (standard deviation ± 3.561). This shows that respondents'
collaboration level ranges around the average with relatively high precision, but there is a
significant variation in their perception. Cross-sector, inter-institutional, inter-jurisdictional,
strategic partnerships, and Governance that are multi-stakeholder, multi-level, deliberative,
and networked are often not well differentiated.
These results illustrate that most respondents agree that their superiors are directing good
cooperation among all parties to achieve common goals, indicating the importance of support
from leaders in collaboration. The results of interviews with respondents showed that the
dimension of collaboration in handling stunting is that midwives always collaborate with
stakeholders in the TTS district to involve the community in reducing stunting, both those who
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Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor Region, East Nusa
Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
URL: http://dx.doi.org/10.14738/aivp.126.18036
have been affected and those who have not been affected, starting from midwives who convey
information to the community to go to health facilities. The Family Assistance Team comprises
Family Planning Cadres, Midwives and PKK Cadres.
To support this collaboration, the Midwives also formed an alliance with existing OPDs by
forming the Stunting Reduction Acceleration Team at the district, sub-district, and village levels.
Therefore, every year, a meeting is held to gather information about stunting in each region,
after which the information obtained from the meeting is forwarded to PPTS.
Midwives can consult with various specialists in caring for mothers and babies, and midwives
can provide primary care for mothers and babies. Midwives have a vital role in handling
stunting, especially interventions in pregnant women, infants and toddlers, school-age children
and adolescents of productive age. The results of this finding are in line with the opinion of
Thoha (2002:68) that the implementation of good Governance lies in the constellation between
three components, namely the people, the government and entrepreneurs who run in a
cohesive, harmonious, congruent and comparable manner. Innovative Governance signifies
collaboration among various actors to address social challenges (Caragliu et al., 2011; Dameri
& Rosenthal-Sabroux, 2014; Giffinger et al., 2007; Hollands, 2015).
Attachment:
Successful disease prevention, diagnosis, and treatment are only possible if citizens,
governments, and citizens actively participate. Policies can no longer be implemented like that:
success requires co-production, community involvement, and cooperation. This involvement
can be a unit, from information provision to empowerment, consultation to co-production,
delegation of authority, and final control over decisions.
Based on the results of the descriptive statistical analysis for the variable "Attachment," it can
be concluded that there is a variation in the perception of respondents related to the aspect of
attachment in the context of handling stunting. The average overall score for this variable is
17.15, with a value range between 8 to 24 with an SEM value of 0.213 and an SD of 3.205. The
low SEM value indicates that the average population estimate of the sample is entirely accurate,
although there is a significant variation in the perception of attachment among the respondents.
Respondents tend to agree that attachment is needed between midwives, health centre staff
and people who experience stunting to create a harmonious atmosphere in stunting services.
This indicates an awareness of the importance of good interaction between health workers and
the community in handling stunting. However, there are variations in perceptions related to
other aspects.
This study reveals that interaction between the government, police, and communities affected
by stunting is essential for a harmonious approach to handling stunting. However, there are
variations in perception that are influenced by other factors. The study found that the services
provided by health workers in TTS areas focus on community needs and the need for
cooperation between the government, the community, and health workers. It also emphasizes
the need for a more specific and community-based approach to improve the effectiveness and
efficiency of stunting control programs.
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Regulation:
The availability of stunting data in BPS TTS Regency is not used as a reference by OPD. Each
OPD collects its data through a data system by name by address, while if carefully researched,
organizational capacity development is a unity between organizations such as in the context of
the system (Brown, 2001); Morison, 2001; Araya-Quesada et al. (2010), community (Banyan,
2007), environment (OECD, 2008), Institution (Grindle, 1997; Horton et al., 2003) have the
same orientation, namely how the dimensions of individuals and organizations can interact
with the environment in developing their capacity. Systems and communities are the
environments of organizations and individuals within the organization.
However, what is attributed to the regional apparatus organization in TTS Regency is that each
agency also has a different calculation method from the other. This condition causes the
absence of valid and reliable data integration to be used as a reference in harmonizing regional
programs and work plans. In addition, the current data does not represent the calculation
method set by Bappenas in the Metadata document for stunting indicators. Therefore, data
integration is needed to design policies and regulations that are really on target to achieve the
goals that have been set by Gandara (2008:9) or to be achieved (Rainer Rohdewohld, 2005, p.
11).
Based on the results of the descriptive statistical analysis for the variable "Regulation," it can
be concluded that there are variations in the perception of respondents related to regulatory
aspects in the context of stunting service management. The overall mean score for this variable
was 17.36, with a value range between 9 to 25 with an SEM of 0.211 and an SD of 3.166,
indicating considerable variation in the perception of regulation among respondents. However,
the average population estimate of the sample was quite precise.
From a quantitative perspective, respondents generally showed diverse views related to
government programs carried out partially and simultaneously according to SOPs. However,
there is a tendency to agree with the results of the author's interviews and observations,
namely that there needs to be an agreement between the government, related agencies, the
community and religious leaders on efforts to integrate stunting data and solve stunting
problems. This shows the importance of collaboration and coordination between various
related parties for the effectiveness of stunting handling. In addition, there are differences of
opinion about the effectiveness of implementing self-regulation or self-control in managing
stunting services.
Some respondents may see it as significantly successful, while others may view it differently.
This emphasizes the importance of self-regulation in designing more effective stunting
management policies and strategies based on data and coordination between agencies in the
future.
Independent Institutions and Expert Bodies:
The management of a health problem is not only a function of the government but also a
function of local governments or agencies responsible for coordinating and harmonizing
research on health issues. This management approach operates at a wide range of scales, from
local to global, to manage power and influence in a rapidly changing world. The study found
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Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor Region, East Nusa
Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
URL: http://dx.doi.org/10.14738/aivp.126.18036
that health services in South Central Timor have several independent and non-governmental
organizations, such as NGOs, Momentum, Women's organizations, UNICEF, nutrition
organizations, and the Indonesia Midwives Association. However, non-governmental
organisations need more independence and the ability to use data and information to refer to
government stunting programs to avoid problems. The results of the observations in the study
also found that the role of the government as a regulator is still not adequate and optimal in
increasing the availability of information, coordination, and the ability of institutions to provide
practical solutions in decision-making. The role of the government as a regulator must be
flexible and adaptable to the new distribution of power. The study also found significant
differences in respondents' perceptions of independence and non-governmental organizations
in the TTS stunting program. Respondents emphasized the importance of involving
independent and non-governmental organizations in the program, although there are
differences in interpretation of independence. This highlights the need for a clearer
understanding of the role of independent and non-governmental organizations in TTS stunting
programs.
Adaptive Policies, Resilient Structures and Foresight:
The results of the descriptive statistical analysis for the variable "Adaptive Policy, Resilient
Structure and Foresight" are also in line with the results of the author's observations and
interviews where it was found that the average overall score for this variable was 17.67, with
a value range between 6 to 24 with an SEM value of 0.207, and an SD of 3.116, showing a
significant variation in the perception of adaptive policies, Resilient structure, as well as
foresight among respondents with high precision in estimating the average population.
This indicates that respondents show varying perceptions related to adaptive policies, resilient
structures, and foresight in handling stunting. In general, there is an awareness of the
importance of adaptive policies, which can adapt to change to achieve significant results. This
shows an understanding of the importance of flexibility in formulating policies to face various
challenges in handling stunting.
Obstacles to the Implementation of Stunting Management Services in Puskesmas in South
Central Timor Regency
The study and analysis using the innovative governance theory model succeeded in identifying
several obstacles that could hinder the management of stunting in health centres in the South
Central Timor Regency. These obstacles are as follows.
Tractability of The Problems:
The research findings show that the intervention program in TTS cannot be successful due to
the technical complexity of the problem. If visualized in the context of research, it will be seen
that the system of stunting management services at health centres in South Central Timor
Regency has not been declared successful because the existing technical difficulties have not
been resolved.
Diversity of Target Group Behavior:
The results of the study found that the prevalence of stunting in TTS can be related to the need
for proper planning and implementation of a program or community that can be homogeneous
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or heterogeneous. Homogeneous communities will find it easier to implement a program, while
heterogeneous communities will find it more difficult or stressed. Research shows that if a
program or community is planned and implemented correctly, the program will succeed,
resulting in a high prevalence of stunting in TTS. Therefore, effective implementation must
involve the administration or local government agencies involved in the program or the
community affected by the stunting program and the proper planning and implementation of
the program.
Clarity of Policy Content:
A policy taken by the government must contain clear and consistent content. A policy with
explicit content will facilitate and avoid distortion or deviation in its implementation. This is
because if a policy already has explicit content, the possibility of wrong interpretation by the
implementer will be avoided and vice versa; if the content of a policy is still unclear or floating,
the potential for distortion or misunderstanding will be great. Integrated Stunting Reduction
Interventions are implemented using a Holistic, Integrative, Thematic, and Spatial (HITS)
approach. Efforts to reduce stunting will be more effective if specific and sensitive nutritional
interventions are carried out in an integrated manner. Several studies, both from within and
outside the country, have shown that the success of an integrated approach carried out on
priority targets in focus locations is to prevent and reduce stunting. Therefore, the
intervention's implementation will focus on specific districts/cities and villages. However, in
its implementation, this specific and sensitive intervention has also yet to be successful due to
the lack of funds and coordination between related agencies and the human resources of
midwives in the TTS Regency area.
Accuracy of Fund Allocation:
The study found a shortage of financial resources for stunting prevention services in the South
Central Timor district, which results in a need for more funding for programs related to stunting
reduction. The effectiveness of stunting prevention services is highly dependent on the
availability of policy resources, which is critical to implementing the program—risk or
ineffectiveness of funds in implementing stunting prevention.
The Socioeconomic Conditions of Society and the Level of Technological Advancement:
Socioeconomic conditions in a society can be categorized into general, modern, and traditional.
Modern society makes it easier to implement programs compared to traditional societies.
Technology can help in implementing programs. Studies show that stunting treatment services
in TTS areas are limited by the economic status of local communities, which do not provide
health services. Socially, TTS residents do not prioritize stunting, believing that it is a threat
from God. They do not care about their children because they always go to the womb and will
be raised by their families. However, financial resources are not available in the TTS district to
support stunting handling services, hampering the implementation of this program.
Support from Officials for Stunting Prevention Policies:
The committee responsible for implementing health policies is an essential variable in health.
The committee must be able to prioritize health policies and achieve those priorities. The study
found that health services in the TTS region have a more significant environment, such as the
National Health Agency and the TTS Health Agency. However, their implementation at the local
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Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor Region, East Nusa
Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
URL: http://dx.doi.org/10.14738/aivp.126.18036
level could be more optimal due to the lack of good interaction between local governments and
OPDs to deal with the problem. This environment can be beneficial for implementing health
policies in TTS, as the potential for positive or negative impacts on the implementation of health
policies is very high if the committee has the necessary resources and support. Conversely,
negative effects or adverse impacts on the implementation of health policies can lead to
conflicts, as public health is considered a good relationship between government units and their
environment.
Stunting Management Service Model in South Central Timor Regency
After conducting a situation analysis, the next stage is a quantitative analysis to find a
determination coefficient that functions to evaluate the factors that affect the Stunting
Management Health Service System. This model includes variables such as Adaptive Policy,
Resilient Structure and Foresight, Regulation, Engagement, Independent Institutions and
Expert Bodies, and Collaboration. With the results that can describe how well this model
matches the observed data and how these independent variables contribute to explaining the
variation in the dependent variables, the adjusted R2 (Adjusted R Square) number of 0.436 is
obtained. This shows that the percentage contribution of the influence of independent variables
on dependent variables is 0.436 or 43.6%. According to Priyanto (2008), adjusted R2 is used
as the determination coefficient for regression using more than two independent variables—
the Error of the Estimate standard measures the number of regression model errors in
predicting the Y value.
The results also show that the factors included in the model, such as Adaptive Policy, Resilient
Structure, Forward-Looking Perspective regulation attachment to independent Institutions
and Expert Bodies, and Collaborations, significantly contribute to the variation in health service
systems related to stunting management.
However, there is still about 56.4% variation in the dependent variables that are not explained
by this model, indicating that other factors outside the model that affect health services related
to stunting management need to be considered. Therefore, to improve prediction and
understanding of the observed phenomena, it is necessary to consider other factors that may
affect the dependent variables and further evaluate the statistical validity of the predictors used
in the model.
The above service model is made by adjusting the results of the research findings with the
regulation of the President of Indonesia Number 59 of 2017 concerning the Implementation of
the Achievement of Sustainable Development Goals. The regulation is also a commitment to
ensure that the implementation and achievement of the SDGs are carried out in a participatory
manner by involving all parties. To implement this policy, private sector midwives, civil society
organizations and the community must work together and synergize to achieve inclusive
development. The model of stunting management services at health centres in South Central
Timor Regency into six cycles that continue to rotate, namely:
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Stunting Service Arrangement Model in South Central Timor Regency
Data:
Efficiency, effectiveness, responsiveness, and stunting rate reduction programs will be right on
target as one of the main agendas in TTS Regency if they are compiled based on accurate data
and needs that are in accordance with the field context by mapping and integrating national
targets and indicators into the Medium-Term Development Plan. These data can later be used
as a reference for determining targets that must be achieved in each region in the TTS Regency.
Policy:
After the required data is met, the data can later be used as a reference for determining the
target of reducing stunting rates that must be achieved in the region with the formulation of
policies that are by the stunting problem in various regions in the TTS Regency.
Budget:
To implement the policy, an adequate budget must be accompanied by accurate data (data- based budget) so that the budget allocation can be mapped for each post and optimally
absorbed for the policy implementation to reduce stunting rates in TTS Regency as one of the
main agendas.
Coordination:
If the data and budget that have been prepared have been fulfilled, coordination is needed
between institutions tasked with reducing the stunting rate in TTS Regency as one of the leading
indicators in the region; this coordination can be in the form of equalization of goals and
objectives, division of duties and authorities between organizations and individuals so that they
do not overlap and equalization of data and information needed for the implementation of
stunting rate reduction which is integrated in TTS Regency.
Socialization:
Policy socialisation is needed after the data, policies, budget, and coordination have been
carried out and deemed sufficient. This is important considering that not all policies have been
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Sormin, R. E. M., Salesman, F., Neolaka, M., & Toda, H. (2024). Stunting Service Management Model in the South-Central Timor Region, East Nusa
Tenggara, Indonesia. European Journal of Applied Sciences, Vol - 12(6). 709-720.
URL: http://dx.doi.org/10.14738/aivp.126.18036
understood by every policy implementer, especially at the lowest level that directly deals with
the community and the community itself, so socialization must be continuously carried out until
policy-implementing institutions, policy-implementing individuals (midwives) and the
community as policy recipients understand the implementation of reducing stunting rates in
TTS Regency is one of the main agendas in the region.
Implementation
The last stage is implementing the intervention policy to reduce stunting rates in the TTS
Regency. This policy can be implemented when all the above stages are met. This is important
considering that each indicator supports the other indicators, so if one of the indicators is not
met, the stunting management service system at the health center in South Central Timor
Regency will be poorly implemented.
CONCLUSION
The South-Central Timor Regency's stunting treatment program has qualitative and
quantitative variations in collaboration, attachment, regulations, adaptive policies, and the
involvement of independent institutions qualitatively and quantitatively, with variations that
have yet to be optimally implemented. Several socio-cultural, socioeconomic, budgetary, and
regulatory obstacles must be of particular attention before creating an effective service
management model. Service implementation must be carried out collaboratively and
participatorily, especially about data, policies, budgets, coordination, socialization, and
implementation.
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