MANILA, PHILIPPINES (18 February 2005) - ADB will assist the Government of Indonesia in identifying and preparing a project to carry out an integrated nutrition program for poor urban communities in six cities, through a technical assistance (TA) grant approved for US$400,000.
The project aims to develop public-private partnerships and community-based schemes to address widespread urban malnutrition by strengthening food fortification and food safety.
In the selected cities, the TA will help local governments prepare nutrition programs on the basis of consultations with stakeholders from the public and the private sector.
The TA will develop a policy framework for implementing effective urban nutrition programs catering to the needs of the poor and determine the most cost-effective approaches to establishing or strengthening community-based initiatives in nutrition monitoring and behavioral change.
Recent data for Indonesia show that improvement in nutritional status has slowed down over the last 10 years. More than a third of children suffer stunting or low height. Wasting or low weight for height is estimated to occur in 11.4% of children.
There are several factors influencing nutrition trends in Indonesia. Increasing urbanization, which leads to higher-fat diets, predisposing people to chronic noncommunicable diseases such as diabetes and cardiovascular disease in later life, demands a reorientation of nutrition programs in terms of service delivery structure and for curative, preventive, and promotive approaches.
"In Indonesia, adult obesity is twice as prevalent in urban areas as in rural areas," says Barbara Lochmann, an ADB Social Protection Specialist. "A unique issue emerging is the problem of under- and overnutrition in the same household. Nutritional surveillance data suggest that in urban slum areas, undernutrition occurs in 22% of households with obese mothers."
Most nutrition programs in Indonesia focus on reducing rural malnutrition and have largely neglected growing malnutrition among urban poor communities.
To date there is little emphasis placed on dietary quality, a key factor in reducing malnutrition, and limited nutrition outreach or community programs accessible to the poor.
The poorer the household, the higher the proportion of income spent on food. In some areas of Jakarta, households spend about 70% of their income on food-related expenses. ADB research under an earlier TA in Indonesia suggests that the urban poor do not necessarily face food shortages, but have to survive on nutritionally inferior food, often purchased from street vendors, who use inadequate equipment and unsafe additives.
"Nutritional deficiencies among poor urban dwellers such as iron adeficiency anemia and Vitamin A deficiency can be addressed through fortification of processed foods with vitamins and, minerals," adds Ms. Lochmann. "Reducing micronutrient deficiencies through food fortification will help to strengthen the economy by lowering healthcare costs and increasing worker productivity. Fortification reaches populations at a minimal cost. For example the cost for salt iodization is $0.05 per person per year."
She says that stronger public-private partnerships will be needed to expand current fortification efforts beyond salt iodization and iron fortification of wheat flour, which is already in place, to, for instance, fortification of palm oil with vitamin A.
It should be noted, that the recent Copenhagen Consensus, a panel of the world's most distinguished economists, which prioritizes cost-effective interventions for confronting 10 great global challenges, ranked the fight against malnutrition through the provision of micronutrients as the second most efficient approach.
The total cost of the TA is about $500,000 equivalent, of which the Government will finance about $100,000. The Directorate General of Community Health in the Ministry of Health will be the executing agency for the TA.