Governance-Driven Stunting Reduction in an Archipelagic Regency: Community-Based Implementation in Bintan, Indonesia

Friska Agustina Sianturi, Darmanto Darmanto, Rudi Subiyakto

Abstract


This study aims to analyze how local governance shapes the implementation of community-based stunting reduction programs in Bintan Regency, Indonesia, an archipelagic and semi-rural area facing administrative and logistical challenges. A qualitative descriptive design was employed through semi-structured interviews with 15 key informants, including village heads, midwives, community health cadres, health officials, and members of the Stunting Reduction Acceleration Team (TPPS). Data were analyzed thematically using five governance dimensions: political commitment, intersectoral coordination, program leadership, data and monitoring systems, and community participation. The findings show that political commitment and community participation were relatively strong, as reflected in village fund allocation, active local leadership, nutrition education, home visits, and community-based initiatives such as foster-home activities. However, inter-sectoral coordination, data utilization, and frontline leadership remained uneven across subdistricts and villages, often depending on informal coordination and individual initiative. The study concludes that stunting reduction in Bintan is not merely a technical health intervention, but a local governance challenge. Strengthening institutional coordination, digital data systems, frontline capacity, and sustained community engagement is essential for improving the effectiveness, equity, and sustainability of stunting reduction programs.


Keywords


Stunting; Local Governance; Community Participation; Health Governance; Bintan Regency.

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Agarwal, S., Sripad, P., Johnson, C., Kirk, K., Bellows, B., Ana, J., Blaser, V., Kumar, M. B., Buchholz, K., Casseus, A., Chen, N., Dini, H. S. F., Deussom, R., Jacobstein, D., Kintu, R., Kureshy, N., Meoli, L., Otiso, L., Pakenham-Walsh, N., ... Warren, C. E. (2019). A conceptual framework for measuring community health workforce performance within primary health care systems. Human Resources for Health, 17, Article 86. https://doi.org/10.1186/s12960-019-0422-0

Akhmadi, A., Sunartini, S., Haryanti, F., Madyaningrum, E., & Sitaresmi, M. N. (2021). Effect of care for child development training on cadres’ knowledge, attitude, and efficacy in Yogyakarta, Indonesia. Belitung Nursing Journal, 7(4), 311–319. https://doi.org/10.33546/bnj.1521

Al Djono, T. P., & Daniel, D. (2022). The effect of community contribution on the functionality of rural water supply programs in Indonesia. Groundwater for Sustainable Development, 19, Article 100822. https://doi.org/10.1016/j.gsd.2022.100822

Andromeda, A., Rafshanzany, M. L., & Buntoro, J. D. (2023). Association between personal hygiene and nutritional status in school-age children. Mutiara Medika: Jurnal Kedokteran dan Kesehatan, 23(2), 70–77. https://doi.org/10.18196/mmjkk.v23i2.17848

Anggreani, S. S., & Werdani, K. E. (2024). Evaluation of the role of village government in handling of stunting policy in Surakarta. Malahayati International Journal of Nursing and Health Science, 7(10), 1244–1253. https://doi.org/10.33024/minh.v7i10.585

Aryastami, N. K., Shankar, A., Kusumawardani, N., Besral, Jahari, A. B., & Achadi, E. (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3, Article 16. https://doi.org/10.1186/s40795-017-0130-x

Ayuningtyas, D., Hapsari, D., Rachmalina, R., Amir, V., Rachmawati, R., & Kusuma, D. (2022). Geographic and socioeconomic disparity in child undernutrition across 514 districts in Indonesia. Nutrients, 14(4), Article 843. https://doi.org/10.3390/nu14040843

Baker, P., Hawkes, C., Wingrove, K., Demaio, A. R., Parkhurst, J., Thow, A. M., & Walls, H. (2018). What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Global Health, 3(1), Article e000485. https://doi.org/10.1136/bmjgh-2017-000485

Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal & Child Nutrition, 14(4), Article e12617. https://doi.org/10.1111/mcn.12617

Bennett, S., Glandon, D., & Rasanathan, K. (2018). Governing multisectoral action for health in low-income and middle-income countries. PLOS Medicine, 15(4), Article e1002535. https://doi.org/10.1371/journal.pmed.1002535

Bintan Regency Health Office [Dinas Kesehatan Kabupaten Bintan]. (2023). Publication of stunting at the subdistrict level across Bintan Regency in 2023 [Publikasi stunting tingkat kecamatan se-Kabupaten Bintan tahun 2023]. Retrieved June 28, 2026, from https://dinkes.bintankab.go.id/menu/page/download

Braun, R., Catalani, C., Wimbush, J., & Israelski, D. (2013). Community health workers and mobile technology: A systematic review of the literature. PLOS ONE, 8(6), Article e65772. https://doi.org/10.1371/journal.pone.0065772

Danaei, G., Andrews, K. G., Sudfeld, C. R., Fink, G., McCoy, D. C., Peet, E., Sania, A., Fawzi, M. C. S., Ezzati, M., & Fawzi, W. W. (2016). Risk factors for childhood stunting in 137 developing countries: A comparative risk assessment analysis at global, regional, and country levels. PLOS Medicine, 13(11), Article e1002164. https://doi.org/10.1371/journal.pmed.1002164

Daniel, D., Prawira, J., Al Djono, T. P., Subandriyo, S., Rezagama, A., & Purwanto, A. (2021). A system dynamics model of the community-based rural drinking water supply program (PAMSIMAS) in Indonesia. Water, 13(4), Article 507. https://doi.org/10.3390/w13040507

De Onis, M., Borghi, E., Arimond, M., Webb, P., Croft, T., Saha, K., De-Regil, L. M., Thuita, F., Heidkamp, R., Krasevec, J., Hayashi, C., & Flores-Ayala, R. (2019). Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutrition, 22(1), 175–179. https://doi.org/10.1017/S1368980018002434

Dehnavieh, R., Haghdoost, A., Khosravi, A., Hoseinabadi, F., Rahimi, H., Poursheikhali, A., Khajehpour, N., Khajeh, Z., Mirshekari, N., Hasani, M., Radmerikhi, S., Haghighi, H., Mehrolhassani, M. H., & Aghamohamadi, S. (2019). The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries. Health Information Management Journal, 48(2), 62–75. https://doi.org/10.1177/1833358318777713

Department of Foreign Affairs and Trade. (2023). Community-based drinking water supply and sanitation (PAMSIMAS): Final independent evaluation, volume 1 – Final V.2. https://www.dfat.gov.au/sites/default/files/pamsimas-independent-evaluation.pdf

Development Initiatives. (2020). 2020 Global Nutrition Report: Action on equity to end malnutrition. https://globalnutritionreport.org/documents/566/2020_Global_Nutrition_Report_2hrssKo.pdf

Development Initiatives. (2021). 2021 Global Nutrition Report: The state of global nutrition. https://globalnutritionreport.org/reports/2021-global-nutrition-report/

Etrawati, F., Lionita, W., Amalia, E., Rahmawati, F., & Meilinda, N. (2023). Improving the knowledge of health cadres for stunting prevention through emotional demonstration technique. Indonesian Journal of Human Nutrition, 10(2). https://doi.org/10.21776/ub.ijhn.2023.010.02.3

Food and Agriculture Organization of the United Nations, International

Fund for Agricultural Development, United Nations Children’s Fund, World Food Programme, & World Health Organization. (2020). The state of food security and nutrition in the world 2020: Transforming food systems for affordable healthy diets. https://doi.org/10.4060/ca9692en

Gillespie, S., Haddad, L., Mannar, V., Menon, P., Nisbett, N., & Maternal and Child Nutrition Study Group. (2013). The politics of reducing malnutrition: Building commitment and accelerating progress. The Lancet, 382(9891), 552–569. https://doi.org/10.1016/S0140-6736(13)60842-9

Global Nutrition Report. (n.d.). Indonesia: Country nutrition profile. Retrieved June 26, 2026, from https://globalnutritionreport.org/resources/nutrition-profiles/asia/south-eastern-asia/indonesia/

Glenton, C., Javadi, D., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 5. Roles and tasks. Health Research Policy and Systems, 19(Suppl. 3), Article 128. https://doi.org/10.1186/s12961-021-00748-4

Haldane, V., Chuah, F. L. H., Srivastava, A., Singh, S. R., Koh, G. C. H., Seng, C. K., & Legido-Quigley, H. (2019). Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLOS ONE, 14(5), Article e0216112. https://doi.org/10.1371/journal.pone.0216112

Haywood, X., & Pienaar, A. E. (2021). Long-term influences of stunting, being underweight, and thinness on the academic performance of primary school girls: The NW-CHILD study. International Journal of Environmental Research and Public Health, 18(17), Article 8973. https://doi.org/10.3390/ijerph18178973

Heidkamp, R. A., Piwoz, E., Gillespie, S., Keats, E. C., D’Alimonte, M. R., Menon, P., Das, J. K., Flory, A., Clift, J. W., Ruel, M. T., Vosti, S., Akuoku, J. K., & Bhutta, Z. A. (2021). Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: An agenda for action. The Lancet, 397(10282), 1400–1418. https://doi.org/10.1016/S0140-6736(21)00568-7

Indra, J., & Khoirunurrofik, K. (2022). Understanding the role of village fund and administrative capacity in stunting reduction: Empirical evidence from Indonesia. PLOS ONE, 17(1), Article e0262743. https://doi.org/10.1371/journal.pone.0262743

Janmohamed, A., Sohani, N., Lassi, Z. S., & Bhutta, Z. A. (2020). The effects of community home visit and peer group nutrition intervention delivery platforms on nutrition outcomes in low- and middle-income countries: A systematic review and meta-analysis. Nutrients, 12(2), Article 440. https://doi.org/10.3390/nu12020440

Keats, E. C., Das, J. K., Salam, R. A., Lassi, Z. S., Imdad, A., Black, R. E., & Bhutta, Z. A. (2021). Effective interventions to address maternal and child malnutrition: An update of the evidence. The Lancet Child & Adolescent Health, 5(5), 367–384. https://doi.org/10.1016/S2352-4642(20)30274-1

Khairani, N., & Effendi, S. U. (2020). Analysis of stunting incidence among children under five based on basic immunization status and history of infectious disease [Analisis kejadian stunting pada balita ditinjau dari status imunisasi dasar dan riwayat penyakit infeksi]. Prepotif: Jurnal Kesehatan Masyarakat, 4(2), 228–234. https://doi.org/10.31004/prepotif.v4i2.1030

Kok, M. C., Dieleman, M., Taegtmeyer, M., Broerse, J. E. W., Kane, S. S., Ormel, H., Tijm, M. M., & de Koning, K. A. M. (2015). Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy and Planning, 30(9), 1207–1227. https://doi.org/10.1093/heapol/czu126

Laksono, A. D., Sukoco, N. E. W., Rachmawati, T., & Wulandari, R. D. (2024). A secondary data analysis of the 2022 Indonesian national stunting survey: Understanding policy-targeted interventions in urban-poor communities. BMJ Open, 14(9), Article e089531. https://doi.org/10.1136/bmjopen-2023-089531

Lautt, E. P., & Rahayu, A. Y. S. (2024). Integration of regional policies and collaborative governance in acceleration of stunting reduction: Case study of Bekasi City. Jurnal Bina Praja, 16(3), 589–597. https://doi.org/10.21787/jbp.16.2024.589-597

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE Publications. https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842

Miles, M. B., Huberman, A. M., & Saldaña, J. (2020). Qualitative data analysis: A methods sourcebook (4th ed.). SAGE Publications. https://www.sagepub.com/shop/buy-a-book/qualitative-data-analysis-4-246128

Ministry of Health of the Republic of Indonesia. (2023). Pocket book of the 2022 Indonesian Nutrition Status Survey (SSGI) [Buku saku hasil Survei Status Gizi Indonesia (SSGI) 2022]. https://repository.badankebijakan.kemkes.go.id/id/eprint/4855/3/Buku%20Saku%20SSGI%202022%20rev%20270123%20OK.pdf

Ministry of National Development Planning/National Development

Planning Agency. (2018). National strategy for accelerating the prevention of child stunting (2018–2024) [Strategi nasional percepatan pencegahan anak kerdil (stunting) 2018–2024]. https://stunting.go.id/stranas-p2k/

Nisbett, N., Gillespie, S., Haddad, L., & Harris, J. (2015). What drives and constrains effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya. Food Policy, 53, 33–45. https://doi.org/10.1016/j.foodpol.2015.01.001

Nutley, T., & Reynolds, H. W. (2013). Improving the use of health data for health system strengthening. Global Health Action, 6(1), Article 20001. https://doi.org/10.3402/gha.v6i0.20001

Oktarina, S., & Idawati, Y. (2022). The role of village midwives in reducing stunting rates in children under two years old (BADUTA). Midwifery International Journal, 2(4), 1–8. https://midwifery.iocspublisher.org/index.php/midwifery/article/view/777

Prasetyo, A., Noviana, N., Rosdiana, W., Anwar, M. A., Hartiningsih, Hendrixon, Harwijayanti, B. P., & Fahlevi, M. (2023). Stunting convergence management framework through system integration based on regional service governance. Sustainability, 15(3), Article 1821. https://doi.org/10.3390/su15031821

Prendergast, A. J., & Humphrey, J. H. (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health, 34(4), 250–265. https://doi.org/10.1179/2046905514Y.0000000158

Rachmi, C. N., Agho, K. E., Li, M., & Baur, L. A. (2016). Stunting, underweight and overweight in children aged 2.0–4.9 years in Indonesia: Prevalence trends and associated risk factors. PLOS ONE, 11(5), Article e0154756. https://doi.org/10.1371/journal.pone.0154756

Rasanathan, K., Bennett, S., Atkins, V., Beschel, R., Carrasquilla, G., Charles, J., Das, P., Drisse, M.-N. B., Mercure, E., Wilcox, B., & Zaidi, S. (2017). Multisectoral action for health in low-income and middle-income countries: From experience to learning. Health Policy and Planning, 32(8), 1163–1172. https://doi.org/10.1093/heapol/czx121

Republic of Indonesia. (2021). Presidential Regulation Number 72 of 2021 concerning the acceleration of stunting reduction [Peraturan Presiden Nomor 72 Tahun 2021 tentang Percepatan Penurunan Stunting]. https://peraturan.bpk.go.id/Details/174964/perpres-no-72-tahun-2021

Ruel, M. T., Alderman, H., & Maternal and Child Nutrition Study Group. (2013). Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536–551. https://doi.org/10.1016/S0140-6736(13)60843-0

Saleh, A., Khadafi, R., & Nurmandi, A. (2024). Stunting and the hope that must remain: Regional and human resource development perspectives; Inadequate policy problem identification process in the Tabagsel region of Indonesia. Frontiers in Public Health, 12, Article 1337848. https://doi.org/10.3389/fpubh.2024.1337848

Scott, K., Beckham, S. W., Gross, M., Pariyo, G., Rao, K. D., Cometto, G., & Perry, H. B. (2018). What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Human Resources for Health, 16, Article 39. https://doi.org/10.1186/s12960-018-0304-x

Sipahutar, T., Prasetyo, Y. A., Arsyad, D. S., Anwar, R., & Raksanagara, A. (2020). Spatial analysis of seven islands in Indonesia to determine stunting patterns. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 15(4), 203–212. https://scholarhub.ui.ac.id/cgi/viewcontent.cgi?article=1525&context=kesmas

Soliman, A., De Sanctis, V., Alaaraj, N., Ahmed, S., Alyafei, F., Hamed, N., & Soliman, N. (2021). Early and long-term consequences of nutritional stunting: From childhood to adulthood. Acta Biomedica, 92(1), Article e2021168. https://doi.org/10.23750/abm.v92i1.11346

Sufri, S., Iskandar, I., Nurhasanah, N., Bakri, S., Misbahul, J., Rajuddin, R., Nainggolan, S. I., Sirasa, F., & Lassa, J. A. (2024). Implementation outcomes of convergence action policy to accelerate stunting reduction in Pidie District, Aceh Province, Indonesia: A qualitative study. BMJ Open, 14(11), Article e087432. https://doi.org/10.1136/bmjopen-2024-087432

Sufri, S., Nurhasanah, Jannah, M., Dewi, T. P., Sirasa, F., & Bakri, S. (2023). Child stunting reduction in Aceh Province: Challenges and a way ahead. Maternal and Child Health Journal, 27(5), 888–901. https://doi.org/10.1007/s10995-023-03601-y

Sugiyarti, S. R. (2025). Implementation of stunting prevention policy in Tanjung Village, Nguter District, Sukoharjo Regency. Indonesian Journal of Public Administration Review, 2(3), 1–10. https://doi.org/10.47134/par.v2i3.4129

Syafrawati, S., Lipoeto, N. I., Masrul, M., Novianti, N., Gusnedi, G., Susilowati, A., Nurdin, A., Purnakarya, I., Andrafikar, A., & Umar, H. B. (2023). Factors driving and inhibiting stunting reduction acceleration programs at district level: A qualitative study in West Sumatra. PLOS ONE, 18(3), Article e0283739. https://doi.org/10.1371/journal.pone.0283739

Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2019). Determinants of the stunting of children under two years old in Indonesia: A multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients, 11(5), Article 1106. https://doi.org/10.3390/nu11051106

Torlesse, H., Cronin, A. A., Sebayang, S. K., & Nandy, R. (2016). Determinants of stunting in Indonesian children: Evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health, 16, Article 669. https://doi.org/10.1186/s12889-016-3339-8

Tyarini, I. A., Akib, A., Ratnasari, F., Setyaningsih, T. S. A., & Setyawati, A. (2024). Health education lecture method to increase Posyandu cadres’ knowledge about stunting prevention in children. Jurnal Ilmiah Kesehatan Sandi Husada, 13(1), 62–68. https://doi.org/10.35816/jiskh.v13i1.1173

United Nations Children’s Fund. (2020). Nutrition, for every child: UNICEF nutrition strategy 2020–2030. UNICEF. https://www.unicef.org/reports/nutrition-strategy-2020-2030

Vaivada, T., Akseer, N., Akseer, S., Somaskandan, A., Stefopulos, M., & Bhutta, Z. A. (2020). Stunting in childhood: An overview of global burden, trends, determinants, and drivers of decline. The American Journal of Clinical Nutrition, 112(Supplement_2), 777S–791S. https://doi.org/10.1093/ajcn/nqaa159

Westgate, C., Musoke, D., Crigler, L., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 7. Recent advances in supervision. Health Research Policy and Systems, 19(Suppl. 3), Article 114. https://doi.org/10.1186/s12961-021-00754-6

World Health Organization. (2014). Global nutrition targets 2025: Stunting policy brief. https://www.who.int/publications/i/item/WHO-NMH-NHD-14.3

World Health Organization. (2018). Global nutrition policy review 2016–2017: Country progress in creating enabling policy environments for promoting healthy diets and nutrition. https://www.who.int/publications/i/item/9789241514873




DOI: https://doi.org/10.35308/jpp.v12i3.14569

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