NATIONAL ACTION PLANNATIONAL ACTION PLANNATIONAL ACTION PLANNATIONAL ACTION PLAN FOR FOOD AND NUTRITIONFOR FOOD AND NUTRITIONFOR FOOD AND NUTRITIONFOR FOOD AND NUTRITION

2006 2006 2006 2006 ---- 2010 2010 2010 2010

National Development Planning BoardNational Development Planning BoardNational Development Planning BoardNational Development Planning Board

ISBN 978ISBN 978ISBN 978ISBN 978----979979979979----3764376437643764----27272727----6666

RANPG 2006-2010 ii

GENERAL OBJECTIVE

To Improve the health status of the community to serve as the basis for achieving

healthy, intelligent and productive life through strengthening national and regional

food and nutrition resilience by 2010.

NATIONAL DEVELOPMENT PLANNING AGENCY

SPECIAL OBJECTIVE 1. Increase knowledge, attitude and healthy life style 2. Increase the accessibility of the people and individual to food as reflected by

food availability, safety, equity and affordability 3. Increase the accessibility to equitable, affordable and quality health and

nutrition services 4. Increase the accessibility of the family to health and nutrition information 5. Support the poverty alleviation policy and efforts through improvement of

nutrition services for the poor. 6. Improve food safety through producer participations, as well as effective and

efficient supervision.

STRATEGIC ISSUES

National Action Plan for Food and Nutrition 2006 – 2010 addresses 4 main issues i.e. food accessibility, nutritional status, food security, healthy life style, and institutionalization

TARGETS 1. Reduce prevalence of malnutrition (energy-protein, iron, vitamin A, and iodine

deficiency) by 2010 2. Increase food consumption of energy to 2.000 kcal and protein to 53 gram per

capita per day. 3. Reduce food vulnerability by improving distribution system to enable access

to food, including fortified food

4. Maintain availability of energy at 2.200 kcal and protein at 57 grams per day

5. Improve coverage and quality of nutrition services to vulnerable groups

(infants, pregnant mothers, women at reproductive age, female young adult)

6. Improve family knowledge

7. Improve food safety and quality hygiene

NATIONAL ACTION PLAN FOR FOOD AND NUTRITION 2006 - 2010

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PREFACEPREFACEPREFACEPREFACE

State Minister for the National Development PlanningState Minister for the National Development PlanningState Minister for the National Development PlanningState Minister for the National Development Planning//// Chairman of the NationalChairman of the NationalChairman of the NationalChairman of the National Development Planning Board Development Planning Board Development Planning Board Development Planning Board

Vulnerable in the supply of food and nutr i t ion is s t i l l one of the great problems of this nation. The problem o f nut r it ion begins from the incapabi l i ty of the household to access food, because of its avai labil i ty in the local level, poverty , educat ion and knowledge o f food and nutr i t ion, as well as the behavior of the peop le. Micro malnutr i t ion l ike for Vitamin A, iron and iodine has added to the problem of nutr it ion in Indonesia. Therefore the problem of food and nutri t ion is a problem of every sector and is a responsibi l i ty of both the government and the people. Thus, the policy and steps to overcome it also must be formul ized and implemented together .

The Law No. 17 Year 2007 regarding the Year 2005-2025 Nat ional Long Term Development Planning has stressed that “The development and improvement of nutr i t ion shall be conducted in a cross sector manner consist ing of product ion, processing, d istr ibution, unt i l consumption of food having suff icient nutr it ion content, balanced, and its safety assured”. Preparat ion of th is Food and Nutr i t ion Act ion Plan, prepared based on four food and nutr it ion development p il lars, which are : access to food supported by availabil i ty and affordabi l i ty; food securi ty ; nutr it ion status; and healthy l iving pattern, as an elaboration of a comprehensive development of food and nutr i t ion.

This action plan has been prepared as a guidance and direct ive in the implementat ion of the development of food and nutr it ion in the central level , province and regency, government inst itut ions and authori t ies, the public and other actors moving in improvement of food and nutr it ion in Indonesia. As a further fol low up, this document needs to be translated in an act ion p lan for food and nutr it ion in every jur isdict ion. The steps that have been formulated must not remain as documents only, therefore the formulat ion of the action plan for food and nutr i t ion need to be translated into real and actual steps in the development of food and nutr it ion in every province and regency. Fur thermore, i t needs also coordinat ion, per iodical monitor ing and evaluat ion so that the implementat ion of the act ion plan could real ly be appl ied and reach its goal as wel l as br inging progress that cou ld be reached.

For th is, le t us make use of the Action Plan for Food and Nutr i t ion 2006-2010, together we wil l overcome the nutr i t ion problem in Indonesia so that we are able to develop a healthy, smart, and independent generat ion.

Final ly a word of thanks I would l ike to say to representat ives from the Department of Health, Department of Agr icul ture, The Agency for Supervision of Food and Drugs, Department for the Nat ional Educat ion, experts from the Bogor Insti tute of Agr icul ture, Univers ity of Indonesia and Univers ity of Hasanudin, the Profession Associat ion for Nutr it ionists of Indonesia (Persagi) and the Associat ion of Nutr it ion and Food of Indonesia as well as var ious non government organizat ions that have given their thoughts and hard work in preparat ion of this document.

Jakar ta, Juni 2007 State Minister for the Nat ional Development Planning/ The Nat ional Development Planning Board

H. Paskah Suzeta

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LIST OF ABBREVIATIONSLIST OF ABBREVIATIONSLIST OF ABBREVIATIONSLIST OF ABBREVIATIONS AGB = Anemia Gizi Besi = Iron Nutrition Anemia ASI = Air Susu Ibu = Breast Feeding Milk BBLR = Bayi Berat Lahir Rendah = Low Weight of New Born BLT = Bantuan Langsung Tunai = Direct Cash Aid CPMB = Cara Produksi Makanan Yang Baik = Well Produced Food Method CDPB = Cara Distribusi Pangan Yang Baik =Well Distributed Food Method EYU = Eksresi Yodium Urine = Urine Iodine Excretion FDA =Food Drug Administration GAKY =Gangguan Akibat Kurang Yodium = Disorders due to lack of Iodine GKP = Gabah Kering Panen = Harvested Rice with husk HDPP =Harga Dasar Pembelian Pemerintah = Basic Government Purchase Price HDR = Human Development Report HPP = Harga Pembelian Pemerintah = Government Purchase Price IMT = Indeks Massa Tubuh = Body Mass Index IPM = Indeks Pembangunan Manusia = Human Development Index IFPRI = International Food Policy Research Institute ISPA = Infeksi Saluran Pernapasan Atas = Upper Respiratory Infection KEK = Kurang Energi Kronik = Chronic Lack of Energy KLB = Kejadian Luar Biasa = Extraordinary incident KMS = Kartu Menuju Sehat = Health Progress Card KUB = Kelompok Usaha Bersama = Joint Business Group KVA = Kurang Vitamin A = Lack of Vitamin A LILA = Lingkar Lengan Atas = Upper Arm Circumference LSM = Lembaga Swadaya Masyarakat = Non Government Organization MDGs = Millenium Development Goals MP-ASI = Makanan Pendamping Air Susu Ibu = Breast Milk Food Supplement PAUD = Pendidikan Anak Usia Dini = Early Childhood Education PDB = Produk Domestik Bruto = Gross Domestic Product PPH = Pola Pangan Harapan = Food Expectancy Pattern RANPG = Rencana Aksi Nasional Pangan dan Gizi

= National Action Plan for Food and Nutrition RPJMN = Rencana Pembangunan Jangka Menengah Nasional

= National Medium Term Development Plan RPJPN = Rencana Pembangunan Jangka Panjang Nasional

= National Long Term Development Plan RPJMD = Rencana Pembangunan Jangka Menengah Daerah

= Regional Medium Term Development Plan SDM = Sumberdaya Manusia = Human Resources SDKI = Survei Demografi dan Kesehatan Indonesia = Demography and Health Survey in Indonesia SKIA = Survei Kesehatan Ibu dan Anak = Mother and Child Health Survey SKPG = Sistem Kewaspadaan Pangan dan Gizi = Food and Nutrition Awareness System SKRT = Survei Kesehatan Rumah Tangga = Household Health Survey SUVITAL = Sumber Vitamin A Alami = Natural Vitamin A Source Susenas = Survei Sosial Ekonomi Nasional = National Social Economic Survey TBC = Tuberculosis TGR = Total Goiter Rate UPGK = Upaya Perbaikan Gizi Keluarga = Family Nutrition Improvement Effort WUS = Wanita Usia Subur = Fertile Age Women WNPG = Widyakarya Nasional Pangan dan Gizi ` = National Workshop on Food and Nutrition

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LIST OF TERMINOLOGYLIST OF TERMINOLOGYLIST OF TERMINOLOGYLIST OF TERMINOLOGY

AnAnAnAnaaaaemiaemiaemiaemia Low content of haemoglobin in the blood, 50 percent incident of anaemia caused by lack of iron

BBLRBBLRBBLRBBLR Newborn weighing less than 2500 grams

Food DiversificationFood DiversificationFood DiversificationFood Diversification Food variety or Diversification of food are efforts to increase consumption of a variety of food with the principle of balanced nutrition.

Lack of NutritioLack of NutritioLack of NutritioLack of Nutritionnnn Disorders due to lack or imbalanced nutrition needed for growth. The indicator used for measuring lack of nutrition of children is based on the height of the body according to age, the weight according to the age and the weight according to the height, for adults this is based on IMT.

Excessive NutritionExcessive NutritionExcessive NutritionExcessive Nutrition Excessive body weight compared to the height, for adults it is measured based on IMT. For children, measurement is based on the the body weight per height using the z-score international reference.

IMTIMTIMTIMT Body Mass Index, which is the body weight in kilograms divided by the height in square meters (kg/m2)

Food SecurityFood SecurityFood SecurityFood Security Condition and efforts needed to prevent food from the possibility of biological, chemical and other articles of contaminants that could disturb, create loss and endanger human health.

Food ResilienceFood ResilienceFood ResilienceFood Resilience A condition in fulfillment of food for households, reflected by the availability of sufficient food, in amount as well as in quality, evenly distributed and affordable.

Energy ConsumptionEnergy ConsumptionEnergy ConsumptionEnergy Consumption The amount of energy from food consumed by the people stated in kilo callory units (Kkal).

Food ConsumptionFood ConsumptionFood ConsumptionFood Consumption The amount of food and drink consumed by the citizen/person measured in gram per capita per day units.

Protein ConsumptionProtein ConsumptionProtein ConsumptionProtein Consumption The amount of protein from food, livestock or vegetation (plants) consumed, stated in gram per capita per day units.

MalnutritionMalnutritionMalnutritionMalnutrition Consists of macro and micro malnutrition. Macro malnutrition was before mentioned as lack of protein callories (KKP or KEP). Now KKP is no longer used and replaced by lack of nutrition (z score BB/U <- 2 SD) and bad malnutrition (z score BB/U <-3 SD) therefore lack of nutrition pairs with bad malnutrition, no longer mentioned as KKP or KEP because it is not only due to lack of callories and proteins but also lack of micro nutrients.

Balanced NutritionBalanced NutritionBalanced NutritionBalanced Nutrition The recommendation of food sufficient in the need of nutrition by a person in order to live healthy, to be intelligent and productive, based on the Balanced Nutrition General Guidance.

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Adequate Nutrition LevAdequate Nutrition LevAdequate Nutrition LevAdequate Nutrition Levelelelel The amount of nutrition/energy needed by someone in a population to live healthy.

FoodFoodFoodFood Segala sesuatu yang berasal dari sumber hayati dan air, baik yang diolah maupun tidak diolah, yang diperuntukkan sebagai makanan dan minuman bagi konsumsi manusia termasuk bahan tambahan pangan, bahan baku pangan, dan bahan lain yang digunakan dalam proses penyiapan, pengolahan dari atau pembuatan makanan dan minuman.

Staple FoodStaple FoodStaple FoodStaple Food Pangan sumber karbohidrat yang sering dikonsumsi atau dikonsumsi secara teratur sebagai makanan utama, selingan, sebagai sarapan atau sebagai makanan pembuka atau penutup.

Food Consumption PatternFood Consumption PatternFood Consumption PatternFood Consumption Pattern The foods that are usually consumed consisting of the type and amount of food consumed/eaten by someone or group of people in a certain frequency and period of time.

Food Expectation Pattern Food Expectation Pattern Food Expectation Pattern Food Expectation Pattern The amount of food according to the 9 food groups based on the energy contribution fulfilling the need of nutrition quantitatively, qualitatively as well as the variety, with considerations to the social aspect, economy, culture, religion and the taste itself.

StuntingStuntingStuntingStunting Failure to attain optimal growth, measured based on TB/U (body height according to age)

WastingWastingWastingWasting Failur to attain optimal growth, measured based on BB/U (body weight according to age)

XerophthalmiaXerophthalmiaXerophthalmiaXerophthalmia Disorders due to lack of vitamin A in the eyes causing abnormality to the eye ball anatomy and disturbances to the retina functions causing further blindness

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TABLE OF CONTENTSTABLE OF CONTENTSTABLE OF CONTENTSTABLE OF CONTENTS PREFACE i LIST OF ABBREVIATIONS ii LIST OF TERMINOLOGY iii TABLE OF CONTENTS v LIST OF TABLES vi LIST OF DRAWINGS vii I. I. I. I. INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION 1 A. BACKGROUND 1 B. OBJECTIVE OF PREPARATION 2 C. SCOPE 3 D. PREPARATION PROCESS 4 E. USER 4 II. II. II. II. FOOD AND NUTRITION AS AFOOD AND NUTRITION AS AFOOD AND NUTRITION AS AFOOD AND NUTRITION AS AN INVESTMENT INN INVESTMENT INN INVESTMENT INN INVESTMENT IN DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT 5 A. FOOD AND NUTRITION TO DETERMINE THE QUALITY OF HUMAN RESOURCES B. INVESTMENT OF FOOD AND NUTRITION IN DEVELOPMENT OF HUMAN

RESOURCES 6 C. CAUSES OF FOOD AND NUTRITION PROBLEMS 9 D. MIND SET OF FOOD AND NUTRITION RESILIENCE 13 E. REVIEW STRATEGIES IN SHORT AND LONG TERM NUTRITION IMPROVEMENT 15 III. III. III. III. ANALANALANALANALYSIS OF THE FOOD AND NUTRITION SITUATIONYSIS OF THE FOOD AND NUTRITION SITUATIONYSIS OF THE FOOD AND NUTRITION SITUATIONYSIS OF THE FOOD AND NUTRITION SITUATION 17 A. PUBLIC NUTRITION STATUS 17 B. FOOD CONSUMPTION 21 C. ACCESS OF HOUSEHOLDS TO FOOD 26 D. FOOD SECURITY 34 E. HEALTHY LIVING PATTERN AND PHYSICAL ACTIVITY 43 IV. IV. IV. IV. ACTION PLAN ACTION PLAN ACTION PLAN ACTION PLAN 51 A. STRATEGIC ISSUES 51 B. OBJECTIVES 54 C. TARGETS 54 D. POLICY 56 E. STRATEGY 58 V. V. V. V. MATRIMATRIMATRIMATRIX FOR THE NATIONAL ACTION PLAN FOR FOOD AND NUTRITIONX FOR THE NATIONAL ACTION PLAN FOR FOOD AND NUTRITIONX FOR THE NATIONAL ACTION PLAN FOR FOOD AND NUTRITIONX FOR THE NATIONAL ACTION PLAN FOR FOOD AND NUTRITION 64 LIST OF REFERENCES 77 ATTACHMENTS 79

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LIST OF TABLESLIST OF TABLESLIST OF TABLESLIST OF TABLES

1. Cost per unit and Economic Benefit of various Nutrition Programs 8

2. Prevalence of Stunting of children under five years of age < -2SD 18

3. Total Goitre Rate (TGR) based on Survey in 1996/1998 and 2003 19

4. Carbohydrate Source Food Consumption 22

5. Protein Source Food Consumption 22

6. Fat and Vitamin/Mineral Source Food Consumption 23

7. Consumption Pattern of Staple Food According to territory and Producer Groups 24

8. Development in Consumption of Energy and Protein according to territory 25

9. Development in quality of consumption of Food based on PPH 26

10. Comparison of consumption of Recommended Food and Actual in the year 1999-2005 26

11. Spread of Production of Staple Food According to Island Territory 27

12. Development in Production of Food Grain Per Capita 27

13. Development in Meat Production 28

14. Development in Egg Production 28

15. Number of Food Vulnerable Population According to Province 30

16. Volume of Rice and number of Target Families of the Rice Program for the Poor 33

17. Results of Examination of Medium and Above Industry Production Means 35

18. Results of Examination of Household Food Industry Production Means 36

19. Issuance of Registration Number of Medium and Large Scale Food Products 37

20. Results of examination of circulated food products 37

21. Percentage of violation in Food Products 38

22. Percentage of results in supervision of food snacks for school children 38

23. Number of violations in Various Criteriae not Fulfilling Requirements 39

24. Data of Findings of Dangerous Substances in Food Products 39

25. Findings of Formaldehyde in Food Products 40

26. Results of Monitoring of Wet Noodle Products, Soy Bean Curd and Fish in Six Provinces 40

27. Number of Cases of Poisoning in the Year 2001 – 2005 42

28. Percentage of Population Above 15 Years of Age that Smoke

Within the Last Month Per Province According to Territory in the Year 2004 50

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LIST OF DRAWINGSLIST OF DRAWINGSLIST OF DRAWINGSLIST OF DRAWINGS

1. Mind Set of the Causes of Nutrition Problems of children Under Five Years of Age 10

2. The Linking of Poverty and Nutrition Status 12

3. Framework System for Resilience in Food and Nutrition 14

4. Anaemia Prevalence in children under five years of age (SKRT 2001) 19

5. Proportion of WUS with the Risk of KEK (LILA <23.5 cm) 20

6. Number of rejection of food import cases of Indonesia by the FDA 41

7. Prevalence of Degenerative Disease Patients in the Year 2001 and 2004 43

8. Prevalence of Excessive Nutrition in Adult women (villages, NSS-HKI 1999-2001) 45

9. Activity level of the population above 15 years of age (2004) 48

10. Percentage of the population aged 10 years old and above that Smoke during the

Last Month (For 2005: 15 Years old and Above) 49

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FIGURE 1 TRANSLATION (RANPG WORD ISI BUKU)

BAHASA INDONESIA ENGLISH

1. Status Gizi Anak Child Nutrition Status

2. Konsumsi Makanan Food Consumption

3. Status Infeksi Infection Status

4. Ketersediaan & Pola Konsumsi

Rumah Tangga

Availability & Consumption Pattern of the

Household

5. Pola Asuh –Pemberian ASI/MP-

ASI,Pola Asuh Psikososial,

Penyediaan MP-ASI, Kebersihan dan

Sanitasi

Rearing/CarePattern-Giving of Breast

Feeding Milk/Food Supplement,

Psychosocial Rearing, Provisions of Food

Supplement to Breast feeding Milk,

Hygiene and Sanitation

6. Pelayanan Kesehatan dan Kesehatan

Lingkungan

Health Services and Environmental Health

7. Daya Beli, Akses Pangan, Akses

Informasi, Akses Pelayanan

Buying Power, Access to Food, Access ti

Information, Access to Services

8. Kemiskinan, Ketahanan Pangan &

Gizi, Pendidikan, Kesehatan,

Kependudukan

Poverty, Resilience in Food & Nutrition,

Education, Health, Demography

9. Pembangunan Ekonomi, Politik,

Sosial

Development in Economy, Politics, Social

10. Hasil Outcome

11. Penyebab Langsung Direct Cause

12. Penyebab Tidak Langsung Indirect Cause

13. Akar Masalah Root of the Matter/Problem

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RANPG 2006-2010 1

CHAPTER I. INTRODUCTIONCHAPTER I. INTRODUCTIONCHAPTER I. INTRODUCTIONCHAPTER I. INTRODUCTION A. A. A. A. BACK GROUND BACK GROUND BACK GROUND BACK GROUND

Achievement in development of a nation is determined by the availability of quality human resources (HR), human resources which have strong physical body, strong mental ability, in prime health, as well as intelligent. Empirical evidence shows that this is very much determined by a good nutrition status, and a good nutrition status is determined by the amount of food consumed. Regarding malnutrition and bad malnutrition is influenced directly by the factors of food consumption and infectious diseases. It is influenced indirectly by the pattern in caring, availability of food, the social-economic factor, culture and politics (Unicef, 1990). If malnutrition and bad malnutrition continually occur, this could become a constraint to the national development.

Currently it is estimated that about 50 percent of the Indonesian population or more than 100 million people are experiencing various problems of lack of nutrition, which are malnutrition and excessive nutrition. The problem of malnutrition is often out of sight or from normal sight and often is not quickly taken care of, in fact this could raise great problems. Besides lack of nutrition, and at the same time, Indonesia also is beginning to face excessive nutrition with a tendency to increase from time to time. In other words, currently Indonesia is facing a double nutrition problem. Slowly but sure, malnutrition will have an impact to the high level of mortality rate of mothers, babies and children under five years of age, as well as a low life expectancy. Besides that, the impact of malnutrition is evident also in the low participation in schools, low education, as well as the slow rate of economic growth.

The United Nations has revealed the importance in overcoming malnutrition in connection with the efforts of enhancing human resources in all age groups according to the life cycle (January, 2000)1. Investment in the social sector becomes very important in enhancing human resources because this will give impact to the state economic growth. Investment in nutrition also has the important role to break the demonic cycle of poverty and malnutrition as an effort for enhancement of human resources. Several bad impacts of malnutrition are : (i) low work productivity; (ii) loss of opportunity to go to school; and (iii) loss of resources because of high health costs (World Bank, 2006). In order to maintain that the individual does not have lack of nutrition, then access of every individual to food must be assured. Access to food of every individual depends very much to the availability of food and the capacity to have access continually (spatial and time). The capacity to access to food is influenced by the buying power, which is linked to the level of income and how poor the individual is.

In our legislation system, efforts to increase hunman resources is regulated in the 1945 Constitution article 28 H paragraph (1) which states that every individual has the

1 Nutrition throughout life cycle. 4th report on The World Nutrition Situation, January 2000.

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right to a good life, and health services is one of the human rights. Therefore the fulfillment of food and nutrition for the health of the citizens is an investment for increasing the quality of human resources. Meanwhile, the regulation in regard to food is mentioned in Law No.7 Year 1996 regarding Food, stating also that food is a basic human need which the fulfillment becomes the right of every individual. The fulfillment of the right to food is reflected in the definition for food resilience which is : ”the condition of fulfillment of food by households which is reflected from the availability of sufficient food, in amount as well as in quality, safe, even distribution and affordable”. Adequacy in food supports the achievement of good nutrition status therefore this will smoothen the streamlining in the application of the 9 year compulsory education in accordance to the mandate of Law No. 20 Year 2003 regarding the National Education System. Furthermore, this will produce a quality young generation.

Efforts to assure adequacy in food and nutrition as well as the opportunity for education will support the commitment in reaching the Millenium Development Goals (MDGs), especially the targets : (1) alleviate poverty and hunger; (2) reaching basic education for all; (3) reduce mortality rate of children; and (4) increase the health of mothers in the year 2015. Other global commitments as a basis for development of food and nutrition are : The Global Strategy for Health for All 1981, The World Summit for Children 1990, The Forty-eight World Health Assembly 1995, World Food Summit 1996 dan Health for All in the Twenty-first Century 1998.

In the national level, development of food, health, and education is also placed as a main priority in the National Long Term Development Plan (RPJPN) 2005-2025 and the National Medium Term Development Plan (RPJMN) 2004-2009, which is elaborated in the strategic plan of the Department of Agriculture, Department of Health and the Department for National Education. In order to elaborate the policy and integrated steps in food and nutrition as well as in the frame of supporting the development of quality human resources, it is necessary to prepare a National Action Plan for Food and Nutrition 2006-2010 (RANPG 2006-2010) as a follow-up from the National Action Plan for Food and Nutrition of (RAPGN) 2001-2005.

B.B.B.B. OBJECTIVES OF THE PREPARATION OBJECTIVES OF THE PREPARATION OBJECTIVES OF THE PREPARATION OBJECTIVES OF THE PREPARATION

General Objective. General Objective. General Objective. General Objective. Providing guidance and directives in implementation of development of food and nutrition to government institutions, the public and other actors that are involved in improvement of food and nutrition in Indonesia, on the national scale, provincial as well as in the regencies (kabupaten/kota).

Special Objective: Special Objective: Special Objective: Special Objective:

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1. Increase the understanding of the importance of the role in development of food and nutrition as an investment to realize quality Indonesian human resources.

2. Increase the capacity in analyzing the development of the food and nutrition situation in every territory so as to have: (i) the capacity to determine the priority in handling food and nutrition matters; (ii) the capacity to select the right intervention and cost effectiveness according to local needs; (iii) the capacity to develop functioning institutions for food and nutrition; and (iv) the capacity to monitor and evaluate development of food and nutrition.

3. Increase coordination in handling food and nutrition matters in an integrated manner.

C. C. C. C. THE SCOPETHE SCOPETHE SCOPETHE SCOPE

The Action Plan consists of a strategy and concrete steps which will be conducted for improvement of food and nutrition in order to realize food resilience and to increase the public nutrition status, which is reflected by the adequacy of the need of food in the amount, the security, and the quality of a balanced nutrition in the household. This Action Plan refers to the Medium Term Development Plan 2004-2009, the commitment to reach the MDGs, as well as other national development policy documents in food and nutrition2.

This action plan document begins with an elaboration on the role of food and nutrition as an investment for development as mentioned in Chapter II. In Chapter II, it elaborates the analysis of the food and nutrition situation for the previous five years as a reflection of the results of the implementation of RANPG 2001-2005 and targets that have not fully been achieved which is still relevant to be continued in RANPG 2006-2010. In this chapter, presented are steps to overcome the new challenges in accordance to the dynamics that occur in the nation with the four pillars of development of food and nutrition, which are : access to food, security of food, nutrition status, and healthy living pattern. Then in Chapter IV, elaborated are strategic issues in development of food and nutrition and objectives that will be achieved through RANPG 2006-2010. Besides that, this chapter also elaborates the policy, target and strategy in strengthening food resilience and improvement of nutrition for the period 2006-2010, which will be further elaborated in Chapter V in the form of a matrix action plan consisting of policy, strategy, main activity, indicators, programs and the institution in charge. Therefore, every activity shall be elaborated by the provincial, regency government as well as other users according to the conditions in each territory. Indicators that are present in this RANPG will become the basis for monitoring and evaluation as well as the development of the food and nutrition status in the household, regency, province as well as the national level.

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D.D.D.D. PROCESS IN THE PREPARATIONPROCESS IN THE PREPARATIONPROCESS IN THE PREPARATIONPROCESS IN THE PREPARATION

The preparation of the RANPG begins with a cross sectoral meeting that agrees to the four pillar development for food and nutrition of the results of WHO-FAO Inter-country Workshop for Updating and Implementing Inter-sectoral Food and Nutrition Plans and Policies in Hyderabad, India in the year 2005 as references. Then, Working Groups are formed and in parallel conduct analysis and discussions to prepare policies, strategies and action plans for each pillar. The preparation process involves consultations with experts, business actors and other stakeholders from the universities, NGOs and profession organizations. Elaboration of the action plan based on the four pillars concept for food and nutrition, then, shall be integrated in the RANPG 2006-2010.

E.E.E.E. THE USERTHE USERTHE USERTHE USER

This National Action Plan for Food and Nutrition (RANPG) is an integrated operational document which unites the development of food and nutrition in the frame of realizing quality human resources (HR) as a capital in social development of the nation and country. The RANPG document shall be prepared as a reference for implementation of the program for resilience infood and improvement in nutrtion for all parties, including the government and the people, which have the responsibility to conduct efforts in improvement of food, nutrition and health.

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CHAPTER II. FOOD AND NUTRITION CHAPTER II. FOOD AND NUTRITION CHAPTER II. FOOD AND NUTRITION CHAPTER II. FOOD AND NUTRITION AS AN INVESTMENT IN DEVELOPMENTAS AN INVESTMENT IN DEVELOPMENTAS AN INVESTMENT IN DEVELOPMENTAS AN INVESTMENT IN DEVELOPMENT

A.A.A.A. FOOD AND NUTRITION TO DETERMINE THE QUALITY OF HUMAN FOOD AND NUTRITION TO DETERMINE THE QUALITY OF HUMAN FOOD AND NUTRITION TO DETERMINE THE QUALITY OF HUMAN FOOD AND NUTRITION TO DETERMINE THE QUALITY OF HUMAN RESOURCESRESOURCESRESOURCESRESOURCES

The development of a nation has the objective to increase the welfare of every

bcitizen. Increase of progress and welfare of the nation very much depends on the quality of its human resources. The measurement of quality of human resources could be seen in the Index for Development of Humans (IPM), whereas the measurement for people’s welfare could among others be seen in the level of poverty and the public nutrition status.

IPM is an agregate measurement influenced by the level of the economy, education and health. The quality of HR of Indonesia currently is still far behind compared to other countries. This has been shown by the IPM position of Indonesia which is the 108th from 177 countries. The IPM postion of other ASEAN countries are much better compared to Indonesia, like Malaysia which is the 56th, Philippines 77, Thailand 67, Singapore 22, and Brunai 25. The percentage of poor population also becomes a very important determining factor of IPM. In the year 2006, the level of poverty in Indonesia still reached 17.8 percent meaning that about 40 million people are still under the line of poverty.

One of the effects of poverty is the incapability of the household to fulfill the need of food in good amount and in quality; more than 10 percent of the population in every province experience food vulnerability, except the Province of West Sumatera, Bali, and Nusa Tenggara Barat. This in effect causes malnutrition, in micro as well as macro nutrients, that could be indicated from the nutrition status of children under five years of age and pregnant mothers. The implications of nutrition matters in the two groups are very broad, which among others are :

a. The high prevalence of Low Weight of newborns (BBLR) as an effect of the high prevalence of the Lack of Chronic Energy (KEK) of pregnant mothers. This BBLR could increase the mortality rate of babies and children under five years of age, physical and mental growth disorders of children, as well as a decline in the intelligence. Children with bad malnutrition(stunted) have the risk of losing 10-15 IQ points. Disorders caused by deficiency of Iodine during the foetus stage or failure of growth in children until two years of age could have a permanent bad impact to the intelligence.

b. Deficiency of iron (iron anaemia) in pregnant mothers could increase the risk of death during delivery, increase the risk of babies born with lack of iron, and will have

RANPG 2006-2010 6

a bad impact to the growth of the child’s brain cells, therefore this could consistently reduce the child’s intellgence. In adults this could reduce productivity to as much as 20-30 percent.

c. Deficiency of vitamin A in children under five years of age could reduce the immunity of the body, increase the risk of blindness, and increase the risk of death due to infection.

d. The spreading of malnutrition in children under five years of age and pregnant women would increase the expenditures of the household as well as the government for health costs because many citizens would easily become ill due to malnutrition. Besides this, it will also cause a decline in productivity.

From the above elaboration it is evident that the incapacity of fulfilling the need of food in the household especially to pregnant mothers and children under five years of age will inevitably cause malnutrition which will further give an impact to the birth of the young generation that are not of quality. In the short term, Indonesia will have difficulty in increasing the IPM. If this matter is not resolved, in the medium and in the long term, there will be a ”generation loss” that could disturb the interest of the nation and country.

B.B.B.B. INVESTMENT OF FOOD AND NUTRITION IN DEVELOPMENT OF HUMAN INVESTMENT OF FOOD AND NUTRITION IN DEVELOPMENT OF HUMAN INVESTMENT OF FOOD AND NUTRITION IN DEVELOPMENT OF HUMAN INVESTMENT OF FOOD AND NUTRITION IN DEVELOPMENT OF HUMAN RESOURCES RESOURCES RESOURCES RESOURCES

Adequacy of food in amount and quality in the household level is a mandate to realize resilience in food according to Law No.7 Year 1996. The government is always placing food resilience in the development program. Various government programs to increase production and continual availability of food through sufficient stock gathering have continued to be conducted. Large investments in development and maintenance of irrigation networks, production lines, as well as increase in the production of fertilizers have been conducted to support domestic food production. Efficiency in the food distribution system have continually been enhanced in order that the price of food is affordable by the people. Food aid and subsidy also have been given to the poor households who are not able to afford the food from the markets. Besides that, the local food also is continually developed considering the variety of food consumption pattern and the archipelago possessed by Indonesia, in order to help food vulnerable areas and remote areas that are far from any national distribution access. An important matter also conducted is the effort in increasing the income of the people, especially farmers and village people where the level of poverty is high therefore their buying power and capacity to access food also continues to increase.

Furthermore in accordance to the World Bank Dunia (2006), improvement in nutrition is a very profitable investment. At least there are three reasons that a country

RANPG 2006-2010 7

needs to conduct intervention in the field of nutrition. First, improvement in nutrition possesses high economic returns; second, intervention in nutrition has proven to drive economic growth; and third, improvement in nutrition helps in reducing the level of poverty through improvement in work productivity, less days of illness, and reduction in medical costs. In bad condition of malnutrition, the decline of productivity of a person is estimated as more than 10 percent of the whole life income potency; and in aggregates has caused a loss of Gross Domestic Product (GDP) between 2-3 percent. A conference of economists in Copenhagen in the year 2005 (Copenhagen Concensus) has stated that intervention in nutrition has produced high economic advantages and is considered as one of the other best 17 alternative development investments. This concensus has evaluated that nutrition improvement, especially intervention through supplementation and fortification of micro nutrients programs (improvement of deficiency of iron, vitamin A, iodine and Zinc) possesses an economic return that is as high as investment in trade liberalization, eradication of malaria and HIV, as well as clean water and sanitation. Behman, Alderman and Hoddinot (2004) from Worl Bank (2006) have revealed that the Benefit-Cost Ratio/BC-Ratio) of various nutrition programs, especially the program for supplementation and fortification is very high, around 4 until 520 (TablTablTablTable 1e 1e 1e 1).

Until now economists have the opinion that economic investment is the prerequisite to improve the situation of public nutrition. From analysis there is a mutual link between malnutrition and poverty, as well as the economic analysis towards nutrition investment profits, it is known that nutrition improvement could be conducted without waiting for a certain level of economic improvement. Development of science and technology during this last decade has given the possibility for more rapid improvement of nutrition without waiting for economic improvement. The study conducted by IFPRI in 15 countries shows that income growth as much as only 5 percent per year without any improvement of supporting infrastructures like access to clean water and nutrition programs have proven unable to bring countries to reduce even half of their malnutrition matters in 2020.

Several countries having the same GDP turned out to have different figures of prevalence of malnutrition in children under five years of age. Zimbabwe which has a lower GDP than Namibia, has a better nutrition status for children under five years of age. The sam with China, the GDP per capita of this country isrelatively lower compared to other Asian countries however, having the lowest prevalence of malnutrition in children under five years of age.

Until the 1970-s many economists and experts in development planning, including the World Bank, have given a narrow meaning to investment. Investment in economic development is more meaningful as a capital investment to build the industry of goods and services in the frame of creating job oppotunities. The main point of investment is to develop economic facilities like roads, bridges and transportation.

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During that time it is very seldom that development planners include improvement of nutrition, health and education as part of an economic investment.

Entering the period of the 1990-s the situation started to change. In 1992 the World Bank stated that improvement in nutrition is a development investment. Investment in this field becomes one of the priorities of the World Bank in granting loans to developing countries. The link between efforts in improvement of nutrition with economic development was also forwarded by the Secretary General of the United Nations, Kofi Annan, who stated that good nutrition can change the lives of children, increase physical growth and mental development, protect the health, and lay the foundation for the future child productivity.

The change in policy of the World Bank and the attention of the UN towards development in improvement of nutrition is evident in the increased Bank loan allocation.

Table 1. Cost per Unit and Economic Benefit of various Nutrition ProgramsTable 1. Cost per Unit and Economic Benefit of various Nutrition ProgramsTable 1. Cost per Unit and Economic Benefit of various Nutrition ProgramsTable 1. Cost per Unit and Economic Benefit of various Nutrition Programs

Cost Per Unit And Location

Type of Intervention Cost per Unit (US$/target)

Country & Assessment

Year

Economic Benefit Per 1

US$ Investment (BC-Ratio)

Intervention in Food and Nutrition in the Public 1. Food Subsidy * - Indonesia, 2004 0,9 2. Public Based Nutrition Program Intervention as Part of Basic Health Services

8.01 Indonesia, 2004 2.6

3. Nutrition Education 0.37 Indonesia, 2004 32.3 4. Promotion of Breast Feeding Milk in hospitals

- - 5-67

5. Integrated Child Services Program - - 9-16 Micro Nutrients Intervention 6.Iodine Injections 0.49

0.14 0.21

Peru, 1978 Zaire, 1977

Indonesia, 1986 -

7. Iodized Water 0.04 Italia, 1986 - 8. Iodized Salt 0.04 India, 1987 28.0 9. Iodine Supplementation to Women

- - 15-520

10. Vitamin A Supplementation to Children under five years of age

0.46-0.68 - 4 -50.0

11. Fortification of Vitamin A in Sugar

0.14 Guatemala, 1976 16.0

12. Supplementation of Iron Tablets to Pregnant Mothers

2.65-4.44 N.A. 1980 24.7

13. Fortification of Iron in Salt 0.10 India, 1980 14. Fortification of Iron in Sugar

0.10 0.80

Guatemala, 1980 Not Mentioned,

1980 -

15. Fortification of Iron - - 176-200

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16. Fortification of Iron in Staple Food (Flour)

- - 84.1

Giving Additional Food 17. PMT To children under five years of age

3.99 Indonesia, 2004 1.4

Source: Soekirman & Assoc. (2003). Situational Analysis of Nutrition Problems in Indonesia: Its Policy, Programs and Prospective Development. Directorate for Nutrition and World Bank (Processed from various sources). * Behrman, Alderman, and Hoddinott (2004) in World Bank (2006)

The World Bank for projects in improvement of nutrition in developing countries have increased 18 fold from only US$ 50 million in the 1980-s to become US$ 900 million in the 1990-s. In line with that, the allocation of development budget for nutrition improvement in Indonesia also has increased significantly from Rp 61 Billion in the year 2000 to become Rp 179 Billion in the year 2005, or increasing almost three times in a period of five years. Even though the increase of the budget is quite high however this amount is considered still not adequate, therefore it is necessary to choose government intervention that are really “cost-effective”. The World Banka (1996) recommended a form of intervention that is considered cost-effective for various situations. Meanwhile Soekirman & Assoc. (2003), based on data from various sources also preseted information regarding unit cost and cost-effectiveness of various nutrition programs of results of study of various countries (Table 1Table 1Table 1Table 1).

C. C. C. C. CAUSES OF FOOD AND NUTRITION PROBLEMSCAUSES OF FOOD AND NUTRITION PROBLEMSCAUSES OF FOOD AND NUTRITION PROBLEMSCAUSES OF FOOD AND NUTRITION PROBLEMS

1. 1. 1. 1. The Links in the Causes of Food and Nutrition ProblemsThe Links in the Causes of Food and Nutrition ProblemsThe Links in the Causes of Food and Nutrition ProblemsThe Links in the Causes of Food and Nutrition Problems

There are two direct factors to the cause of malnutrition in children under five years of age, which are the factors of food and infectious diseases and both of them drives each other. For an example, an under five year old child that does not get enough balanced nutritious food possesses low resistance to diseases therefore very easy to be attacked by infection. On the other hand, infectious disease like diarhea and infection to the upper respiratory system (ISPA) could cause inadequate absorption of nutrition by the body further causing bad malnutrition. Because of this, prevention of infection also could reduce lack of nutrition and bad malnutrition. Various factors directly or indirectly causing malnutrition is illustrated in the mind frame of UNICEF (1990) (Figure 1)Figure 1)Figure 1)Figure 1).

The first direct cause is the food consumed, it should fulfill the amount and composition of nutrition that fulfills a balanced nutrition requirements. Consumption of food influenced by availability of food, which at the macro level is indicated by the national production level and adequate food reserves. The availability of food throughout time, in adequate amounts and at affordable prices very much detemines the food

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consumption level in the household. Furthermore the food consumption pattern will influence the composition of the food consumed.

A complete balanced nutritious food for babies until the age of six months is breast feeding milk (ASI), which is continued with additional food supplementing breast feed milk for babies of 6 months until two years old. Dat indicates the low percentage of mothers giving breast feed milk and food supplement that do not fulfill a balanced nutrition because of so many reasons. The direct second cause is infection that is linked

To the high prevalence and incidence of enfectious diseases especially diarhea, Upper Respiratory Infection (ISPA), TBC, malaria, dengue fever and HIV/AIDS. This infection could disturb absorption of nutrition therefore driving to malnutrition and bad malnitrition.

Penyebab Langsung

Penyebab

Tidak

Langsung

lah

RANPG 2006-2010 11

On the other hand malnutrition weakens the resistance of the child therefore easily contracting illnesses. These two factors as direct causes to malnutrition needs attention in the policy of food resilience and nutrition improvement program as well as increasing the public health.

These two direct causes could arise due to three indirect cause factors, which are : (i) availability and food consumption pattern in the household, (ii) child rearing pattern, and (iii) access and quality public health services. The three could influence the quality of consumption of children and the frequency of infectious diseases. If the condition of the three is not so good, this will lead to malnutrition. The low food consumption quality is influenced by the lack of access of the household and the people to food, due to availability of food itself as wellas the level of income that influences the buying power of the household for food. The rearing pattern, health services and sanitation of the environment is influenced by education, health services, information, family planning services, as well as the public social institution for the empowerment of the people especially women.

Instability of the economy, politics and social aspect, couldhave an effect in the low level of welfare of the people which among others is reflected by the large spread of malnutrition and bad malnutrition among the people. Efforts to overcome this matter is pivoted on the development of the economy, politics and social aspect which must be able to reduce the level of poverty in every household in order to realize resilience in food and nutrition as well as giving access to education and health services.

2. 2. 2. 2. Poverty and the Problem of NutPoverty and the Problem of NutPoverty and the Problem of NutPoverty and the Problem of Nutritionritionritionrition

From the various factors causing nutrition problems, poverty is considered possessing the important role and mutual in nature, meaning that poverty will cause malnutrition and the individual having malnutrition will have an effect or create poverty. The problem of malnutrition will slow down the growth of the economy and drive the process of poverty through three ways. First, malnutrition will directly cause loss of productivity due to physical weakness. Second, malnutrition will indirectly lower the cognitive function capacity and effecting a low education level. Three, malnutrition is able to reduce the family economic level due to increased expenditures for medical treatment. These three could be explained as follows (Figure 2) (Figure 2) (Figure 2) (Figure 2) .

The level and quality of consumption of food of poor family members does not fulfill the needed nutrition adequacy. With food that is considered not adequate, the family members, including the children under five years of age become more vulnerable towards infections therefore are often suffering from illness. The poor family is reflected by the profession/occupation which usually are low class labor/workers having low

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education therefore the level of knowledge in food and family rearing pattern also lacks quality. The poor family is also indicated by the high level of pregnancy bue to lack of knowledge regarding family planning and with the existence of the belief that children could be workers that could add to the family income. However, having many children would mean causing the amount of burden to the members of the family in a poor household.

All these factors could cause malnutrition to every member of the poor household which could have an effect in : (i) decline in productivity of the individual due to bad physical condition as well as low intelligence level and low level of education; (ii) high expenditure for maintaining health due to often ill. On the other hand, these two also causes poverty to the individual.

With the link between poverty and malnutrition, it is often meant that efforts in alleviating malnutrition can only be conducted effectively if the economic situation becomes better and poverty could be reduced. This opinion is not all true. Empirically this has been proven that to prevent and overcome malnutrition does not need to wait until poverty is resolved. Many ways to improve public nutrition could be conducted at the time when we are still poor.

By improving the nutrition, productivity of the poor people could be increased as capital to improve the economy and break away oneself from the circle of poverty – malnutrition – poverty. The more poor families’ nutrition have been improved, the less the number of poorpeople. It needs to be realized that development investment in nutrition is not easy and not very quick, just as constructing a building and physical facilities. Improvement in nutrition needs consistency and sustainability of program in the short as well as in the long term .

In the year 2006, the poverty rate of the population of Indonesia was about 17.8 percent or about 40 million people. From the number of poor population, about 68 percent live in the villages, and generally work in the agricultural sector or farm based. The data is not too different with the world level data, which is half from every poor group are small farmers, and one fifth of the poor are farm workers that are not able to produce food needed by their own families. This poor group is actually should become the focus of attention in development in food resilience and nutrition improvement.

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Figure 2. The Link of Poverty with the Nutrition StatusFigure 2. The Link of Poverty with the Nutrition StatusFigure 2. The Link of Poverty with the Nutrition StatusFigure 2. The Link of Poverty with the Nutrition Status

Much intervention in nutrition have been conducted with the main target as poor people and malnutrition, especially children, Women in their Fertile Age (WUS), and pregnant mothers. They obtain education and guidance on balanced nutrition, including the importance of Breast Feeding Milk (ASI) to babies; guidance regarding care of babies and cleanliness; and services for weighing babies and children regularly every month in the Posyandu. Besides that also getting supplements in the form of : iron for pregnant mothers, Vitamin A for children under five years of age and mother after delivery, Food Supplement – Breast Feeding Milk (MP-ASI) for children 6-24 months old, and food for thin pregnant mothers. In an integrative manner, the intervention of nutrition is supported with basic health services like immunization, pregnancy examination, aid in delivery, as well as other health in the Puskesmas.

If combined with efforts to alleviate poverty which could increase the household food resilience, intervention of nutrition for poor people will have a great uplift in

POVERTY

Low Food

Consumption

Often

Infected Low Class

Workers

Frequent

Pregnancy Great Number of

Family Members

Malnutrition

Decline of

productivity due to

bad physical status

Lowering of

productivity due to

low education and

intelligence status

High expenditure

for health cost

RANPG 2006-2010 14

enhancing the health, intelligence, and productivity. This the food situation of the people and households, as well as the development of diseases and status of nutrition of children and pregnant mothers which is popularly known as the Awareness System for Food and Nutrition (SKPG).

D. D. D. D. MIND FRAME OF FOOD AND NUTRITION RESILIENCEMIND FRAME OF FOOD AND NUTRITION RESILIENCEMIND FRAME OF FOOD AND NUTRITION RESILIENCEMIND FRAME OF FOOD AND NUTRITION RESILIENCE The system of resilience of food and nutrition in a comprehensive manner

consists of four sub-systems, which are: (i) availability of food in adequate amounts and types for all the population, (ii) smoothly and evenly distributed food, (iii) consumption of food of every individual which fulfills a balanced nutrition adequacy, giving impact to (iv) the public nutrition status (Figure 3)(Figure 3)(Figure 3)(Figure 3). Therefore, the system of resilience in food and nutrition not only links to production, distribution, and provisions of food in the macro level (national and regional), but also is linked to the micro aspect, which is the access to food in the household level and individual as well as the nutrition status of the members of the household, especially the children and pregnant mothers in poor family households. Even though conceptually the understanding of food resilience covers the micro aspect, however in the daily implementation, it is often stressed to the macro aspect, which is the availability of food. In order that the micro aspect is not being waived, therefore in this document the term resilience of food and nutrition is used.

The narrow concept of food resilience reviews the food resilience system from the input aspect which is the production and provisions of food. As it is much known, nationally as well as globally, availability of abundance of food, more than the need of the people does not assure that all the population is freed from hunger and malnutrition. The broad concept of food resilience has begun from the last objectives of food resilience which is the welfare level of man. Because of this, the first target of the Millenium Development Goals (MDGs) is not the achievement of production or provisions of food, but the reduction of poverty and hunger as an indicator for the welfare of the people. The MDGs use an impact and not input.

The United Nation Development Programme (UNDP) as a competent United Nations institution monitoring the implementation of MDGs has decided two measurements of hunger, which are the amount average energy consumed of the members of the household under the healthy living needed and the proportion of children under five years of age suffering from malnutrition. The measurement indicates that MDGs stress more on the impact instead of the input. Because of this, the food resilience situation analysis must start from the evaluaion of the public nutrition status followed by the consumption level, stock and food production; and not otherwise. The good public nutrition status is indicated by the absence of any people suffering from hunger and malnutrition. This situation indirectly illustrates the adequate and evenly distributed access to food and social services. On the other hand, production and food

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Gambar 3. Framework System for Food and Nutrition ResilienceGambar 3. Framework System for Food and Nutrition ResilienceGambar 3. Framework System for Food and Nutrition ResilienceGambar 3. Framework System for Food and Nutrition Resilience

exceeding the need, does not assure that the people are freed from hunger and malnutrtion.

E. E. E. E. REVIEW REVIEW REVIEW REVIEW OF STRATEGIES IN SHORT AND LONG TERM NUTRITION OF STRATEGIES IN SHORT AND LONG TERM NUTRITION OF STRATEGIES IN SHORT AND LONG TERM NUTRITION OF STRATEGIES IN SHORT AND LONG TERM NUTRITION IMPROVEMENT IMPROVEMENT IMPROVEMENT IMPROVEMENT TA JALANTA JALANTA JALANTA JALAN

Masalah gizi kurang maupun gizi lebih tidak dapat ditangani hanya dengan kebijakan dan program jangka pendek sektoral yang tidak terintegrasi. Pengalaman negara berkembang yang berhasil mengatasi masalah gizi secara tuntas dan berkelanjutan, seperti Thailand, Cina dan Malaysia, menunjukkan perlunya strategi kebijakan jangka pendek dan jangka panjang. Untuk itu diperlukan adanya kebijakan pembangunan bidang ekonomi, pangan dan gizi, kesehatan, pendidikan, dan keluarga berencana yang saling terkait dan terintegrasi untuk meningkatkan status gizi masyarakat (World Bank, 2006).

SANITATION

AND HEALTH

STOCK

DISTRIBUTION

Management of

Consumption

and Family

Rearing Pattern

BODY

BENEFIT

HOUSEHOLD INDIVIDUAL

Consumption

According to

Nutrition Need

N

U

T

R

I

T

I

O

N

S

T

A

T

U

S

INCOME

AND

ACCESS

TO FOOD

AGREGATE

CONSUMPTION

INPUT

Policy and

Performance of

the Econmy,

Social and

Political Sector :

* Economy

- - Farming

- - Fisheries and

- - Forestry

*Facilities /

Means

- Land area

- Water Re-

sources / Irri-

gation

- Communication

Transportation

- Capital

* People’s Wef-

are

- Demography

- Education

- Health

OUTPUT

*Fulfillment

of Rights

to Food

*Quality

Human

Resources

* Resilience

RANPG 2006-2010 16

1.1.1.1. Short Term Strategy Short Term Strategy Short Term Strategy Short Term Strategy

The policy that drives the availability of services consists of : (i) Community based nutrition and health services like efforts in improvement of family nutrition (UPGK) which was conducted from 1970 until the 1990-s, weighing of children under five years of age in Posyandu which are recorded in the in the KMS; (ii) giving of micro nutrient supplements like iron tablets to pregnant mothers, Vitamin A capsules to chidren under five years of age and mother after delivery; (iii) food aid for children with malnutrition from poor families; (iv) fortification of food materials like fortification of salt with iodine, fortification of flour with iron, zinc,folic acid, vitamin B1 and B2; and (v) biofortification, a technology for food plants planting which is able to seek rice paddy varieties containing high iron content and with also high biological value, variety of cassava containing carotin etc.

The policy that increases the access of the people towards services, covering : (i) Conditional Direct Aid Cash (BLT) for poor families; (ii) Macro credits for small and medium business actors; (iii) Granting food, especially during emergencies; (iv) Giving micronutrient supplements, especially iron, Vitamin A and iodine; (v) Direct food aid to poor families; and (vi) Giving of ”poor cards” for medical purposes and buying subsidized food, like rice for the poor (Raskin) and complementary food with breast feeding milk (MP-ASI) for children under five years of age of poor families.

The policy that drives changes to healthy living behavior and nutrition awareness is conducted through nutrition and health education. This education has the objective to increase the knowledge of the family members especially the women regarding balanced nutrition, including the importance of exclusive breast feeding milk (ASI), a good and correct complementary food of breast feeding milk (MP-ASI); monitoring the the weight of babies and children until two years of age; good and correct caring of babies and children : clean water and self cleanliness as well as the environment; and other healthy living patterns like doing sports activities, not smoking, eating vegetables and fruits every day.

2. 2. 2. 2. Long term Strategy Long term Strategy Long term Strategy Long term Strategy

The policy that drives provision of services consists of : (i) Basic health services including family planning and eradication of contagious diseases; (ii) Provisions of clean water and sanitation; (iii) Policy regulation in marketing of formula milk; (iv) Policy for food farming in order to assure food resilience in the family and individual level, with sufficient stock and access to food, balanced nutrition, and safe, including vegetable and fruit commodities;; (v) The policy of developing the food industry is that drives healthy

RANPG 2006-2010 17

food industry product marketing and gives constraint to unhealthy food industry product marketing; and (vi) create more sports facilities for the peple.

The policy that drives the fulfillment of demand or the need of food and nutrition, like: (i) Development of the economy that increases the income of poor people; (ii) Development of economy and social aspects that involves and empowers poor people; (iii) The development that creates jop opportunities therefore reducing unemployment; (iv) Fiscal policies and food prices that increases the buying power of poor people in order to fulfill the need of nutrition balanced food; and (v) Regulating the marketing of unhealthy and unsafe food.

The policy that drives changes in behavior which drives healthy living and good nutrition of members of the family : (i) Increase gender equality; (ii) Reducing the work load of women workers especially during pregnancy; and (iii) Increasing education for women in the schools as well as out of schools.

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CHAPTER III. ANALYSIS OF THE CHAPTER III. ANALYSIS OF THE CHAPTER III. ANALYSIS OF THE CHAPTER III. ANALYSIS OF THE FOOD AND NUTRITION SITUATIONFOOD AND NUTRITION SITUATIONFOOD AND NUTRITION SITUATIONFOOD AND NUTRITION SITUATION

A.A.A.A. PUBLIC NITRITION STATUSPUBLIC NITRITION STATUSPUBLIC NITRITION STATUSPUBLIC NITRITION STATUS

One of the benchmarks of the nutrition status of an individual is the measurement of the weight and height according to age. The benchmark could also reflect the condition of public btrition, Besides that, the public nutrition situation could also be indicated bThe benchmark could also reflect the condition of public btrition, Besides that, the public nutrition situation could also be indicated by data of the lack of Vitamin A (KVA), Disorders due to Lack of Iodine (GAKY), Iron Anaemia (AGB), and disturbance to the growth. The following elaboration presents an analysis of nutrition matters according to the life cycle, starting from babies, children under five years of age, school age children until their productive age.

1. 1. 1. 1. Nutrition of Babies and Children Under Five Years of Age Nutrition of Babies and Children Under Five Years of Age Nutrition of Babies and Children Under Five Years of Age Nutrition of Babies and Children Under Five Years of Age

The nutrition condition of babies could be shown with the BBLR. Incidence of BBLR is very closely connected to the condition of malnutrition during the prepregnancy and during pregnancy period and influences the mortality rate of babies. Indonesia does not yet have any BBLR data which is obtained through national surveys. So far the BBLR figure is only an estimation which is not very precise and obtained by the Demography and Health Survey of Indonesia (SDKI) as well as various studies. The results of the SDKI and the various studies indicates that during the period 1986-19993 the proportion of BBLR is around 7–16 percent. Every year it is estimated that as much as 355-710 thousands out of five million babies are born with BBLR condition.

The condition of children under five years of age in general experienced improvement which is indicated by the reduction of prevalence of malnutrition. During the years 1978-1998, prevalence of malnutrition of children under five years of age has decreased from 46,3 percent to become 37,5 percent or average 0,85 percent per year. This prevalence has continued to decrease to becoming 28,0 percent in the year 2005.

Malnutrition in children under five years of age is indicated by the high prevalence of stunting of these children (stunting < -2SD). From several surveys, the prevalenc of stunting of children under five years of age is about 40 percent (Table 2Table 2Table 2Table 2). The average height in general of children under five years of age is clos to normal conditions, only until 5 - 6 months, and after the age of six months the average height of the children under five years of age is lower than the normal condition.

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In the year 1995 the prevalence of stunting in male children according to the SKIA survey is 46.5 percent. The year 2001 data indicates that prevalence of female

Table 2. Table 2. Table 2. Table 2. Prevalence of SPrevalence of SPrevalence of SPrevalence of Stuntingtuntingtuntingtunting of Children Under Five Years of Age of Children Under Five Years of Age of Children Under Five Years of Age of Children Under Five Years of Age <<<< ---- 2SD 2SD 2SD 2SD from Various Types of Surveyfrom Various Types of Surveyfrom Various Types of Surveyfrom Various Types of Survey

SurveySurveySurveySurvey Stunting Stunting Stunting Stunting <<<< ---- 2SD 2SD 2SD 2SD

Suvita (National Survey for Vit. A), Year 1992 (15 Provinces) 41,4

IBT (Eastern Part of Indonesia ), Year 1991 (4 Provinces) 44,5

SKIA (Health Survey of Mothers and Children),Year 1995- National

45,9

JPS (Social Safety Net) 43,8

Nutrition Survey in 7 Prov. (Centre for R&D of Nutrition 2006) 36,3

Children is 45.2 percent. Based on the NSS survey for the prevalence of male and female children in villages and cities is 45.6 percent.

In the year 1992, Indonesia had been stated as free from xeropthalmia, however, there are still 50 percent of children under five years of age found to have retinol serum of less than 20 µg/100 ml, which is a sign of Vitamin A Sub-Clinic deficiency. This incident is suspected due to less successful of educating for the consumption of natural Vitamin A sources (SUVITAL) and the low distribution coverage of Vitamin A capsules (<80 persen). In the year 2000, it had been reported from Nusa Tenggara Barat of the existence of a new case of xerophthalmia. The same thing could happen in other provinces if the coverage of distribution of Vitamin A capsules in such region is less than 80 percent.

According to SKRT 2001, the prevalence of anaemia of children under five years of age is still quite high. The younger the age of babies the higher the prevalence; for babies less than 6 months (61.3 percent), babies 6-11 months (64.8 percent), and children between 12-23 months (58 percent). Furthermore the prevalence declines for 2-5 year old children 2 - 5 tahun (Figure 4)(Figure 4)(Figure 4)(Figure 4).

2.2.2.2. Nutrition of School Age ChildrenNutrition of School Age ChildrenNutrition of School Age ChildrenNutrition of School Age Children

Growth disorders of children under five years of age continues when the child starts to go to school. During the five years, increase of nutrition status of school children occurs which is measured by the height according to age (TB/U). In the year 1994 the

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number of stunted school children is about 40 percent and declines to 36.4 percent in the year 1999.

Another nutrition problem of school children is the presence of growth disturbances. Children during school age also experience GAKY, even though the prevalence has declined significantly. In the year 1980, the prevalenc of GAKY in school children was measured by the swelling of the thyroid gland (Total Goiter Rate/TGR) of 30 percent. This figure has declined in the year 1990, and became 11.1 percent in 2003.

0,0

20,0

40,0

60,0

80,0

100,0

Pe

rsen

% Anemia 61,3 64,8 58,0 45,1 38,6 32,1

< 6 bln 6-11 bln 12-23 bln 24-35 bln 36-47 bln 48-59 bln

Figure 4. Prevalence of Anaemia in Children Under Five Years of Age (SKRTFigure 4. Prevalence of Anaemia in Children Under Five Years of Age (SKRTFigure 4. Prevalence of Anaemia in Children Under Five Years of Age (SKRTFigure 4. Prevalence of Anaemia in Children Under Five Years of Age (SKRT 2001) 2001) 2001) 2001)

Even though the prevalenc of GAKY in school children had declined, it was evident that there were still 14 Regencies (Kabupaten) considered as seriously endemic. Classification illustration of the Kabupaten according to level of endemy of GAKY can be seen in Table 3Table 3Table 3Table 3.

On the international level, calculation regarding the proportion of population that are suffering from thyroid illness as an indicator of GAKY is no more recommended because it is considered invalid based on statistics. Besides that, the indicator then appears in the fonal level as an accumulation of lack of iodine for a long period therefore is considered late if being used as a basis for prevention. The GAKY indicators recommended by WHO are (i) the content of iofine ine the urine (EYU= Excretion of Iodine Urine), which is the proportion of EYU under 100 µg/L which must be less than 50 percent and the proportion of EYU under 50 µg/L must be less than 20 percent; and (ii) the consumption of iodized salt by the household, which is 90 percent of households use salt with sufficient iodine. These two indicators could be seen during the initial phase, at the level where lack of iodine is still very little. Because of this, the two indocators could

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Tabel 3. Total Goitre Rate (TGR) from Survey in 1996/1998 and 2003

Sumber: National IDD Survey 1998, and National IDD Evaluation Survey 2003

be used as a basis for preventive actions before any thyroid illness appears or other more worse like stunting and mental retardation.

In the year 2003 the median of EYU of school children in Indonesia is 22,9 µg/L, whereas the data for proportion of EYU had already reached 16,7 percent from the proportion of 100 µg/L. Based on the resultys of survey of the Centre of R&D of Nutrition in the yaer 2006, the coverage of consumption of iodized salt on the national scale had increased from 68,5 percent in the year 2002 to 72,8 percent in the year 2005 (Susenas 2005). This indicates still the high potency incident of GAKY in the population. Lack of iodine in children at the initial phase has proven to reduce the IQ. Children suffering from lack of iodine tend to have IQ of 10-15 points less compared to a healthy child.

3. 3. 3. 3. Nutrition during Productive AgeNutrition during Productive AgeNutrition during Productive AgeNutrition during Productive Age

Malnutrition could also occur in the productive age group, which could be measured by the upper arm circumference which is less than 23,5 cm (LILA < 23,5 cm). This measurement is an indicator illustrating the risk of Chronic Lack of Energy (KEK). On the national scale, the proportion of LILA < 23,5 cm declines from 24,9 percent in 1999 to become 16,7 percent in 2003. Generally the WUS group of young age possesses prevalence of KEK much higher compared to older age groups. WUS with KEK risk have a risk in giving birth of BBLR babies(Figure(Figure(Figure(Figure 5) 5) 5) 5).

Besides KEK, in productive age groups there is a problem of over weight (IMT>25) and obesity (IMT>27). These two nutrition problems also occur in slum areas

Total

Non Endemic Endemic-light Endm-medium Endm-serious kabupaten Non Endemic

86 26 2 1 115 Classification of Kabupaten

Endemic-light 28 52 13 3 96 According to TGR Endm-medium 5 18 7 5 35

Year 2003 Endm-serious 3 8 6 5 22

Total kabupaten 122 104 28 14 268

No Change 150 Worsen 68 Better 50

Classification of Kabupaten accord. to TGR Year 1998

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Figure 5. Proportion of WUS with the Risk of KEK (LILA < 23.5 cm) 1999-2003

In the cities as well as in the villages. The results of survey of the NSS-HKI in the year 2001 in four cities (Jakarta, Semarang, Makassar, Surabaya) show that prevalence of overweight in productive age women in slum areas of cities are around 18-25 percent, which is much greater than prevalence of underweight (11-14 persen). This is similar, in villages of the provinces of West Java, Banten, Central Java, East Java, Lampung, West Sumatera, West Nusa Tenggara, and South Sulawesi, the prevalence of overweight is around 10-21 percent, meanwhile the prevalence of underweight is between 10-14 percent.

Nutrition problems could also be indicated by the prevalence of anaemia. The national survey in the year 2001 shows that prevalence of anaemia in married WUS, unmarried WUS, and pregnant mothers each respectively are 26.9 percent, 24.5 percent and 40 percent. Regarding other micro nutrition problems which need attention is the lack of zinc in pregnant mothers. Lack zinc (zinc content <7 mg/dl of blood serum) could cause risk in complications during pregnancy and hairlip in babies born. A research in East Nusa Tenggara (1996) shows that, about 71 percent of pregnant women suffer from lack of zinc. In the year 1999, in Central Java the prevalence of lack of zinc in pregnant women is quite high, which is between 70 to 90 percent. Small scale research in West Java, Central Java and NTB (1997-1999), shows that prevalence of lack of zinc in babies is around 6 to 39 percent. Whereas the amount of other problems of lack of micro nutrients like Folic acid, selenium, calcium, vitamin C, dan vitamin B1 until now is still not known.

0%

10%

20%

30%

40%

50%

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Umur (tahun)

% WUS (LILA<23.5 cm) cm)

1999 2000 2001 2002 2003

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B. B. B. B. FOOD COMMISSION FOOD COMMISSION FOOD COMMISSION FOOD COMMISSION

1.1.1.1. Level and Pattern of Food ConsumptionLevel and Pattern of Food ConsumptionLevel and Pattern of Food ConsumptionLevel and Pattern of Food Consumption

Requirements in sufficiency in order to reach sustainability in food consumption is the presence of physical and economical accessibility towards food. Accessibility is reflected from the number and type of food consumed by the household. Therefore the food consumptiomn data could really show the capacity of the household in access to food and illustrates the sufficiency level of food in the household. Development of the food consumption level implicitly also reflects the level of income or buying power of the people towards food.

In the year 1999 the consumption rate in all types of food had declined during the conomic crisis which continued since 1997. The consumption of rice declined about 6 percent, wheras the consumption of corn and manioc slightly increased. During the economic recovery period (2002-2005), the consumption of rice and corn declined, whereas consumption of cassava and manioc increased. The highest increase occurred for the consumption of cassava which reached 17,2 percent (Table 4Table 4Table 4Table 4).

Table 4. Carbohydrate Source of Food Consumption (Kg/cap/Yr)Table 4. Carbohydrate Source of Food Consumption (Kg/cap/Yr)Table 4. Carbohydrate Source of Food Consumption (Kg/cap/Yr)Table 4. Carbohydrate Source of Food Consumption (Kg/cap/Yr)

TahuTahuTahuTahunnnn RiceRiceRiceRice CornCornCornCorn CassavaCassavaCassavaCassava ManiocManiocManiocManioc

1996 124,5 3,1 11,7 3,0

1999 116,5 3,4 13,4 3,0

2002 114,5 3,4 12,8 2,8

2005 105,2 3,3 15,0 4,0

Laju 1996-1999 (%/th) -6,4 9,7 14,5 0,0

Laju 2002-2005 (%/th) -8,1 -2,9 17,2 4,3

Source : Susenas 1996, 1999, 2002, 2005 (processed)

Consumption of protein source of food, meat, eggs, milk as well as fish had declined during the crisis period. Consumption of protein foods came back to increase in 2002-2005, even though the meat from livestock has not reached the consumption level befor the crisis (Table 5).

Table 5. Protein Source of Food Consumption (Kg/cap/Yr)Table 5. Protein Source of Food Consumption (Kg/cap/Yr)Table 5. Protein Source of Food Consumption (Kg/cap/Yr)Table 5. Protein Source of Food Consumption (Kg/cap/Yr)

Year Livestock meat

Poultry flesh

Eggs Milk Fish grains

1996 3,0 3,6 5,1 1,1 16,5 18,0

1999 1,3 1,9 3,5 0,8 14,1 6,8

2002 1,7 3,6 5,6 1,3 16,8 8,9

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2005 1,8 4,1 6,1 1,4 18,6 9,3

Rate 1996-1999 (%/th) -23,3 -47,2 -31,4 -27,3 -14,5 -15,0

Rate 2002-2005 (%/th) 5,9 13,9 8,9 7,7 10,7 4,5

Source : Susenas 1996,1999, 2002, 2005 (processed)

This also happened to consumption of fat sources of food, vitamins and minerals declined during the crisis, especially consumption of fruits and vegetables which reached more than 20 percent. During the economic recovery period, the increase of consumption of fat source food was relatively stagnant, even though for cooking oil which was still negative. Whereas for source food of vitamin/mineral, this has increased until above five percent (Table 6).

This above condition illustrates that during the crisis period, there haven been adjustments in the strategy to fulfill the need of food in the household level. With the decline of the buying power, peope have reduced the type of high cost food and sustituted them with relatively cheaper food. The consumption of rice was partly replaced by corn and other root crops. Whereas the consumption of animal protein was reduced. Therefore the fulfillment of food was stressed mainly to the concept of ”full stomach” without giving attention to the nutrition content.

Table 6. Fat and Vitamin/Mineral Source of Food ConsumptionTable 6. Fat and Vitamin/Mineral Source of Food ConsumptionTable 6. Fat and Vitamin/Mineral Source of Food ConsumptionTable 6. Fat and Vitamin/Mineral Source of Food Consumption (Kg/cap/Yr)(Kg/cap/Yr)(Kg/cap/Yr)(Kg/cap/Yr)

Fat Source Vit/Mineral Source Year

Cooking Oil Oily Seeds Vegetables Fruits

1996 7,2 4,1 67,5 24,6

1999 7,0 2,7 40,7 18,5

2002 8,3 3,4 47,5 27,2

2005 8,2 3,4 50,8 31,7

Rate 1996-1999 (%/th) -2,8 -4,1 -39,7 -24,8

Rate 2002-2005 (%/th) -1,2 0,0 6,9 16,5

Source : Susenas 1996, 1999, 2002, 2005 (processed) Efforts in economic recovery conducted by the government has had a positive

impact towards the increase of consumption of food by the people. The consumption of livestock, vegetables and fruits had increased. However, the consumption of livestock must be increased in order to enhance the quality of human resources to be able to compete in the globalization era. Currently the consumption of livestock of the Indonesia people has just reached 6,2 kg/capita/year. This consumption level is lower compared to Malaysia and The Philippines each respectively reached 48 kg/cap/year and 18 kg/capita/year. This is very much connected to the level of income per captia of the population of Indonesia which is lower compared to the other countries mentioned above.

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A very interesting development in the consumption of carbohydrate sources of food which is the tendency to decline in the consumption of rice and flour which the staple food, even though the consumption level is still high compared toother carbohydrate sources of food. Currently, the consumption of processed products from flour like instant noodles and various cakes tend to increase. Another interesting development is the tendency to change the staple food consumption pattern of low income groups of people, especially in the villages, which is directed to rice and flour based food materials, including dried noodles, wet noodles, and instant noodles(Table 7Table 7Table 7Table 7). This change needs our awareness because wheat is an import commodity and not yet produced in Indonesia, therefore the change of direction in the consumption pattern could create dependence imported food.

2.2.2.2. Consumption oConsumption oConsumption oConsumption of Energy and Proteinf Energy and Proteinf Energy and Proteinf Energy and Protein

Sufficiency in the need of food among others could be indicated from the fulfillment of the need to energy and protein. The National Workshop on Food and Nutrition VIII (WNPG) in the year 2004 recommended the consumption of energy and protein of the population of Indonesia each respectively is 2000 kcal/capita/day and 52 grams/capita/day.

Table 7. Consumption Pattern of Staple Food According to Territory and Expenditure Table 7. Consumption Pattern of Staple Food According to Territory and Expenditure Table 7. Consumption Pattern of Staple Food According to Territory and Expenditure Table 7. Consumption Pattern of Staple Food According to Territory and Expenditure PostsPostsPostsPosts

Expenditure Group (Rp/cap/Mnth)

2002 2003 2004 2005

City+Village < 60.000 B,J,UK B,J,UK B,T B,T 60.000-79.999 B,J,UK,T B,J,T,UK B,T B,T 80.000-99.999 B,T,UK B,T,UK B,T B,T 100.000-149.999 B,T B,T B,T B,T 150.000-199.999 B,T B,T B,T B,T 200.000-299.999 B,T B,T B,T B,T 300.000-499.999 B,T B,T B,T B,T >500.000 B,T B,T B,T B,T City < 60.000 B,T B B,T B,T 60.000-79.999 B,T B,T,J B,T B,T 80.000-99.999 B,T B,T B,T B,T 100.000-149.999 B,T B,T B,T B,T 150.000-199.999 B,T B,T B,T B,T 200.000-299.999 B,T B,T B,T B,T 300.000-499.999 B,T B,T B,T B,T >500.000 B,T B,T B,T B,T

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Village < 60.000 B,J,UK B,J,UJ B,T B,T 60.000-79.999 B,J,UK B,J,UK,T B,T B,T 80.000-99.999 B,J,T,UK B,T,UK B,T B,T 100.000-149.999 B,T B,T B,T B,T 150.000-199.999 B,T B,T B,T B,T 200.000-299.999 B,T B,T B,T B,T 300.000-499.999 B,T B,T B,T B,T >500.000 B,T B,T B,T B,T

Source ; Susenas 2002, 2003, 2004, 2005 (processed)

Legend: B = Rice, J = Corn, UK = Manioc, T = wheat flour

In aggregates, the consumption of energy in the year 1996 reached 2.019 kcal /capita/day, is already higher than recommended. The economic crisis that happened in mid year 1977 had reduced the consimption level of energy to become 1.849 kcal /capita/day in the year 1999 or only reached 92,5 percent from the recommended level. Howver after the end of the crisis, the consumption of energy of the population gradually recovered, even though the consumption level of the city people had not revovered. This had caused the average energy consumption level of the people lower than the nationally recommended level. The level of protein consumption during the crisis period experienced similar development however after the crisis became better and in fact in the year 2005 this had exceeded the level before the crisis. (Table 8Table 8Table 8Table 8).

Table 8. DevelopmTable 8. DevelopmTable 8. DevelopmTable 8. Development in Consumption of Energy and Protein According to Territoryent in Consumption of Energy and Protein According to Territoryent in Consumption of Energy and Protein According to Territoryent in Consumption of Energy and Protein According to Territory

No. Deatail 1996 1999 2002 2003* 2004* 2005

1. Energy (Cal/cap/day)

City 1.983 1.802 1.945 1.951 1.941 1.923

Village 2.040 1.879 2.011 2.018 2.018 2.060

City+Village 2.019 1.849 1.986 1.991 1.986 1.996

2 Protein(Gram/cap/day)

City 55,9 49,3 56,0 56,7 55,9 55,3

Village 53,7 48,2 53,2 54,4 53,7 55,3

City+Village 54,5 48,7 54,4 55,4 54,7 55,23

* Module Data Source : Susenas in various years (processed) Legend : Recommendation WNPG 2004 :AKE=2000 kcal/cap/day and AKP=52 g/cap/day

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3.3.3.3. Food Consumption QualityFood Consumption QualityFood Consumption QualityFood Consumption Quality

In order to analyze the development of food consumption, besides needing information regarding quality of the food consumption, it is important to know the quality level. The quality of the food consumption can be seen by using the value /score of the Food Expectancy Pattern (PPH). The value/score quality(PPH) could give information regarding the achievement of diversification of food consumption. The higher the score of PPH, the higher the quality of food consumption. The quality of food consumption considered perfect is given a sufficient nutrition figure with a PPH score reaching 100.

Efforts in economic recovery had increased the food consumption quality which is indicated by the increased score of PPH from 66.3 in the year 1999 to 72.6 in the year 2002 (Table 9Table 9Table 9Table 9). The consumption quality kept increasing and in the year 2005 it reached 79.1 which means an increase of 9.0 percent during 4 years. The higher rate of increase of the PPH score compared to the increase of consumption of energy and protein indicates that there have been changes in the food consumption pattern.

The food consumption quality (Table 9Table 9Table 9Table 9) is a realization of the quantity and variety of actual consumption (Table 10Table 10Table 10Table 10). According to ideal conditions (PPH=100) consumption of grain crops recommended is 1.000 Kcal/capita/day. However, during the crisis as well as currently, the actual consumption of actual grain crops is already more than recommended, and still tend to increase. Meanwhile, the consumption of other food groups is still under the recommended level especially for root plants, livestock food, vegetables and fruits. The level of consumption of oil and fat as well as sugar is close to

TTTTable 9. Development in Quality of Consumption of Food based on PPHable 9. Development in Quality of Consumption of Food based on PPHable 9. Development in Quality of Consumption of Food based on PPHable 9. Development in Quality of Consumption of Food based on PPH Wilayah 1999 2002 2003* 2004* 2005

Kota 68,5 80,1 81,9 80,0 81,0

Desa 64,4 72,5 75,1 74,0 77,6

Kota+Desa 66,3 72,6 77,5 76,9 79,1

Sumber : Susenas berbagai tahun (diolah) *Data Modul

Level recommended. With the pattern of quantity and variety of consumption like this, the level of PPH could then reach the score of 79.

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Tabel 10. Comparison of Consumption of Recommended Food and ActualTabel 10. Comparison of Consumption of Recommended Food and ActualTabel 10. Comparison of Consumption of Recommended Food and ActualTabel 10. Comparison of Consumption of Recommended Food and Actual in the Year 1999 in the Year 1999 in the Year 1999 in the Year 1999----2005200520052005

(kcal/capita/dayi) Actual Consumption

No Food Group Recom-menda-tion

1999 2002 2003* 2004* 2005

1 Grain 1000 1240 1253 1252 1248 1241

2 Root Crops 120 69 70 66 77 73

3 Animal Meat Food 240 88 117 138 134 139

4 Oil+Fat 200 171 205 195 195 199

5 Fruits/oily seeds 60 41 52 56 47 51

6 Peas/beans 100 54 62 62 64 67

7 Sugar 100 92 96 101 101 99

8 Vegetables+fruits 120 70 78 90 87 93

9 Others 60 26 53 32 33 35

TOTAL 2000 1851 1986 1992 1986 1997

PPH Score 100 66,3 72,6 77,5 76,9 79,1

Source: Susenas(processed) * Module Data

C.C.C.C. ACCESS OF HOUSEHOLDS TO FOOD ACCESS OF HOUSEHOLDS TO FOOD ACCESS OF HOUSEHOLDS TO FOOD ACCESS OF HOUSEHOLDS TO FOOD

1.1.1.1. Availability of Food per TerritoryAvailability of Food per TerritoryAvailability of Food per TerritoryAvailability of Food per Territory

Rice is a staple food consumed by almost all of the poplation of Indonesia. Because of this, the production of rice becomes a very important indicator for its achievement to be given attention. During the period of 2001-2005 the availability of the grain originating from domestic production had increased on average of 1.8 percent per year, which increased from 50.46 million tons of milled rice with husk (GKG) in the year 2001 to become 54.15 million tons in 2005. By calculating the number of population, the production rate of the rice grain is equal to the availability of rice per capta as much as 137 kg/year. Reviewed from the spread of area, the rice production is still concentrated on the island of Java with a proportion of 55 percent. Sumatera island possesses a proportion of the rice production of 23 percent, Sulawesi as much as 10 percent, Kalimantan 6 percent, as well as Bali and Nusa Tenggara islands of 5 percent. (Tabel Tabel Tabel Tabel 11111111).

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Table 11 . Spread of Production of Staple Food According to Island Territory Table 11 . Spread of Production of Staple Food According to Island Territory Table 11 . Spread of Production of Staple Food According to Island Territory Table 11 . Spread of Production of Staple Food According to Island Territory

(in thousand Tons GKG)(in thousand Tons GKG)(in thousand Tons GKG)(in thousand Tons GKG) Island/Year 2001 2002 2003 2004 2005

J av a 28.312 28.608 28.167 29.636 29.764 Sumatera 11.287 11.542 12.136 12.666 12.675 Bali & Nusa Tenggara 2.696 2.647 2.725 2.807 2.616 Kalimantan 3.074 3.169 3.358 3.657 3.614 Sulawesi 4.983 5.438 5.602 5.171 5.301 Maluku & Papua 109 85 149 151 181

Indonesia 50.461 51.489 52.137 54.088 54.151

Source: BPS

Meanwhile the production of corn and other food commodities also increased. Corn production experienced the highest increase compared to other food commodities. Within that period, corn production increased with an average growth rate of 7.7 percent; cassava 3.3 percent; and manioc 1.7 percent per year. With this development of production, the availability per capita of the commodities of corn, cassava, and manioc in 2005 each respectively reached 57 kg, 88 kg, and 8,4 kg (Table 12).

Tabll 12. Availability of Rice and Food Harvests Per Kapita Tabll 12. Availability of Rice and Food Harvests Per Kapita Tabll 12. Availability of Rice and Food Harvests Per Kapita Tabll 12. Availability of Rice and Food Harvests Per Kapita (kg)(kg)(kg)(kg) Year Rice Corn Cassava Manioc 2001 135,4 44,8 81,7 8,4 2002 136,4 45,7 80,0 8,4 2003 136,3 50,8 86,5 9,3 2004 139,5 51,7 89,5 8,8 2005 137,9 57,0 87,9 8,4

The main protein source of food is mainly meat and eggs. The fulfillment of the national meat consumption of 65 percent comes from poultry and for as much as 19 percent from beef. For poultry the largest proportion is obtained from broiler chickens reaching 70 percent, while 24 percent are from other poultry (ayam buras). (Table 13).

Tabll 13. Development in Meat Production (in thousand tons) Tabll 13. Development in Meat Production (in thousand tons) Tabll 13. Development in Meat Production (in thousand tons) Tabll 13. Development in Meat Production (in thousand tons)

No Type 2001

2002 2003 2004 2005

1 Cow 338,69 330,29 369,71 447,57 358,70

2 Water Buffalo 43,64 42,30 40,64 40,24 38,10

3 Goat 48,70 58,17 63,86 57,13 50,60

4 Sheep 44,78 68,71 80,64 66,06 47,30

5 Pig 160,15 164,49 177,09 194,68 173,70

6 Horse 1,09 1,06 1,60 1,57 1,60

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7 Buras Chicken 275,14 288,34 298,52 296,42 301,40

8 Egg Laying Hens 88,30 42,78 48,15 48,38 45,20

9 Broiler chickens 536,95 751,93 771,12 846,10 779,10

10 Duck 23,12 21,78 21,25 22,21 21,40

Total 1.560,56 1.769,85 1.871,53 2.020,36 1.817,10

Source : Direct. Gen. For Animal Husbandry, 2006

Production of eggs in the year 2001 is 850 thousand tons which increased to 1.149 tons in 2005 (Table 14Table 14Table 14Table 14). The level of egg production has sufficed the need of domestic consumption. As with grain crops, the egg production is also concentrated on Java island and Sumatera, and the main provinces in egg production are East Java, Central Java, West Java and North Sumatera.

Livestock animal food which role is also important is the milk. Fulfillment of milk consumption currently still relies on the supply of imported milk poducts. The availability of milk from domestic production is still limited, and development of its production also tends to decline. In the year 2003 milk production achieved 553 thousand tons, then decreased to 550 thousand tons in 2004, and 536 thousand tons in 2004, and 536 tons in 2005.

Table 14. Development in Egg Production (in thousand tons)

Territory 2001 2002 2003 2004 2005

Java 433,2 476,6 484,0 596,6 607,3

Bali and Nusa Tenggara 25,7 26,1 37,1 44,2 44,8

Sumatera 280,7 287,7 309,2 324,3 341,3

Kalimantan 44,2 48,5 68,0 68,8 71,5

Sulawesi 63,9 67,0 71,0 68,2 78,4

Maluku and Papua 2,6 2,9 4,2 5,4 5,6

Outside Java 417,1 432,3 489,6 510,8 541,6

Indonesia 850,3 908,9 973,6 1.107,4 1.148,9

Source : Dept. Of Agriculture

2.2.2.2. Food Vulnerability Food Vulnerability Food Vulnerability Food Vulnerability

Availability of food on the makro level can not fully asure its availability in the micro level. The production matter which only happens in a certain area and certain time has caused concentrated availability in production centres and during harvesting time. The consumption pattern which is relatively the same among individuals, among time, and among regions have caused the presence of times of deficits and food deficit

RANPG 2006-2010 31

locations. Therefore, the market mechanism and food distribution among locations as well as among the time by relying on ”stock” which will influence the balance between availability and consumption as well as the price in the market. The balance factor which is reflected to the price is very much connected to the buying power of the household for food. Therefore, even though food commodity is available in the market however, if the price is too high and not affordable dy the household, then the household will not have any access to this available food. This kind of condition could cause vulnerability in food.

Food vulnerable people is defined as those who have an average energy consumption level between 71-89 percent of the energy adequacy norm. Whereas the population who are very vulnerable in food is less than 70 percent from the energy adequacy level.

The number of population which are food vulnerable still occurs in all the provinces with different amounts. Based on the SUSENAS data contained inthe Nutrition Map of Indonesia Year 2006, the lowest number of food vulnerable population exists in the province of Bali which is 4.8 percent, and the highest in the City of Yogjakarta which reaches 20.0 percent (Table 15Table 15Table 15Table 15). The proportion of the food vulnerable population in all the provinces is still above 10 percent, except for the province of West Sumatera, Bali and NTB. In fact in all the provinces which are food production centres like the province of East Java, Central Java, South Sumatera, West Java and Sulawesi the proportion of food vulnerable population is still quite high.

Furthermore, the number of children under five years of age having the status as bad nutrition status and malnutrition in these regions also is still high. The high proportion of food vulnerable households and children under five years of age having lack of nutrition indicates that food resilience in the national or territorial level does not always mean that the level of food resilience in the household and the individual is also fulfilled. Problems in distribtion and market mechanism that have influence to the price, household buying power in connection to poverty and household income, and level of knowledge regarding food and nutrition very much influences the consumption and adequacy of food and nutrition in the household.

Table 15. Number of Food Vulnerable Population According to ProvinceTable 15. Number of Food Vulnerable Population According to ProvinceTable 15. Number of Food Vulnerable Population According to ProvinceTable 15. Number of Food Vulnerable Population According to Province Number of Food Vulnerable

people No. Province

(Thousands of people)

(%)

1 NAD 295 17,1 2 North Sumatera 1.162 11,0 3 West Sumatera 305 7,2 4 Riau 621 13,1 5 Jambi 290 12,1 6 South Sumatera 1.182 17,1

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7 Bengkulu 221 13,9 8 Lampung 919 13,8 9 Bangka Belitung Islands 122 13,6 10 DKI Jakarta 1.404 16,9 11 West Java 6.224 17,5 12 Central Java 5.089 18,8 13 DI.Yogyakarta 621 20,0 14 East Java 6.684 19,3 15 Banten 690 10,2 16 Bali 144 4,8 17 West Nusa Tenggara 295 7,7 18 Nusa Tenggara Timur 565 14,9 19 West Kalimantan 614 16,5 20 Central Kalimantan 119 6,6 21 South Kalimantan 299 11,8 22 East Kalimantan 342 18,2 23 North Sulawesi 225 11,4 24 Central Sulawesi 210 10,5 25 South Sulawesi 1.185 15,2 26 Sulawesi Tenggara 227 12,8 27 Gorontalo 98 11,8 28 Maluku 161 15,3 29 North Maluku 113 16,9 30 Papua 335 19,1

*) Survey not totally conducted Source : Nutrition in Figures (2005) and Nutrition Map of Indonesia, 2006

3.3.3.3. Increase Access to FoodIncrease Access to FoodIncrease Access to FoodIncrease Access to Food

Every household has different capacities in fulfilling their need of food quantitatively as well as qulaitatively in order to fulfill sufficient nutrition. In connection with this, the government has applied various policies to assure that the household and individual possesses access to available food. Efforts or general policies applied are stabilization of staple food prices so that the existing market mechanism and distributioncould provide the staplefood with affordable prices. One of the policy instruments to stabilize prices is the food reserves possessed by the government.

Another policy is food subsidy/aid in the form of rice for the household for those having income under the poverty level. Considering that the rice is the most staple food being consumed, the main prority then of the government is to assure the people in order to be able to access to rice in sufficient amount.

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i.i.i.i. Food Price StabilityFood Price StabilityFood Price StabilityFood Price Stability

Rice price stability is measured based on the average price development and the coefficient of variation and continual monitoring. Within the period of the year 2000 – 2004, the development of the rice price in Java and Bali tends to be stable which is marked by a low price variation coefficient.

Policy in price control possesses two sides regulated by Presidential Instruction No. 13 Year 2005. On one side, the government applied the Government Purchase Price (HPP) to give an adequate production price to the farmers so that the farmers do not receive a lower price than the production cost. On the other side, the husk rice purchased from farmers are to be used for the operation of rice for the poor program and as a reserve government rice in order to stabilize the price in the consumer level.

The results of applying price incentives for farmers is reflected by the development of the Harvested Rice Husks (GKP) which indicates that the HPP policy gives adequate benefit to the farmers. Development in transaction prices that occur in general are higher than the HPP, except in areas difficult for access (isolated) or which the product commodity does not fulfill the purchase requirements.

In the consumer level during 2000-2004, the average monthly retail price for medium rice also does not experience any significant fluctuations. Trading among cross regions and cross islands is able to maintain price stability. During instances where certain regions occur great fluctuations, the government uses the rice reserves that it possesses in order to stabilize the price through market operation activities.

ii.ii.ii.ii. Rice For Poor Families (Raskin)Rice For Poor Families (Raskin)Rice For Poor Families (Raskin)Rice For Poor Families (Raskin)

Besides through market mechanism and food aid during disasters, the government also possesses food subsidies in the form of rice for the poor household. Rice for the poor households (Raskin), during the beginning was named Special Market Operations (OPK), which was released since July 1998. This program was applied as one of the efforts to overcome lack of food in poor households which during the economic crisis were the most who suffered. Through this progam, the government distributed rice with subsidized price therefore poor people with very limited buying power were able toobtain staple food, which was rice.

The amount of volume of rice distributed in the Raskin program kept on rising from year to year. In the year 2000 the amount reached 1.35 million tons, increased to 1.48 million tons in 2001, and 2.24 million tons in the year 2002. During the following years the volume of rice distributed was relatively stable around 2.0 million tons.

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In volume, the rice distributed under the Raskin program was quite large, however this has yet to fulfill all the needs according to the norms of 20 kg per month and all poor households. Until now the percentage of poor families that could be accessed is about 65 percent (Table 16)(Table 16)(Table 16)(Table 16).

The volume of Raskin rice which is not adequate to fulfill the need according to the norms is 20 kg/Head of Family/Month is still a constraint in implementation in the field. This constraint is taken care of by the community level through the village assembly. However as an effect, the rice was distributed to every poor family but in amount less than 20 kg. An evaluation survey conducted by 35 universities in the year 2003 found that on the average the Raskin rice received was 13.3 kg/Head of Family/month. Another implementation constraint is the existence of mistake in target. The number of recipients are surely poor families which are “considered having rights” which is estimated about 84 percent. This means that there are 16 percent distribution of Raskin which are not the precise targets. Several causes is the feeling of solidarity therefore making an even distribution to all the population, however there also exists where the cause is due to deviation conducted by the implementors. Separate from the presence of weaknesses in determining the recipient of the benefit, the Raskin program is considered giving contribution in reducing the poverty level by various reasons, which are : (1) the Raskin program has narrowed the poverty gap about 20 percent; (2) the level of consumed callories of poor families recipient of Raskin is higher, between 17-50 kcal per day compared to those that do not receive Raskin; (3) gives an indirect stimulation towards deman of aggregates due to the presence of a multiplication effect of the income transfer which increases the buying power of Raskin recipients (Tabor and Sawit, 2005).

Table 16. Volume of Rice and Number of target Families Table 16. Volume of Rice and Number of target Families Table 16. Volume of Rice and Number of target Families Table 16. Volume of Rice and Number of target Families

of the Rice Program for the Poorof the Rice Program for the Poorof the Rice Program for the Poorof the Rice Program for the Poor Poor

Families (PF) Distribution Plan

Distribution Realization Percentage of PF

Year

(Thousands of PF)

Rice (ton)

(Thousands of PF)

Beras (ton)

(Ribu KK) Plan Realization

2000 14.782,4 1.350.000 9.674,9 1.353.248 10.934,9 65,45 73,97

2001 15.135,6 1.501.274 9.835,4 1.482.030 8.316,2 64,98 54,94

2002 15.135,6 2.349.600 9.029,6 2.235.137 12.333,9 59,66 81,49

2003 15.746,8 2.057.438 8.574,9 2.023.864 11.832,9 54,45 75,14

2004 15.820,5 2.061.793 8.590,8 2.059.707 11.546,0 54,30 72,98

2005 15.790,0 1.992.000 8.300,0 1.991.131 11.207,9 52,56 70,98

Source: Perum BULOG

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iii.iii.iii.iii. Food ReservesFood ReservesFood ReservesFood Reserves

Besides being used for market operations in order to stabilize prices, the Government Rice Reserves (CBP) is also used to overcome food shortages that occur due to natural disasters. In a higher level CBP also is used to fulfill the commitment of the government of Indonesia in providing rice reserves in the frame of cooperation of the ASEAN Emergency Rice Reserve.

In order to fulfill the lack of food due to disasters, the Governor and Regent/Mayor have the authority to ask CBP directly with a maximum limit each of 200 tons and 100 tons within one year. With the existence of CBP and the authority possessed by the Head of the region, the people suffering from the impact of the disaster are able to fulfill their needs of their staple food consumption.

Until this moment the food reserves for the emergency response necessity is only in the form of rice. In emergency conditions at the time of disaster, the people have also difficulty to obtain fuel, clean water, as well as cooking utensils. Therefore, food aid in the form of rice often cannot overcome food shortages quickly. It is necessary to think about provisions of ready to be consumed food reserves for emergency needs, especially food which is liked by the local people. For this purpose, ready to use food reserves by the region and suitable with the consumption pattern of the region is very important to be developed. The mandate of Government Regulation Number 68 Year 2002 regarding Food Resilience for development of the regional food reserves development (regional government and people) until this moment has not been developed therefore causing steps to overcome the food problem which a larger part is still leaning on the Central Government which becomes the focal point.

D.D.D.D. FOOD SECURITY FOOD SECURITY FOOD SECURITY FOOD SECURITY

Issues regarding food secrity is an important problem because it is estimated that more than 90 percent of the health problems of the people is connected to food. Based on data of WHO (2000) it is known of diseases due to food (foodborne disease) which is the cause of 70 percent from about 1,5 billion incidences of diarhea, and every year causing 3 million deaths of children under 5 years of age.

In order to limit the occurrences of diseases due to food, supervision is conducted towards the food security among others by supervision of listed food products and examination of circulated food products. This is in line with the development of food security as mandated in Law No. 7 Year 1996 regarding Food and Government

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Regulation No. 28 Year 2004 regarding Security, Quality and Nutrition of Food. In this regulation, food security is defined as a condition and efforts needed to prevent food from the possibility of biological, chemical and contamination of other substances that could disturb, discredit and endanger the health of humans.

Besides that the strengthening of production of food also is supported by the application of various pracices and processes of food like : Good Caring Methods, Good Fresh Food Production Methods, Good, Good Processed Food Production Methods, Good Food Distribution Methods, Good Food Retail Methods, and Good Ready to Serve Food Production Methods. Other efforts are through institutional strengthening, building a food security network domestically and with foreign countries as well as strengthening the role of human resources (supervisor for food, producer and consumer). In the aspect of legislation, sveral responsibilities connected to food security activities are the preparation of regulations regarding the standards and food security limitations for example the type and safe method in using pesticides, the technology and process methods, storage and handling of food, type and maximum limit in using BTP (Additional Food Material), examination methods and maximum contamination limits of microbes, chemicals and other substances that influences the food security.

In order to assure the food quality, the role of producer in applying various technologies and principles in food processing is very important, including the package labeling. With the number of large and medium food processing companies numbering about 5900 and 1 (one) million small and household industries added by importers and distributors, this figure is the potencial and at the same time a challenge in producing safe food.

Land for farming, factory, distribution and food product selling places are parts of the system of food chain which are passed through by the food product. All facilities and means present in the area as well as the treatment received by the food product has a large opportunity to influence the food security. Because of this, the condition of the factory, the place of distribution and selling of the food product indirectly is one of the food security indicators. This indicator, indirectly could illustrate the knowledge and awareness of the producer in regard to food security.

1.1.1.1. Supervision of Food Supervision of Food Supervision of Food Supervision of Food before Circulationbefore Circulationbefore Circulationbefore Circulation

In order to produce quality food products from the asoect of health, quality and nutrition, the food industry should apply the principles of good food production methods. Examination of production means is conducted periodically by food supervisors in the frame of evaluating application of hygiene and sanitation of production means or Good Food Production Methods (CPMB) as well as applying the Good Ready to Serve Food Production Methods.

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Examination is conducted for industry that already possess a registration number MD for Food, household industry already possessing a registration number SP/P-IRT (Fostering Participation Certificate/Products- Household Industry) as well as household industri that are not registered. The results of evaluation of food production means are grouped into 3 (three) categories which are good (B), sufficient (C), and insufficient (D). The results of examination of production means for medium food industries and above (already obtained the MD number) within the perod of 2000-2005 can be seen in Table Table Table Table 17171717.

Table 17. Results of Examination of Medium and Above Industries Table 17. Results of Examination of Medium and Above Industries Table 17. Results of Examination of Medium and Above Industries Table 17. Results of Examination of Medium and Above Industries of their Production Meansof their Production Meansof their Production Meansof their Production Means

Results of Examination

Good Sufficient Insufficient Year Number

of Samples Sum % Sum % Sum %

2000 278 54 19.4 184 66.2 40 14.4

2001 229 56 24.5 143 62.4 30 13.1

2002 339 55 16.2 209 61.7 75 22.1

2003 741 105 26.1 236 58.7 61 15.2

2004 602 327 54.3 229 38.0 46 7.6

2005 570 91 16.0 390 68.4 89 15.6

From the Table 17 it can be seen that a large part of the medium scale industry and above have the predicate “sufficient” in applying CPMB. A significant increase occurred for the percentage of production means having Good predicate from the year 2000 (19,4 percent) to the year 2004 (54,3 percent), however in the year 2005 a decline re-occurred, becoming 16 persen.

The results of examination of production means for the household industry during the period 2000-2005 can be seen in Table 18 below. below. below. below.

Table 18. Results of Examination of Household Food IndustryTable 18. Results of Examination of Household Food IndustryTable 18. Results of Examination of Household Food IndustryTable 18. Results of Examination of Household Food Industry

of their Production Means of their Production Means of their Production Means of their Production Means Results of Examination

Good Sufficient Insufficient Yearn Number

of Samples Sum % Sum % Sum %

2000 1632 83 5.1 810 49.6 739 45.3

2001 1649 52 3.2 668 40.5 929 56.3

2002 2104 66 3.1 903 42.9 1135 53.9

2003 1536 157 10.2 512 33.3 867 56.4

2004 3951 337 8.5 1921 48.6 1693 42.8

2005 2555 101 4.0 1287 50.4 1167 45.7

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From the above table it can be seen that a large part of the household industry is still considered insufficient in applying CPBM. About a half of the household industry is still considered insufficient in applying CPBM, which are consecutively from the year 2000, 2001, 2002, 2003, 2004 and 2005 are 45 percent, 56 percent, 53 percent, 56 percent, 42 percent, and 45 percent.

The main cause factor of food product industry considered insufficient in applying CPMB is the still low application of personal hygiiene; lack of awareness in processing the environment like disposal of wastes; insufficient factory and cleaning facilities; production facilities not free from insects; as well as insufficient equipment and clean water supply.

Food distribution means that do not fulfill the requirements (TMS) consists of means that sell expired products, not registered, damaged, labelled TMS, specially marked, and means that sell TMS products like placing food products containing pork not separated from other products, and food products that are mixed with non food products. In the examination results of these distribution means, in one distribution mean could conduct several types of violations. The results of the examination indicates that a large part of the distribution means already has applied the CPMB and the percentage of distribution means fulfilling the requirements (MS) kept on increasing by the year, which is consecutively and respectively from the year 2000, 2001, 2002, 2003, 2004 and 2005 are 80 percent, 80 percent, 74 percent, 88 percent, 72 percent, and 71 percent.

In the frame of supervision before being circulated, evaluation is conducted in regard to the security, quality and nutrition of the food product and if it is in accordance to the requirements, a registration number therefore is issued. The food product data registered during the years 2001–2005 is based on groupings of food types which can be seen in Table 19 Table 19 Table 19 Table 19 below. From the data it can be seen that there is a tendency to increase the number of processed food products by medium and large registered industries and circulated in Indonesia.

Table 19. Issuance of Registration Number of Medium and LargeTable 19. Issuance of Registration Number of Medium and LargeTable 19. Issuance of Registration Number of Medium and LargeTable 19. Issuance of Registration Number of Medium and Large Scale Food Scale Food Scale Food Scale Food Products Products Products Products

YearYearYearYear TotalTotalTotalTotal

Domestic Food Domestic Food Domestic Food Domestic Food Imported Food Imported Food Imported Food Imported Food

2001 2539 765

2002 2227 1397

2003 1768 1735

2004 2793 1258

2005 5377 1843 Source: BPOM, 2006

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2. Supervision of Circulated Food ProductsSupervision of Circulated Food ProductsSupervision of Circulated Food ProductsSupervision of Circulated Food Products

The examination (sampling and examining) to circulated food periodically to registered food with the number MD/ML and SP/P-IRT, in order to assure conformity with the data and information accepted during the registration process. The results of examination during the years tahun 2001–2005 can be seen in Table 20 below.

Table 20. Results of Examination of Circulated Food ProductsTable 20. Results of Examination of Circulated Food ProductsTable 20. Results of Examination of Circulated Food ProductsTable 20. Results of Examination of Circulated Food Products

2001200120012001 2002200220022002 2003200320032003 2004200420042004 2005200520052005

Fulfilling Requirements 3.817 16.542 19.289 29.564 23.372

Not Fulfilling Requirements 1.399 1.396 1.258 3.176 3.934

Source: BPOM, 2006

From the results of the examination, it is known that a large part of food products that are circulated have fulfilled the requirements with a percentage during the years 2001, 2002, 2003, 2004, and 2005 which are respectively 73 percent, 92 percent, 94 percent, 90 percent and 86 percent.

i.i.i.i. Food Products Not fulfilling Requirements (TMS)Food Products Not fulfilling Requirements (TMS)Food Products Not fulfilling Requirements (TMS)Food Products Not fulfilling Requirements (TMS)

There are several parameters which determine if a food product is categorized as a product not fulfilling the requirements, among others the use of prohibited additional food material, use of additional food material exceeding the permissible maximum level as well as containing contamination exceeding the permissible maximum level. In one product alone it is possible to find more than one TMS criteria.

During the years 2002 – 2005, violations that are most often found are food products that use artificial sweetening that are not in accordance to the stipulations. Other criteriae include the overall weight, labelling, the content and use of additional food material that are not permissive as well as prohibited. In Table 21Table 21Table 21Table 21 can be seen the percentage of the results of supervision during the years 2001 – 2005.

Table 21. Percentage of Violation in Food Prodycts RESULTS OF

EXAMINATION 2001 2002 2003 2004 2005

Number of Samples %

Number of Samples %

Number of Samples %

Number of Samples %

Number of Samples %

Number of Samples 5216 17938 20547 32740 27306 A. Number of samples fulfilling requirements 3817 73,18 16542 92,22 19289 93,88 29564 90,30 23372 85,59

B. Number of TMS 1399 26,82 1396 7,78 1258 6,12 3176 9,70 3934 14,41

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samples :: - TMS artificial sweetening 219 15,65 645 46,20 326 25,91 - 844 21,45

- TMS preservatives 229 16,37 170 12,18 52 4,13 372 11,71 216 5,49 - Formaldehyde 137 9,81 82 6,52 213 6,71 282 7,17

- Borax 127 9,10 106 8,43 538 16,94 307 7,80 - Non food coloring 190 13,61 204 16,22 967 30,45 445 11,31 - TMS microbe contamination 79 5,65 - 33 2,62 748 23,55 225 5,72

- Others 811 57,97 - 475 37,76 338 10,64 1605 40,80 Source: BPOM, 2006 Legend : Number of samples equals the sum of A and B.

During the period 2002–2005, supervision had been conducted to snack food products for school children. Table 22Table 22Table 22Table 22 shows data on the results of examination of snack food products for school children in the years 2002 - 2005.

Tabel 22. Percentage of results in Supervision of Food Snacks

for School Children RESULTS OF

EXAMINATION 2002 2003 2004 2005

Number of Samples %

Number of Samples %

Number of Samples %

Number of Samples %

Number of samples fulfilling requirements 913 56,12 393 59,91 390 42,81 517 60,05

Number of samples not fulfilling requirements 714 43,88 263 40,09 521 57,19 344 39,95

Source: BPOM, 2006

From the results of examination it can be seen that the criteria of not fulfilling the requirements have been found because of violations in using preservatives exceeding the maximum level, the use of dangerous formaldehyde, borax, rhodamin-B, misuse of artificial sweetening and microbe contaminated food exceeding the maximum level. In one food product sample there may be found more than one TMS criteria. The following Tabel 23Tabel 23Tabel 23Tabel 23 shows the data of the results of examination of snack food for school children for the years 2002-2005:

Table 23. Number of Violations in Various Criteriae not FulfillinTable 23. Number of Violations in Various Criteriae not FulfillinTable 23. Number of Violations in Various Criteriae not FulfillinTable 23. Number of Violations in Various Criteriae not Fulfilling requirementsg requirementsg requirementsg requirements Number of Violations in the Year Criteria Not Fulfilling Requirements

(TMS) 2002 2003 2004 2005 Artificial sweetening exceeding requirement limits

282 154 402 122

Preservatives exceeding limits 86 8 19 10 Prohibited Coloring (Rhodamin-B, Methanyl yellow, Amaranth)

133

63

147

90

Formaldehyde 139 9 1 7

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Borax 74 20 38 34 Microbe contamination No data 9 198 198 Source: BPOM, 2006

ii.ii.ii.ii. Food Products Containing Dangerous SubstancesFood Products Containing Dangerous SubstancesFood Products Containing Dangerous SubstancesFood Products Containing Dangerous Substances

From the results of examination during the period from the year 2002 until 2005, violations have been found in the use of dangerous substances in food products. Dangerous substances found in food products consists of substances prohibited to be used in food products like Formaldehyde (Formalin), Borax, Rhodamin B and Methanyl Yellow (Table 24Table 24Table 24Table 24). The use of these dangerous substances could be due to the limited knowledge of producers in regard to the stipulations in prohibiting the use in food production or even the lack of concern towards security of food products that badly affect the health.

Table 24. Data of Findings of Dangerous Substances in Food Products

Year Total Samples Finding of Dangerous Substances **)

Sum %

2002 19078 454 2 2003 20547 392 2 2004 32740 1718 5

2005*) 26990 935 3

Source: BPOM, 2006

**) Consisting of Formaldehyde, Borax, Rhodamin B, and Methanyl Yellow

Table 25 Table 25 Table 25 Table 25 shows findings of formaldehyde in food products during the period of the year 2002 until 2005. From this table it can be seen that since the year 2002 formaldehyde (formalin) had been found in food products, and the percentage of food products containing formaldehyde since the year 2002 until 2005 experienced a decline.

Table 25. Findings of Formaldehyde in Food ProductsTable 25. Findings of Formaldehyde in Food ProductsTable 25. Findings of Formaldehyde in Food ProductsTable 25. Findings of Formaldehyde in Food Products

YearYearYearYear Total Total Total Total

SamplesSamplesSamplesSamples Findings of Food ProductsFindings of Food ProductsFindings of Food ProductsFindings of Food Products Containing FormaldehydeContaining FormaldehydeContaining FormaldehydeContaining Formaldehyde

NumberNumberNumberNumber %%%% 2002200220022002 248 139 56 2003200320032003 180 73 41 2004200420042004 786 274 35 2005200520052005*)*)*)*) 1160 177 15

Source: BPOM, 2006 *) Data until the month of November 2005

Further examination of certain types of food containing formaldehyde was conducted since 6 January 2006. Monitoring was conducted to wet noodle products, soy bean curd and fish in several provinces in Indonesia. The following Table 26Table 26Table 26Table 26 shows the

Comment [AH1]:

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results of monitoring of wet noodles, soy bean curd and fish in 6 (six) provinces in the use of formaldehyde.

Table 26. Results of Monitoring of Wet Noodle Products, Soy Bean Curd Table 26. Results of Monitoring of Wet Noodle Products, Soy Bean Curd Table 26. Results of Monitoring of Wet Noodle Products, Soy Bean Curd Table 26. Results of Monitoring of Wet Noodle Products, Soy Bean Curd and Fish in Six Provincesand Fish in Six Provincesand Fish in Six Provincesand Fish in Six Provinces

Sample CollectorSample CollectorSample CollectorSample Collector Number Number Number Number

of of of of SamplesSamplesSamplesSamples

Fulfilling Fulfilling Fulfilling Fulfilling RequirementsRequirementsRequirementsRequirements

Containing Containing Containing Containing FormaldehydeFormaldehydeFormaldehydeFormaldehyde

SamplesSamplesSamplesSamples %%%% SamplesSamplesSamplesSamples %%%% BBPOM Makasar 40 38 95 2 5 BPOM Jambi 50 48 96 2 4 BBPOM Manado 55 36 65 19 35 BBPOM Yogyakarta 41 41 100 0 0 BBPOM Jakarta 116 91 78 25 61 BBPOM Semarang 107 99 93 8 7

Sum 409 353353353353 56 14141414

Source: BPOM, 2006

The security condition of food products can also be seen from the number of food rejection cases of ffod exported to other countries. Various factors that determine the acceptance or not of such food among others is the security factor (chemical, microbe and physical contamination), the quality factor, labeling factor, producer and others. Figure 6 illustrates the reason rejection of food products from Indonesia by the Food and Drug Administration (FDA), United States of America.

Sumber : Food Drug Administration, 2006

Figure 6Figure 6Figure 6Figure 6 . Number of Indonesian Food Import Rejecti . Number of Indonesian Food Import Rejecti . Number of Indonesian Food Import Rejecti . Number of Indonesian Food Import Rejection Cases by the FDA on Cases by the FDA on Cases by the FDA on Cases by the FDA

Number of Indonesian food import rejection cases based on reasons of rejection (February 2005 – January 2006)

(N = 235)

212

23

Food Security Labelling, Producer, etc

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The large number of cases of rejection with the reason of food security indicates the low level of food product security, which may originate from the food raw materials used not fulfilling the requirements or not yet applying the good principles in handling, processing, packaging or the distribution.

Fishery products are more rejected than other products. This is due to the reason that fishery products are considered in the high risk food group and is a main export commodity if compared to other food products. From the data released by the FDA (2006) it is seen that during the year 2005 a large part of the food rejected are fishery products with the reason among others are the cleanliness of the product, contamination of Salmonella, contamination of nitrofuran, contamination of histamin, contamination of feed drugs, the labeling, containing toxins, and Chloramfenicol. Whereas for processed type food besides fishery products the reason for rejection was mistake in labeling, usingunsafe coloring, and unlisted producers. The total rejection from February 2005 – January 2006 is 235 cases.

iii.iii.iii.iii. The case of Food PoisoningThe case of Food PoisoningThe case of Food PoisoningThe case of Food Poisoning

The main parameter that can be easily seen to indicate the level of food security of a country is the number of toxic cases occuring due to food. The data obtained based on reports received covering a number of Extraordinary Incidences (KLB) of food poisoning, the number of ill patients, and the number of deaths.

Table 27Table 27Table 27Table 27 shows, in the period of 5 years (2001-2005) the number of KLB poisoning as well as contaminated people, ill and deaths due to poisoning tends to increase; the case also with the Case Fatality Rate (CFR) and Incident Rate (IR). During the last 2 years the largest IR value happened in the Special Province of Yogyakarta. However this does not indicate that KLB food poisoning in Yogyakarta is more worse compared to other regions. The high value of IR in Yogyakarta may be caused by the good awareness of the local health personnel in reporting this KLB food poisoning in the area. It is suspected that there are still many KLB food poisoning that have yet to be reported in Indonesia.

Table 27. Number of cases of Poisoning in the Year 2001 Table 27. Number of cases of Poisoning in the Year 2001 Table 27. Number of cases of Poisoning in the Year 2001 Table 27. Number of cases of Poisoning in the Year 2001 ---- 2005 2005 2005 2005

Year KLB Contaminated Ill Deaths CFR*) IR**)

2001 26 1965 1183 16 1.35 0.54

2002 43 6543 3635 10 0.28 1.67

2003 34 8651 1843 12 0.65 0.84

2004 164 22297 7366 51 0.69 3.37

2005 184 23864 8949 49 0.55 4.11

*) Case Fatality Rate (CFR): ratio between number of deaths and ill multiplied by 100. **) Incident Rate (IR) is the number of incidences per 100.000 population.

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Source: BPOM, 2006

Reviewed fro the ethyology aspect, the cause of KLB food poisoning reported in the year 2005 is konown as 5.43 percent confirmed, 18.48 percent suspected and 76.09 percent having unknown causes. The cause of microbiology food poisoning which often arise among others are Staphylococcus aureus, Bacillus cereus, Salmonella sp, dan E.coli patogen. Meanwhile the causes of chemical food poisoning are among others nitrite, histamine, formaldehyde, cyanide, methanol, as well as tetradotoxine.

The source of food as a cause of food poisoning in the year 2004 are : household food (53,7 percent), processed food (15,2 percent), fast foods (15,2 percent), snack/small foods (12,2 percent), as well as not reported (3,7 percent); whereas in the year 2005 are household food (42,4 percent), processed food (15,2 percent), fast foods (21,2 percent), snack/small foods (17,9 pecent), and others (3,3 pecent).

E.E.E.E. HEALTHY LIVING PATTERN AND PHYSICAL ACTIVITYHEALTHY LIVING PATTERN AND PHYSICAL ACTIVITYHEALTHY LIVING PATTERN AND PHYSICAL ACTIVITYHEALTHY LIVING PATTERN AND PHYSICAL ACTIVITY

As a developing country, Indonesia has experienced many problems in contagious diseases. However, the prevalence of non contagious diseases indicates the tendency to increase as a cause of death. The results of the Household Health Survey (SKRT) shows, death caused by degenerative diseases have increased from 15.4 percent (1980) to become 48,5 pecent (2001). Cardivascular disease increased from 9,1 percent (1986) to 26,4 percent (2001). Cardivascular disease becomes the 11th cause of death in the year 1972, but then increased to become the number 3 in the year 1986 and the first cause of death in 1992, 1995 and 2001.

The prevalence of hypertension disease or high blood pressure in Indonesia is quite high, which is 83 per 1.000 members of household in the year 1995. In the year 2001, the population of 25 years of age and higher of as much as 27 percent of males and 29 percent of females suffer from hypertension, 0.3 percent experienced ischemic heart disease, and stroke, 1.2 percent experienced diabetes and 1.3 percent of males and 4.6 percent of females experienced excess weight. Cancer disease is the cause of 6 percent of deaths in Indonesia.

Figure 7,Figure 7,Figure 7,Figure 7, shows increase in overweight (IMT e” 25) in male and female. Furthermore also with hyperglichemia as an effect of high fat consumption as well as hypercholesterol.

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8.1

26.6

8.9

5.8

17.3

28.9

5.97.2

12.7 12.2 12.9

9.2

24

15.5

9.7

16.7

0

5

10

15

20

25

30

35

Kegem

ukan

Hiper

tens

i

Hiper

glikem

a

Hiper

kolester

ol

Kegem

ukan

Hiper

tens

i

Hiper

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Figure 7. Prevalence of Degenerative Disease Patients in the Year 2001 and 2004Figure 7. Prevalence of Degenerative Disease Patients in the Year 2001 and 2004Figure 7. Prevalence of Degenerative Disease Patients in the Year 2001 and 2004Figure 7. Prevalence of Degenerative Disease Patients in the Year 2001 and 2004

Increase of prevalence of noncontagious diseases like cardiovascular, hypertension, cancer and others indicates a presence ofchange of the living pattern, especially bad eating habits and reduced physical activity.

Scientific evidence shows that good eating habits and physical activity could lower the risk in developing diabetes for as much as 58 percent, hypertension 66 percent, as well as heart attacks and stroke 40-60 percent. Besides that, one third of types of cancer could be avoided by applying healthy living pattern, increase physical activity and reduce consumption of saturated fats.

In many countries, including Indonesia, the risk factor causing illnesses and deaths include hypertension, hypercholesterol, insufficient consumption of fruits and vegetables, overweight and obesity, low physical activity, as well as tobacco consumption. All these risk factors are the cause of non contagious diseases (The World Health Report 2002). Therefore the eating pattern and physical activity is a part of the main cause of non contagious diseases, like diabetes, cadivascular, cancer, caries of the teeth and osteoporosis. Smoking also increases the risk towards the attack of these noncontagious diseases.

Male Female

Source : SKRT 2001, 2005

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1.1.1.1. Unhealthy Eating PatternUnhealthy Eating PatternUnhealthy Eating PatternUnhealthy Eating Pattern

Unhealthy eating pattern could cause various illnesses. For example the low consumption of fruits and vegetables is estimated to cause 31 percent of ischemic heart disease, 11 stroke and 19 percent gostrointestinal cancer (WHO 2005). Unhealthy eating pattern among others consists of eating excessively, low consumption of fruits and vegetables, high consumption of salt, sugar and fat.

Increases in industrialization, urbanization and mechanization could cause the occurrence of changes in the eating pattern, which is food rich in fat and energy while the physical activity is becoming less. In many countries, including Indonesia, the problem of nutrition occurs more at the same time with malnutrition and bad malnutrition in the population, in fact even in the same family.

The increase of excessive nutrition incidence not only happens to the population having adequate income to purchase food, but also to the poor population in the cities and villages as well as male and female. The HKI data shows that prevalence of excessie nutrition (IMT>25) of females in villages from the years 1991-2001 shows a tendency of increasing in all age groups with a tendency for overweight occurring in the middle aged (Figure 8Figure 8Figure 8Figure 8). However the incidence of over nutrition also occurs in children but with a smaller prevalence.

0

10

20

30

40

50

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Umur (t ahun)

1999

2000

2001

Eating habits connected to overweight and obesity among others is the habit of

eating snacks and eating in restaurants. Babies that do not get exclusive breast feeding milk are also having the risk to be overweight. The influence of the environment like advertisements and promotion gives a contribution for increasing consumption of food with a high energy density like fat and carbohydrates. Other factors that also drives overweight and obesity among others are the increasing numbers of ready to serve restaurants, increase consumption of sugar containing dinks and fruit juice.

Figure 8. Prevalence of Excessive Nutrition in Adult Women (villages, Figure 8. Prevalence of Excessive Nutrition in Adult Women (villages, Figure 8. Prevalence of Excessive Nutrition in Adult Women (villages, Figure 8. Prevalence of Excessive Nutrition in Adult Women (villages, NSSNSSNSSNSS----HKI 1999HKI 1999HKI 1999HKI 1999----2001)2001)2001)2001)

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i.i.i.i. Lack of Consumption of Fruits and VegetablesLack of Consumption of Fruits and VegetablesLack of Consumption of Fruits and VegetablesLack of Consumption of Fruits and Vegetables

Fruits and vegetables are an important part of the good healthy eating pattern. Fruits and vegetables adequately consumed could prevent cardiovascular and cancer diseases. According to The World Health Report 2002, low consumption of fruits and vegetables is estimated to be the cause of 31 percent of ischemic heart diseases and 11 percent stroke. In the whole world 2.7 million lives could be saved every year if consumption of fruits and vegetables could be increased.

The Joint FAO/WHO Expert Consultation on diet, nutrition and the prevention of chronic diseases has recommended consumption of a minimum of 400 grams of fruits and vegetables per day (not including potatoes and root plants that contain starch) in order to prevent chronic diseases like heart, cancer, diabetes and obesity, at the same time as an effort for prevention of micro malnutrition. Adequate consumption of fruits and vegetables will give also an adequate amount of food fibres into the body.

According to data of Susenas 2004, the percentage of expenditure for fruits ad vegetables in the household level tends to decline. In the year 2002, expenditures for vegetables and fruits each respectively is 2.84 percent and 4.73 percent; then decline to 2.61 percent and 4.33 percent in the year 2004. The decline of expenditures for fruits and vegetables have caused the decline of average consumption of fruits and vegetables in Indonesia. In the year 1999, the consumption of vegetables and fruits was 309 grams per capita per day; this figure declined in 2004 to 221 grams per capita per day (Susenas 1999 and 2004). The low consumption of fruits and vegetables contributed to the low consumption of fibres which newly reached an average 10 gr/day, which is far lower from sufficient which is 30 gr/day ( Jahari AB, 2000).

Efforts in increasing the habit consuming fruits and vegetables as one of the healthy life styles actually has been supported with the abundant availability of fruits and vegetables. Production of vegetables and fruits indicates an increasing pattern. In the year 2004 the production level of vegetables had reached 9.1 million tons and became 9.2 tons in the year 2006 or experienced an increase of 0.54 percent per year. Production of fruits also incrased from 14.3 million tons in the year 2004 to 15.5 tons in the year 2006, or an increase of 3.91 percent per year.

ii.ii.ii.ii. Excessive consumption of salt, sugar and fat Excessive consumption of salt, sugar and fat Excessive consumption of salt, sugar and fat Excessive consumption of salt, sugar and fat

Excessive consumption of salt, sugar, and fat also is one of the characteristics of unhealthy eating habits. Excessive consumption of these foods could increase the risk of attack of hypertension, diabetes, cardiovascular, stroke, and other chronic diseases. Because of this, the increase in knowledge of the people regarding eating habits in connection with salt, sugar and fat needs to be enhanced.

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Consumption of salt by the population of Indonesia in the year 1999 reached 5.6 grams per capita per day, and in the year 2004 increased to 6.3 grams per capita per day. According to the Indonesian National Standards (SNI) the content of Sodium Chloride in salt minimal is 97.1 percent (Class I) and 94.7 percent (Class II). Besides that SNI obliges iodization to the salt consumed in order to increase the iodine content, with a minimal content of Potassium Iodate of 30-80 mg/kg.

The WHO Technical Report on Diet, Nutrition and the Prevention of Chronic Disease recommended a reduction in salt consumption as a part og good eating habits to reduce the risk of non contagious chronic disease attack. However the efforts to reduce the salt consumption, until this moment has not become a national policy because of several challenges like efforts to reach consumption of iodized salt for all (Universal Salt Iodization or USI).

Adequate consumpption level of iodized salt newly reached 72.81 percent in the year 2005 (Susenas 2005). Because disorders as aneffect of lack of iodine (GAKY) is still the main problem in Indonesia, the government then stipulated a policy to increase iodized salt consumption coverage. One of the main messages that have been brough forth from 13 General Messages for Balanced General Nutrition (PUGS), is ”use only iodized salt”. Therefore there were nospecial messages to reduce the consumption of salt, as recommended in the Technical Report of WHO mentioned above.

In consideration of the two matters that occur at the same time (co-exist) which is GAKY which demands increase of iodized salt consumption, and the development of contagious diseases which recommend reduction of consumption of salt, therefore a strategic step must be taken in stipulation of the policy for consumption of salt so that the benefit could be maximally felt.

Consumption of food having high energy density also contribute to the increase of overweight and obesity which in the end increases the incident of diabetes. One of the type of food that has a high energy density is sugar. The household data for consumption indicates sugar consumption in Indonesia has increased on the average of 22.6 grams per capita per day (year 1999) to 24.4 grams per capita per day (year 2004).

Besides salt and sugar, excessive consumption of fat, especially saturated fat also increases the risk of various chronic diseases. The change in the consumption pattern to types of food that contain much fat among others is influenced by globalization therefore types of fatty food becomes easier to obtain, changes in the life style by increasing consumption of ready to serve food and others. The risk of attack by diseases will be higher, if consumption of fat, salt and sugar is not followed by sufficient physical activity.

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2.2.2.2. Lack of Physical Activity Lack of Physical Activity Lack of Physical Activity Lack of Physical Activity

The absence or low physical activity and the unbalanced consumption pattern is estimated globally to cause increase prevalence of overweight and causing the incidence of 22 percent ischemic heart disease, 10-16 percent breast cancer, cancer of the intestines and rectal cancer as well as diabetesmellitus. In whole there are 1.9 million deaths caused by low physical activity. Food and physical activity could influence the healthin both or separately. The effect of eating pattern and physical activity has an interaction, especially in connection with obesity, the physical activity is the main method in increasing physical and mental health of the individual.

Results of the SKRT in the year 2004 shows a large part (more than 84 percent) from the 15 years and above age groups are not very active conducting physical activity, as much as 9.1 percent in fact are not active, and only 6 percent are doing physical activity actively. (Figure 9)Figure 9)Figure 9)Figure 9).

Less Active

84.9%

Not Active

9.1%Active

6.0%

Not Active

Less Active

Active

Figure 9. Activity level of the population above 15 years of age (2004)Figure 9. Activity level of the population above 15 years of age (2004)Figure 9. Activity level of the population above 15 years of age (2004)Figure 9. Activity level of the population above 15 years of age (2004)

The current living pattern of the young adult generation as experienced changes because of the influence of the environment, the infrastructures and the living style. The habit of walking, for example is replaced by the existence of transportation and better infrastructure facilities. Beside that, the limitation of facilities for physical activities in

Active: exercise every day for 10 minutes, total cumulative 150 minutes/week Less Active: exercise every day for 10 minutes, total cumulative <150 minutes/week

Source : Susenas, 2005

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schools and public facilities have caused further lack of physical activities being conducted. Various types of entertainment, meetings and other acivities often demand the physique to be inactive, like watching television, films, shows and so on.

Population growth has caused the reduction of open areas and public facilities as well as sports facilities. With the absence of comfortable and adequate sports facilities, added by the lack of knowledge, awareness and motivation this has caused the frequency to have sports as one of the forms of physical activity also to even become lower.

3.3.3.3. Habit of Smoking Habit of Smoking Habit of Smoking Habit of Smoking

Tobacco, cogarettes, and the smoke containing nikotin and other chemical substances causing addiction as well as health disorders. There are more than 4.000 chemical substances contained in one cigarette, 60 of them are carcinogenic in nature that could cause the incident of cancer. People who are in contact with the chemical substances, active smoker as well as passive, have a larger risk to be attacked by various diseases of cancer, heart disease, stroke, emphysia and other diseases.

Besides the impact toward health, smoking also has a direct impact towards the nutrition status, which among others area the decreasing of the vitamin and mineral content in the body, decreasing the vitamin C content from the body tissue and blood as well as reducing the vitamin D level in the body. A research shows the presence of a difference in the consumption pattern between a smoker and nonsmoker. The smoker consumes much more : energy, total fat, saturated fat, cholesterol and alcohol; however consuming lesser multiple non saturated fat, fibres, vitamin C, Vitamin E, and beta carotene. The consumption pattern of the smoker like this increases the bad effects like cancer and heart attacks.

The use of tabacco is one of the main contributors of illnesses in among the poorest population in Indonesia. In the year 2004, about 34 percent of the population of 15 years old and above smoke, with a higher prevalence in the village areas (36,6 percent), compared to the city area (31,7 percent), Table 28Table 28Table 28Table 28. This figure increases from 27,7 percent in the year 2001 (Figure 10)Figure 10)Figure 10)Figure 10).

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26.2327.7

34.44

0

5

10

15

20

25

30

35

40

1995 2001 2004

Pe

rce

nt

FFigure 10. Percentage of the Population aged 10 years old and above that Smoke during the Last Month (For 2005: 15 Years Old and Above)

About 77,9 percent of these smokers started smoking before the age of 19 years old, at the time when they were not able to understand the risk of smoking and nature of nicotine which is very addictive. Because a large part (91,8 percent) of smokers at the age of 10 years old and above smoke in the house when they are togerther with other family members, it is estimated that the number of children passive smokers are 43 million people.

Table 28. Percentage of Population Above 15 Years of Age that Smoke Within the

Last Month Per Province According to Territory in the Year 2004

Province City Village Total Province City Village Total

NAD 32.50 36.57 35.4 Bali 25.05 23.53 24.30 North Sumatra 34.07 34.36 34.23 NTB 31.63 33.23 32.62

West Sumatra 32.64 34.95 34.22 NTT 24.75 27.81 27.28 Riau 34.60 40.62 37.86 West Kalimantan 30.27 40.30 37.44

Jambi 32.44 39.51 37.42 Central Kalimantan 29.35 39.29 36.29

South Sumatra 32.02 44.04 39.76 South Kalimantan 24.02 29.47 27.36 Bengkulu 31.88 41.62 38.75 East Kalimantan 26.80 33.20 29.64

Lampung 39.53 39.41 39.44 North Sulawesi 29.49 41.98 37.14

Bangka Belitung 32.10 31.47 31.74 Central Sulawesi 23.08 37.20 34.19 DKI Jakarta 31.21 - 31.21 South Sulawesi 25.32 30.67 29.02

West Java 36.87 41.19 38.91 Southeast Sulawesi 25.78 33.26 31.53

Central Java 29.10 35.14 32.62 Gorontalo 34.37 41.32 39.39 DI Yogyakarta 27.17 31.07 28.76 Maluku 28.83 33.69 32.22

Jawa Timur 28.74 35.20 32.48 North Maluku 35.60 44.41 41.90

Banten 36.17 41.09 38.31 Papua 30.77 40.93 38.38

Indonesia 31.72 36.60 34.44

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In Indonesia, the use of tobacco constributes quite large to the burden of health. One of two smokers in the long term, dies because of this habit, and half of the deaths occuri their economic productive age. Smoking not only influences to health care costs, but also reduce the work productivity. The group of the poor is the most of disadvantage because the use of tobacco. In 2001, the poorest population use 9.1 percent of their monthly expenditures for tobacco, compared to 7.5 percent of the rich people group. The percentage of expenditures for tobacco in the group of poor exceeds the expenditure for health and education which is only 2.5 percent (village area) and 5.9 percent (city area). The expenditure for smoking, actually could be used to fulfill the nutrition consumption of the family. Buying tobacco products more than expenditures for food has a large impact to the health and nutrition of poor families.

Several steps recommended to reduce the demand of smoking among others is the applying of high price and taxation, protection towards contact to tobacco smoke, regulating the nicotine content, regulating the packaging and labeling, education, prohibition of advertisement and promotion of cigarettes, stern measures to black market trading, prohibition of selling to children and provisions of alternative activities economically for farmers and employees of tobacco factories.

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CHAPTER IV. ACTION PLAN CHAPTER IV. ACTION PLAN CHAPTER IV. ACTION PLAN CHAPTER IV. ACTION PLAN

A. A. A. A. STRATEGIC ISSSTRATEGIC ISSSTRATEGIC ISSSTRATEGIC ISSUEUEUEUE

Based on the analysis of the situation of the food and nutrition in the previous chapters, several strategic issues have been obtained which still need to get attention and further handling in the National Action Plan for Food and Nutrition 2006-2010. These strategic issues are divided into five groups in connection with: (i) accessibility to food, (ii) nutrition, (iii) food security, (iv) healthy living behavior, and (v) institutionalization.

1. Strategic issues linked to Food are as follows :1. Strategic issues linked to Food are as follows :1. Strategic issues linked to Food are as follows :1. Strategic issues linked to Food are as follows :

i. Limitation in production capacity for rice and carbohydret source of local food as well as the limted production of food from livestock.

ii. Availability of food in the household level is still becoming a problem and influences the level of adequacy of nutrition consumption even though on the national scale the availability of food in the market is adequate. The main problem is increasing the effectiveness and efficiency of food distribution among regions and time as well as the household buying power therefore able to access to food.

iii. Pola konsumsi pangan masih didominasi oleh kelompok padi-padian terutama beras, konsumsi sayuran dan buah sebagai sumber vitamin dan mineral serta protein hewani masih rendah.

2. Strategic Issues Linked to Nutrition are as f2. Strategic Issues Linked to Nutrition are as f2. Strategic Issues Linked to Nutrition are as f2. Strategic Issues Linked to Nutrition are as follows :ollows :ollows :ollows : i. The still very high prevalence of malnutrition in children under five years of age is

very close related to matters of KEK in WUS and the decline of the habit in giving exclusive breast feeding milk for 6 months, especially by city women and women workers.

ii. The still lack ofawareness to nutrition matters due to low level of education and lack of knowledge regarding the most critical period in increasing nutrition (Window of Opportunity), which are pregnant mothers, babies, and children until 2 (two) years of age become a constraint in the efforts of nutrition improvement.

iii. The still low level of health of poor people due to low access to basic health services, the low quality of the basic health services, lack of understanding of healthy living behavior, and lack of reproduction services.

iv. Increase of matters in excess nutrition due to the high level of consumption of food rich in carbuhydrates, fat, salt, low fibre, habit of smoking and lack of physical activities causing excess nutrition is one of the causes of degenerative diseases (not contagious).

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v. The still high figure of infectious diseases in children under five years of age causing decline in the nutrition status, especially in connection to the status of drinking water and sanitation of the surroundings or environment which is still far from being adequate, as well as insufficient health services. Various infections with a high rate of incidence among others are the dengue fever, diarhea and upper rspiratory infection (ISPA).

3. Strategic Issues Linked to Food Security are as follows :3. Strategic Issues Linked to Food Security are as follows :3. Strategic Issues Linked to Food Security are as follows :3. Strategic Issues Linked to Food Security are as follows :

i. Awareness in food security of the producers and consumers still needs to be increased because the awareness of food security, would be the beginning of efforts to create food products that are safe to be consumed.

ii. Availability of supervisors is still limited, awareness of the producers and consumers is still low, as well as the availability of limited food examination materials still is a constraint in applying the food security standard consistently.

iii. The still large use of dangerous additional food substances, especially in small and medum food industries and households. Efforts to limit and avoid the use of dangerous addtional food substances become difficult because of the limitation of supervisors and law enforcers as well as the low knowledge and awareness of the peole, the consumers as well as the food industries.

iv. The still to be developed alternative additional food products that are safe and affordable is still one of the factors of numerous use of dangerous additional food substances in the food industry.

4. Strategic Issues Linked to the Healthy Living Pattern are as follows :4. Strategic Issues Linked to the Healthy Living Pattern are as follows :4. Strategic Issues Linked to the Healthy Living Pattern are as follows :4. Strategic Issues Linked to the Healthy Living Pattern are as follows :

i. The still lack of efforts in advocacy and education regarding the importance of physical activity for the health which needs support and commitment as well as agreement of other sectors especially in providing sports facilities and opn space for physical activity as well as efforts in increasing knowledge and awareness of the people.

ii. Currently lack of nutrition matters, whether macro or micro, they occur at the same time (co-exist) with excessive nutrition and chronic diseases, however there is not yet a strategy or method that is comprehensive in efforts to overcome lack of nutrition, which at the same time also takes care of excessive nutrtion and chronic diseases. As an example, efforts in increasing consumption of energy could have an impact on the increase of consumption of excessive salt because giving iodine is conducted through fortification of salt.

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iii. The still low awareness of the people in applying the habit for consuming vegetables and fruits as one of the healthy living habits. In fact the availability of vegetables and fruits is more than sufficient, indicated by the increasing production data.

iv. Efforts are not yet optimal in reducing the habit of smoking, which is seen from the increasing trend of prevalence in smoking of the population as well as the increase of prevalence of chronic diseases due to tobacco. This is connected among others with the habit and culture, awareness, the state financial sources and source of life of the tobacco farmer.

5. Strategic Issues Linked to Institutionalization are as follows : 5. Strategic Issues Linked to Institutionalization are as follows : 5. Strategic Issues Linked to Institutionalization are as follows : 5. Strategic Issues Linked to Institutionalization are as follows :

i. Currently the handling of nutrition matters is still divided to various sectors like health and farming, however the Long Term Development Plan 2005-2025 has given directives that nutrition matters must be handled cross sectors. Without any independent institution which specially handles nutrition matters, efforts are needed to handle nutrition integratively and with strong leadership.

ii. The indicator for development of food and nutrition currently is available and generally is one of the indicators that the data could be obtained systematically until the regional level. It is necessary to enhance the use of these data as indicators that could be used as the basis for decision making for the right and timely intervention in evaluating the food and nutrition resilience. Because of thisthe development of indicators for relience of food and nutrition that is sensitive in the local level as well as the national level becomes an issue that must be well handled.

iii. The efforts are still not optmal for increasing the concern of the people in fighting vulnerable food matters and lack of nutrition because of the absence of accompaniment and empowerment of the people including NGOs and the private sector.

iv. The availability of energy in the field of food and nutrition is still becoming a constraint. Because the provisions of personnel in the field of food and nutrition needs a very long investment duration and involves education, employment system, and profession, therefore efforts in fulfilling food and nutrition enrgy is not very easy. For this, extra effort is needed to increase availability of skilled personnel in the field of food and nutrition.

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B. B. B. B. OBJECTIVESOBJECTIVESOBJECTIVESOBJECTIVES

1. 1. 1. 1. General ObjectiveGeneral ObjectiveGeneral ObjectiveGeneral Objective

To realize the people with good nutrition condition as the basis for achieving people who are healthy, intelligent, and productive through strengthening the naional and regional resilience in food and nutrition in the year 2010.

2. 2. 2. 2. Special Objective Special Objective Special Objective Special Objective

i. Increase knowledge, attitude and behavior of healthy living with the high awareness to nutrition of the people as part of the efforts for improvement of people’s nutrition.

ii. Increase the capacity of the peole and the individual to access food with balanced nutrition needed for healthy living, which is reflected from the availability of sufficient, good in amount as well as in the the nutrition quality of food, safe, evenly distributed and affordable.

iii. Increase the capacity of the people and the individual for access to nutrition and health services evenly, affordable and in quality as well as cost-effective.

iv. Increase the access of the family to nutrition and health information to form a food and nutrition awareness behavior as well as living healthy.

v. Support the policy and efforts in alleviation of poverty through special nutrition services for the poor people therefore realizing public nutrition improvement as a capital in reducing poverty.

vi. Increase the security of food circulated through increased food producer participation and implementation of effective and efficient supervision.

C. C. C. C. THE TARGET THE TARGET THE TARGET THE TARGET

1. Reduce prevalence of various forms of malnutrition, which are lack of nutrition, lack of iron, lack of vitamin A, and lack of iodine, in the year 2010, at least becoming 50 percent of the prevalence in the year 2005, as well as to prevent the increasing prevalence of overweight due to excess nutrition.

2. Increase the consumption of food per capita to fulfill the need of a balanced nutrition with sufficient energy of minimal 2,000 kcal/day and protein as much as 52 grams/day and sufficient micro nutrients as well as to increase the food variety with a score of Food Pattern Expectancy (PPH) minimal 85, therefore the consumption of

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rice will decline as much as 1 percent per year, root plants to increase 1-2 percent per year, vegetables to increase 4.5 percent per year, fruits increase 5 percent per year, and livestock food increase 2 percent per year.

3. Reduce the number of population experiencing vulnerable food consumption by making effective the food distribution system and increasing the easiness/ capacity of the people to access to food, including fotified food.

4. Maintain availability of energy per capita minimal 2.200 kcal/day and provision of protein per capita minimal 57 grams/day, especially animal protein as well as increasing the consumption of vegetables and fruits.

5. Increase coverage and quality of nutrition services to the people especially to vulnerabvle groups with the following targets :

i. Increase giving of exclusive breast feeding milk to babies until 6 months of age.

ii. Increase the percentage of children aged 6 - 24 months to obtain the right food supplement to breast feeding milk(MP - ASI).

iii. Reduction of prevalence of anaemia in pregnant mothers and Fertile Age Women.

iv. Increase effectiveness of surveillance and intervention in WUS, pregnant mothers and young women having risks of Chronic Energy Deficiency (LILA < 23,5 cm).

v. Reduction of prevalence to xerophthalmia.

6. Increase knowledge and capacity of the family to apply the healthy living pattern and awareness behavior in food and nutrition, which is indicated by increase of access to nutrition services and family food consumption.

7. Increase security, quality and hygiene of food consumed by the people by reducing violations towards food security regulations until 90 percent and increasing research in order to seek for safe preservatives and affordable by the poor people.

D. D. D. D. THE POLICYTHE POLICYTHE POLICYTHE POLICY

1.1.1.1. Strengthening of Food ResilienceStrengthening of Food ResilienceStrengthening of Food ResilienceStrengthening of Food Resilience. Policy directives: (a) assure availability of food, especially from domestic production, in amount and variety to support the food consumption in accordance to the principles of a balanced health and nutrition; (b) develop capacity in the growth and management of food reserves of the government and the people; (c) increase the national food production capacity through determination of permanent production lands in the spatial planning of

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the territory and to increase the quality of the environment as well as land and water resources.

2.2.2.2. Increase in easiness and capacity of access to foodIncrease in easiness and capacity of access to foodIncrease in easiness and capacity of access to foodIncrease in easiness and capacity of access to food. Policy directives: (a) increase the buying power and reduce the number of poor people; (b) increase effectivity and efficiency in distribution and trade of food through development of means and facilities of distribution and to eradicate constraints in distribution of food in cross regions;(c) develop technology and institution for processing and marketing food in order to maintain the quality of food products and to promote increase of added value; (d) increase and improve the infrastructure and institution of the village economy in the frame of developing food distributionschemes to certain society groups that experience vulnerability in food.

3.3.3.3. Increase of quantity and quality of food consumption towards a balanced nutritionIncrease of quantity and quality of food consumption towards a balanced nutritionIncrease of quantity and quality of food consumption towards a balanced nutritionIncrease of quantity and quality of food consumption towards a balanced nutrition. Policy directives: (a) to assure fulfillment of consumption of food for every household member in amount and in sufficient quality, safe and edible by religion and balanced nutrition; (b) promote, develop and nuild, as well as facilitating the participation of the people in fulfilling the food as an implementation of the rights in the fulfillment of food; (c) developing cost effective nutrition improvement programs, among others are through increase and strengthening the food fortification program and supplementation program of micro nutrition substances especially iron and vitamin A; (d) developing network among society organizations for fulfillment of the rights to food and nutrition; and (e) increase efficiency and effectiveness intervention of food aid/food subsidy to the poor groups of people especially to children and pregnant mothers with malnutrition.

4.4.4.4. Increase of Public Nutrition StatusIncrease of Public Nutrition StatusIncrease of Public Nutrition StatusIncrease of Public Nutrition Status. Policy directives: (a) priority for efforts in preventive, promotive and services nutrition and health to the poor people in the frame of reducing the number of malnutrition oatients, including lack of micro nutrition (lack of vitamins and minerals); (b) priority given to groups that determine the future for the children, which are pregnant mothers and candidate pregnant mothers/young women, mothers after delivery and breast feeding, babies until the age of two years of age without waiving aside the other age groups; (c) increase efforts in preventive, promotive and services in nutrition and health for adults and old people in order to reduce the increasing rate of prevalences of diseases not connected to infections relating to nutrition which are overweight, high blood pressure, diabetes, and cancer; as wellas other degenerative diseases; (d) increase capacity in research in the field of food and nutrition to support efforts in preparing policies and programs, monitoring, surveillance of nutrition, and evaluation of the food and nutrition program, based on evidences; (e) increase professionalism of nutrition workers from various

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levels through regular and sustainable education and training and improving the distribution of positions of these nutrition workers; (f) increase effectiveness of the coordination functions of government institutions and the private sector in the center and in the regions, in tjhe field of food and nutrition therefore assuring integrity of policy, program and activities among sectors in the center and region,especially with the health sector, agriculture and food resilience, industry, trade. education, religion, alleviation of poverty, as well as the regional government.

5.5.5.5. Increase of quality and security of foodIncrease of quality and security of foodIncrease of quality and security of foodIncrease of quality and security of food. Policy directives: (a) increase supervision in food security; (b) fully completing the laws and regulations in the field of quality and security of food; (c) increase awareness of producers, importers, distributors and retail towards food security; (d) increase awareness of consumers towards food security, and (e) developing technology in safe preservation and coloring of food anfd fulfilling the health requirements as well as affordable by the small and medium businesses of producers of food and snacks.

6.6.6.6. Improvement of healthy living patternImprovement of healthy living patternImprovement of healthy living patternImprovement of healthy living pattern. Policy directives: (a) support as wide an access possile to education and services for the people in conducting their healthy living pattern; (b) increase the commitment and participation of stakeholders insupporting the healthy living p;attern program; (c) increase the function and capacity of the relevant sectors in development of the heqalthy living pattern in the center as well as in the region; (d) optimally involving the participation of the media in the efforts of socialization programs and policy programs for healthy living pattern; (e) assuring the presence of involvement of all the levels of society actively in the program as well as the policy in implementation of the healthy living pattern program; (f) increase capacity in administration of dxata and information therefore forming accurate data; (g) developing the School Health Programm(UKS); (h) developing Life Skills Education programs).

E. E. E. E. THE STRATEGYTHE STRATEGYTHE STRATEGYTHE STRATEGY

Accessibility to Food:Accessibility to Food:Accessibility to Food:Accessibility to Food:

1. Development of programs for the dicersification of food is enhanced through assesment of various ”useful precise technology” and affordable in regard to the processing of flour based food, for : (a) maintaining the local food consumption pattern which in the region and certain society groups have a variety especially in their staple food, and (b) development of the culinery aspect and acceptance of

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the consumers, through various nutrition education, training, and nutrition campaigns to inc rease the local food image, as well as to increase the income and general education.

2. Preparation of the development policies in the field of food and nutrition ha ving a cross sector nature, therefore promoting commitment and investment in the field of food and nutrition therefore i the national and regional development.

3. Increase of the capacity of the local government and people in developing and benefiting the food and nutrition awareness system for early detection of possible occurrences of vulnerable food disasters, hunger and malnutrition, as well as quick actions that must be conducted by the people and the local government.

4. Increase of activities and targets of food resilience not only in the aspect of provisions of food in the macro level, but also the aspect of food access which assures food consumption with balanced nutrition for the family and individual, as well as the impacts to the nutrition status.

Nutrition Status :Nutrition Status :Nutrition Status :Nutrition Status :

1. Priority to the nutrition program target to very vulnerable groups which are : young women in their fertile age, pregnant mothers, breast feeding mothers, and babies until 2 years of age in the frame of strengthening the achievement basis of the program for development of children in their early childhood (PAUD) in determining th future quality of human resources (SDM).

2. Increase in the program for prevention and overcoming micro malnutrition matters, through supplementation and fortification of vitamins and minerals especially iron, iodine, and vitamin A in order to increase the quality of human resources.

3. Increase nutrition awareness of the family and people through communication, information and education to prevent disturbances.

4. Prioritization of the nutrition program targets to the poor people through efforts in alleviation of poverty caused not because of the income (“non-income poverty”) in the frame of development of human resources.

5. Increase quality of services to excessive nutrition patients through periodic monitoring of the body weight and height, integrated management in handling excessive nutrition cases and increase of KIE.

6. Increase in efforts of overcoming infectious diseases especially to children under five years of age through prevention and overcoming the risk factor, increase in surveillance and epidemiology, immunization as well as KIE.

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Food Security :Food Security :Food Security :Food Security :

1. Increase awareness regarding food and nutrition security through efforts in early prevention and law enforcement in the frame of maintaining the quality of food security.

2. Increase food security through strengthening of regulations, monitoring and law enforcement, consumer protection in the frame of protecting the public health status.

Healthy Living Pattern :Healthy Living Pattern :Healthy Living Pattern :Healthy Living Pattern :

1. Increase physical activity of the people through increase of promotion, increase in provisions of means and facilities of sports and open space, in the frame of growing and creating awareness of all the levels of society.

2. Increase promotion fr consumption of vegetables and fruits through a balanced nutrition eating pattern in the frame of prevention of degenerative diseases.

3. Increase of promotion of low fat eating pattern, as well as salt and sugar especially to certain high risk groups through preparation of regulations that regulate regarding advertisements of food and drinks in order to reduce incidences of degenerative diseases in the youth.

4. Increase promotion regarding the danger of smoking through regulations in advertisments related to smoking, policies in reducing demand of cigarette supply in order to prevent chronic diseases.

InstitutionalInstitutionalInstitutionalInstitutional Aspect Aspect Aspect Aspect: : : :

1. Increase cooperation in cross sectors through coordinated food and nutrition programs in the frame of development in the field of food and nutrition.

2. Revitalization of SKPG to increase availability of food and nutrition data in the region

3. Strengthen cooperation between the government and the people in conducting the food and nutrition program.

4. Digging for and benefitting the potency of resources from the people in overcoming the problems of food and nutrition.

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5. Increase capacity and quality of research and development of food and nutrition through research institutions, universities, and the people, in the frame of producing more reliable data and information.

6. Increase the capacity of administrative workers and professionals through coordination in planning and management of the food and nutrition program in order to maximize the effectiveness of the public nutrition improvement program.

7. Increase the education and use of professionals in nutrition in various levels of the Central and Regional, as well as the people, in order to maximize the role of professionals in the nutrition program.

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BAB V. MATRIX OF THE NATIONAL ACTION PLAN FOR FOOD AND NUTRITION 2006-2010

NO

STRATEGIC ISSUE

POLICY STRATEGY ACTIVITY INDICATOR PROGRAM INSTITUTION IN CHARGE

I. ACCESSIBILITY TO FOOD

1. Limitation of the capacity of rice production and local food as sources of carbohydrates as well as limitation in production of food from livestock..

Security in resilience in food

Assure availability of food, especially from domestic production, in sufficient amount and variety.

1. Increase productivity and production of staple food

2. Assessment and development of food processing technology

3. Revitalization of training and enhancing of the farmer’s institutional capacity

4. Increase availability of alternative low cost, safe, resilient, and easy to distribute types of food.

5. Increase effectivity in irrigation facility services

6. Increase easiness in access of farmers to quality production means

1. Availability of staple food that fulfills the need

2. Increase the type and availability of staple food that is safe to be consumed

Food Resilience Dept. Of Agriculture,

Dept. Of Public Works, Regional Government

RANPG 2006-2010 65

Security in resilience in food

Developing food reserve capacity of the government and community as well as the capacity in the management

1. Procurement of rice harvest by the government

2. Promote the formation of regional and community food reserves

3. Developing ready to consume non-rice food reserves

4. Development of means and facilities for process of government and community food reserves

1. Reaching the safe amount and quality of government and community food reserves

2. Reduction of the regions and population vulnerable to food

Food Resilience Dept. Of Agriculture, Agency for Logistics, Regional Government

Security in Resilience in Foof

Provisions of permanent land area for food production in assuring production capacity able to fulfill the need of staple food

1. Preparation of regulations stipulating permanent land area for agriculture

2. Control in transfering function of productive agricultural land areas

1. Issuance of laws and regulations that stipulate permanent agriculture land areas for food production

2. Reduction of conversion level of productive land areas

Food Resilience Dept. Of Agriculture, National Land Board, Parliament

Increase easiness and capacity for access to food

Increase effectivity and efficiency in distribution and trade of food

1. Development of distribution means and facilities

2. Reduction in constraints in distribution of food among regions

1. Quality of increasing food distribution means and facilities.

2. The shorter of the food distribution chain

Development of Agrobusiness

Dept. Of Agriculture

2. Availability of food in the household level is still continuing to be a problem and affecting the adequacy level of nutrition consumed even though the availability of food on the national scale in the markets is sufficient. The main problem is that the increase in effectivity and efficiency of food distribution among regions and timely manner as well as being affordable by households therefore able to access to food.

Increase easiness and capacity to access food

Development of technology as well as institution for processing and marketting of food

1. Revitalizing of institution for processing and marketting of food

2. Technology innovation in

1. Increase quality of food products

2. Increase of added value to food products

Pengembangan Agribisnis

Dept. Of Agriculture

RANPG 2006-2010 66

food processing and marketting of food

Increase of easiness and capacity for access to food

Increase as well as improvement of the infrastructure and village economy institution

1. Institution revitalization of the village economy to support food distribution

2. Improvement of food distribution facilities in the village, like rice stalls.

Dept. of Agriculture, Dept. For Trade

Increase easiness and capacity for access to food

Increase efficiency and effectivity of intervention of food aid/subsidy to specific community groups

More efficient and effective distribution of subsidized rice to poor people

Market Operation in the frame of stabilizing food prices

Food aid for emergency/disaster conditions.

1. Efficient and targetly distribution of subsidized food

2. Stable price of food and affordable

Targetly and timely distribution of food aid

Program to Increase Resilience in Food

Agency for Logistics, DepFor Trade, Social Dept., Regional Government

3. Food consumption pattern is still dominated by the grain group mainly rice, the consumption of vegetables and fruits as a source of vitamins and minerals as well as livestock proteins is still low.

Increase in quality and quantity of food consumption resulting in a balanced nutrition

Maintaining the local food consumption pattern and certain community groups that have differentiated mainly in the staple food

1. Socialization in variety of quality and balanced nutritious food

2. Increase in understanding the importance of a variety of foods

3. Development of culinary aspect and acceptance of local food

1. The high level of understanding of the people on the importance of consuming a variety of food

2. Maintaining a balanced variety of food consumption

Dept. Of Agriculture, Dept. Of Health

RANPG 2006-2010 67

II. INCREASE OF NUTRITION STATUS OF THE PEOPLE

1. High prevalence of malnutrition is still occurring to children under five years old which is closely connected to the problems of KEK towards fertile age women and the small habit of giving exclusive breast feeding milk.

Increase the nutrition status and health of the people.

Target priority program for nutrition to very vulnerable groups which are : fertile age young women, pregnant mothers, breast feeding mothers, and babies until 2 years of age

1. Revitalization of the Posyandu and revitalization of the Puskesmas

2. Giving guidances in regard to exclusive breast feeding milk for babies of 0-6 months

3. Monitoring the growth

4. Development of a Nutrition Post

1. Increase in the number of active posyandu

2. Availability of activity achievement data (SKDN, BGM, Immunization)

3. Implementation of the incentive mechanism for Posyandu cadres

4. Increase of the number of puskesmas officers and posyandu cadres being trained

5. Increase in the use of exclusive breast feeding milk

6. Increase of antenatal services in the Puskesmas

Efforts for Public Health

Improvement in Public Nutrition

Early childhood education

Dept of health

Dept of National Education

Dept of Home Affairs

Dept. Of Agriculture

Dept of Industry

Dept. Of Trade

State Ministry for Women Empowerment

Family Welfare Guidance (PKK)

Regional Government

Increase the nutrition status and health of the people.

Increase prevention programs and overcoming micro malnutrition problems.

1. Social marketting of vitamin A sources

2. Increase consumption of iodized salt for all (KGBS)

3. Fortification of vegetable oil with vitamin A

4. Data recording of baby target data, children under

1. Increase consumption of iron tablets and accuracy of consumption

2. Achievement of giving Vit. A capsules to every baby/children aged 6-59 months

3. Reduction of

Increase of welfare and child protection

Dept. Of Health

Dept. Of Agriculture

Dept of Industry

Dept. Of Home Affairs

RANPG 2006-2010 68

five years old, pregnant mothers, breast feeding mothers through the RT/RW periodically.

5. Increase in giving iron supplement tablets to female youth, premarital women and women workers

6. Giving of MP-breast milk to children under five years old from poor families having risks of malnutrition

7. Giving of vitamin A capsules every month of February and August

8. Giving iron tablets to pregnant mothers

9. Promotion and montoring the consumption of iodized salt

10. Handling of bad malnutrition cases

11. Benefitting the garden to fulfill the need of food of the family

xeropthalmia prevalence (X1b < 0,33%)

4. Reduction of anemia prevalence of pregnant mothers, mothers after child birth, children five years old and fertile age women

5. Increase of consumption of iodized salt

6. Number of bad nutrition cases handled successfully

2. Lack of awareness still occurring towards nutrition due to low level of education and presence of various attitudes

Increase the nutrition status and health of the people.

Increase of nutrition-aware families and people.

1. Increase of education and gender equality in order to increase the quality of pregnancy care and the care of babies and children

1. Increase the percentage of nutrition –aware families (kadarzi)

2. Increase awareness of

Promotion of Health and Empowerment of the People

Dept. Of Health

State Ministry for Empowerment of Women

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constraining nutrition improvement.

2. Formation of peer educators among youths in schools as well as out of schools

3. Nutrition education through campaigns, spreading of communication, information and education.

4. to include food and nutrition in education curriculums in elementary skill learning schools

5. Spreading of information through the printing and electronic media.

6. Spreading information through religious groups, get-togethers, local youth organization, Family Welfare Guidance, Scouts, NGOs, etc.

7. Spreading information in schools, place of work, other public areas

8. Conducting activitiies to increase family income (Joint business groups, small industries, etc.)

the people in regard to quality food since early childhood

3. Increase knowledge and consumption of the population regarding Vitamin A sources of food

4. Increase the content of the household by adequate consumption of iodized salt

5. Successful implementation of the guidance and procedures in the case of bad nutrition

6. Availability of information regarding nutrition in all medias for all levels of the society

7. Increase of the groups formed and conducting discussion activitites regarding food and nutrition

8. Increase in the number of families that makes use of the garden for fulfilling the family need of food.

Increase quality of life and protection of women

Resilience and Empowerment of the Family

The National Family Planning Board

Regional Government

Family Welfare Guidance (PKK

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3. The program in handling nutrition of poor families yet needs to be optimal.

Fulfilling the basic rights of the poor people to quality basic health services

Nutrition program target priority to poor people.

1. Providing quality health services and affordable to poor people especially in handling malnutrition/lack of nutrition

2. Giving supplements of micro nutrition substances, especially iron, vitamin A and iodine

3. Giving “poor card” for health treatment and for buying subsidized food like rice for the poor (Raskin) and MP-breast feeding milk for children under five years old from poor families

4. Direct aid in obligated cash for poor people

5. Increase participation of the people in development of health and nutrition services for the poor people

1. Increase of health services for the poor families

2. Reduction of bad nutrition occurrences in poor families

Promotion of Health and Empowerment of the People

Improvement of the nutrition of the people

Depkes

Depdagri

4. Increase tendency of excessive nutrition matters.

Prevention in overcoming excessive nutrition

Increase in quality of services for excessive nutrition patients

1. Conducting periodic monitoring of BB and TB

2. Conducting integrated management in handling excessive nutrition cases and degenerative diseases and other diseases

Reducing prevalence of overweight

Improvement of public nutrition

Dept. Of Health

Dept. Of National Education

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3. Increase of promotion regarding prevention of overweight and obesity

5. Rate of infection still very high in under five year old children which is connected to sanitation, environment, and insufficient health services.

Increase public knowledge regarding sicknesses, healthy environment, growth and development of children, family nutrition and healthy living behavior

Increase of efforts in overcoming infectious diseases especially to children under five years old.

1. Prevention and overcoming risks factors

2. Increase surveillance and epidemiology and overcoming epidemics

3. Increase content of immunization

4. Increase of KIE regarding prevention and eradication of diseases

Reduction of the number of infectious diseases in under five year old children.

Improvement of public nutrition

Prevention and eradication of diseases

Dept. Of Health

III. FOOD QUALITY AND SECURITY

1. Awareness of food security at the producer as well as consumer still must be increased because awareness of food security is the beginning of efforts to create food products that are safe to be consumed.

Increase of Quality and Security of Food

Increase of awareness of food security in the producers and consumers society

1. Increase socialization of regulations and standards in food security

2. Increase effectivity of agriculture quarantine

1. Increase awareness of the public in food security

2. Prevention in entering of imported food that do not fulfill the requirements of food security

3. Understanding of producers towards CPMB

Supervision and security of food

Agency for Supervision of Food and Drugs

Dept. Of Industry

Dept. Of Agriculture

Dept. Of Home Affairs

Dept. Of Trade

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2. Availability of supervisors which is still limited, still low awareness of producers and consumers, as well as availability of food examination materials which is still limited is still a constraint in application of the food security standards consistently.

Increase of Quality and Security of Food

Increase food security supervision

Increase protection to consumers

1. Increase the number and competence of employees as well as supervision laboratory

2. Increase scope of area and types of food products supervised

1. Adequate number of supervisors, food supervision laboratories, number of food products and scope of area supervised

Agency for Supervision of Food and Drugs

Dept. for National Education

Ministry for Supervision of Government Institutions

3. The extensive use of dangerous food additives, especially in the small and medium industries as well as the household.

Increase Food Quality and Security

Increase of food security supervision

1. Efforts in completeness of the laws and regulations in the field of food quality and security

2. Stipulation of standards of food that are safe to be consumed

3. Providing safe food preservatives, coloring, and additional processing functions

1. Reduction of the circulation of TMS food products

2. Completion in compilation of food security and quality standards

3. Availability and accessibility of food preservatives and coloring to small food snacks producers

Agency for Supervision of Food and Drugs

Dept. Of Agriculture

4. Safe and affordable alternative food additives have yet to be developed.

Increase of Food Quality and Security

Increase in Research and Development of safe food additives.

1. Development of food processing technology

2. Implementation of research to seek for alternative food additives

Availability of safe and affordable alternative food additives

Agency for Supervision of Food and Dr

The Indonesian Institution for Science

RANPG 2006-2010 73

IV. IMPROVEMENT IN HEALTHY LIVING PATTERN

1. Low physical activity leading to increased degenerative disease patients

Improvement of a healthy living pattern.

Increase of physical activity of the public.

1. Increase of promotion regarding physical activity

2. Increase promotion in the benefit of physical activity for health, prevention of degenerative disease.

1. Increase understanding on the benefit of physical activity

2. Increase the means and facilities for sports as well as open space for public activities.

Promotion of Health and empowerment of the public

Guidance and Socializing Sports

Increase the Means and Facilities for Sports

Dept. Of Health

Dept. Of Agriculture

Ministry for Youth and Sports

Agency for Supervision of Food and Drugs

Dept. For National Education

Regional Government

2. Still low consumption of vegetables and fruits

Improvement to a healthy living pattern.

Increase promotion for consumption of vegetables and fruits

Increase socialization and advocacy for consumption of vegetables and fruits.

Increase on the average consumption per capita per day of vegetables and fruits

Promotion of Health and Empowerment of the Public

Dept. Of Agriclture

Dept. For National Education

Dept. Of Health

3. Increase consumption of sugar, salt, fat

Improvement to a healthy living pattern.

Increase promotion of eating pattern of low fat, salt and sugar especially to certain high risk groups

1. Increase promotion regarding the reduction of consuming fat, sugar and salt.

2. Developing methods of conveying messages from the Balanced General Nutrition Guidance (PUGS)

1. Increase awareness regarding good eating habits

2. Increase public understanding regarding the messages of PUGS

3. Increase frequency of

Promotion of Health and Empowerment of the People

Dept. Of Health

Dept. For National Education

Agency for Supervision of Food and Drugs

RANPG 2006-2010 74

that is easily understood by the public.

showing information about healthy living pattern and balanced nutrition in the mass media.

4. Increase knowledge and capacity of the family to apply the haelthy living pattern

5. Increase in the number of healthy Schools

1. Still not optimal in the prevention of habitual smoking

Improvement to a healthy living pattern.

Increase promotion regarding the dangers of smoking

2. Increase of promotion regarding the danger of smoking to the health.

3.Increase efforts in regulating in order to reduce availability of cigarettes in the market.

4Law enforcement in prohibiting smoking in public places.

1. Reducing expenditure of the household for smoking

2. Increase the number of places where smoking is prohibited

3.Implementation of regulations regarding marketting of cigarettes

Promotion of Health and Public Empowerment

Dept. Of Health

Ministry fo Youth and Sports

Dept. Of Trade

Regional Government

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V. INSTITUTIONAL DEVELOPMENT AND STRENGTHENING

1. The problem with food and nutrition which is multidimensional, multi sectoral, and multi discipline in nature have not been handled in an integrated and coordinated way.

Strengthening and development of an Institution for Food and Nutrition

Increase cooperation in cross sectors through preparation of coordinated food and nutrition programs in the frame of developing the field of food and nutrition.

Advocacy of food and nutrition to planning decision makers in the government and parliament level.

1. Policy for Food and Nutrition is clearly accommodated in the national and regional level planning document like Long Term Development Plan-Regional Long Term Development Plan-Medium Term Development Plan (RPJP-RPJPD-RPJMD) and Strategic Plan-Regional Strategic Plan (Renstra-Renstrada)

2. Increase of the program and funding of food and nutrition

3. Creation of synergic cooperation among government institutions, private sector, and the people that are concerned on quality of food and nutrition

Perbaikan Gizi Masyarakat

National Planning Board

Regional Planning Board

Dept. Of Health

Dept. Of Agriculture

Organization of professions

Ministry for Supervision of Government Institutions

2. Still limited in the use of food and nutrition data as indicators to assess

Strengthening and development of an Institution for Food and

Revitalization of the System Awareness for Food and Nutrition (SKPG)

1. Development and analysis of food and nutrition datai the System Awareness for

1. Making use of the reporting and information system to

Food Resilience

Dept. Of Health

Dept. Of Agriculture

RANPG 2006-2010 76

resilience in food and nutrition at a suitable local level and timely for decision making.

Nutrition Food and Nutrition

2. Gathering, processing and analysis of data for strengthening the System Awareness for Food and Nutrition (SKPG)

3. Advocacy of analysis results of SKPG to decision makers (authorized official)

prepare the policy

2. All kabupaten/kota have conducted mapping, the skill of the SKPG Team in overcoming food and nutrition problems

3. Already put to use of the information of SKPG for decision making, formulation of olicies, program planning and evaluation

4. Availability of map showing vulnerable areas for food and nutrition

Improvement of Public Nutrition

The National Family Planning Board

The Agency for Logistics

Dept. of Home Affairs

Central Bureau of Statistics

3. Still not optimal regarding the efforts to increase concern of the public in fighting the vulnerable problem of food and malnutrition.

Strengthening and Development of a Food and Nutrition Institution

Strengthening cooperation between the government and the public in conducting the program for food and nutrition

Further digging and benefitting the potency of resources from the people to overcome the problem of food and nutrition

1. Increase cooperation with non-government institutions and other society groups that are concerned towards the enhancement of human resources.

2. To drive the NGOs and the private sector to take a role in overcoming the problem of food and nutrition

3. Development of a system in overcoming vulnerability of food through cooperation

Increase in number of NGOs and private companies involved in overcoming food and nutrition problems

Resilience in Food

Research and Development

Public Nutrition Improvement

Dept. Of Agriculture

Dept. For the National Education

Dept. Of Health

RANPG 2006-2010 77

with the government, private sector, and the public.

Strengthening and development of a Food and Nutrition Institution

Increase capacity and quality of research and development of food And nutrition through research institutions, universities and the public, in order to produce more confident and reliable data and information.

1. Preparation of a policy for development of food and nutrition

2. Increase cooperation of education institutions, research institutions and program managers.

Increase the role of research institutions, universities and the public in producing confident and reliable data.

Resilience if Food

Research and Development

Improvement of Public Nutrition

Dept.of Agriculture

Dept. Of National Education

Dept. Of Health

Strengthening and Development of an Institution for Cfood and Nutrition

Increase the capacity of administrators and professionals through coordination in planning and management of the food and nutrition program in order to maximize effectivity of the program for the improvement of the public nutrition.

1. Preparation in planning for the need of human resources for food and nutrition

2. Further digging of potential resources (human, means and funding) existing in NGOs and private sector.

Availability of adequate human resources for food and nutrition

Resilience in Food

Government office education

Improvement of Public Nutrition

Dept. Of Agriculture

Dept. Of National Education

Dept. Of Health

4. Still limited in the availability of skilled personnel in food and nutrition.

Strengthening and Development of Institution fo Food and Nutrition

Increase in education and use of professional human resources in Nutrition in various levels of the central and regional governments, as well as the public, in order to maximize the role of professional human

1. Development of curriculum and development of education of nutrition human resources

2. Development of profession certificates

3. Development of food and

The number of personnel of food and nutrition trained

Resilience in Food

Non Formal Education

Government Official Education

Dept. Of Agriculture

Dept. for National Education

Dept. Of Health

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resources in the nutrition program.

nutrition professional human resources through cooperation with education institutions and with professional organizations

Control in the rate of increase of the population

6. Development of population based policies and development programs consisting of the aspect of quantity, quality and mobility

7. Integration of the population factor into sectoral and regional development

Harmony

Policy Demography

The National Family Planning Board

RANPG 2006-2010 79

LIST OF REFERENCESLIST OF REFERENCESLIST OF REFERENCESLIST OF REFERENCES

Central Bureau for Statistics (BPS). 2003. Demography and Health Survey in Indonesia (SDKI) 2002-2003. Bappenas and Unicef. 2000. Indonesia Report for preparation of the End Decade Goal 2000. Department for the National Education, Guidance in Fostering and Development of Health School Business (UKS). Jakarta. 2006 Department of Health. 2005. National Action Plan for the Prevention and Overcoming of Bad Malnutrition 2005 – 2009. Department of Agriculture. Agricultural Statistics 2005, 2006 Council for Food Resilience. National General Policy for Food Resilience. 2005 Nutrition in Figures until 2005. Department of Health. 2006 Government of Indonesia (GOI). 2004. Indonesia Progress Report on the Millenium Development Goal. Government Regulation No.7 Year 2005 regarding the 2004-2009 Medium Term Development Plan Profile of Food and Agriculture 2003 – 2006. Directorate for Food and Agriculture, Bappenas. 2006 UNDP. 2006. Human Development Report: Beyond scarcity: Power, poverty and the global water crisis. LIPI. 2000. National Workshop on Food and Nutrition VII.2000. LIPI. 2004. National Workshop on Food and Nutrition VIII.2004. Soekirman and Associates. 2003. Situational Analysis of Nutrition Problems in Indonesia: Its Policy, Programs and Prospective Development. RI-WHO. 2000. National Action Plan for Food and Nutrition 2001-2005, Jakarta. Law No 20. 2003. The National Education System which also regulates the “9 Years Compulsory Education”. World Bank. 2006. Repositioning Nutrition as Central to Development A Strategy for Large-Scale Action.

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WHO. Global Strategy on Diet, Physical Activity and Health, A Framework to Monitor and Evaluate Implementation. Geneva. 2006

ATTACHMENTATTACHMENTATTACHMENTATTACHMENT

PREPARATION TEAM FOR THE NATIONAL ACTION PLAN PREPARATION TEAM FOR THE NATIONAL ACTION PLAN PREPARATION TEAM FOR THE NATIONAL ACTION PLAN PREPARATION TEAM FOR THE NATIONAL ACTION PLAN

FOR FOOD AND NUFOR FOOD AND NUFOR FOOD AND NUFOR FOOD AND NUTRITIONTRITIONTRITIONTRITION YEAR OFYEAR OFYEAR OFYEAR OF 2006 2006 2006 2006----2010201020102010

((((Based on DecisionBased on DecisionBased on DecisionBased on Decision N N N Numberumberumberumber: KEP. 339/M.PPN/12/2005: KEP. 339/M.PPN/12/2005: KEP. 339/M.PPN/12/2005: KEP. 339/M.PPN/12/2005 Regarding the Formation of a Preparation Team for the National Action Plan for Regarding the Formation of a Preparation Team for the National Action Plan for Regarding the Formation of a Preparation Team for the National Action Plan for Regarding the Formation of a Preparation Team for the National Action Plan for

Food and Nutrition for the YearFood and Nutrition for the YearFood and Nutrition for the YearFood and Nutrition for the Year 2006 2006 2006 2006----2010)2010)2010)2010) Steering CommitteeSteering CommitteeSteering CommitteeSteering Committee Chairman : Deputy for Human Resources and Culture, Ministry of The National Development Planning Board (Bappenas) Vice Chairman: Deputy III for Supervision of Security of Food and Dangerous Materials,

Agency for Supervision of Food and Drugs Members : 1. Dir.Gen. for Guidance to Public Health, Department of Health

2. Head of the Agency for Resilience of Food, Department of Agriculture 3. Deputy for Natural Resources and Environment, Ministry for National

Development Planning/ Bappenas 4. Dir.Gen. for Management of Basic and Medium Education, Dept. For

National Education 5. Chairman for the Indonesian Nutrition Experts Association

(PERSAGI) 6. Chairman for the Nutrition and Food Association (Pergizi Pangan) 7. Chairman of the Indonesian Medical Nutrition Doctors Association

(PDGMI) 8. Chairman for the Indonesian Food Technology Expert Association

(PATPI) 9. Chairman for the Driving Team for Family Welfare Program(TP-PKK) 10. Chairman of the Foundation for Welfare of Indonesian Children

(YKAI) 11. Chairman for the Commission for Child Protection TTTTechnical Teamechnical Teamechnical Teamechnical Team Chairman : Director for Public Health and Nutrition, Bappenas Vice Chairman: Director for Food and Agriculture of Bappenas

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Secretary : Head of Sub Direct. For Public Nutrition, Directorate for Health and Nutrition, National Development Planning Board

Members : 1. Head of Sub Direct. For Food, Direct. For Food and Agriculture, Bappenas

2. Ir. Destri Handayani, ME 3. Pungkas Bahjuri Ali, STP, MS

I. I. I. I. Nutrition GroupNutrition GroupNutrition GroupNutrition Group Chairman : Director for Public Nutrition, Department of Health Secretary : Head of Sub Direct. Macro Nutrition, Direct. For Public Nutrition, Dept.

Of Health Members : 1. Head of Sub Direct. For Food Awareness, Directorate for Public

Nutrition, Dept. Of Health 2. Head of Section for Standardization, Sub Direct. Nutrition Awareness,

Directorate for Public Nutrition, Dept. Of Health 3. Head of Section for Standardization, Sub Direct. Micro Nutrition,

Directorate for Public Nutrition, Dept. Of Health 4. DR. Abbas Basuni Jahari, MSc., Centre for Nutrition R&D, Dept. Of

Health 5. DR. Imam Sumarno, MPH, Centre for Nutrition R&D, Dept. Of Health 6. Dian Proboyekti, staff of Sub Direct. Macro Nutrition, Dept. Of Health

II. II. II. II. Food Security GroupFood Security GroupFood Security GroupFood Security Group Chairman : Director for Standardization of Food Products, Agency for Supervision

of Food and Drugs Secretary : Head of Sub Direct. Standardization of Special Food, Agency for

Supervision of Food and Drugs Members : 1. Head of Sub Direct. for Evaluation of Special Food, Agency for

Supervision of Food and Drugs 2. Head of Sub Direct. for Surveillance and Overcoming Food Security, Agency for Supervision of Food and Drugs 3. Head of Sub Direct. for Inspection of Production and Circulation of

Food Products, Agency for Supervision of Food and Drugs 4. Anggraini, STP, Staff of Directorate for Standardization of Food Products,

Agency for Supervision of Food and Drugs 5. Manager for Standardization, Centre forStandardization and Accreditaton,

Dept. Of Agricuture

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6. Manager for Vulnerability of Food Quality, Centre for Food Awareness, Dept. Of Agriculture

III. III. III. III. Food Accessibility GroupFood Accessibility GroupFood Accessibility GroupFood Accessibility Group Chairman : Director for Food Consumption and Security, Dept. Of Agriculture Secretary : Manager for Local Food Consumption, Centre for Food Consumption and

Security, Dept. Of Agriculture Members : 1. Manager for Planing, Secretariat for the Agency for Food Resilience,

Dept. Of Agriculture 2. Manager for Monitoring Food Production, Centre for Food Availability

Development, Dept. Of Agriculture 3. Manager for Price Analysis, Centre for Food Distribution Development,

Dept. Of Agriculture 4. Manager for Food Variety, Centre for Food Consumpton and Security,

Dept. Of Agriculture 5. Manager for Patern Empowerment, Centre for Resilience

Empowerment, Dept. Of Agriculture IV. IV. IV. IV. Healthy Living Pattern GroupHealthy Living Pattern GroupHealthy Living Pattern GroupHealthy Living Pattern Group Chairman : Director for Development of Physical Body Quality Secretary : Manager for Development of Life Skill Education and Health, Centre for

Development of Physical Body Quality, Dept. For National Education Members :1. Head of Sub Direct. for Student Activity, Direct. For Education of

Primary and Elementary School, Dept. for National Education 2. Head of Sub Direct. for Student Activity, Directorate for Junior High

School, Dept. For National Education 3. Head of Sub Direct. for Student Activity, Directorate for Senior High

School, Dept. For National Education 4. Kasubdit Kesehatan Olahraga, Dept. For National Education

5. Manager for Student Sport Activity, State Ministry for Youth and Sports 6. Ismoyowati, SKM, M.Kes, Centre for Health Promotion, Dept. Of

Health

RANPG 2006-2010 83

TTTTEAM OF EDITORSEAM OF EDITORSEAM OF EDITORSEAM OF EDITORS

1. Abbas Basuni Jahari 16. Irawati Susalit

2. Ali Muharam 17. Kismanto

3. Andriyanto 18. Mewa Ariani

4. Arif Haryana 19. Minarto

5. Arum Atmawikarta 20. Muhammad Zakky

6. Atmarita 21. Nana Mulyana

7. Darwin Karyadi 22. Nita Yulianis

8. Dhian P. Dipo 23. Razak Thaha

9. Drajad Martianto 24. Soekirman

10. Endah Murniningtyas 25. Subiyakto

11. Endang L. Achadi 26. Pungkas Bahjuri Ali

12. Entos Zaina 27. Noor Avianto

13. Hardinsyah 28. Tety H. Sihombing

14. Ima Anggraini 29. Yosi Diani Tresna

15. Inti Wikanestri