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19/B-NUWSP/Juni/2023

Stunting merupakan isu yang hangat dibicarakan belakangan ini. Pasalnya, stunting adalah masalah utama pada anak balita di Indonesia (Cegah Stunting, 2021). Menurut Candra (2010), stunting merupakan suatu kondisi kurangnya tinggi badan seseorang jika dibandingkan dengan tinggi normal berdasarkan usianya. Jika seseorang mengalami stunting sejak dini, beberapa gangguan berpotensi muncul, baik gangguan mental, psikomotor, hingga kecerdasan. Stunting memiliki kaitan yang erat dengan pembangunan sumber daya manusia di masa depan. Oleh karena itu, program percepatan penurunan stunting menjadi program yang diprioritaskan Presiden Republik Indonesia (Kementerian Pendayagunaan Aparatur Negara dan Reformasi Birokrasi, 2022).

Pemerintah Indonesia mengerahkan 23 Kementerian/Lembaga untuk berkolaborasi mencegah stunting (Pemerintah Indonesia, 2018). Kementerian/Lembaga yang terlibat dapat dilihat pada Tabel 1. Secara garis besar, program pencegahan stunting yang dilakukan oleh pemerintah untuk menurunkan prevalensi stunting di Indonesia dapat dikelompokkan menjadi 2 jenis, yaitu intervensi gizi spesifik dan intervensi gizi sensitif. Intervensi gizi spesifik adalah program untuk mengatasi penyebab langsung stunting seperti pemenuhan gizi serta perkembangan janin dan anak. Sedangkan intervensi gizi sensitif adalah program yang secara tidak langsung memengaruhi kejadian stunting. Beberapa program yang termasuk dalam intervensi sensitif yaitu peningkatan akses air minum dan sanitasi, peningkatan akses dan kualitas layanan kesehatan, perbaikan pola asuh, serta keamanan pangan (BKKBN, 2021; TNP2K dan Sekretariat Wakil Presiden Republik Indonesia, 2018).

Tabel 1. Kementerian/Lembaga pelaksana program pencegahan stunting

Peningkatan akses air minum merupakan salah satu program yang mendukung penurunan stunting melalui intervensi gizi sensitif. Akses air minum diyakini memiliki pengaruh yang besar dalam kejadian stunting di Indonesia (baca selengkapnya di sini). Oleh sebab itu, pemerintah berkomitmen untuk meningkatkan akses air minum hingga 100% pada tahun 2024 dengan target terhubungnya 10 juta sambungan air minum ke rumah. Dalam pelaksanaannya, target tersebut didukung oleh berbagai program, salah satunya National Urban Water Supply Project (NUWSP). Harapannya, program peningkatan akses air minum, termasuk NUWSP dapat menurunkan angka stunting Indonesia di masa mendatang.

Stunting di Indonesia

Di Indonesia, angka stunting diukur oleh Kementerian Kesehatan melalui Studi Status Gizi Indonesia (SSGI) secara rutin setiap tahunnya. Hasil SSGI pada tahun 2022 mencatat prevalensi stunting Indonesia saat ini bernilai 21,6%. Artinya, dari seluruh balita yang dilakukan pengukuran tinggi badan, sebanyak 21,6% di antaranya mengalami stunting. Angka ini masih lebih tinggi dari toleransi stunting maksimal yang ditetapkan WHO yakni sebesar 20% (Indriani, 2021). Selain itu, angka ini juga masih melebihi target yang ditetapkan pemerintah dalam Rencana Pembangunan Jangka Menengah Nasional (RPJMN) 2020-2024 seperti terlihat pada Tabel 2.

Tabel 2. Target stunting berdasarkan RPJMN 2020-2024

Penurunan stunting memerlukan integrasi lintas sektor berdasarkan faktor-faktor yang memengaruhinya, baik secara langsung maupun tidak langsung. Peningkatan akses air minum merupakan salah satu sektor pendukungnya. Oleh sebab itu, berbagai program yang mendukung peningkatan akses air minum telah ikut ambil bagian dalam upaya penurunan stunting, tak terkecuali program NUWSP.

Stunting di Lokasi NUWSP

NUWSP adalah program nasional yang bertujuan untuk meningkatkan akses dan kualitas pelayanan air minum jaringan perpipaan bagi masyarakat di daerah perkotaan. Hingga saat ini, 54 kabupaten/kota yang tersebar di 24 provinsi telah bergabung menjadi bagian dari program NUWSP. Apabila dikelompokkan berdasarkan nilai prevalensi stunting-nya, lokasi program NUWSP terbagi menjadi 3 kategori stunting, yaitu rendah, sedang, dan tinggi seperti terlihat pada Gambar 1. Pengelompokan ini dilakukan menurut klasifikasi prevalensi stunting WHO, yaitu kategori rendah (<20%), sedang (20-29%), tinggi (30-39%), dan sangat tinggi (≥ 40%) (Onis dkk., 2018 dalam Sholihah, 2021).

Gambar 1. Pengelompokan lokasi program NUWSP berdasarkan prevalensi stunting

Dalam RPJMN 2020-2024, pemerintah telah menetapkan jumlah lokasi prioritas untuk penurunan stunting pada tahun 2023 dan 2024, yaitu sebanyak 514 kabupaten/kota (Tabel 2). Dengan dilaksanakannya program NUWSP di 54 kabupaten/kota, maka setidaknya NUWSP telah berkontribusi dalam upaya menekan angka stunting pada 10,51% lokasi prioritas. Nilai ini dihitung berdasarkan perbandingan antara jumlah lokasi program NUWSP dan lokasi prioritas penurunan stunting. Berdasarkan Gambar 1, sebanyak 23 lokasi program NUWSP atau sekitar 42,6% masuk dalam kelompok stunting rendah karena nilai prevalensi stunting-nya sudah <20%. Sementara itu, sebesar 42,6% masih berada dalam kategori stunting sedang dan 13% kategori stunting tinggi. Kategori stunting sedang dan tinggi adalah kelompok-kelompok yang urgen untuk diintervensi karena prevalensi stunting-nya ≥20%. Namun, angka ini belum cukup untuk mencapai target prevalensi stunting yang ditetapkan pemerintah. Apabila dibandingkan dengan target RPJMN 2020-2024, sebanyak 74,1% lokasi program NUWSP penting untuk diintervensi karena prevalensi stunting-nya >14% (Gambar 2).

Gambar 2. Pengelompokan lokasi program NUWSP berdasarkan target prevalensi stunting RPJMN 2020-2024 dan toleransi stunting WHO

Itulah sekilas tentang stunting di Indonesia dan sebarannya di lokasi NUWSP. Semoga ke depannya berbagai program peningkatan akses air minum, termasuk NUWSP, dapat meluas sehingga kejadian stunting dapat menurun dan Indonesia memiliki sumber daya manusia yang lebih berdaya saing di masa mendatang.

Sumber:

1. BKKBN (2021): Kebijakan dan Strategi Percepatan Penurunan Stunting di Indonesia, Training of Trainer (ToT) Pendampingan Keluarga dalam Percepatan Penurunan Stunting Bagi Fasilitator Tingkat Provinsi, diperoleh melalui situs internet: https://lms-elearning.bkkbn.go.id/pluginfile.php/18037/mod_resource/content/1/4.%20Buku%20Kebijakan%20Dan%20Strategi%20Percepatan%20Penurunan%20Stunting%20Di%20Indonesia.pdf.

2. Candra, Aryu (2020): Epidemiologi Stunting, diperoleh melalui situs internet: http://eprints.undip.ac.id/80670/1/Buku_EPIDEMIOLOGI_STUNTING_KOMPLIT.pdf.

3. Cegah Stunting (2021): Kontribusi PERSAGI Mengakselerasi Penurunan Stunting, diperoleh melalui situs internet: https://cegahstunting.id/berita/kontribusi-persagi-mengakselerasi-penurunan-stunting/.

4. Indriani (2021): Stunting RI Urutan Kedua ASEAN, Apa yang Dilakukan Pemerintah?, diperoleh melalui situs internet: https://finance.detik.com/berita-ekonomi-bisnis/d-5692457/stunting-ri-urutan-kedua-asean-apa-yang-dilakukan-pemerintah.

5. Kementerian Kesehatan (2022): Buku Saku Hasil Studi Status Gizi Indonesia (SSGI) Tahun 2022, diperoleh melalui situs internet: https://promkes.kemkes.go.id/download/grjm/files46531.%20MATERI%20KABKPK%20SOS%20SSGI.pdf.

6. Kementerian Pendayagunaan Aparatur Negara dan Reformasi Birokrasi (2022): Percepatan Penurunan Stunting Program Paling Prioritas untuk Membangun Manusia Indonesia, diperoleh melalui situs internet: https://www.menpan.go.id/site/berita-terkini/berita-daerah/percepatan-penurunan-stunting-program-paling-prioritas-untuk-membangun-manusia-indonesia.

7. Pemerintah Indonesia (2018): Strategi Nasional Percepatan Pencegahan Anak Kerdil (Stunting), diperoleh melalui situs internet: https://tnp2k.go.id/filemanager/files/Rakornis%202018/Stranas%20Percepatan%20Pencegahan%20Anak%20Kerdil.pdf.

8. Pemerintah Indonesia (2020): Peraturan Presiden Nomor 18 Tahun 2020 tentang Rencana Pembangunan Jangka Menengah Nasional Tahun 2020-2024.

9. Sholihah, L.A. (2021): Stunting prevalence and its associated factors among children in primary school in Sidoarjo District: A secondary data analysis, Aceh Nutrition Journal, 6(2).

10. TNP2K dan Sekretariat Wakil Presiden Republik Indonesia (2018): Strategi Nasional Percepatan Pencegahan Stunting 2018-2024, diperoleh melalui situs internet: https://www.tnp2k.go.id/filemanager/files/Rakornis%202018/Sesi%201_01_RakorStuntingTNP2K_Stranas_22Nov2018.pdf.

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Ditulis oleh:

Deviana Matudilifa Yusuf

Stunting in Indonesia and Its Distribution at NUWSP Locations

Stunting has become a hot topic recently as it is a major problem threatening toddlers in Indonesia (Cegah Stunting, 2021). According to Candra (2010), stunting is a condition when a person has a low height for their age. If someone is stunted at an early age, several disorders potentially appear, such as mental, psychomotor, and intelligence disorders. Stunting is closely related to human resource development in the future. Therefore, the acceleration of stunting reduction is a priority program by Indonesia’s President (Ministry of State Apparatus Empowerment and Bureaucratic Reforms, 2022).

The Government of Indonesia mobilized 23 Ministries/Agencies to collaborate in stunting prevention (Government of Indonesia, 2018). The Ministries/Agencies involved can be seen in Table 1. In general, the program of stunting prevention carried out by the government aims to reduce Indonesia’s stunting prevalence. The program can be classified into 2 types, namely specific nutritional interventions and sensitive nutritional interventions. Specific nutritional interventions are programs to address the direct causes of stunting such as nutritional fulfillment as well as fetal and child development. Meanwhile, sensitive nutritional interventions are programs that indirectly affect stunting, such as improving access to drinking water and sanitation, improving access and quality of health services, improving child care and food security (BKKBN, 2021; TNP2K and Secretariat of Indonesia’s Vice President, 2018).

Table 1. Ministries/agencies involved in stunting prevention programs

Improving access to drinking water is one of the programs that support stunting reduction through sensitive nutritional interventions. Access to drinking water is believed to have a major influence on stunting in Indonesia (read more here). Therefore, the government is committed to achieve 100% drinking water access by 2024 with a target of connecting 10 million household connections. In its implementation, the target is supported by various programs, one of which is National Urban Water Supply Project (NUWSP). Hopefully, all programs that aim to increase drinking water access, including NUWSP, can reduce Indonesia's stunting rate in the future.

Stunting in Indonesia

In Indonesia, stunting rates are measured by the Ministry of Health through the Study of Indonesian Nutritional Status (SSGI) regularly every year. SSGI results in 2022 recorded that Indonesia's stunting prevalence is currently valued at 21.6%. It means that of all toddlers measured, 21.6% of them were stunted. This figure is still higher than the maximum stunting tolerance set by WHO, which is 20% (Indriani, 2021). In addition, this figure also still exceeds the target set by the Indonesian Government in the 2020-2024 National Medium-Term Development Plan (RPJMN) as shown in Table 2.

Table 2. Stunting target based on 2020-2024 RPJMN

Stunting reduction requires cross-sector integration based on the factors that affect it, either directly or indirectly. Improving drinking water access is one of the supporting sectors. Therefore, various programs that support improving drinking water access have taken part in efforts to reduce stunting, including the NUWSP program.

Stunting in NUWSP Locations

NUWSP is a national program that aims to improve access and quality of piped drinking water services for people in urban areas. Until now, 54 regencies/cities spread across 24 provinces have joined as part of the NUWSP program. Based on the value of stunting prevalence, NUWSP locations fall into three stunting categories, namely low, medium, and high as shown in Figure 1. These categories are in accordance with WHO stunting prevalence classification, which are low (<20%), medium (20-29%), high (30-39%), and very high (≥ 40%) categories (Onis et al., 2018 in Sholihah, 2021).

Figure 1. Classification of NUWSP locations based on stunting prevalence

In the 2020-2024 RPJMN, the government has set the number of priority locations for stunting reduction in 2023 and 2024, namely 514 regencies/cities (Table 2). With the implementation of the NUWSP program in 54 regencies/cities, at least NUWSP has contributed to the effort of stunting reduction in 10.51% of stunting priority locations. This value is calculated based on a comparison between the number of NUWSP locations and priority locations for stunting reduction. Based on Figure 1, as many as 23 locations or around 42.6% of NUWSP locations are included in the low stunting category because the value of their stunting prevalence is <20%. Meanwhile, 42.6% are still in the medium category and 13% in the high category. Medium and high stunting categories are groups that are urgent to intervene because their stunting prevalence is at least 20% higher than the maximum stunting tolerance. However, this figure is not enough to achieve the target set by the government. When compared to the 2020-2024 RPJMN target, as many as 74.1% of NUWSP locations are important to intervene because the stunting prevalence is >14% (Figure 2).

Figure 2. Classification of NUWSP locations based on the 2020-2024 RPJMN stunting prevalence target and WHO stunting tolerance

That's a glimpse of stunting in Indonesia and its distribution at NUWSP locations. Hopefully, various programs pursuing drinking water improvement, including NUWSP, can expand so that stunting can decrease and Indonesia has a more competitive human resource in the future.

Sources:

1. BKKBN (2021): Kebijakan dan Strategi Percepatan Penurunan Stunting di Indonesia, Training of Trainer (ToT) Pendampingan Keluarga dalam Percepatan Penurunan Stunting Bagi Fasilitator Tingkat Provinsi, obtained through the internet site: https://lms-elearning.bkkbn.go.id/pluginfile.php/18037/mod_resource/content/1/4.%20Buku%20Kebijakan%20Dan%20Strategi%20Percepatan%20Penurunan%20Stunting%20Di%20Indonesia.pdf.

2. Candra, Aryu (2020): Epidemiologi Stunting, obtained through the internet site: http://eprints.undip.ac.id/80670/1/Buku_EPIDEMIOLOGI_STUNTING_KOMPLIT.pdf.

3. Cegah Stunting (2021): Kontribusi PERSAGI Mengakselerasi Penurunan Stunting, obtained through the internet site: https://cegahstunting.id/berita/kontribusi-persagi-mengakselerasi-penurunan-stunting/.

4. Indonesia Government (2018): Strategi Nasional Percepatan Pencegahan Anak Kerdil (Stunting), obtained through the internet site: https://tnp2k.go.id/filemanager/files/Rakornis%202018/Stranas%20Percepatan%20Pencegahan%20Anak%20Kerdil.pdf.

5. Indonesian Government (2020): Presidential Regulation Number 18 of 2020 concerning the National Medium-Term Development Plan for 2020-2024.

6. Indriani (2021): Stunting RI Urutan Kedua ASEAN, Apa yang Dilakukan Pemerintah?, obtained through the internet site: https://finance.detik.com/berita-ekonomi-bisnis/d-5692457/stunting-ri-urutan-kedua-asean-apa-yang-dilakukan-pemerintah.

7. Ministry of Health (2022): Buku Saku Hasil Studi Status Gizi Indonesia (SSGI) Tahun 2022, obtained through the internet site: https://promkes.kemkes.go.id/download/grjm/files46531.%20MATERI%20KABKPK%20SOS%20SSGI.pdf.

8. Ministry of State Apparatus Empowerment and Bureaucratic Reforms (2022): Percepatan Penurunan Stunting Program Paling Prioritas untuk Membangun Manusia Indonesia, obtained through the internet site: https://www.menpan.go.id/site/berita-terkini/berita-daerah/percepatan-penurunan-stunting-program-paling-prioritas-untuk-membangun-manusia-indonesia.

9. Sholihah, L.A. (2021): Stunting prevalence and its associated factors among children in primary school in Sidoarjo District: A secondary data analysis, Aceh Nutrition Journal, 6(2).

10. TNP2K dan Secretariat of Indonesia’s Vice President (2018): Strategi Nasional Percepatan Pencegahan Stunting 2018-2024, obtained through the internet site: https://www.tnp2k.go.id/filemanager/files/Rakornis%202018/Sesi%201_01_RakorStuntingTNP2K_Stranas_22Nov2018.pdf.

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Written by:

Deviana Matudilifa Yusuf

#nuwsp #ditairminun #ciptakarya #watersupply

#airminum #drinkingwater #stunting #rpjmn #malnutrition