Page 1 of 12
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
Page 2 of 12
Services for Science and Education – United Kingdom 710
European Journal of Applied Sciences (EJAS) Vol. 12, Issue 6, December-2024
(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,
Page 3 of 12
711
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