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JOSS:

Journal of Social Science

IMPLEMENTATION OF STUNTING REDUCTION ACCELERATION

POLICY IN PONOROGO REGENCY

Faradiba Aisyah

Universitas Sebelas Maret Surakarta, Indonesia

Email: faradibaa[email protected]

KEYWORDS

Policy

Implementation

Process, Stunting,

Supporting Factor,

Inhibitor Factor

ABSTRACT

Stunting remains a critical public health concern globally, with severe

consequences for child development and long-term well-being. This

abstract highlights the implementation of the Stunting Reduction

Acceleration Policy in Ponorogo Regency, Indonesia. The policy aims to

address the high prevalence of stunting among children under five years old

by employing a multifaceted approach, including nutrition intervention,

healthcare access, and community engagement. This research provides an

overview of the policy's key components, its implementation process, and

the challenges encountered during execution. Data from government

reports, interviews with policymakers, healthcare professionals, and

community members, as well as field observations, were used to assess the

effectiveness and sustainability of the policy. Preliminary findings indicate

progress in reducing stunting rates, improved awareness, and community

participation. However, persistent challenges, such as limited resources and

infrastructure, require ongoing attention to achieve sustainable stunting

reduction. This study underscores the importance of continued collaboration

between government agencies, healthcare providers, and communities to

successfully address the stunting crisis in Ponorogo Regency and beyond.

INTRODUCTION

One of Indonesia's main problems today is stunting. According to WHO data, there are

178 million children under five stunted. Africa and Asia (including Indonesia) are the 2 (two)

continents with the highest percentage of stunting toddlers in the world, namely 40% and 36%

(DPR RI, 2020), with this background President Jokowi has scheduled stunting handling to

become one of the national priority programs (Organization, 2014).

The government has launched a National Action Plan for Stunting Handling which is

contained in Presidential Regulation Number 72 of 2021 concerning the Acceleration of

Stunting Reduction which emphasizes convergence activities at the national, regional, and

village levels to prioritize specific intervention activities and sensitive interventions in the First

1000 Days of Life (HPK) up to the age of 6 years. Specific interventions are aimed at pregnant

women and children in 1000 HPK with a contribution of 30% reduction in stunting and are

generally carried out by the health sector (Rajpal, Joe, Kim, Kumar, & Subramanian, 2020).

Meanwhile, sensitive interventions are aimed at various development activities outside the

health sector with a contribution of 70% to reducing stunting rates targeting the general public

and not specifically for pregnant women and toddlers in 1000 HPK (Presidential Regulation

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Number 72 of 2021 concerning the Acceleration of) (Shauma, Udzu Nabila &; Purbaningrum,

2022).

In conducting an annual evaluation of the success of accelerating stunting reduction, the

Ministry of Health conducts a nutritional status survey (SSGI) (Pramono, 2020). SSGI is a

survey conducted throughout Indonesia, with a survey method and is carried out to show

representative results or represent conditions in Indonesia (Saputra, Suryoto, & Sutikno, 2022).

The 2022 Indonesian Nutritional Status Survey (SSGI) provides an overview of the nutritional

status of toddlers (stunting, wasting, underweight, overweight) and its determinants including

indicators of specific nutritional interventions and nutrition-sensitive interventions using the 2-

stage stratified sampling method in a cross-sectional manner (Subramanian, Karlsson, & Kim,

2022). The implementation of SSGI 2022 involves the Vice President, Bappenas, BPS,

Ministry of Agriculture, Poltekkes, Provincial Health Office, District/City Health Office, and

experts from several universities (Zaleha & Idris, 2022).

A policy implementation must of course always be monitored and evaluated by the

parties involved, in supporting and overseeing the policy, the Regent of Ponorogo establishes

a team through the Regent Decree Number 188.45/563/405.12/2022 concerning the

Establishment of a Team to Accelerate Stunting Reduction in Ponorogo Regency for 2022 -

2024, Regent Decree Number 188.45/1036/405.12/2022 concerning the Formation of a District

Stunting Reduction Acceleration Team (TPPS) in Ponorogo Regency (Wahyuningsih,

Novianto, & Purwadi, 2017).

The policies contained in the Regent Regulation are one of the efforts to accelerate

stunting reduction in Ponorogo through specific nutrition interventions aimed at addressing the

direct causes of stunting in children through the health sector, nutrition-sensitive interventions

to address indirect causes of stunting with cross-sector health cooperation targeting all

communities (Rahmasari & Wicaksono, 2022), as stated in Regent Regulation Number 33 of

2022 article 6, the third part of the Pillars. These policies are made to improve the nutritional

status of the community and the quality of human resources with strategies to be carried out in

the form of education (Nutrition, 2013), training and counseling on health and nutrition through

family independence, healthy living community movements, and strengthening the first

thousand days of life (HPK) movement. Reducing stunting cases must involve collaboration

between the health sector and the non-health sector in the form of promotive, preventive,

curative, and rehabilitative efforts carried out by local governments and the entire community,

as stated in Ponorogo Regent Regulation Number 33 of 2022 Chapter V "Implementation of

Activities", articles 10 to 13. Each article is explained regarding the stages carried out in

specific intervention activities, sensitive intervention activities, programs/activities that must

be implemented by the village government as the target of the regent regulation, as well as the

implementation of coordination of stunting reduction acceleration teams at the village level

involving Human Development Cadres (KPM), health workers (midwives, nutrition workers

and environmental health workers), PKK mobilization teams, family planning counselors,

PAUD managers, village family planning guidance assistants (PPKBD), working groups and

integrated service post cadres (Posyandu), village local assistants, as well as cadets and/or other

community elements (Patton, 1999).

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By Ponorogo Regent Regulation Number 33 of 2022, the Ponorogo Regency

Government is committed to implementing efforts to reduce stunting in Ponorogo Regency by

touching the smallest level of government, namely in village government. In addition to the

village level, the implementation of coordination, integration, and collaboration are also carried

out from the district to village levels. In addition, the village government synchronizes in

planning and budgeting village development activities for stunting prevention (Prihatini, D.,

&; Subanda, 2020). Village governments should ensure that each priority target receives and

utilizes a package of priority nutrition intervention services. The implementation of activities

is carried out in collaboration with Human Development Cadres (KPM), Family Hope Program

(PKH) assistants, Puskesmas officers, and village midwives, as well as Family Planning (KB)

officers, village governments strengthen monitoring and evaluation of service implementation

to all priority targets and coordinate target data collection and regular data updates.

The success of reducing stunting rates is certainly a commitment of cooperation and hard

work from related parties. The Ponorogo Regency Government has made a policy, where every

policy made must be continued with the policy implementation process. "Implementation is

considered the main form and decisive stage in the policy process" (Birklan, 2001: 177;

Heineman et al., 1997: 60; Ripley and Franklin, 1986; Wibawa et al., 1994: 15). According to

Edwards III (1984: 1) the implementation of policies that are said to be ineffective, can cause

policymakers to make decisions that cause the policy cannot be implemented.

Looking at the phenomenon from previous studies conducted by several researchers in

several regencies/cities in East Java, as well as stunting prevalence data in Ponorogo Regency,

the data shows that Ponorogo Regency has exceeded the prevalence of Indonesia's stunting

rate, there are still sub-districts in Ponorogo Regency that have increased stunting rates. For

this reason, researchers decided to research on how the policy implementation process related

to accelerating stunting reduction in Ponorogo Regency.

The implementation of the stunting reduction acceleration policy is an activity carried

out to produce output for the community by the policy goals and objectives, In order for theForn

of stunting reduction to be successful and on target, research on policy implementation is

needed. From the background description that has been presented, researchers are interested in

conducting research on thresearchinglicies to accelerate stunting reduction in Ponorogo

Regency. Based on the initial study, researchers found that policymakers in Ponorogo Regency

involved in this policy are committed and able to encourage the success of the stunting

acceleration policy, so as to condition the community andtoments involved in this policy to

comply with it. The implementation analysis that researchers use is a model initiated by Van

Metter &; Carl Van Horn (1975). Van Metter & Van Horn (1975) said that "there are 6 variables

analyzed, namely standards and policies, resources, communication between implementing

organizations, characteristics of implementing organizations, attitudes of implementers and

performance". The policy to accelerate stunting reduction is a top-down policy, the success or

failure of this policy is determined by the implementing organizations, so the Van Metter &

Van Horn model is most suitable for this study.

While many studies have explored the effectiveness of stunting reduction policies in

various regions, the Implementation of Stunting Reduction Acceleration Policy in Ponorogo

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Regency research offers a unique perspective by focusing on a specific geographic area in

Indonesia. This study not only delves into the policy's outcomes but also investigates the

intricacies of its implementation within a rural setting, shedding light on the contextual

challenges and innovative strategies employed to combat stunting. Moreover, this research

explores the interplay between local traditions, cultural practices, and policy implementation,

providing valuable insights into the customization of anti-stunting interventions to fit the

cultural fabric of the Ponorogo community. By examining these distinct aspects, the study

contributes a fresh perspective to the broader discourse on stunting reduction policies and offers

potential solutions that can be tailored to similar contexts worldwide.

METHOD

The method used in this study is a qualitative research method because researchers feel

the need for an approach that can conduct a comprehensive and in-depth study of the policy to

accelerate stunting reduction in Ponorogo Regency (Sharp, 2003). According to Asyifah

(2021), qualitative research methods are research that investigates a social phenomenon and

human problems. This research was conducted at the Ponorogo Regency Government,

especially at the Regional Apparatus Organization (OPD) which is directly related to the policy

of accelerating stunting reduction in Ponorogo Regency (Sugiyono, 2018).

In this study, researchers used data collection techniques from Cresswell, 2009.

According to Cresswell, there are four models as a data collection system with qualitative

research models (Creswell, 2009):

a. Qualitative observation, where researchers went to the field to see the role of stakeholders

and policyholders in the stunting bug forum and the stunting reduction acceleration team

(Peterson, 2019).

b. In-depth interviews are conducted directly with selected informants, guided by interview

guides, and open-ended and unstructured frequently asked questions aimed at expressing

participants' opinions and perspectives.

c. Qualitative documents, Researchers also use qualitative documents, namely in the form of

public documents related to research. Examples of qualitative documents are reports, regent

regulations, regent decrees, newspapers, articles, and papers.

d. Visual material, researchers also use several photo documents as support to show

accelerated activities to reduce stunting.

RESULT AND DISCUSSION

Implementation Process of Ponorogo Regent Regulation Number 33 of 2022 concerning

the Acceleration of Stunting Reduction at the Village Level

In examining the implementation process of Ponorogo Regent Regulation Number 33 of

2022, researchers use the policy implementation theory expressed by Charles O. Jones (1996),

where the implementation of the policy is seen with three main things, namely interpretation,

organization, and application. Researchers conducted research by these three indicators.

a. Interpretation

The initiation process for the acceleration of stunting reduction began with the issuance

of Presidential Regulation Number 72 of 2021 concerning the Acceleration of Stunting

Reduction, which was immediately followed up by stunting rembug activities at the

Pusdalop Building on September 28, 2021.

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b. Organization

In the implementation of Ponorogo Regent Regulation Number 33 of 2022, rules have

been established that contain the main duties of related parties, contained in the Ponorogo

Regent Decree Number 188.45/563/405.12/2022 concerning the Establishment of a Team

for the Acceleration of Stunting Reduction in Ponorogo Regency for 2022-2024. The Decree

certainly stipulates the details of the duties of each implementation team, by the tupoksi

attached to each implementation team.

c. Application

After the issuance of Ponorogo Regent Regulation Number 33 of 2022 concerning the

Acceleration of Stunting Reduction at the Village Level, the Regent of Ponorogo launched

a movement to support the implementation of the stunting reduction acceleration policy.

Coinciding with the 58th National Health Day on November 12, 2022, the "Ceting Beraksi"

movement has been launched, which stands for "Prevent Stunting Together and Integrated".

Following up on the implementation of the Ceting Beraksi movement, the Ponorogo

Regency Government carried out several activities related to accelerating stunting reduction

activities as a continuation of Ceting Beraksi. The innovation implemented by the district

government is the inauguration of the Chairman of the District PKK TP and the Head of the

District PKK TP to become the Mother of Stunting Ponorogo. The inauguration of the

chairman of TP PKK Regency and Sub-district as the mother of stunting is expected to

further emphasize that the Chairman of TP PKK district and sub-district also has an

important role in the movement to accelerate stunting reduction in Ponorogo Regency. The

stunting mother was confirmed by the Regent of Ponorogo.

Policy Standards and Objectives

Policy standards and objectives are one component that influences how effectively

policies are implemented. The success rate of policy implementation can be measured by

knowing whether the scope and objectives of the policy are by the social culture at the executive

level.

a. Clear and Measurable

b. Justice

Resources

The implementation of the policy to accelerate the stunting reduction in Ponorogo

Regency will certainly not succeed without the ability to utilize the resources owned by the

Regional Government. The existing resources are not only human resources but financial

resources, time resources, and infrastructure.

Communication Between Implementing Organizations

The success of a policy implementation also depends on communication and

coordination with other sectors. The better the communication and coordination between the

parties involved, the greater the success rate of a policy.

Characteristics of the implementing organization

The performance of a policy will certainly show the characteristics and characteristics of

the implementation team. This is related to the policy context, implementers must be

appropriate by their fields so as to accelertosuccess of a policy. The scale of implementation

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of a policy also affects the success, the greater the scale of implementation, the more

implementing organizations are involved.

Bureaucracy is a unique type of organizational ownership that affects the services

provided. The existence of a system used to assign responsibilities in an organization The

smooth running of vertical delivery will be hampered if the bureaucratic structure of program

management is too complex and the scope of control is too long.

Executive Attitude

The attitude of the implementer is the last variable expressed by Van Metter and Van

Horn in the implementation or implementation of policies. The attitude of the implementer is

defined as the desire of the parties involved to implement the policy.

The success or failure of public policy implementation is strongly influenced by the

attitude of the implementing agent. Van Meter and Van Horn state that the disposition of the

executing agent greatly influences the success of a policy, and the ability of the executing agent

influences the disposition of the executing agent. If the implementor has a positive tendency

towards the policy, it will increase the points in the success of the policy, but if the implementor

has a negative tendency, the likelihood that the policy will fail is even greater.

Implementers must be competent in what they must know and the skills needed to

implement the policy if the policy is to be effectively implemented. Researchers focus on three

implementing elements that may influence the ability and desire for implementation of the

policy, namely: the response of the implementer, knowledge and understanding, and

consistency of attitude.

Discussion

Based on the findings and facts that have been found in the research field and adjusted

to the theory used as the main reference, a discussion of these findings and facts is carried

out. The results found by the researcher are the performance of the implementation of Regent

Regulation Number 33 of 2022 in Ponorogo Regency according to the theory established by

Charles O. Jones (1996) through 3 stages, namely interpretation, organization, and

application.

In the interpretation stage, Ponorogo Regent Regulation Number 33 of 2022

concerning the Acceleration of Stunting Reduction at the Village Level is a derivative of

Presidential Regulation Number 72 of 2021 concerning the Acceleration of Stunting

Reduction. The implementation of Ponorogo Regent Regulation Number 33 of 2022 has been

followed up optimally by the implementation team which has been determined by the Regent

Decree which is a follow-up to the regent regulation. In addition, Ponorogo Regent

Regulation Number 33 of 2022 is also the legal basis for other regulations that support the

implementation of the stunting reduction acceleration program. From the results of the

research, it is known that the process of submitting Ponorogo Regent Regulation Number 33

of 2022 concerning the Acceleration of Stunting Reduction at the Village Level has run well

and optimally, where it is known that the Regent Regulation is the legal basis for other

provisions.

This statement is supported by variables that have been studied by researchers, namely

policy goals and objectives. According to the variables of policy targets and objectives, it is

found that the implementation of policies related to the acceleration of stunting reduction in

Ponorogo Regency has been implemented clearly and measurably, according to the

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predetermined target and in its implementation has been structured and has clear levels at

each stage that has been regulated. In the stunting reduction acceleration program, each

region sets its target related to the extent to which stunting prevalence can be achieved by the

region.

For the organizational stage, as a follow-up to Regent Regulation Number 33 of 2022,

an implementation team was formed to accelerate the stunting reduction in the Ponorogo

Regency. The implementation team was then determined by the Decree of the Regent of

Ponorogo Number: 188.45/563/405.12/2022 concerning the Establishment of a Team to

Accelerate Stunting Reduction in Ponorogo Regency for 2022-2024. This organizational

stage is supported by resource variables, consisting of human resources, financial resources,

and facilities and infrastructure. From the results obtained by researchers, it is known that in

accelerating stunting reduction there are sufficient human resources in the implementation of

the policy, starting from the district level to the village level. Human resources ranging from

the level of policymakers in OPD to implementers work by their respective tupoksi.

For financial resources, these financial resources are in the form of budget allocations

either from the Ponorogo Regency Government, Province, or Financial Assistance from the

Center to the budget at the village level from the Village Fund and Village APB. The budget

is used to carry out planning, training, monitoring, and evaluation at the district and village

levels. Financial resources to support the acceleration of stunting reduction are still lacking,

because there are still several villages that are still lacking in allocating village funds to meet

the program of accelerating stunting reduction activities. This can happen because there are

still villages that are not the locus, feeling that the stunting program has not become a top

priority. After all, they feel that their village is not the locus of stunting. But overall, financial

resources to support the stunting reduction acceleration program have been said to be

maximum and optimal.

In terms of resources, facilities, and infrastructure are attached to each party and use

the existing budget, both specifically used for stunting reduction and integrated in other

activities, for example, Village Healthy Houses (RDS). So that infrastructure facilities are

determined to have become resources that optimally support the implementation of

accelerating stunting reduction because they are directly attached to each OPD of the

implementation team.

The next supporting variable is communication between implementing organizations.

Based on the results of interviews and also a review of documents that have been conducted

by researchers, researchers can draw conclusions, namely communication and coordination

between parties involved in the implementation of policies to accelerate stunting reduction

have been implemented both at the district and village scales, but it should be noted that

activeness, commitment, and improvement efforts determine the success or failure of policy

implementation.

The next variable that is supporting is the characteristics of the implementing

organization. Researchers found that the characteristics of the implementation team were

adjusted to the objectives of each work unit. So that the characteristics of the implementing

organization can be said to be in accordanbyives specified in the stunting reduction

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acceleration team in the Decree of the Regent of Ponorogo Number 188.45/563/405.12/2022

concerning the Establishment of the Ponorogo Regency Stunting Reduction Acceleration

Team for 2022-2024.

The third stage is the application stage. At the application stage after the issuance of

Regent Regulation Number 33 of 2022, the Ponorogo Regency Government launched the

Creating Action Movement. Since the launching of the citing movement in action,

agencies/agencies/institutions have also become more active in implementing programs

related to accelerating stunting reduction, namely the inauguration of the Mother of Stunting

and audits related to the implementation of the acceleration program for stunting reduction.

The supporting variable of this application stage is the attitude of the implementer. From the

results of research obtained by researchers, it can be said that the tendency of implementers

varies, but all responses are the same because stunting reduction is a national priority

program, All implementing parties accept and implement this policy, even though there are

some dostand, causing efforts made to fulfill obligations to superiors.

CONCLUSION

Based on the formulation of the problem set by the researcher, it can be concluded as

follows (Wahab, 2012):

The implementation of policies related to the acceleration of stunting reduction in

Ponorogo Regency is a derivative of Presidential Regulation Number 72 of 2021 concerning

the Acceleration of Stunting Reduction, namely Ponorogo Regent Regulation Number 33 of

2022 concerning the Acceleration of Stunting Reduction at the Village Level. The

implementation of the Regent Regulation which then became the basis for the implementation

team in implementing the provisions for accelerating stunting reduction in Ponorogo Regency,

began with the enactment of the Decree of the Regent of Ponorogo Number:

188.45/563/405.12/2022 concerning the Establishment of a Team for the Acceleration of

Stunting Reduction in Ponorogo Regency for 2022-2024, Decree of the Chief Executive of the

Ponorogo Regency Stunting Reduction Acceleration Team Number: 188.4/1036/405.12/2022

concerning the Formation of a Reduction Acceleration Team Stunting (TPPS) Sub-District in

Ponorogo Regency in 2022, as well as the Issuance of the Decree of the Regent of Ponorogo

Number: 188.45/472/405.27/2023 concerning the Determination of Village Focus Locations

for Integrated Stunting Reduction Interventions in Ponorogo Regency in 2023.

Supporting factors in the successful implementation of the stunting reduction

acceleration policy come from the standards and policy objectives, coordination,

communication, commitment of implementing organizations, and responses from

implementers who are ready to implement the policy, as well as implementing organizations

appointed to implement policies by their respective tupoksi.

The inhibiting factor in policy implementation is the financial resources derived from

village funds, it is felt that there are still some villages that are not optimal in their allocation.

In addition, not all implementers understand and are competent in supporting the policy, and

the evaluation of policies carried out monthly is considered ineffective.

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Faradiba, Aisyah (2023)

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