Developing An Advocacy and Behaviour Change Communication Strategy For Stunting Reduction

1
UN04242
ROADMAP FOR DEVELOPING

AN ADVOCACY AND BEHAVIOUR CHANGE
COMMUNICATION STRATEGY
FOR STUNTING REDUCTION
IN INDONESIA
April 2018
3
ROADMAP FOR DEVELOPING

AN ADVOCACY AND BEHAVIOUR CHANGE
FOR STUNTING REDUCTION
IN INDONESIA
April 2018
Appendix C
The process to achieve advocacy goals
Acknowledgment
Once the Advocacy Goals are defined, the following four-part process can be used to achieve them:
We gratefully acknowledge the technical input, guidance, and assistance of the following
Na�onal Assem�ly Scien��c
Government Agencies Scien��c
Ministries Socio-Cultural
Paul Zambrano; IMA World Health– Iwan Hasan;(Current
Mul�-lateral Millennium
Status)
Challenge Account Indonesia –
Organiza�on Interna�onal Status
Farah Amini, Iing Mursalin,
INGOs Bonaria Siahaan;
ESTABLISH UNICEF
DEVELOP Indonesia – Jee Hyun Rah, Sri Sukotjo,
Media Agencies & SUSTAIN EVIDENCE
PARTNERSHIP BASE
ADVOCACY
GOAL
BUILD DEVELOP
CONCENSUS MESSAGES &
MATERIALS
i
Advocacy Strategic
Mee�ng & Communica�on
Workshops
Policy Briefs
Find and Deploy
Champions Media Engagement
Figure 1. The process for Policy Change
1. ESTABLISH AND SUSTAIN PARTNERSHIPS. Each partner brings unique resources that contribute to
advancing the advocacy agenda.
Existing networks for advocacy in Indonesia:
■ SUN networks and working groups

■ Gerakan Kesehatan Ibu dan Anak (GKIA)/Maternal and Child Child Health Movement
■ Professional associations
■ INGO networks (e.g. SUN Civil Society Alliance)
■ Faith-based organisations
■ Media agencies
■ Academic networks
■ Labor Unions
Recommendations include:
■ Identify the “moderator” or main coordinator for the Advocacy strategy

■ Identify potential partnerships for sub-national advocacy (e.g. with Ministry of Home Affairs,
ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
CHANGE COMMUNICATION
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
others such as formal associations of Bupatis if such are in place)
■ Revitalize existing partnership networks for coordination of Advocacy efforts (e.g. SUN
Advocacy Working Group)
■ Acronyms
Establish regular nutrition advocacy coordination meetings with key stakeholders and
influencers
■ Develop and maintain a contact list to support outreach around key milestones
A&T – Alive & Thrive
■ (e.g. Stunting Summits, World Breastfeeding Week, Nutrition Month, relevant national
holidays)
ECD – Early Childhood Development
2. DEVELOP THE EVIDENCE BASE. In addition to the earlier studies recommended, economic re-
search could help guide decisions on policies with funding implications (e.g. extending maternity
GKIA – Gerakan Kesehatan Ibu dan Anak
leave duration). Formative research points out the major barriers to improved feeding practices.
GoI – Government of Indonesia
Here are examples of such studies or sources of evidence from Indonesia:
ii
■ National surveys on current nutrition practices and stunting prevalence (Riskesdas, Indonesia
DHS)
■ TheIYCF
Economic
– InfantCost
andofYoung
Not Breastfeeding
Child Feeding in Indonesia conducted by the University of
Padjadjaran in 2015
■ Costing study for extending paid maternity leave to six months (also by the University of
Padjadjaran in 2015)
■ Media scan that shows inappropriate marketing of breastmilk substitutes in South-East Asia
including Indonesia (2016)
■ Indonesia-specific data in global databases such as NutriDash (UNICEF) and the Global
Nutrition Report Keluarga Harapan
PKH – Program
■ Studies
PKK –on the impact of Kesejahteraan
Pemberdayaan conditional cash transfers on health and nutrition
Keluarga
■ Recommended studies include:
■ Costing studies to guide budget decisions at the district level
3. DEVELOP COMPELLING, TARGETED, AND TESTED MESSAGES AND MATERIALS. Consistent, per-
suasive messages used by all partners makes them more memorable and credible. Advocacy
materials and messages are responsive to policymakers’ needs and preferred formats. Sustained
media engagement to tell the story of the impact of policies or programs is also critical.
Examples of effective message frames from nutrition advocacy in Southeast Asia include:
■ Investing in human capital and human resources

■ Reinforcing civic, religious or cultural themes – e.g. breastfeeding is encouraged in the Quran
■ Referencing global commitments – e.g. Indonesia’s progress in achieving the nutrition-
related Sustainable Development Goals
ROADMAPFOR
ROADMAP FORDEVELOPING
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
COMMUNICATIONSTRATEGY
STRATEGY
FORSTUNTING
FOR STUNTINGREDUCTION
REDUCTIONINININDONESIA
INDONESIA
Appendix C
About this document
This document is a roadmap to provide a clear path and guidance for the government and
other key stakeholders to develop a national advocacy and behaviour change communication
strategy for stunting reduction. The roadmap aims to facilitate alignment, improve the sense of
ownership, ensure relevant stakeholders are involved
Na�onal Assem�ly and set an appropriate structure for the
Scien��c
process of putting together theMinistries
communication strategy. Socio-Cultural
(Current Status)
Mul�-lateral
Interna�onal Status
This document is not a developed communication strategy,
Organiza�on
INGOs
as it does not identify target
ESTABLISH DEVELOP
audiences, key messages or tactical elements
Media Agencies& such
SUSTAIN
PARTNERSHIP as communication channels.
EVIDENCE
BASE
Global best practices show that the first stepADVOCACY

to design and implement an effective
communication strategy to change behaviour GOAL is support from stakeholders. This document
advocates for a proper consensus-buildingBUILD
process among relevant stakeholders prior to
DEVELOP
CONCENSUS MESSAGES & iii
developing an integrated andAdvocacy
developed strategy. MATERIALS
Strategic
Workshops
The roadmap is written for use by government officials at the national level and development
Find and Deploy
Policy Briefs
partners, but sub-national government official will also benefit from the information presented
in this document.

■ Media agencies
■ Labor Unions

ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
■
Table of Contents
Revitalize existing partnership networks for coordination of Advocacy efforts (e.g. SUN
■ Establish Acknowledgment
regular nutrition advocacy coordination meetings with key stakeholders and i
influencers
Acronyms ii
■ Develop and maintain a
About this documentcontact list to support outreach around key milestones iii
■ (e.g. Stunting Summits, World Breastfeeding Week, Nutrition Month, relevant national iv
Table of contents
holidays)
Stunting Reduction has become a National Priority in Indonesia 1
Situational analysis 2
2. DEVELOP THE EVIDENCE BASE. In addition to the
Communication materials assessment earlier studies recommended, economic re- 3
search could helpMaternal
guide decisions on policies with funding implications (e.g.
Infant and Young Child Nutrition (MIYCN) practices and extending maternity
communication 2
Here are examplesWhy do we
of such needorbehaviour
studies sources ofchange
evidence communication?
from Indonesia: 4
iv Behaviour change program design 5
Advocacy 6
DHS)
Interpersonal Communication and Community Mobilization 6
■ The Economic Cost of Not Breastfeeding in Indonesia conducted by the University of
Mass Communication 7
Padjadjaran in 2015
Strategic Use of Data 8
■ Costing study for extending paid maternity leave
Behaviour Change Communication Step by Step to six months (also by the University of 8
Why do we need advocacy? 9
■ Media scan that shows inappropriate marketing of breastmilk
Planning for the advocacy strategy and defining advocacy goals substitutes in South-East Asia
9
including Suggested
Indonesia (2016)
steps 10
■ Indonesia-specificAdvocacy
data in global databases such as NutriDash (UNICEF) and the Global 15
Communication
Nutrition Report 14
■ Studies on theCommunication Strategic
impact of conditional Planning
cash transfers on health and nutrition 11
Leadership and Coordination 10
Monitoring and Evaluation 15
■ Costing studies to guide budget
Suggested Timeline decisions at the district level 17
Challenges to be considered 17
A Common Term for Stunting 17
Decentralization 18
Geography and Cultural Diversity 17
media engagement Multi-Sectoral Partnerships
to tell the story and Alignment
of the impact of policies or programs is also critical. 18
Examples of effective message

Appendix frames from
A Maternal, nutrition
Infant advocacy
and Young ChildinNutrition
SoutheastPractices
Asia include: 21
■ Investing Appendix B Communication
in human capital and human Materials
resources Assessment 31
Appendix C The process to achieve advocacy goals 36
References 43
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ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
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INDONESIA
Appendix C
Stunting Reduction has become a National
Priority
The process toin Indonesia
achieve advocacy goals
The nutrition situation in Indonesia remains problematic despite the country’s good progress and the
Government of Indonesia’s (GOI) commitment to reducing malnutrition. In 2013, approximately 9
million children under five (37%) were estimated to be stunted1. To combat stunting the GOI issued
a Presidential Decree no. 42/2013 to launch ‘Gerakan Nasional
Percepatan Perbaikan Gizi’ (National
Movement to Accelerate NutritionMinistries
Improvement) - focusedSocio-Cultural
on the
(Current Status)
first 1000 days of life, in line with
the global SUN Movement. Mul�-lateral
INGOs ESTABLISH DEVELOP
& SUSTAIN EVIDENCE
Subsequently, the GOI launched the National
Media Agencies Stunting
PARTNERSHIP BASEReduction Movement in 2017. With the
aim of reducing stunting of under-two children to 28% by 2019, Rencana Pembangunan Jangka
ADVOCACY
Menengah Nasional (RPJMN) (National Medium-Term GOAL Development Planning) 2015-2019 (Book II-
2-97) stipulated that the Acceleration of Community Nutrition Improvement Strategy must promote
BUILD DEVELOP
behaviour change as one of its main components. CONCENSUS Additionally,
MESSAGES &
MATERIALS
Vice President, Jusuf Kalla, as the 1
Advocacy Strategic
head of Tim Nasional Percepatan Penanggulangan
Mee�ng & Kemiskinan Communica�on
(TNP2K) (National Team to Accelerate
Workshops
Poverty Alleviation) introduced theFindconcept
and Deployof the five pillars of
Policy stunting reduction. This included
Briefs
Media Engagement
the implementation of a national campaign focusing on knowledge, behaviour change, political
Champions
commitment and accountability for stunting reduction (Figure 1). The Government of Indonesia
named 100 priority districts to receive interventions starting in 2018, and a plan to scale up in 2019 –
2021.
5 Pilar Penanganan Stun�ng
PILAR 1 PILAR 2 PILAR 3 PILAR 4 PILAR 5
<ĂŵƉĂŶǇĞ
EĂƐŝŽŶĂů <ŽŶǀĞƌŐĞŶƐŝ͕
ďĞƌĨŽŬƵƐƉĂĚĂ DĞŶĚŽƌŽŶŐ
Existing networks for advocacy in Indonesia: <ŽŽƌĚŝŶĂƐŝ͕
<ŽŵŝƚŵĞŶĚĂŶ
<ĞďŝũĂŬĂŶ WĞŵĂŶƚĂƵĂŶ
sŝƐŝWŝŵƉŝŶĂŶ ƉĞŵĂŚĂŵĂŶ WƌŽŐƌĂŵEĂƐŝŽŶĂů͕
ƉĞƌƵďĂŚĂŶ ͚EƵƚƌŝƟŽŶĂů ĚĂŶǀĂůƵĂƐŝ
dĞƌƟŶŐŐŝEĞŐĂƌĂ
■ SUN networks and working groups ĂĞƌĂŚĚĂŶ
ƉĞƌŝůĂŬƵ͕ &ŽŽĚ^ĞĐƵƌŝƚǇ͟
DĂƐǇĂƌĂŬĂƚ
■ Gerakan KesehatanŬŽŵŝƚŵĞŶƉŽůŝƟŬ
Ibu dan Anak (GKIA)/Maternal and Child Child Health Movement
ĚĂŶĂŬƵŶƚĂďŝůŝƚĂƐ͘
■ INGO networks (e.g. SUN Civil
Figure Society
1. Five PillarsAlliance)
to Reduce Stunting by TNP2K
The ■
importance of communication and behaviour change has been repeatedly mentioned in various
Media agencies
government policies, however, an integrated national communication strategy for stunting reduction
■ been
has not Academic networks
established. As a result, efforts to promote stunting reduction have been sporadic,
leading
■ stakeholders
Labor Unionsto develop their own efforts that are often inconsistent and at times include
inaccurate information. The roles and responsibilities of different stakeholders in stunting reduction
communication activities also have not been clearly defined, creating a challenging environment for
coordination,
■ Identifydecision making, andoraccountability.
the “moderator” main coordinator for the Advocacy strategy
ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
Situational analysis
Maternal Infant and Young Child Nutrition (MIYCN) practices and
■ Establish regular nutrition advocacy coordination meetings with key stakeholders and
communication
influencers
A desk
■ review
Developconducted by Alive
and maintain and Thrive
a contact list in
to 2017 summarized
support the existing
outreach around literature on MIYCN
key milestones
practices in Indonesia focusing on the first ‘1000 days’ nutrition window of opportunity. Overall,
■ (e.g.
disparities in allStunting
MIYCN Summits,
indicatorsWorld Breastfeeding
exist across IndonesiaWeek,
due toNutrition Month,
significant relevant
inequities national
in wealth,
holidays)
infrastructure, and levels of urbanity/rurality, with malnutrition worst in areas with limited access to
schools, markets, and health facilities. Even among the wealthiest households, between 24 and 29%
of children are stunted.
The review
searchpresents
could help current
guideMIYCN practices
decisions and what
on policies is knownimplications
with funding about determinants of key maternity
(e.g. extending MIYCN
and related health-seeking
leave duration). behaviours.
Formative researchPotential
points outimportant
the major knowledge
barriers togaps are identified.
improved feedingThis
practices.
review underscores the need for a comprehensive advocacy and behaviour change communication
Here aretoexamples
strategy of such
address the studies
barriers or sourcesoptimal
to achieving of evidence
MIYCN from Indonesia:
in the first 1000 days. A summary of the
2
highlights of this review is below, and a matrix providing more details
■ National surveys on current nutrition practices and stunting prevalence is included in AppendixIndonesia
(Riskesdas, A.
DHS)height for age)
Stunting (low
■ Most people are not familiar with the term stunting.2
Padjadjaran in 2015
■ Stunting is not currently seen as a public health problem among mothers, as well as
healthcare workers and non-healthcare stakeholders.3
■ Many believe it is caused by hereditary factors.2
Maternalincluding
nutritionIndonesia (2016)
■■ Indonesia-specific
Reduced eating anddata
foodintaboos
global occur
databases such
during as NutriDash
pregnancy 2
. (UNICEF) and the Global
Nutrition Report
■ Diets are influenced by husbands and mothers/mothers-in-law who are decision makers on
■ Studies
foods on theand
bought impact of conditional
consumed 2
. cash transfers on health and nutrition
■■ Recommendeddeficiencies—iron
Micronutrient studies include: and calcium affect pregnant women4.
Early■initiation
Costing
ofstudies to guide(EIBF)
breastfeeding budget decisions
and at breastfeeding
exclusive the district level
0-6 months (EBF)
■ Early initiation of breastfeeding is not the norm; only about half of mothers initiate
3. breastfeeding
DEVELOP withinTARGETED,
COMPELLING, one hour ofAND 4
.
birthTESTED MESSAGES AND MATERIALS. Consistent, per-
■suasive
Onlymessages
1 out of 2used by all
infants 0-6partners
months makes them more
are exclusively memorable
breastfed 5 and credible. Advocacy
■ Mothers assisted by a health professional during delivery are less likely to practice EIBF or
within one day compared to mothers assisted by a TBA or by relatives6
Examples
■ Poorof effective
knowledgemessage frames frompractices,
of breastfeeding nutritionlack
advocacy in Southeast
of motivation Asia include:
to breastfeed, and lack of
■ confidence
Investing inall servedcapital
human as barriers to exclusive
and human breastfeeding3,7.
resources
■■ There is a confidence
Reinforcing gap inormothers’
civic, religious ability to– produce
cultural themes the right quality
e.g. breastfeeding and quantity
is encouraged in theofQuran
breastmilk .
3

■ Working mothers experience
related Sustainable Developmentchallenges
Goals to exclusive breastfeeding; for example, lack of
private lactational areas, lack of flexible schedule8
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ANDBEHAVIOUR
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FORSTUNTING
INDONESIA
Appendix C
■ Promotional materials, BMS samples, and other Code violations are barriers to EBF.
Complementary feeding
The■process to achieve advocacy goals
Early introduction of complementary foods is common, with half of all breastfed children age
Once the 4-5 monthsGoals
having
arealready had
thesome type of solid orprocess
semi-solid
canfood . to achieve them:
4
Advocacy defined, following four-part be used
■ Adequate frequency of feeding children 6 to 24 months is an issue; only two-thirds of
children are fed the recommended number of times per day3.
■ Half of the mothers report feeding only on demand
Na�onal Assem�ly Scien��c .
2

■ Only about one-third of children
Ministries age 6-23 monthsSocio-Cultural
are fed according to the WHO revised
(Current Status)
IYCF recommendations,Mul�-lateral
including
Organiza�on
food and breastfeeding frequency and adequate dietary
diversity .
4
PARTNERSHIP BASE
Communication materials assessmentADVOCACY

GOAL
An assessment of existing communication materials related to stunting (Appendix B) indicates that:
BUILD DEVELOP
MATERIALS
3
■ There is a clear need to establish a set of guidelines toCommunica�on
Advocacy
Mee�ng &
make sure that all communication
Strategic
efforts deliver consistent and accurate information.Policy Briefs

Workshops
Find and Deploy
■ Although stunting is a major problem in Indonesia, and lack of awareness is one of the
key findings of the research studies referenced2,3, no comprehensive campaign properly
addressed the topic.
■ The national campaign by MoH is mostly related to interventions to prevent stunting such as
Figure
Exclusive Breastfeeding, Free1.Open
The Defecation,
process for Policy Change with Soap, etc.
Hand Washing
■ There is also a campaign at the sub-national level conducted by NGOs such as GAIN on Infant
and Young Child Feeding.
■ The only
advancing thecomprehensive
advocacy agenda.behaviour change communication (BCC) effort at national level was
conducted by IMA WorldHealth in 2016-2017, but since there is no statistical evidence of the
Existing networks for advocacy
performance in Indonesia:
of the program available at this time, it is hard to determine its effectiveness.
■■ A new
SUN awareness
networks andcampaign about stunting started by IMA WorlHealth in December 2017,
working groups
is a step in the right direction, although it should have been the initial campaign before
running the BCC program.
■ The different campaigns currently running, pointing in many directions and with many
■ INGO networks
providing (e.g. SUN
inaccurate Civil Society
information, Alliance)the need to create consensus on how to
underscore
■ address stunting
Faith-based reduction, to coordinate efforts and speak with one voice on all fronts.
organisations
■ Media agencies
■ Labor Unions

ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
influencers
holidays)

UN04252
4
DHS)
Why do we need behaviour change

Padjadjaran in 2015
communication?
As indicated by the Government of Indonesia, advocacy and BCC are necessary components of a
■ Media nutrition
comprehensive scan thatprogram
shows inappropriate marketing
aimed at stunting of breastmilk
reduction. substitutes
which requires the in South-East
adoption of Asia
including
key behaviours Indonesia
known (2016)
to prevent undernutrition in the critical first 1,000 days – from the start of
conception up to the first two years
■ Indonesia-specific data in global of a child’s life. such as NutriDash (UNICEF) and the Global
databases
Nutrition Report
Improving nutrition outcomes through the adoption of new behaviours takes time and effort at many
■ It requires
levels. Studies on
an the impactcombining
approach of conditional cash transfers
advocacy on health
to make BCC part ofand
an nutrition
overall GoI program to
create awareness of malnutrition’s
■ Recommended studies include: effect on children, as well as the social and behaviour change
interventions needed to promote and support better MIYCN practices in the community and
household.
To be able to scale and replicate this approach beyond the initial 100 districts initially targeted
and
3. ensure
DEVELOP thatCOMPELLING,
other populations will also
TARGETED, ANDimprove
TESTED their nutrition,
MESSAGES it isMATERIALS.
AND also essential to build the
Consistent, per-
capacity of local
suasive and national
messages stakeholders
used by all partnersin the design
makes and implementation
them more memorable andofcredible.
behaviour change
Advocacy
methodologies.
materials andTheir exposure
messages areand engagement
responsive as policymakers
to policymakers’ needsandand
at the community
preferred level
formats. is a key
Sustained
component of behaviour to
media engagement change towards
tell the story ofnutrition promotion.
the impact of policies or programs is also critical.
Within thisofcontext,
Examples effectiveBCC can have
message different
frames from but interrelated
nutrition roles.
advocacy in Southeast Asia include:
Increase
■ knowledge. By ensuring
Investing in human that
capital anddifferent
human audiences
resources receive the basic facts about malnutrition
as the main cause of stunting in an easy to understand manner.
Stimulate communityglobal
■ Referencing dialogue. By encouraging
commitments – e.g. community
Indonesia’s discussion
progress inon the basicthe
achieving facts of nutrition
nutrition-
and the factors
relatedthat contribute
Sustainable to the malnutrition
Development Goals problem, among them inappropriate behaviours,
cultural practices related to food and eating habits, and family influences on nutrition in the ‘1000
Days’ period.
ROADMAPFOR
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
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Appendix C exclusive breastfeeding in the first six months, optimal feeding during the
Promote change. By encouraging appropriate attitudinal and practices changes such as early
initiation of breastfeeding,
6 to 23 month period, open-mindedness about social norms, and basic needs of pregnant/lactating
women (maternal nutrition), to prevent stunting.
Create demand for healthy food, information, and services. By stimulating individuals and
communities to request information on good nutritional practices and demand the support services
needed to implement better practices.
Improve skills. By focusing on teaching or Assem�ly

Na�onal reinforcing new skills including counselling on new
Scien��c
behaviours, such as prenatal care,Ministries
exclusive breastfeeding Socio-Cultural
and an age-appropriate nutritional diet for
(Current Status)
the whole family, among others.Mul�-lateral
To be effective, BCC requiresMedia
theAgencies
foundation& of a comprehensive
SUSTAIN
PARTNERSHIP
EVIDENCE
BASE
behaviour change strategy and
program, sound implementation and continuous monitoring to enable adjustments as needed based
on credible data and information. ADVOCACY
GOAL
BUILD DEVELOP
5
Behaviour change program design
MATERIALS
Advocacy Strategic
Workshops
Policy Briefs
Find and Deploy
Global best practice shows that for a change in behaviour Media
Champions to beEngagement
adopted and sustained, any behaviour
change strategy should contain advocacy, interpersonal communication (IPC) and community
mobilization, mass media and the strategic use of data.
Partnership & alliances in the health

Figure 1.system
The process for Policy Change
and other sectors for scale and sustainability
ADVOCACY INTERPERSONAL COMMUNICATION

1. & COMMUNITY
ESTABLISH AND SUSTAIN MOBILIZATION
PARTNERSHIPS. Each partner brings unique resources that contribute to
MASS COMMUNICATION
■ SUN networks
Policy Staﬀ ofandService
working groups Mothers & Improved
markers & Employers mul�ple providers & Family Caregathers Improved
legislators sector community knowledge, breas�eeding & Improved
■ Gerakan Kesehatan Ibuleaders dan Anak (GKIA)/Maternal and Child
briefs, Child Health Movementhealth
complementary
skills, and feeding prac�ces outcomes
■ Professional associations environment

STRATEGIC USE OF DATA
■ Media agencies
■ Academic
Figure networks
2 - The A&T framework, a systematic, data-driven, collaborative approach to program
design, provides
■ Labor a process to guide decisions on project design for behaviour change, dividing it
Unions
into those four tactical elements.

ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
Advocacy
■ Revitalize
Advocacy existing
is the process partnership
of educating andnetworks forinfluential
motivating coordination of Advocacy
audiences efforts
to take (e.g.
specific SUN in
actions
support ofAdvocacy
an issue, Working Group)
in this case prioritizing stunting reduction by creating an enabling environment
for mothers and families to adopt
■ Establish regular nutrition optimal MIYCN
advocacy practices. meetings
coordination This may with
include
keysupporting
stakeholderslaws,
and
policies, financing, or planning for nutrition on a large scale. The exact need, goal, or policy action is
influencers
shaped by Indonesia-specific barriers, its political system, and social context.
Advocacy is necessary
■ (e.g. Stuntingbecause
Summits, even when
World mothers andWeek,
Breastfeeding families are reached
Nutrition Month,through
relevanthealth systems
national
and mass holidays)
media campaigns, environmental barriers remain. For example, mothers may have to
return to work after only a few weeks after giving birth, making exclusive breastfeeding for six months
difficult. A mother may receive misleading messages because of unregulated marketing practices by
infant formula companies,
2. DEVELOP THE EVIDENCE leading her
BASE. Into give formula
addition to the instead of breastfeeding.
earlier studies recommended, economic re-
search
Stunting could help
reduction guide
requires decisions
action fromon policies
multiple with funding
sectors (health,implications (e.g. extending
nutrition, education, WASH,maternity
leave duration).
agriculture, Formative research
social protection,etc.). points the
In Indonesia, out decentralized
the major barriers to improved
government feeding
context meanspractices.
that
Hereadvocacy needsoftosuch
are examples be harmonized across these
studies or sources sectors,
of evidence at multiple
from levels of government, and
Indonesia:
6 across geographies. The central government can play a leadership role in motivating and leveraging
■ National
commitments surveys from
and actions on current nutrition
sub-national practices
leaders and and stunting prevalence (Riskesdas, Indonesia
departments.
DHS)
Some examples of successful
Padjadjaran in 2015 advocacy efforts include:
■ Costing
Working study
closely withfor
theextending paid maternity
Vietnam Women’s Union,leave to six months
stakeholders (also by
conducted anthe University of
intensive
Padjadjaran
advocacy campaigninon2015)
paid maternity leave and the International Code of Marketing of
Breastmilk
■ Media Substitutes
scan that to parliamentarians
shows inappropriateinmarketing
2012. As aofresult, paid maternity
breastmilk substitutesleave duration Asia
in South-East
was increased from 4 to 6 months
including Indonesia (2016) in support of exclusive breastfeeding. Advertising of
breastmilk substitutes marketed for children under 24 months was also banned, in line with
■ Indonesia-specific
global recommendations.data in global databases such as NutriDash (UNICEF) and the Global
Nutrition Report
■ Studies on the impact of conditional cash transfers on health and nutrition
Interpersonal Communication and Community Mobilization
“People talking to people is still how the world’s standards change.” - Atul Gawande.
IPC, the most effective form of communication, involves face-to-face conversations and activities with
mothers or family
3. DEVELOP members. Through
COMPELLING, TARGETED, IPC,AND
frontline workers
TESTED can create
MESSAGES AND awareness
MATERIALS.about the effects
Consistent, per-
of malnutrition that lead to stunting, explain the importance of good nutrition during
suasive messages used by all partners makes them more memorable and credible. Advocacy the different
stagesmaterials
of the first
and1000 days, and
messages are advice on ways
responsive to prevent stunting.
to policymakers’ needs and preferred formats. Sustained
media engagement to tell the story of the impact of policies
Through community mobilization, local opinion-leaders are mobilized or programs is also
to recognize thecritical.
importance of
proper nutrition
Examples for stunting
of effective messagereduction, support
frames from community-based
nutrition workers, and
advocacy in Southeast Asiapromote
include:adoption of
recommended nutrition practices
ROADMAPFOR
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
STRATEGY
FORSTUNTING
INDONESIA
Appendix C
In countries where A&T implemented its successful SBCC programs, IPC was key to reach
Thepregnant
processwomen and women
to achieve with a child
advocacy goalsunder 2 years of age. In Bangladesh, mothers
in over 220 sub-districts were reached through home visits, using workers from existing
Once the Advocacy
programs Goals
carried by aare defined,
large the following
local NGO.In four-part
Ethiopia, process can
health workers and be used toorganizations
women’s achieve them:
home visits, combined with community mobilization activities, were the main communication
channels. In Vietnam, interpersonal counseling through social franchises and Infant and
Young Child Feeding (IYCF) support groups played important roles in reaching mothers.
All three country programs increased access
Government Agenciesto health volunteers and health workers trained
Scien��c
in counseling on IYCF, strengthening
Mul�-lateral frontline workers and the health systems – reaching
(Current Status)
around 3.7 million mothersINGOs
of children under
Organiza�on
the DEVELOP
ESTABLISH
age of two.
PARTNERSHIP BASE
ADVOCACY
Mass Communication GOAL
BUILD DEVELOP
Mass communication campaigns (broadcast, out-of-home,
CONCENSUS MESSAGESand
MATERIALS
& online) featuring the importance 7
Advocacy Strategic
of key practices, combined withMee�ng
the other
& program components, help maximize reach and impact.
Communica�on
Workshops
Mass communication, the most efficient form
Find and Deploy
of communication at
Policy Briefs large scale, is essential to reach
Media Engagement
audiences at the national level. Champions
In Bangladesh, mass communication reached 6.5 million mothers of children under 2 years
directly, over a three-year period,
Figure in1. Ethiopia it reached
The process nearly
for Policy 1 million, and in Vietnam
Change
2.3 million. The mass media messages touched millions more who could support mothers’
behaviours, including fathers, grandmothers, health workers, doctors, and decision makers,
with common, tested messages delivered in a consistent manner.
advancing
Mass the advocacy
communication agenda. lent credibility to frontline workers’ messages, making
campaigns
mothers more open to their support. The campaigns likely helped frontline workers remain
true to the program’s priority messages.
The TV, radio spots and other materials featured key messages and promoted new
■ Gerakanusing
behaviours, Kesehatan
imagesIbu anddan Anakof(GKIA)/Maternal
stories desirable infant and Childpractices.
feeding Child Health Movement
In Ethiopia, a radio
and TV campaign for men
■ Professional associations was developed because of their influence on feeding decisions
and their access to mass media. Each TV and radio spot featured one IYCF action and how
a■father
INGO networks
could support (e.g. SUN
it. In VietCivil
Nam, Society Alliance)
an award-winning TV campaign featuring “Talking
Babies” addressedorganisations
■ Faith-based misperceptions about the adequacy of breastmilk and the need for water.
The campaign also promoted iron-rich foods and advised mothers to use the IYCF counselling
■ Media agencies
services of the social franchises.
The internet, social media, and mobile phone applications targeted mothers in urban areas.
■ Labor Unions

ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
Strategic Use
others suchof
as Data
formal associations of Bupatis if such are in place)
■ Revitalize
Data-informed existing
decisions partnership
result in betternetworks
programs.for coordination
Research of Advocacy
is conducted efforts
to guide the (e.g. SUN
program
Advocacy
design, focusing on Working Group)
interventions proven to be effective at reducing stunting. Baseline data collection
helps■set Establish
realistic targets, specific
regular nutritionand relevantcoordination
advocacy to the geographic areas
meetings targeted
with by the program.
key stakeholders and
influencers
Data helps to develop and sustain partnerships, shape advocacy priorities, and program decision
■ Formative
making. Develop and maintain
research a contact
studies, list toanalysis,
landscape support media
outreach around
scans, key milestones
surveys, and stakeholder
mapping help design country-tailored programs. Special studies and routinely collected
■ (e.g. Stunting Summits, World Breastfeeding Week, Nutrition Month, relevant national data guide
revisions in program design and implementation. Internal monitoring units and external evaluation
holidays)
teams collect and cross-check core indicators and track program reach. Monitoring systems help
determine if corrective actions should be taken or if the program is on track.
Behaviour Change Communication Step by
8 Step
A BCC strategic planning process starts with a joint national collaborative planning effort for strategic
DHS)
communication, bringing to the table different sectors, perspectives, and experiences from various
parts■of the
Thecountry
Economic Cost of Not
representing Breastfeeding
the in of
wide diversity Indonesia conducted
communities by the University of
in Indonesia.
Padjadjaran in 2015
The process is divided into five phases.
ƐŝƚƵĂƟŽŶĂůĂŶĂůǇƐŝƐŝŶĐůƵĚŝŶŐƐƚĂŬĞŚŽůĚĞƌĐŽŶƐƵůƚĂƟŽŶƐ͕
ͻ ^ŝƚƵĂƟŽŶĂƐƐĞƐƐŵĞŶƚƐ͕
Understand
■ Mediathe scan that shows inappropriate marketing
ĐŽŶƐƵůƚĂƟŽŶƐ͕ĨŽƌŵĂƟǀĞ of breastmilk substitutes in South-East Asia
ƌĞǀŝĞǁƐŽĨĞǆŝƐƟŶŐĚĂƚĂƐĞƚƐĂŶĚƌĞƉŽƌƚƐƚŽŝĚĞŶƟĨǇ
situa�on
ƌĞƐĞĂƌĐŚ͕ŶĂƟŽŶĂůƐƵƌǀĞǇƐ
ƐƚƌĂƚĞŐŝĐĐŚŽŝĐĞƐĂŶĚŐĂƉƐŝŶƚŚĞĚĂƚĂ͕ŵĞĚŝĂĂƵĚŝƚƐ͕
ƌĞǀŝĞǁŽĨƚŚĞŚĞĂůƚŚƐǇƐƚĞŵ͕ĨŽƌŵĂƟǀĞƌĞƐĞĂƌĐŚĂŶĚĂ
■ ďĂƐĞůŝŶĞƐƵƌǀĞǇ͘
Indonesia-specific data in global databases such as NutriDash (UNICEF) and the Global
Nutrition Report
ͻ /ĚĞŶƟĨǇŝŶŐpriority dŚĞŬĞǇƚŽƐƵĐĐĞƐƐĨƵůŝƐĨŽĐƵƐŝŶŐŽŶĂƐŵĂůůŶƵŵďĞƌŽĨ
Focus and Design behaviors ƚŽƉƌŽŵŽƚĞĂŶĚ ďĞŚĂǀŝŽƵƌƐĂŶĚƚŚĞĚŝƐĐŝƉůŝŶĞĚĐŽŵŵŝƚŵĞŶƚƚŽƐƚĂǇ͞ŽŶ
■ Studies on theƐĞƌǀŝĐĞĚĞůŝǀĞƌǇŵŽĚĞůƐ
impact of conditional cash transfers on health and nutrition
ŵĞƐƐĂŐĞ͟ǁŝƚŚĞĂĐŚŽĨƚŚĞƉƌŽŐƌĂŵΖƐĐŽŵŵƵŶŝĐĂƟŽŶ
ĂĐƟǀŝƟĞƐ͘
DĂƐƐĐŽŵŵƵŶŝĐĂƟŽŶĐĂŵƉĂŝŐŶƐĂŶĚƐƵƉƉŽƌƚŵĂƚĞƌŝĂůƐ
Create
■ Costing
communica�on studies to guide budget decisions
ͻ ^ƵƉƉŽƌƚŵĂƚĞƌŝĂůƐ͕ũŽďͲĂŝĚƐ͕ at the district level
ĚĞǀĞůŽƉĞĚŝŶƉĂƌƚŶĞƌƐŚŝƉǁŝƚŚŽƚŚĞƌƐƚĂŬĞŚŽůĚĞƌƐĂŶĚ
ƚƌĂŝŶŝŶŐŵĂŶƵĂůƐ ĐƌĞĂƚĞĚďǇĂĚǀĞƌƟƐŝŶŐĂŐĞŶĐŝĞƐ͘
materials
3. DEVELOP COMPELLING, TARGETED, AND TESTEDĂƚĂĨƌŽŵƌŽƵƟŶĞŵŽŶŝƚŽƌŝŶŐƐǇƐƚĞŵƐĂŶĚƐƉĞĐŝĂůƐƚƵĚŝĞƐ

MESSAGES AND MATERIALS. Consistent, per-
Implement and
suasive messagesͻused
WĞƌĨŽƌŵĂŶĐĞŵŽŶŝƚŽƌŝŶŐ ƚŽŝŵƉƌŽǀĞƵŶĚĞƌƐƚĂŶĚŝŶŐŽĨƚŚĞƐƚƌĞŶŐƚŚƐĂŶĚ
by all partners makes them more memorable and credible. Advocacy
ĂŶĚƐƵƉƉŽƌƟǀĞƐƵƉĞƌǀŝƐŝŽŶ ǁĞĂŬŶĞƐƐĞƐŝŶƉƌŽŐƌĂŵŝŵƉůĞŵĞŶƚĂƟŽŶĂŶĚǁŚĂƚ
Monitor
ĐŽƌƌĞĐƟǀĞĂĐƟŽŶƐĂƌĞŶĞĞĚĞĚ͘
Use data for &ŽƌĞǀĂůƵĂƟŽŶĂŶĚĐŽƌƌĞĐƟŽŶƐ͕ďĂƐĞůŝŶĞ͕ŵŝĚůŝŶĞ͕ĂŶĚ
Examples ͻ DŝĚͲĐŽƵƌƐĞĐŽƌƌĞĐƟŽŶƐ͕
of effective message frames from nutrition ĞŶĚůŝŶĞĐƌŽƐƐͲƐĞĐƟŽŶĂůƐƵƌǀĞǇƐĂƌĞŬĞǇĞůĞŵĞŶƚƐŽĨĂŶǇ
advocacy in Southeast Asia include:
strategic
ĂĚũƵƐƚƉůĂŶƐ ^ƉƌŽŐƌĂŵ͘
adjustments
ROADMAP
ROADMAPFOR
FORDEVELOPING
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
STRATEGY
FOR
FORSTUNTING
STUNTINGREDUCTION
INDONESIA
Appendix
Why do weC need advocacy?
Advocacy
The and communication,
process while different,
to achieve advocacy goalscomplement and reinforce each other. The main
distinction is not just the target audiences, but also what communication channels and materials are
Once thereach
used to Advocacy
them.Goals
Whileare defined, the following
communication four-part changes
targets individual process can be used toand
in knowledge achieve them:
behaviour,
advocacy is directed at policymakers, leaders, and decision-makers at different levels, to affect change
of a specific policy, law or program.
In defining its objectives, an advocacy program

Na�onal Assem�lymust take into consideration:
Scien��c
■ The political, economic, social,
Ministries and/or cultural motivations
Socio-Cultural of the target audience.
(Current Status)
Mul�-lateral
■ Available resources such
INGOs
as money,ESTABLISH
people, DEVELOP
and political support.
■ The barriers and obstacles preventing audiences
PARTNERSHIP BASE from acting.
■ The program’s ability to help to find a solution
ADVOCACY for removing barriers and obstacles.
GOAL
Planning for the advocacy strategy and

BUILD DEVELOP
MATERIALS
9
Advocacy Strategic
Workshops
defining advocacy goals

Policy Briefs
Find and Deploy
1. Policy and decision-making landscape analysis: Examine relevant policy actions that need to be
made at each level of government, as well as the key decision-makers for each policy action.
■ What has been done in Indonesia:

Figure 1. TheNutrition landscape
process for analysis, nutrition sector review.
Policy Change
■ Recommendations: Legal reviews (including legislative procedures), expanding policy scans
to include nutrition-sensitive areas
1.
2. ESTABLISH AND
Stakeholder SUSTAINBuilding
mapping: PARTNERSHIPS.
from the Each
policypartner brings unique resources
and decision-making landscapethat contribute
analysis, a to
stakeholder map can be developed for each policy goal identified (the stakeholders will change
depending
Existing networksonfor
the advocacy
advocacy inpriority).
Indonesia:
■■ Recommendation:
SUN Conductgroups
networks and working or update issue-specific stakeholder mapping for including sub-
national level. This may be done through consultative meetings.
3. Opinion leader and decision-maker assessments: This rapid assessment effort is a quick way to
■gather
Professional associations
insights from decision-makers through interviews to better understand their knowledge
■ INGO networks (e.g. SUNand
and views of undernutrition Civilstunting; motivations in favor of supporting stunting as a prior-
Society Alliance)
ity; barriers to greater political and public will for undernutrition and stunting reduction; and
views and momentum related to specific policy actions.
■ Media agencies
■ What has been done in Indonesia: Opinion Leader Research on IYCF conducted by SMERU
■ Academic networks(April 2016).
Research Institute
4. ■Example
LaborAdvocacy
Unions Goals and Objectives
1. At least 50 districts from 100 districts targeted in Indonesia adopt stunting reduction as a
development
■ Identify target through
the “moderator” theircoordinator
or main District Medium Term
for the Development
Advocacy strategyPlan RPJMD by the
end of 2018.
ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
2. At
others
leastsuch
X% ofaslocal
formal
funding
associations
allocated
of for
Bupatis
evidence-based
if such are innutrition-specific
place) and sensitive
activities with concrete and measurable implementation plans by the end of 2019
Objectives:
1. Raise awareness of stunting’s impact on health, social and economic outcomes for families,
influencers
provinces, and the nation among key decision-makers at national and sub-national level
2. Clearly communicate evidence-based solutions to reduce stunting
3. Clearly communicate the roles and actions that specific sub-national leaders, at different
holidays)
levels, must take to implement stunting reduction solutions
See Appendix C for the Process to Achieve Advocacy Goals

Suggested steps

10 A comprehensive stunting prevention effort should be addressed on several fronts.
DHS)
Leadership and Coordination
1. To establish a committee
Padjadjaran in 2015 on advocacy and BCC for stunting reduction
Effective
■ coordination
Costing studyamong multi-sectoral
for extending stakeholders
paid maternity leaveistokey
sixto the success
months of the University
(also by National of
Stunting Reduction Movement.
Padjadjaran in 2015) With thirteen line-ministries directly included in the Presidential
Decree no. 42/2013 as implementers of national stunting movement (Gernas PPG1000HPK),
coordination and integration have been challenging.
Nutrition Report
Advisory Team Campaign
;ŽŽƌĚŝŶĂƟŶŐDŝŶŝƐƚĞƌ
■ TASK FORCE studies include: ŽĨWĞŽƉůĞtĞůĨĂƌĞͿ
Recommended Advocacy
;ŽŽƌĚŝŶĂƟŶŐDŝŶŝƐƚĞƌ
ŽĨWĞŽƉůĞtĞůĨĂƌĞͿ Technical Team Training
;ĞƉƵƚǇDŝŶŝƐƚĞƌŽĨ,ƵŵĂŶ
ZĞƐŽƵƌĐĞƐĞǀĞůŽƉŵĞŶƚΘ
ƵůƚƵƌĂůīĂŝƌͲĂƉƉĞŶĂƐͿ
suasive messages used by all partners Partnership
makes them more memorable and credible. Advocacy
media engagement to tell the story of the impact of policies or programs is also critical.&
Planning
Budge�ng
Examples of effective message frames fromTeam Experts
nutrition advocacy in Southeast Asia include:
;^ƵƉƉŽƌƟŶŐ
dĞĐŚŶŝĐĂůdĞĂŵͿ Environmental,
Safety Health
■ Referencing global commitments – e.g. of
Figure 6. Structure Indonesia’s progress in achieving the nutrition-
Gernas PPG1000HPK
ROADMAP
ROADMAPFOR
FORDEVELOPING
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
STRATEGY
FOR
FORSTUNTING
STUNTINGREDUCTION
INDONESIA
Appendix C

(Current Status)
Mul�-lateral
PARTNERSHIP BASE
ADVOCACY
GOAL
© UNICEFUN04241Estey
BUILD DEVELOP
MATERIALS
11
Advocacy Strategic
Workshops
Policy Briefs
Find and Deploy
The current structure of the Gernas PPG 1000 HPK (figure 6) indicates two working groups being
directly related to advocacy and behaviour change communication, namely the 1) Campaign and 2)
Advocacy. These working groups need to be revitalized and, if possible, streamlined into just one
working group on advocacy and behaviour change communication to ensure an integrated approach
to the issue. Figure 1. The process for Policy Change
A committee or an ultimate decision-making body on advocacy and behaviour change communication

will also
1. need toAND
ESTABLISH be established to facilitate effective
SUSTAIN PARTNERSHIPS. strategic
Each partner decision-making
brings processes.
unique resources This
that contribute to
committee can be small enough
advancing the advocacy agenda.to function efficiently, comprising the heads of the three (two?)
relevant working groups and other government institutions. Ideally, the committee may include
Existing networksfrom
representatives for advocacy in Indonesia:
the Ministry of Development Planning (BAPPENAS), Ministry of Health, Ministry
of Communication and Informatics, Ministry of Home Affairs, Ministry of Village, Disadvantaged
Regions and Transmigration, as well as Presidential Staff Office (KSP), National Team for the
■ Gerakan
Acceleration Kesehatan
of Poverty Ibu dan
Reduction Anak (GKIA)/Maternal
(TNP2K), Public Health andandCommunication
Child Child Health Movement
experts to ensure
communication efforts are coordinated
■ Professional associations both at the national and sub-national levels.

Communication Strategic Planning
2. To prepare a stunting awareness communication strategy by conducting a stakeholder work-
■ Media agencies
shop that will prepare national guidelines for terminology and key messages.
Convening a group of nutrition and communication experts from the SUN Movement and
■ Laborpartners
development Unions to brainstorm and agree on key messages for different audiences, while
establishing a set ofinclude:
Recommendations communication guidelines related to stunting, will not only lead to uniformity of
communication but will also achieve consensus among stakeholders. This will ensure that all stunting
■ Identify
reduction the “moderator”
communication or main
campaigns coordinator
will deliver for the
clear and Advocacy
consistent strategy
messages.
Rationale:
ROADMAP
ROADMAP FOR
FOR DEVELOPING
DEVELOPING AN
AN ADVOCACY
ADVOCACY AND
AND BEHAVIOUR
BEHAVIOUR CHANGE
STRATEGY
FOR
FOR STUNTING
STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
■ Existing
others such
formative
as formal
research
associations
and other
of Bupatis
sources ifidentified
such are in
in the
place)
literature analysis provide
enough information to guide the design of a stunting awareness communication strategy.
■ There
Advocacy
is a need
Working
to establish
Group) a set of stunting communication guidelines at the national level
for all communication efforts to deliver consistent and accurate information.
■ There
influencers
is a need to standardize the terminology and key messages at the national level.
■■ ADevelop
workshop
andwill
maintain
bring together
a contactnational
list to support
and local
outreach
stakeholders
aroundtokey
achieve
milestones
consensus on the
strategy and national stunting communication guidelines.
■ The
holidays)
stakeholder workshop will also help build capacity among stakeholders, preparing them
for future nutrition communication efforts.
2. To DEVELOP
prepareTHE EVIDENCE
strategyBASE. In addition to the earlier studies recommended, economic re- a
3. a BCC by convening a national and regional group of stakeholders to draft
strategy and conduct a consultation process to confirm it at the regional and local levels.
As a next step, it is recommended to hold a separate Advocacy and BCC working group workshop to
Here are examples
on whatof such studies or sources
be the of evidence from Indonesia:
12 brainstorm behaviours should focus of a behaviour change effort aimed at reducing
stunting and draft a communication strategy. The draft strategy agreed
■ National surveys on current nutrition practices and stunting prevalenceupon will be tested byIndonesia
(Riskesdas,
conducting focus group discussions with different stakeholders in different districts. The results of the
DHS)
consultation effort will help confirm or revise the BCC strategy to come up with a final version that
■ used
will be ThetoEconomic
develop theCostBCC
of Not Breastfeeding in Indonesia conducted by the University of
campaign.
Padjadjaran in 2015
Rationale:
Padjadjaran
■ Existing in 2015)
research findings provide useful information that, combined with the stakeholders’
■ expertise
Media scanwillthat
helpshows
put together a draftmarketing
inappropriate BCC strategy2,3.
of breastmilk substitutes in South-East Asia
■ Aincluding Indonesia
consultation (2016)
with local stakeholders around the country will help confirm and adjust the
■ strategy to local needs
Indonesia-specific datawhile achieving
in global consensus.
databases such as NutriDash (UNICEF) and the Global
■ Nutrition Report
Using this methodology will allow conducting the qualitative research within a relatively
■ short period
Studies of impact
on the time, speeding up producing
of conditional the communication
cash transfers on health andmaterials
nutritionand the launching
of the BCC campaign.
■ The SBCC strategy developed will be culturally sensitive and targeted to connect with the
■ Costing studies
appropriate to guide budget decisions at the district level
audiences.
■ The stakeholder workshop and the consultation methodology will help build capacity among
3. stakeholders.
DEVELOP COMPELLING, TARGETED, AND TESTED MESSAGES AND MATERIALS. Consistent, per-

ROADMAP
ROADMAPFOR
FORDEVELOPING
DEVELOPINGAN
ANADVOCACY
ADVOCACYAND
ANDBEHAVIOUR
BEHAVIOURCHANGE
CHANGECOMMUNICATION
STRATEGY
FOR
FORSTUNTING
STUNTINGREDUCTION
INDONESIA
13
UN04229
Communication
■ Revitalize existing
Two complementary stuntingpartnership networks
reduction efforts for coordination
should of Advocacy
run in two stages. A massefforts
media (e.g. SUN
stunting
awarenessAdvocacy Working
campaign, followedGroup)
by a BCC program addressing the most complex issues of the stunting
problem at the community level to affect
■ Establish regular nutrition behaviour
advocacy change.meetings with key stakeholders and
coordination
influencers
4. ■ implement
To Develop and maintain
a mass mediaa awareness
contact listcampaign
to supporton
outreach
stuntingaround key
and the milestones
first 1000 days
Stage ■one (e.g. Stunting reduction

of a stunting Summits, effort
WorldisBreastfeeding Week, Nutrition
to make the audiences awareMonth, relevant national
that malnutrition may lead to
holidays)
stunting among children in Indonesia as well as the effects of stunting on children’s development.
This campaign should be created by a professional communication organization, based on

the
2. stunting
DEVELOPawareness communication
THE EVIDENCE strategy,to
BASE. In addition following thestudies
the earlier agreedrecommended,
upon guidelines.economic
The re-
communications materials
search could need
help guide to be pre-tested
decisions on policiesamong the target
with funding audience before
implications putting together
(e.g. extending maternity
the final campaign
leave materials.
duration). Formative research points out the major barriers to improved feeding practices.
Rationale:
14
■■ Existing
Nationalresearch
surveysindicates that
on current lack of awareness
nutrition of stunting,
practices and its cause and
stunting prevalence consequences
(Riskesdas, by
Indonesia
mothers,
DHS) family members, and health workers is one of the barriers to prevent stunting2.
■■ Existing researchCost
The Economic indicates
of Notlack of understanding
Breastfeeding of what
in Indonesia the first 1000
conducted by thedays refer to2.
University of
Padjadjaran in 2015
■ Before individuals and communities can change their behaviour, the first step is to make
■ them aware
Costing of for
study howextending
malnutrition
paidaffects theirleave
maternity family
to and community.
six months (also by the University of
Padjadjaran
■ Mass media isinthe
2015)
most efficient vehicle to create awareness among the target audiences.
5. including aIndonesia
To implement national (2016)
BCC stunting prevention campaign
The second stage of a stunting reduction effort, once the audiences are aware of causes and effects of
Nutrition Report
stunting among children, is to try to change the key behaviours that lead to stunting.
A mass media campaign should be part of comprehensive BCC program including advocacy,
■ Recommended
interpersonal studies
communication andinclude:
community mobilization, supported by government institutions
and stakeholders
■ Costing at the national
studies to guideand local decisions
budget level. at the district level
Again, all communication materials should be created by a professional communication organization
and approved by the committee, based on the BCC strategy agreed upon, and the materials need to
be pre-tested among the target audience before putting together the final BCC campaign materials.
Rationale
■ Running a stunting awareness campaign alone will not affect behaviour change.
■ A well-orchestrated and properly implemented BCC program will affect behaviours to help
■ reduce stunting.
Investing in human capital and human resources
■■ Once individuals
Reinforcing civic,and communities
religious learn
or cultural the basics
themes – e.g.about the effects
breastfeeding is of malnutrition
encouraged andQuran
in the
its prevention, they will be susceptible to adopt new behaviours and learn a set of skills
to improve nutrition when receiving additional information through IPC and community
mobilization efforts.
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ANDBEHAVIOUR
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STRATEGY
FOR
FORSTUNTING
STUNTINGREDUCTION
INDONESIA
Appendix
Advocacy
C
Advocacy and communication complement and reinforce each other as part of a comprehensive BCC
The process
program. to achieve
Advocacy is directedadvocacy goalsleaders, and decision-makers at different levels, to
at policymakers,
affect change in a specific policy, law or program.
6. To design and implement a national advocacy strategy to drive policy- and decision-maker ac-
tions at national and sub-national levels
Based on existing studies or proposed analysis (e.g. stakeholder mapping), this strategy should define
Socio-Cultural
Ministries
specific advocacy goals and objectives,
Mul�-lateral identify specific target audiences among decision-makers and
(Current Status)

specific actions for them, adopt as much as ESTABLISH
INGOs
possible DEVELOP
a four-part process founded on good evidence
and strong partnerships (seeMedia
Annex C), and
Agencies align withEVIDENCE
& SUSTAIN
PARTNERSHIP the broader stunting reduction strategy
BASE
through centralized coordination and accountability measures.
ADVOCACY
GOAL
Rationale:
BUILD DEVELOP
■ Support from sub-national leaders to adoptMESSAGES
CONCENSUS
stunting
MATERIALS
&
reduction strategies and plans, and to 15
Advocacy Strategic
allocate sufficient resources
Mee�ng &to them, will be critical toCommunica�on
Workshops
achieving reach and scale.
Policy Briefs
Find and Deploy
■ Advocacy is sometimes addressed
Champions within other activities, but to achieve its full strategic
Media Engagement
potential it needs clear and specific goals, segmented by audiences and supported by
harmonized activities among stakeholders.
Monitoring and Evaluation

The implementation of an initial BCC intervention in 100 districts, should aim to generate the
evidence base to inform policy around effective models for improved nutrition around the country to
ensure
1. that theAND
ESTABLISH evidence generated
SUSTAIN is proactively
PARTNERSHIPS. Eachutilized
partnerwhen
bringsscaling upresources
unique the program
thatthroughout
contribute to
Indonesia.
7. To ensure
Existing that
networks foraadvocacy
Monitoring and Evaluation (M&E) framework is included as a major compo-
in Indonesia:
nent of any future strategies
To track, adjust and measure the success of the intervention, a combination of evaluation studies and
■ monitoring
routine Gerakan Kesehatan Ibu dan
are required. Anak
A few (GKIA)/Maternal
considerations and
for the Child
M&E Child Health
framework areMovement
the following:
1. Monitoring
a. Design and implement a monitoring framework, using various data sources including routine
monitoring data, where available, to identify the strengths, weaknesses, gaps, issues, and
problems
■ Media faced during implementation.
agencies
■
b. Academic networks (e.g. monitoring changes in practices or knowledge) can be done
Outcome monitoring
■ through
Labor Unions
i. Sentinel
Recommendations site surveys in target areas to determine reception and recall of key messages
include:
from media campaigns and interpersonal counselling, trends in practices (e.g. increase
■ Identify the “moderator”
in breastfeeding or main coordinator for the Advocacy strategy
rates)
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STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
ii.others
More
such
localized
as formal
analysis
associations
of nationally
of Bupatis
representative
if such are surveys
in place)(e.g. Riskesdas, Indonesia
DHS) in priority districts
Advocacy
iii. Working
Mass media Group)
performance reports, activity monitoring, penetration studies, media scans
■ and saturation
Establish studies advocacy
regular nutrition can be conducted by local
coordination mediawith
meetings tracking firms such asand
key stakeholders Nielsen
but will
influencers often require external funding to conduct the analysis.
2. ■ Develop and maintain a contact list to support outreach around key milestones
Evaluation
■
a. (e.g. Stunting
A baseline, Summits,
mid-term World
and Breastfeeding
endline evaluationWeek, Nutrition Month,
can complement routinerelevant national
monitoring to deter-
holidays)
mine the extent to which the stated objectives have been achieved, the effects and even-
tual impact of the advocacy or communication efforts, the effects and eventual impact of
the advocacy or communication efforts.
b. Possible
search approaches:
could help guide decisions on policies with funding implications (e.g. extending maternity
i. Repeated surveys to determine practices, behaviours, and change in determinants
16 ii. Special studies to determine the association of exposure to interventions (e.g. mass
■ Nationalmedia spotson
surveys and inter-personal
current nutritioncounselling) tostunting
practices and MIYCN practices
prevalence (Riskesdas, Indonesia
DHS)
c. Rigorous impact evaluations can be very costly and will require a high-level of technical
■ The Economic
capacity. WhileCost of Not
ideal, Breastfeeding
this option should in Indonesia
only conducted
be considered if thebyresources
the University of
are available.
Padjadjaran in 2015
Rationale:
■ There is a need
Padjadjaran to provide evidence of the success or failure of the BCC program.
in 2015)
■■ Tracking allows
Media scan thatfor adjustments
shows along the
inappropriate way, inof
marketing terms of communication
breastmilk asSouth-East
substitutes in well as media
Asia
placement and effectiveness
including Indonesia (2016) of communication channels.
■■ Statistical evidencedata
Indonesia-specific will help guidedatabases
in global future BCC programs’
such design(UNICEF)
as NutriDash and implementation.
and the Global
■ Nutrition Report
Implementing an advocacy or BCC program requires continuous feedback and evaluation.
■■ Studies
The on the impact
implementation ofof
anconditional cash transfersinon
initial BCC intervention health
100 and should
districts, nutrition
aim to generate
■ the evidence base
Recommended to inform
studies policy around effective models for improved nutrition around
include:
the country.
■ Evidence generated will be utilized when scaling up the program throughout Indonesia.

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STUNTINGREDUCTION
INDONESIA
Appendix C
Suggested Timeline
The process to achieve advocacy

2018 goals 2019
Activity
Once the Advocacy Goals
Apr May
areJundefined,
Jul Aug
the
Sep
following
Oct Nov
four-part
Dec Jan Feb
process
Mar Apr
can
May
beJun used
Jul
to
Aug
achieve
Sep Oct
them:
Nov Dec
Brainstorming session to
prepare stunting awareness
communication strategy
Baseline survey
Mass media stunting Na�onal Assem�ly Scien��c

awareness campaign
Brainstorming session to Ministries Socio-Cultural
(Current Status)
prepare BCC strategy Mul�-lateral
Consult stakeholders to
confirm and get consensus INGOs ESTABLISH DEVELOP
on BCC strategy Media Agencies & SUSTAIN EVIDENCE
PARTNERSHIP BASE
Preparatory phase for
Advocacy (stakeholder
analysis, etc.)
ADVOCACY
Advocacy for priority GOAL
decision-maker actions
BUILD DEVELOP
Mid-term evaluation
MATERIALS
17
Advocacy Strategic
National BCC stunting Workshops
prevention campaign Policy Briefs
Find and Deploy
Endline Survey
Monitoring

Note: While the purpose of this document is to guide the preparation of a BCC strategy, the
timeline includes the estimated time required to implement the recommended components,
for illustration
1. ESTABLISH ANDpurposes.
SUSTAIN A PARTNERSHIPS.
more detailed plan of action
Each partner is required
brings to prepare
unique resources ancontribute
that actual to
timeline for those
advancing activities,
the advocacy based on the time it will take to put together the communication
agenda.
strategies.
Challenges toworking
■ SUN networks and begroups
considered
A Common Term for Stunting
There is no direct translation of the word “stunting” in Bahasa Indonesia, which explains why many
terms were used to describe the concept. Various documents and communication materials produced
■ ministries
by line Faith-based
andorganisations
other stakeholders have used the English term “stunting” or “pendek” (short),
while■ Media agencies condition as “kerdil” (midget) or “stanting”. Instead of sending a consistent
others refer to the
message to the public, the use of various terms can potentially cause confusion and decrease the
■ Academic
effectiveness networks
of message dissemination. To ensure effective communication, it is imperative that
stakeholders
■ Laboragree upon one common term to be used in all the communication materials.
Unions
Geography and Cultural Diversity
Statistics Indonesia had identified 1.340 ethnics groups and Ministry of Education has documented
733 languages being spoken across the country, with many in Papua, West Papua, Maluku, North
ROADMAP
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STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
influencers
holidays)

18 © UNICEFUN04263Estey
DHS)
Maluku and East Nusa Tenggara still unidentified. As one of the most diverse countries in the world,
■ The
Indonesia Economic
is facing a realCost of NotinBreastfeeding
challenge disseminatinginmessages
Indonesiaonconducted
stunting. by the ethnic
Many University of
groups
Padjadjaran in 2015
have their own beliefs and values regarding health, illness, the value of a child, food, and nutrition.
These■willCosting
need tostudy
be taken into consideration
for extending when developing
paid maternity leave to six amonths
communication strategy
(also by the and key
University of
messages Padjadjaran
will need to inbe2015)
tailored to best appeal to different target audiences.
Decentralization
Based■on the
Indonesia-specific data of
data from Ministry in Home
global Affairs,
databases such asconsists
Indonesia NutriDash (UNICEF)
of 34 andand
provinces the514
Global
districts/
Nutrition Report
municipalities. In the Law no. 23/2014 regarding regional government, health is a categorized as
a concurrent
■ Studiesissue,
onwhich meansofthe
the impact responsibilities
conditional are shared
cash transfers on between
health andthe central and the sub-
nutrition
national governments.
The central government already included stunting in its medium-term development plan (RPJMN
2015-2019) and launched the National Food and Nutrition Action Plan (RANPG 2015-2019). Most of
the provincial and district governments included in the assessment do not have updated Food and
Nutrition Action Plan, nor do they include stunting as an indicator in their regional medium-term
development plan. This indicates the need for advocacy efforts directed at regional governments to
make stunting a priority.
Multi-Sectoral Partnerships and Alignment
Involvement of the stakeholders is necessary to reduce stunting, but it also presents a challenge
■ Investing
in decision making andin human capital and
coordination. human
Based resources
on the lessons learned during the National Nutrition
Communication Campaign
■ Reinforcing civic, implemented by MCA
religious or cultural Indonesia,
themes – e.g.itbreastfeeding
is quite clear is
that a decision-making
encouraged in the Quran
mechanism needs to be developed, especially if a national communication strategy is to be
implemented in the future. Roles, responsibilities, and procedure to obtain approval must be in place
to allow efficient flow of activities as well as avoid confusion and conflicts between stakeholders.
ROADMAP
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FORSTUNTING
STUNTINGREDUCTION
INDONESIA
Appendix
ReferencesC
1 Badan Penelitian dan Pengembangan Kesehatan, Riset Kesehatan Dasar, Kementerian Kesehatan
OnceRI,the Advocacy Goals are defined, the following four-part process can be used to achieve them:
2013
2 IMA World Health. Formative research (2015)
3 IMA World Health. Final Report: NNCC Model and Lessons Learned (2015-2018)
4 Statistics Indonesia (Badan Pusat Statistik-BPS) (2012). “Indonesia Demographic and Health Sur-
vey 2012 Mul�-lateral
(Current Status)
Organiza�on
5 Preliminary Result IDHS 2017
Media Agencies & SUSTAIN
PARTNERSHIP
EVIDENCE
BASE
6 Titaley, C. R., Loh, P. C., Prasetyo, S., Ariawan, I., & Shankar, A. H. (2014). Socio-economic fac-
ADVOCACY
tors and use of maternal health services are associated with delayed initiation and non-exclusive
GOAL
breastfeeding in Indonesia: secondary analysis BUILD ofDEVELOP

Indonesia Demographic and Health Surveys
2002/2003 and 2007. Asia Pac
J Clin Nutr, 23(1), 91-104. doi:
MATERIALS 10.6133/apjcn.2014.23.1.18 19
Advocacy Strategic
Workshops
7 We Are Social Singapore. (2017). “Digital in 2017 Global Policy
Find and Deploy
Overview.”
Briefs Retrieved from https://www.
Media Engagement
slideshare.net/wearesocialsg/digital-in-2017-global-overview/52
Champions
8 Sari, Y. (2016). Lack of exclusive breastfeeding among working mothers in Indonesia. Kesmas:
National Public Health Journal, 11(2), 61-68.
9 Roshita, A., et al. (2011). “Child-care andprocess
Figure 1. The feeding for
practices
Policy of urban middle class working and
Change
non-working Indonesian mothers: a qualitative study of the socio-economic and cultural environ-
ment.”

■ Media agencies
■ Labor Unions

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STUNTING REDUCTION
REDUCTION IN
IN INDONESIA
INDONESIA
20
ROADMAP FOR DEVELOPING AN ADVOCACY AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY © UNICEFUN04263Estey
FOR STUNTING REDUCTION IN INDONESIA
Appendix A
Maternal, Infant and Young Child Nutrition Practices
Potential important
Ideal behavior Current practices Determinants and influences
knowledge gaps
• About 94% of pregnant women received ANC serviced by a health • Women in West Nusa Tenggara (WNT), East Java, and Papua report beliefs that How to encourage early
worker, with 77.4% of pregnant women attending at least four ANC they should keep their pregnancies secret until their belly is showing. Ref: 50 ANC—during the first
visits. (2017) Ref: 140One in five do not attend an ANC appointment trimester
• Social shame contributes to stigma of pregnancy outside of marriage. These
until the second trimester. Ref: 21
women are less likely to seek out ANC or facility-based delivery, putting them at
Ways to reach and motivate
• Almost all provinces met the 2015 Strategic Plan goal of 72% attend an increased risk of maternal or neonatal mortality. Ref: 50
ANC participation among
Attend four antenatal for visits; exceptions are: Central Sulawesi, East Nusa Tenggara (ENT),
• Staff/volunteers at Integrated Health Service Post, Posyandu, document pregnant the most disadvantaged
care (ANC) visits—1 Maluku, West Papua, and Papua. Ref: 11
women’s visits and encourage ANC appointments. Refs: 43,50 including pregnancy outside
in first trimester, 1 of marriage
• 99% of women in East Java received ANC from a skilled provider; 58%
in second trimester,
of women in Papua. Ref: 50
and 2 in the third
trimester • Women from urban areas are more likely to attend 4 ANC visits; wom-
en from the highest wealth quintile are almost one and a half times
more likely to receive at least four ANC visits. Ref: 41
• An analysis of seven regions indicates Sulawesi, Maluku, Papua and
West Papua islands are at a disadvantage accessing ANC. \
Evidence suggests prenatal deficiencies in iron and calcium. Refs: 14,15 • Traditional beliefs on prenatal nutrition as well as food insecurity contributes to Adolescent nutrition
East Java evidence showed that during pregnancy, caloric intake drops to the decrease in caloric intake during pregnancy. Ref: 12
75% of the recommended 1900 kcal and 44g of protein a day. Women most susceptible to
• Women affected by influencers; they usually buy and prepare food, but often
In Central Java 26% of pregnant women responded on a survey to avoid “eating down during preg-
have to get permission from husbands or mothers/mothers-in-law on what to
many nutritionally beneficial foods, due to food taboos. Ref: 21 nancy”
buy. Ref: 28
Survey in West Java showed 37% of respondents restrict some fruit and
vegetables during pregnancy. • In some households, women typically eat last including during pregnancy. Ref: 28 Motivations for encourag-
Common restrictions include pineapple, avocado, pomegranate, guava, ing better maternal diet and
Consume an ad- orange squash, durian, jack fruit, papaya, sugar cane, and eggplant, goat • Common to limit food intake during pregnancy, believe less food produces a adequate calorie consump-
equate maternal diet meat, durian, glutinous rice (ketan), spicy foods, coffee, peanuts, eggs, smaller baby, and makes birth easier. Ref: 28 tion overall?
tofu, and lentils. Ref: 50 • Grandmothers perpetuate food myths/restrictions. ‘Hot’ or ‘cool’ food belief
systems are common. Often ‘hot’ foods avoided in the first trimester. Ref: 135
• Rice is encouraged during pregnancy; thought to provide strength during preg-
nancy and delivery.
• Pregnancy-related nausea affects consumption. Ref: 135

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21
22
Potential important
knowledge gaps
• In 2012, 33% of women were supplemented with 90 iron folate tablets • Side effects including nausea and the bad taste and smell associated Improvements at level of service
during their pregnancy, but significant provincial disparities exist, with the tablets cause many women to discontinue use. Ref: 136 delivery and in families to support
particularly in Central Sulawesi, West Papua, Maluku, and Papua. Ref: • Women reported preferring herbal remedies over supplements or compliance with iron supplements
141 medicines; believed safer and had no side effects. Refs: 17,27 during pregnancy
• In 2012 women self-report showed 30.9% took iron folate for less • Belief that supplements will cause increased birthweight and a more
IFA than 60 days, 7.1% took it between 60 and 89 days, and 32.7% took difficult delivery. Ref: 12
supplementation recommended 90 days. Almost 23% reported not taking any iron folate
during pregnancy (IDHS 2012). Ref: 21 • Reported confusion among both the community and providers
(at least 90 days) regarding the concept of anemia, or “kurang darah”, which translates
• Iron-folate (IFA) tablets are provided to pregnant women for free to “not enough blood”, and low blood pressure, known as “low blood”.
by the government and distributed through Puskesmas and private- The government issued iron-folate tablets are called Tablet Tambah
practice midwives. Darah, or “Tablets to Increase Blood”, leading some people to associate
• Government switched to to blister packs over sachets containing 60 these tablets as “increasing blood” and are mistakenly associated with

mg ferrous fumarate and 400 mcg folic acid in an effort to improve hypertension (2014 assessment). Ref: 12
compliance.
• Limited counseling on supplements at health facilities and the MCH
Book (every woman receives at an ANC visit at a government health
facility) simply mentions that “iron tablets are not dangerous for your
baby”. Refs: 12,135
Facility-Assisted Delivery Facility-Assisted Delivery Barriers TBA capacity and skills supportive of
• 79% of women deliver in a health facility. • Preference for TBAs– more experience, trust, older, and adherence to early newborn care and nutrition
• Not meeting 75% target of births being facility-assisted: Papua 44%, cultural practices. Comfort of delivering at home.
Papua Barat 50.5%, Maluku Utara 34.1%, Maluku 28.5%, Sulawesi Barat • Traditional beliefs – including herbal remedies and the importance of
63%, Sulawesi Tenggara 48.3%, Sulawesi Tengah 58.1%, Kalimantan ancestors’ involvement in birth.
Selatan 66.9%, Kalimantan Tengah 40.9%, Kalimantan Barat 59.9%, • Adherence to local traditions (ex: warm water for ritual bathing is not
Nusa Tenggara Timur 65.8%, Banten 72.8%, Bengkulu 66%, Jambi available at many facilities).
56.4%, Riau 52.9%, Sumatera Utara 61.1% (2017 IDHS Preliminary • Distance to healthcare facilities, including poor road conditions
indicators). Ref: 140 • Cost of travel (ambulances are free of however difficulties in calling an
• Nationally, the poorest 40% of women have a higher tendency to ambulance or reports of no fuel)

Assisted delivery by deliver at home. Ref: 47 • Indirect costs (food and accommodations for family members at
health personnel in • Another nationally representative study identified Sulawesi, Maluku, facility). Ref: 36
a health facility Papua and West Papua as being particularly disadvantaged in terms of
access to safe delivery services. Ref: 15
Health Personnel-Assisted Delivery
• TBAs are closer to the woman and her home at the time of birth, and
Health Personnel-Assisted Delivery adhere to traditional practices during pregnancy and delivery, not
• Coverage of deliveries assisted by trained health providers increased followed by midwives. Refs: 31 35
from 73% in 2005 to 90.9% in 2017. Ref: 140 • TBAs are trusted more than midwives because they live in their
• Over 50% of births in rural areas are assisted by TBAs who have the community, speak the same language, and share the same culture.
least amount of training. Ref: 33 • TBAs are regarded as elders with more experience, while midwives are
viewed as young and less experienced.
• Low perceived risk of giving birth with TBAs. Ref: 35
Potential important
knowledge gaps
• Extended care: TBAs stay with the mother from the time contractions
start and provide services up to one week after the baby is born.
Assisted delivery by • MoH initially discouraged use of TBAs. Joint engagement of TBAs and • Perceptions that TBAs are cheaper than midwives, even though giving
health personnel in midwives is gaining popularity to promote facility-based deliveries and birth in government hospitals is free and encouraged under the JKN
a health facility the uptake of postnatal care in community health centers. Ref: 43 insurance.
• Logistical hassles involved with facility-births, where most midwives
practice.
• Approximately 31% of women receive “timely” postnatal care--within • Mothers report preferring TBAs over midwives because they provide Quality of TBA provision of any PNC,
six to 48 hours after birth. Refs: 11,14 post-natal services up to one week after birth such as bathing the and timely PNC
• Attendance at all 3 postpartum appointments was 87% in 2015. Ref: 11 mother and baby, washing clothing and bedding from the birth,
• Twenty-six percent of all mothers in Indonesia receive no postnatal ensuring clean detachment of the umbilical cord, and massaging the Access to and quality of timely
care. Ref: 14 mother. Ref: 35 PNC care provided by nurses and
• Approximately 86% of urban women receive timely postnatal care, • Barriers to postnatal care utilization in villages: mother and family others—focus on areas of low
compared to 74% of rural women. members’ health literacy on postnatal care, sociocultural beliefs and coverage
• Lowest coverage of mothers receiving timely postnatal care: Riau practices, and health service responses. Ways to identify and prioritize LBW
(63%), Maluku (44%), West Papua (29%), and Papua (28%). • Parents, parents-in-law, and other elder extended family members infants
• Seventy percent of mothers in Papua receive no postnatal checkup in perpetuate myths and misconceptions about PNC. Mothers who lived
Participate in
the first two days after birth. Ref: 21 in the same households as these influencers more likely to abide by
postpartum and
• 84% of newborns in Indonesia receiving their first neonatal visit within myths.
Early Newborn Care
the first two days of birth. Refs: 11,14 • The likelihood of a child being reported as very small or smaller than
visits
• Provinces most lagging behind include Maluku 44%, ENT 42%, West average at birth does not vary much by the child’s birth order, mother’s
Papua 20%, Papua 15%, and South Sulawesi 11%. Ref: 11 smoking status, or urban-rural residence. Children of mothers in
• Attendance at all 3 postpartum care appointments has improved due the highest wealth quintile are less likely than other children to be
to better support of Puskesmas and Posyandus by the MoH, including reported as having less than average birth size. Ref: 21
intensifying home visits for those who miss their appointments. Ref: 11 • Low birth weight (LBW) was determined to be the most significant
• Post-natal care is most often done by nurses, midwives, or village determinant of stunting, with infants who were born LBW being 1.74
midwives. Fewer TBAs perform the first maternal post-natal check-up, times more likely to be stunted than those born with normal weight.
ranging from zero to 12% across all provinces Ref: 21 Ref: 42
• Food restrictions practiced during the 40 days postnatally; Eating
animal products thought to harm both mother and baby. Refs: 39,40

23 23
24
Potential important
knowledge gaps
• The richest, urban population is seven times more likely to access health • High cost of medical care, uneven distribution of health providers, and Understanding of the connection
services than the poorest.43 of public insurance, often serves as barriers to accessing health care in between service quality, its
• Widest disparities in health service delivery in Eastern provinces: Papua rural and socially disadvantaged women. Refs: 33,36 perception among pregnant women,
and West Papua, Nusa Tenggara, and Maluku. • Primary care centers conveniently located; but long wait times and short and its subsequent uptake
• More than 9,700 Community health centers (Puskesmas) are central hours of operation. Ref: 45
point of care, serving 25,000 to 30,000 people each; require at least one • Women in Papua, West Papua, and East Java report distance to health
physician on staff. Refs: 11,49 facilities, road conditions hinder accessing care. Refs: 21,36
• National Health Insurance Program, Jaminan Kesehatan Nasional (JKN), • Poor staff attendance, lack of operational funds, poor quality of
Seek health insures 164 million Indonesians as of April 2016. Ref: 47 equipment, accountability issues, disrespectful staff barrier to demand
services when • Eighty-five percent of women having pregnancy care insurance for community health center services. Refs: 50,51
necessary coverage. Ref: 111 • Maternal perceptions of low quality health services by midwives at the

• Approximately 44 midwives per 100,000 people; significantly short of Puskesmas, not attentive or patient-centered care, no rapport. Refs:
the 2019 target of 120 per 100,000. Ref: 11 21,36,39
• Sixteen percent of over 9,700 health centers have been registered or • Husbands make decisions on seeking health services, varies by province;
licensed to provide traditional health services (2015). Ref: 11 getting permission for treatment barrier to care. Refs: 21, 36
• Money for treatment is a problem. Women of low SES with government-
financed health insurance were 19% more likely to deliver in a health
facility and 17% more likely to deliver with a skilled birth attendant
compared to poor women without insurance. Refs: 48,21
• 61.2% of babies put to the breast immediately after birth and 59% of • Mothers assisted by a health professional during delivery less likely to Health facility practices that inhibit
babies had skin-to-skin contact with their mothers immediately after EIBF or within one day compared to mothers assisted by a TBA or by EIEB
birth (2017 IDHS preliminary indicators). Ref: 140 relatives.
• About half (49.3%) of all children were breastfed within one hour of • Delayed initiation of BF associated with higher wealth quintiles. Ref: 58
birth; two-thirds (66%) were breastfed within one day of birth. (2012 • Delayed initiation of BF more common in Sumatera region, Caesarean
IDHS) section birth, and deliveries in government-owned and a non-health
• EIBF varies by province with a low of 26% in Riau to a high of 74% in facility. Ref: 58
West Nusa Tenggara. • Prelacteal feeding most common among urban children, children
Early Initiation of
• Newborns breastfed within the first day ranges from a low of 39% in delivered by a health professional, children of mothers with more
Breastfeeding (EIBF)
West Sumatera to a high of 85% in West Nusa Tenggara. education, and children in the highest wealth quintile. Ref: 21
< 1 hr after birth
• Sixty percent of children received a prelacteal feed during the first three

days of life. (2012 IDHS) Prelacteal foods such as softened dates, honey,
banana, biscuit and breast milk substitutes (BMS) are commonly given
to newborn babies in both urban and rural areas. Ref: 142
• Some mothers do not feed colostrum to newborns perceiving it to be
“dirty,” “cheesy,” “indigestible” and of no nutritional value and that
if their newborn was fed colostrum, their baby would suffer from
stomachache, illness such as fever and that their child would not be
intelligent. Ref: 57
Potential important
knowledge gaps
• 96% of children under two have been breastfed. • Perception that breastmilk is nutritionally insufficient and that Most important reasons
• 74% of mothers offer supplementary liquids besides breastmilk supplementary food is needed. Infant formula is believed to be equally for introducing BMS and/or
somewhere between 7 days and 6 months. good. Widespread belief that honey is good for the baby. Ref: 135 supplementary food before 6
• EBF increased to 51.5% of all infants under six months in 2017 from 42% • Family members give food such as bananas, honey, softened dates, months—how varies by region
in 2012. Ref: 140 sweetened condensed milk, sugar water and rice flour is still popular in
• Rates vary by province: low of 25% in Kepulauan Bangka Belitung to rural areas for infants under 6 months.
a high of 70% in both DI Yogyakarta and Nusa Tenggara Barat. Only 9 • Poor knowledge, inadequate skills such as positioning and latching on,
provinces have reached the World Health Assembly global target of EBF motivation, and lack of confidence inhibit EBF.
prevalence of at least 50%: Lampung, Sumatera Selatan, Jawa Tengah, • Grandmothers’ lack of support, receiving formula samples from
Sulawesi Selatan, Sulawesi Barat, Kalimantan Utara, Nusa Tenggara midwives at hospital discharge, and maternal breast engorgement
Timur, DI Yogyakarta and Nusa Tenggara Barat. Ref: 143 shortened duration of EBF.
• Increased breastfeeding knowledge was associated with longer duration
• Infants 0-5 months old who are breastfed are also being fed a variety of EBF.
of liquids and foods: breastmilk and water (6.3%), breastmilk and fluids • Mothers almost universally know and believe that breastmilk is the best
that is not milk (0.6%), breastmilk and other types of milk (15.5%), and food for babies, there is a confidence gap in their own ability to produce
breastmilk and complementary foods (13.7%). Ref: 140 the right quality and quantity of breastmilk. Ref: 139
• Older mothers more likely to EBF compared to younger mothers • Most mothers are unaware that decreased breastmilk production is
• Higher educated mothers more likely to EBF linked to consumption of formula by their child. Ref: 139
• Unemployed mothers more likely to EBF; Mothers who are employed • Reasons women stopped breastfeeding or supplemented breastmilk:
Exclusive
have a lower chance of exclusive breastfeeding. Full-time working perceived obstacles (“Baby is restless”), mother’s feelings and emotions
Breastfeeding for 6
mothers were 1.54 times less likely to exclusively breastfeed than (“I feel groggy and numb”), negative influences from family members
months (EBF)
unemployed mothers. (“My mother-in-law said if I exclusively breastfeed my baby will be
hungry”), sore nipples and breast engorgement, lack of skills, formula
• Mothers with a high wealth index less likely to EBF samples provided by clinics, discouraging words from relatives, beliefs
• Infants who receive early breastfeeding initiation have a higher likelihood regarding breastfeeding (“You know, I have small breasts”), and early
of being exclusively breastfed. complementary feeding practices. Ref: 72
• In one study, the presence of a dedicated breastfeeding facility increased • Poor breastfeeding counseling during ANC visits and insufficient training
EBF practice almost threefold. Knowledge of the breastfeeding support of birth attendants. Ref: 135
program increased EBF practice by almost six times. Refs: 68,69 • Barriers cited include: lack of private lactational areas, lack of flexible
• Children who are ill during the first 28 days of life or during the neonatal schedule, bad relationships with employer or supervisor, declining
period are less likely to receive exclusive breastfeeding.72 productivity and financial concern. Ref: 73
• The 2003 Labor Law gave three months of paid maternity leave • A 2014 compliance report, documented that only 12 out of 67 garment
to working mothers and employers must provide opportunities to factories in the Greater Jakarta Area provided facilities, policies or
breastfeed during working hours. At least 1.5 months of this maternity procedures for breastfeeding breaks.
leave must be taken after the birth of the child. • A 2011 study reported that only 10% of government offices and 11% of
• A 2009 law states that every infant to be breastfed or be given private offices provide places to breastfeed or pump.
breastmilk from donors or milk banks exclusively for the first six months
and be given time and special facilities. Enforcement of provision for
special facilities is weak.

25 25
26
Potential important
knowledge gaps
• Mean duration of exclusive breastfeeding is 3.7 months; overall duration • In East Java, continued breastfeeding patterns related to mother’s
of any breastfeeding is 21.4 months and the mean duration is 20.5 confidence or lack thereof; feeding was primarily child-led; and mothers
months. (2012 IDHS) faced pressure from family, friends, and neighbors to try to stop crying
• 77% of infants continue to breastfeed at one year and 55% of children babies by any means necessary to avoid judgment of the mother’s skills.
Continued are breastfed at two years (IDHS 2012). • Child-rearing was often described as communal with family and friends
Breastfeeding • Median duration of breastfeeding varies by province; low of 9.4 months influencing the feeding of young children.
through 2 years of any breastfeeding in Riau Islands to a high of 29.7 months of any • The majority perceive that the older the baby, the less the priority to
breastfeeding in West Kalimantan. Ref: 21 breastfeed. Breastfeeding no longer becomes a priority after the baby
• A 2012 study looking at feeding practices of mildly wasted children in turns 6 months. It is only for comfort and sleep time. Ref: 139
Nias Island, North Sumatra Province, found that only 10% of children
were breastfed at least two years. Ref: 57
No bottle feeding • More than one-third of breastfed children under 2 months were given • Some mothers report seeing commercials that they believe say formula BMS marketing practices

formula (2012). Ref: 76 milk is better.
• 37% of infants age 0-23 months were bottle-fed. Ref: 76 • Some women feel that she cannot produce enough milk because of using Code violations
• Many poor families who use formula or breastmilk substitutes can barely an oral contraceptive or because she is not eating enough herself. Ref: 78
afford to do so. Because of this financial burden, families dilute the • Community-based workers and village health centers or Posyandus are
breastmilk substitutes. Ref: 78 not covered by the regulations preventing inappropriate marketing of
• Women who delivered in health facilities (43%) had a higher prevalence BMS. These Posyandus are almost always women providing services
of bottle feeding than those who delivered at home (24%). This may be related to monitoring mother and child health, nutrition, immunization,
because wealthier women, who are more likely to bottle feed are also diarrhea control and family planning. They are set up once a month
more likely to deliver in health facilities, or that health facilities do not and can be an important delivery platform for counseling mothers on
give appropriate counseling on EIBF and EBF. Ref: 79 breastfeeding. Ref: 99
• Disasters can contribute to the use of BMS. After the 2006 earthquake • A study found that 20% of women had received advice and information
in Yogyakarta, the initial recovery response included distribution of large about BMS and 72% had seen promotional materials for BMS. About 15%
quantities of BMS without regard to whether the household had been reported receiving free samples from health workers or from company
using BMS before the earthquake or not. staff, and 16% received gifts. Almost a quarter of health care staff
reported receiving visits from formula companies.
• 52% of mothers have adequate knowledge of appropriate child feeding • Working mothers who have access to family caregivers showed an Influence of snacking on quality of
practices based on WHO recommendations. increased lack of confidence in performing child care and good food diets in children 6-24 months
• 79% to 81% of children were introduced solid, semi-solid, or soft foods practices (including breastfeeding, scheduled feeding, monitored
before six months of age, with a mean age of complementary food food intake, and purchase of health foods, among others), depending Quality of first foods and ways to
Timely and

introduction at 4.4 months across studies reviewed. increasingly on caregivers. Ref: 93 enhance quality
adequate (amount,
• At 4-5 months of age more than one-third of babies were being fed • Child-driven feeding practices. Ref: 135
frequency,
fortified baby foods as the most common early complementary food. • Mothers reluctant to force feed to avoid crying. Ref: 135 Feeding practices across the 6-24
consistency,
Ref: 21 • Poor feeding practices more prevalent among those mothers who lacked month period; how changes, where
diversity)
• 75% of infants and young children, age 6 to 23 months who are not family support (particularly from husbands) and those who carry a opportunities for improvements
complementary
breastfed, consume a diverse diet, compared to 51.8% of breastfed greater share of domestic work. Ref: 135
feeding beginning
children (2012 IDHS). • In North Sumatra Province a perceived lack of supply of breastmilk was Impact of other caregivers on
at 6 months
• Diverse diet varies by province: lowest performing parts of Sulawesi, East the main reason mentioned for the early introduction of complementary complementary feeding when
and West Nusa Tenggara, and the islands of Maluku and Papua foods in the study area. Ref: 57 mothers work/unavailable
Potential important
knowledge gaps
• 67% of children age 6 to 23 months are offered complementary foods • MoH established food groups for infants and young children includes
the minimum times per day by age group in addition to breastmilk. Ref: infant formula in a food group and not breastmilk, sending the message
95 that infant formula is part of a complete and balanced diet. Ref: 21
• 61% of breastfed children met their minimum meal frequency, as • Unlike the consumption of foods rich in vitamin A, the consumption of
opposed to 79% of non-breastfed children. foods rich in iron increases markedly with the mother’s education. Ref:
• -Half of mothers reported feeding only on demand. 135 11
• -Most mothers fed only two food groups, grains (typically rice) and • To improve dietary diversity, GAIN and the MOH supported a mass
vegetables. Animal protein was rare. Ref: 135 media and community-based intervention, Gerakan Rumpi Sehat (the
• 37% of children age 6-23 months were fed according to the WHO Health Gossip Movement), in Sidoarjo, East Java. Results indicate that
revised IYCF recommendations (including food and breastfeeding mass media can have a measurable effect on nutrition-related behavior
Timely and frequency and diversity of diet). The percentage was lower for breastfed change; effects are enhanced through complementary community
adequate (amount, children (34%) than non-breastfed children (43%). Ref: 21 activation. Ref: 100
frequency, • Overall, 81% of breastfed children age 6-23 months consumed food
consistency, made from grains, 72% consumed fruits and vegetables rich in vitamin
diversity) A, 50% had meat, fish and poultry, and 46% consumed eggs. Ref: 21
complementary • 82.7% of Indonesian children age 6-23 months consumed foods rich in
feeding beginning vitamin A in the last 24 hours. This ranges from 64.3% in North Maluku
at 6 months to 88.9% in the Riau Islands. Ref: 21
• About 68% of children age 6-23 months consumed foods rich in iron
ranging from 50.8% in West Sulawesi to 78.3% in Jakarta (2012 IDHS).
• - 2012 reports show 45 to 74% of rural children and 28 to 57% of urban
children had a protein intake below the local recommended daily
amount (RDA). 54.2% (0-59 months) received high protein sufficiency,
11.5% average, and 34.2% low or severely low protein sufficiency
(2012). Ref: 11
• Babies are typically fed during family meal times but snacking is
common and child-led. Ref: 139
• 14.3% of mothers surveyed reported their children under five had No information noted Limited literature addressed this
diarrhea in the past two weeks (2012). Ref: 21 topic, more research needs to be
• 40% of children reportedly given more fluids than normal, 43% given done to understand the attitudes
Follow
the same amount, and 17% receiving fewer or no liquids at all. Ref: 21 and drivers behind these practices.
recommended
• Only 10% of children received more food than usual during diarrhea,
Feeding During and
with 39% receiving the same amount, and 46% were given less or no
After Illness
food at all. Ref: 21
• - 9% of mothers surveyed believed that giving foods during illness will
worsen it, and that children are less hungry when they are ill. Ref: 92

27 27
28
knowledge gaps
• 86% of children age 6-59 months received recommended two • Some studies suggest that is it difficult to achieve desired Potential important
Ideal behavior Current practices
doses of vitamin A supplementation at six months apart. Ref: 10
Determinants and influences
density for key nutrients – including calcium, iron, niacin, knowledge gaps
• Of 31 provinces submitting data (2015 Indonesia Health Profile): and zinc – in complementary feeding diets, due to physical or
86% of children
• eleven provinces 6-59 months
age(35%) achieved received recommended
90% coverage two doses
of vitamin A. of • Some studies suggest that is it difficult to achieve desired density for key
vitamin A supplementation at six months apart. Ref: 10
economic access or acceptability of nutrient-dense foods.
nutrients – including calcium, iron, niacin, and zinc – in complementary
Highest coverage vitamin A supplementation on 6-59 months • One study promote
• Of 31 provinces submitting data (2015 Indonesia Health Profile): eleven feeding diets, to
due to physical
keyornutrient
economicintake
accessamong
or acceptability
childrenof
infants was DI Yogyakarta (98.8%); North Sumatera lowest
provinces (35%) achieved 90% coverage of vitamin A. Highest coverage in Lombak suggests
nutrient-dense foods. that to overcome the cost constraints
coverage
vitamin A supplementation
(53.2%). Ref: 11on 6-59 months infants was DI Yogyakarta • of feeding
One young Indonesian
study to promote key nutrientchildren nutrient-dense
intake among children in Lombak
• 13.6% mothers
(98.8%);ofNorth of children
Sumatera lowest coverage
age 6-59(53.2%).
monthsRef:gave11 iron suggests that to overcome
complementary feedingthe cost constraints
diets, feeding young
additionalofaffordable strategies
• supplementation the past
13.6% of mothers ofinchildren ageseven days preceding
6-59 months gave iron the 2012 IDHS Indonesian
to improve children nutrient-dense
nutrient densities of complementary
complementary feeding diets,
foods,
supplementation in the past seven days preceding the 2012 IDHS survey.
survey. additional affordable
particularly strategies
for iron to improve
and calcium, neednutrient densities of
to be considered,
Supplementation • High coverage
• High coverageofofvitamin
vitaminA supplementation
A supplementation partlypartly
due toduegeographical complementary foods, particularly for iron and calcium, need to
Supplementation including home fortification, formulated or fortified
of conditions
to and access
geographical to the Posyandu
conditions and accessin distributing vitamin A.
to the Posyandu in be considered, including home fortification, formulated or fortified
of key
key vitamins
vitaminsand complementary foods, and fortified staple foods. Ref: 128
Provinces with high coverage usually have a high coverage of children complementary foods, and fortified staple foods. Ref: 128
and minerals.
minerals. distributing vitamin A. Provinces with high coverage usually have • Maternal knowledge of anemia is associated lower odds
under five weighed at Posyandu. Low coverage (Papua and West Papua) • Maternal knowledge of anemia is associated with lower
withodds of anemia

ahave coverage
highlow of children under five weighed at Posyandu. Low
public participation in weighing and additional geographical of anemia in children and with some health behaviors related
in children and with some health behaviors related to reducing anemia.
coverage
constraints.(Papua and West Papua) have low public participation Ref: reducing anemia. Ref: 113
to 113
• in weighing
Vitamin and additional
A supplementation in geographical
the provinces of constraints.
DKI Jakarta and North
• Vitamin
SumateraAissupplementation in the provinces
very low due to incomplete records and DKI Jakarta and
of reports.
Children
• North living in urban
Sumatera areas,
is very lowthose
due toborn to highly educated
incomplete records mothers,
and
children of mothers age 20 or older at the child’s birth, and children in
reports.
the highest
• Children wealth
living quintiles
in urban areas, more likely
were those borntotohave received
highly vitamin A
educated
supplements than other children. Ref: 21
mothers, children of mothers age 20 or older at the child’s birth,
• and
92% children
of households
in theuse highest
soap and wealth
waterquintiles were
in the place most more
oftenlikely
used tofor • Study found that targeting new mothers for handwashing interventions Food hygiene practices and
have received vitamin
handwashing.21 A supplements
This varied significantly, with other
thanENT and children.
WNT having Ref:the21 may be useful in establishing key handwashing behaviors while a child is determinants
• 92%
lowest households
ofuse use soap
of soap in their and water
households, at 72%in the
and 73%, most often
placerespectively. Study
• still found
young that targeting
and mothers’ routinesnew
are mothers
changing to handwashing
formeet the needs of their Food hygiene practices and
used
Ref: 21for handwashing.21 This varied significantly, with ENT and interventions
new may be useful in establishing key handwashing
baby. Ref: 119 determinants
• WNT
87% ofhaving
urban households use of soap
the lowest practiced observable
in theirhandwashing
households,inat 72%
urban behaviors while a child is still young and mothers’ routines are
residences,
and with 96% of those
73%, respectively. Ref: 21 who hand wash using soap and water.21 changing to meet the needs of their new baby. Ref: 119
Handwashing at
• 87%
Ruralofareas
urbanfound approximately
households practiced residences are
72% of observable handwashing
engaged in in
critical times for
handwashing, with 89% of those instances using soap and water. Ref: 21
IYCF urban residences, with 96% of those who hand wash using soap
• Surveys found good knowledge of hand washing with soap, but
Handwashing at and
poorwater.21 Rural
practice: 34% washed
areas hands
foundafterapproximately
defecation; 29% of residences
72%after child’s
are engaged in handwashing, with 89% of those instances

critical times for defecation; 73% before a meal; and 60% after a meal. Ref: 136 using
IYCF • soap
A studyand
in Serang
water. in Ref:
Batan
21 province found new mothers reported rarely
washing their
• Surveys found hands
goodbefore food preparation,
knowledge while serving
of hand washing with others, or
soap, but
poor eating. Ref
beforepractice: 34% 119washed hands after defecation; 29% after
child’s defecation; 73% before a meal; and 60% after a meal. Ref:
136
• A study in Serang in Batan province found new mothers reported
rarely washing their hands before food preparation, while serving
others, or before eating. Ref 119
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Appendix
Appendix CB
The
Communication
process to achieve
Materials
advocacy
Assessment
goals
Once
The following
the Advocacy
are findings
Goals are
from
defined,
an assessment
the following of existing
four-partcommunication
process can be
materials
used to related
achievetothem:
stunting, from a communication perspective, conducted by Alive & Thrive. As such, this analysis is
not about content but about clarity and consistency of communication, as well as the appeal of the
campaigns. Special emphasis is put on the IMA WorldHealth National Nutrition Campaign because it
is the most prominent SBCC campaign identified.
The assessment is based on information
Mul�-lateral
from the following sources:
(Current Status)

■ Report on content analysis
INGOs of communication
ESTABLISH
& SUSTAIN
materials for early childhood development,
DEVELOP
EVIDENCE
Media Agencies
prepared for UNICEF and Bappenas. PARTNERSHIP BASE
■ National Nutrition Communication Campaign

ADVOCACY (NNCC) implemented by IMA World Health
GOAL
and the Millennium Challenge Account Indonesia.
BUILD DEVELOP
■ My Plate Stunting Campaign justCONCENSUS
launched MESSAGES
by the &Ministry
MATERIALS of Health. 31
Advocacy Strategic
■ Analysis of MIYCN practices in Indonesia conducted
Workshops byBriefs
Policy Alive & Thrive (2018)
Find and Deploy
1. Communication Materials for Early Childhood Development
Taken from the report on “Content Analysis of Communication Materials for Early Childhood
Development”, prepared for UNICEF and Bappenas.
The report analyses 47 ECD materials and 18 IED materials collected from different organizations such
as Ministry of Health, Ministry of Education, Family Planning Board, Program Keluarga Harapan (PKH),
SUN Secretariat, Ministry of Village, Ministry of Women Empowerment and Child Protection, and
1.Coordinating
ESTABLISHMinistry
AND SUSTAIN
of HumanPARTNERSHIPS.
Development Each
andpartner
Culture.brings unique resources that contribute to
Highlights
Most of the ECD programs’ materials target parents, covering
■ such
topics SUNasnetworks and
parenting, working
healthy groups 1000 days,
behaviours,
child■ development, nutrition,
Gerakan Kesehatan Ibuantenatal
dan Anakcare, under-five care,
(GKIA)/Maternal and Child Child Health Movement
sanitation, health, and education.
The■termINGO
stunting is only(e.g.
networks mentioned
SUN CivilinSociety
the material featured
Alliance)
in Figure 1. However, some ECD materials mention antenatal
■ Faith-based
nutrition and exclusiveorganisations
breastfeeding:
Figure 1 – ECD Material Mentioning Stunting
■ Media agencies
■ MoH’s Early Stimulation, Detection, and Intervention in
■ Academic
Childhoodnetworks
Development program:
■
Labor Unions intake of pregnant women, especially during the last trimester of pregnancy,
̵ “Nutrition
Recommendationsaffect
will fetal growth. For the appropriate development, adequate food intake is
include:
needed”
̵ “Exclusive breastfeeding for the first 6 months, age-appropriate complementary feeding,
■ Identify potential
scheduled partnerships and
immunization, for sub-national advocacy (e.g. with Ministry of Home Affairs,
proper parenting.”
ROADMAP FOR DEVELOPING AN ADVOCACY

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
CHANGEANCOMMUNICATION
ADVOCACY AND BEHAVIOUR
STRATEGY CHANGE COMMUNICATION STRATEGY
FOR STUNTING REDUCTION IN INDONESIA FOR STUNTING REDUCTION IN INDONESIA
■ Family
others Planning
such as formal
Board:associations of Bupatis if such are in place)
■ Revitalize
̵ “To ensure
existing
appropriate
partnership
health
networks
and growth,
for coordination
pregnant women
of Advocacy
needefforts
to be healthy,
(e.g. SUN
give
Advocacy
exclusive
Working
breastfeeding,
Group) practice a healthy lifestyle, consume balanced nutrition and
immunize children as early as possible”
The first 1000
influencers
days explanation is featured in IEC materials as well.
■■ Ministry of Education:
(e.g. Stunting Summits, World Breastfeeding Week, Nutrition Month, relevant national
holidays)
̵ “The first 1000 days is the golden opportunity to shape a healthy and smart child in the
future. During the first 1000 days, nutrition is the main focus. If nutrition is inadequate,
then plasticity and functional capacity of the fetus will be compromised”
■search
Family Planning
could Board:
help guide decisions on policies with funding implications (e.g. extending maternity
leave̵ duration).
“The firstFormative
1000 daysresearch
includespoints out during
270 days the major barriersand
pregnancy to improved feeding
730 days from practices.
birth until 2
years old”
32 ̵ “Targets of the first 1000 days: pregnant women, breastfeeding women and children
■ National surveys
from 0-23 on current nutrition practices and stunting prevalence (Riskesdas, Indonesia
mos”
DHS)
̵ “What happens within 1000 days? Brain development, physical development,
■ Thedevelopment
Economic Cost ofof Not Breastfeeding
metabolism in Indonesia
and adequate immune conducted
system” by the University of
Padjadjaran in 2015
̵ “Long-term effects of under-nutrition includes stunting (short stature due to under-
nutrition)”
̵ “The first 1000 days are the golden opportunity to develop quality human resources”
̵ “By implementing
including the first 1000 days program, children will grow healthy, smart and in
Indonesia (2016)
high quality”
Key findings include:
Nutrition Report
■■ Messages
Studies onon ECD
the are mostly
impact focused cash
of conditional on: Parenting
transfers and
on health and nutrition
healthy behavior (ECD programs), antenatal care and
nutrition (general early child development)
■ Most of the messages on ECD are conveyed using the
“healthy family” theme,
3. ■DEVELOP
Messages are mostlyTARGETED,
COMPELLING, focused onAND
WHAT needsMESSAGES
TESTED to AND MATERIALS. Consistent, per-
be done
suasive but do
messages notby
used give
all concrete
partners behavioural
makes them more memorable and credible. Advocacy
recommendations
materials and messagesonare
HOW to do it.to policymakers’ needs and preferred formats. Sustained
responsive
■media engagement
Stunting messagesto tell
arethe story of the
inconsistent andimpact ofonly
there is policies or programs is also critical.
Examplesone mention message

of effective of stunting.
frames from nutrition advocacy in Southeast Asia include:
Figure 2 - IEC Material on a Healthy Lifestyle
■ Some materials contain inaccurate information.

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
CHANGEAN
COMMUNICATION
Appendix C
2. National Nutrition Communication Campaign
The NNCC is a Social and Behaviour Change (SBCC) program,

The process
funded toand
by MCAI achieve advocacy
implemented by IMAgoals
WorldHealth
Indonesia.
Mass Media Campaign Messages - In 2016 and 2017, the NNCC
mass media campaign focused on two main areas: family
involvement in baby’s feeding time and proper nutrition, and
proper use of latrines using two themes:
Na�onal Complementary
Assem�ly Scien��c
Feeding (Let’s help the child to eat) and Sanitation (Now itSocio-Cultural
Ministries is
(Current Status)
time to use healthy latrines). Theme line: Achieve High Nutrition.
Mul�-lateral
Pros Media Agencies & SUSTAIN
PARTNERSHIP
EVIDENCE
BASE
̵ The production value of all the materials

ADVOCACYis
excellent. GOAL
BUILD DEVELOP
̵ Each piece of the mass media campaign
CONCENSUS delivers
MESSAGES & a 33
MATERIALS
single and very clear message.
Advocacy
Mee�ng &
Strategic
Figure 3 – Poster for Complementary Feeding
Communica�on
Workshops
Policy Briefs
̵ As an SBCC campaign,Findthe look and feel of allMedia
and Deploy theEngagement
Champions
materials are very uniform helping to achieve a synergistic effect.
̵ The IPC training videos and printed support materials are good tools for counsellors and
trainers at the community level.
Cons
̵ The use of national level television to reach only 11 districts, although efficient in terms
of cost-per-thousand persons reached, seems like a waste of impressions if all the
1. ESTABLISHelements of thePARTNERSHIPS.
AND SUSTAIN SBCC campaign Eachwerepartner
not in place nationwide.
brings unique resources that contribute to
̵ Although focused on stunting, the mass media campaign does not provide an
explanation
Existing networks of what
for advocacy is stunting, what causes it and how it can be prevented, missing
in Indonesia:
a good opportunity to create awareness, not only in the 11 districts targeted but at a
national level.
■ Gerakan Kesehatan
̵ Although basedIbu
ondan
the Anak (GKIA)/Maternal
first 1000 and campaign
days, the media Child Childdoes
Health
notMovement
explain what that
■ means, again, missing
Professional associations an opportunity to create awareness at the national level.
Starting in December
■ INGO networks 2017,
(e.g.the
SUNNNCC
Civil shifted
Societythe focus of their mass media campaign, to create
Alliance)
awareness about stunting and the importance of the first 1000 days.
The television and online campaign feature testimonials from influential figures and personalities
■ Media agencies
such as the Vice-president of Indonesia, the Chairman of the Indonesian Nutritionist Association, and
the ■Chairman
Academic networks
of Fatayat NU, among others. The campaign’s theme line is “Let’s Prevent Stunting, It Is
Important!”
■ Labor Unions
Pros
■ ̵ Thethe
Identify campaign shifts the
“moderator” focuscoordinator
or main to stunting.for the Advocacy strategy
■ ̵ Thepotential
Identify use of influential figures
partnerships for and personalities
sub-national lends (e.g.
advocacy credibility to the messages.
with Ministry of Home Affairs,

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
others
̵ Thesuch
theme
as formal
line highlights
associations
the importance
of Bupatis ifofsuch
stunting
are inprevention.
place)
Cons■ Revitalize existing partnership networks for coordination of Advocacy efforts (e.g. SUN
̵ The look and feel are different from the previous campaign, losing its synergistic effect.
̵ Some spots feature several messages making them confusing.
influencers
̵ The stunting message is verylist
inconsistent
to supportfrom one TV spot to the other.
■ Develop and maintain a contact outreach around key milestones
̵ There is noSummits,
explanation of what causes stunting
Week, and potential solutions.
■ (e.g. Stunting World Breastfeeding Nutrition Month, relevant national
holidays)
̵ Stunting effects are associated with height while barely mentioning effects on the brain.
̵ The use of the term dwarf/dwarfism in one of the TV spots is incorrect and confusing.
2. ̵ Confusion
DEVELOP of the BASE.
THE EVIDENCE terms In
chronic malnutrition
addition andstudies
to the earlier stunting.
recommended, economic re-
3. leave
My duration).
Plate StuntingFormative
Campaign research points out the major barriers to improved feeding practices.
AHere are examples

separate stunting of such studies
campaign or sources
just launched byofthe
evidence
Ministryfrom
of Indonesia:
34
Health■ seems to consist
National surveys of on
twocurrent
different sets ofpractices
nutrition posters, one
and stunting prevalence (Riskesdas, Indonesia
explainingDHS)
stunting and a set of posters illustrating a balanced
diet.
Stunting poster - Poster
Padjadjaran in makes
2015 emphasis on height as an indicator
of stunting, addressing nutrition components such as parenting
(breastfeeding and immunization) and sanitation (clean water,
hand washing, and use of latrines). Slogan: Prevent Stunting,
That’s■ Important.
Media scan thatbottom,
At the shows inappropriate marketing
it reads: Get enough of breastmilk substitutes in South-East Asia
nutrition,
completeincluding Indonesia
immunization (2016) sanitation.
and improve
Pros ■ Indonesia-specific data in global databases such as NutriDash (UNICEF) and the Global
Nutrition Report
̵ The visual is easy to understand.
■ Studies on the impact of conditional cash transfers on health and Figure
nutrition
4 – Stunting Poster
̵ The icons on the side are easily recognizable.
̵ The use of the word stunting in the heading.
Cons
̵ The stunting explanation only refers to undersized (height) children. It does not address
other issues related to stunting that may be relevant to parents.
̵ The
materials term
and “midget”
messages are(Kerdil) referring
responsive to stunted children
to policymakers’ maypreferred
needs and create confusion
formats.of terms.
Sustained
media ̵ engagement to tell
It mentions the the
first story
1000 of the
days butimpact
there isoflittle
policies or programs
explanation is also
of what thatcritical.
means. This
Examples of only distracts
effective fromframes
message the main
frommessage andadvocacy
nutrition it is not relevant in this
in Southeast context.
Asia include:
My Plate Poster – It features a plate with coloured sections representing four food groups: fruits,
vegetables, tubers, and protein sources. As secondary messages, it illustrates three areas related
■ Reinforcing
to nutrition: civic, religious
handwashing, or cultural
physical activity, andthemes – e.g.
drinking breastfeeding
water. is encouraged
It also indicates in the Quran
the recommended
proportion of each of global
■ Referencing the food groups.
commitments – e.g. Indonesia’s progress in achieving the nutrition-

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
CHANGEAN
COMMUNICATION
Appendix
Pros
C
̵ The visual is attractive and easy to understand.
̵ The headline is simple and easy to remember.
Once the Advocacy Goals
̵ The icons onare
thedefined,
side arethe following
easily four-part process can be used to achieve them:
understood.
̵ It provides national guidelines adapting them to
different regions.
̵ Based on Indonesia-specific
Na�onal dietary
Assem�ly guidelines.
Scien��c
Cons Ministries Socio-Cultural
(Current Status)
Mul�-lateral
̵ My Plate was not originally designed
INGOs ESTABLISH for a stunting
DEVELOP
campaign but is a pre-existing campaign
PARTNERSHIP for healthy
BASE
lifestyle and diet. It only features ADVOCACY

a nutritional diet
educational message. GOAL
Figure 5 – My Plate regional poster
̵ There is no visual or writtenCONCENSUS
explanation
BUILD to associate
DEVELOP
MESSAGES & 35
the posters with the stunting campaign,MATERIALS
Advocacy except for Strategic
the poster design Workshops
which is similar. Policy Briefs
Find and Deploy
̵ The written explanation of the recommended proportion of each food group is
confusing, using fractions that are hard to understand.
̵ The written explanation of the lunch in the regional posters mentioning calories and
portion size in grams may not be understood by the average person.
̵ There is no indication of age-group and may confuse people because it does not reflect
plates for different age groups
̵ There is no call to action.
advancing
Although part the advocacy
of the agenda. the stunting and the “My Plate” posters seem to be stand-alone
same campaign,
pieces which defeat the purpose of having a unified campaign.
Conclusions
■ There is a clear need to establish a set of guidelines to make sure that all communication
efforts deliver consistent and accurate information.
■ Although stunting is a major problem in Indonesia, and lack of awareness is one of the key
■ INGO networks
findings of the (e.g. SUNstudies
research Civil Society Alliance)
referenced, no campaign properly addressed the topic.
■■ Faith-based organisations behaviour change communication effort was conducted by IMA
The only comprehensive
WorldHealth
■ Media agencies in 2016-2017 but, because there is no statistical evidence of the performance
of the program available at this time, it is hard to determine its effectiveness.
■ The new campaign about stunting started by IMA WorlHealth in December 2017, is a step
■ Labor
in theUnions
right direction, although it should have been the initial campaign before running the
SBCC program.
■■ Identify
The different campaigns or
the “moderator” currently running, pointing
main coordinator for thein many directions
Advocacy strategy and providing
inaccurate information, underscore the need to create consensus on how to address
■ Identify
stuntingpotential partnerships
reduction, for sub-national
to coordinate advocacy
efforts and speak with (e.g. with Ministry
one voice of Home Affairs,
on all fronts.

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
Appendix C
The process to achieve
Advocacy advocacy goals
Working Group)
Once■the Establish
Advocacyregular nutrition
Goals are advocacy
defined, coordination
the following meetings
four-part processwith
can key stakeholders
be used and
to achieve them:
influencers
holidays) Government Agencies Scien��c
(Current Status)
Mul�-lateral
PARTNERSHIP BASE
leave duration). Formative research pointsADVOCACY
out the major barriers to improved feeding practices.
GOAL
Here are examples of such studies or sources BUILD
of evidence
DEVELOP
from Indonesia:
36 CONCENSUS MESSAGES &
MATERIALS
■ National surveys on current
Mee�ng &nutrition practices and stunting
Advocacy Strategic
Communica�on
DHS) Workshops
Find and Deploy
Policy Briefs
Padjadjaran in 2015
1. ■ Indonesia-specific
ESTABLISH data
AND SUSTAIN in global databases
PARTNERSHIPS. such asbrings
Each partner NutriDash (UNICEF)
unique andthat
resources thecontribute
Global to
Nutrition Report
■materials
Faith-based organisations
and messages are responsive to policymakers’ needs and preferred formats. Sustained
media engagement
■ Media agencies to tell the story of the impact of policies or programs is also critical.
■ Academic
networks
■■ Labor Unions
■■ Referencing
Identify global commitments
the “moderator” – e.g. Indonesia’s
or main coordinator for theprogress in achieving
Advocacy strategy the nutrition-

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
CHANGEAN
COMMUNICATION
Appendix C
The process to achieve
Advocacy advocacy goals
Working Group)
Once ■the Advocacy

Establish regular nutrition
Goals are advocacy
defined, coordination
the following meetings
four-part processwith keyused
can be stakeholders and
to achieve them:
influencers
holidays) Government Agencies Scien��c
(Current Status)
Mul�-lateral
PARTNERSHIP BASE
leave duration). Formative research pointsADVOCACY
out the major barriers to improved feeding practices.
GOAL
Here are examples of such studies or sourcesBUILD
of evidence
DEVELOP
from Indonesia:
MATERIALS
37
■ National surveys on current
Mee�ng &nutrition practices and stunting
Advocacy Strategic
Communica�on
DHS) Workshops
Find and Deploy
Policy Briefs
Padjadjaran in 2015
1. ■ Indonesia-specific
ESTABLISH AND SUSTAINdata in global databases
PARTNERSHIPS. such asbrings
Each partner NutriDash (UNICEF)
unique and
resources thecontribute
that Global to
Nutrition Report
■materials
Faith-based organisations
and messages are responsive to policymakers’ needs and preferred formats. Sustained
media engagement
■ Media agencies to tell the story of the impact of policies or programs is also critical.
■ Academic
networks
■■ Labor Unions
■■ Identify
Referencing global commitments
the “moderator” – e.g. Indonesia’s
or main coordinator for theprogress
Advocacyin strategy
achieving the nutrition-

ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
■ Referencing
others such growth
as formal
andassociations
leadership of
status
Bupatis
of Indonesia
if such areasina place)
country
■ activities
Example Revitalizeinclude:
existing partnership networks for coordination of Advocacy efforts (e.g. SUN
■ Develop and test messages in support of each advocacy goal and objective, taking into
■ consideration
Establish regular nutrition
tailoring themadvocacy coordination
to specific audiences meetings with key stakeholders and
influencers
■ Develop policy briefs on key topics, with supporting PowerPoints for meetings and events
■ tailored
Developtoand maintain
specific a contact
target list to support outreach around key milestones
audiences
■■ (e.g. Stunting
Develop Summits,
a Champions Worldwith
toolkit Breastfeeding Week,
key messages andNutrition Month, relevant national
talking points
holidays)
■ Produce high-quality, motivational materials to inspire action (e.g. videos, a message from
the President, etc.)
4. BUILD CONSENSUS. Consensus-building involves meetings with policymakers,
to improvedpresentations in
leave duration). Formative research points out the major barriers feeding practices.
large and small meetings or as part of dedicated national and regional advocacy events, partici-
Herepation
are examples
in working
of such
groups,
studies
scientific
or sources
workshops,
of evidence
and training
from Indonesia:
of champions on effective stunting
38 reduction and messaging skills.
ExamplesDHS)
of opportunities to build consensus in Indonesia include:
■■ The Economic
Stunting Cost of“Summits”
or Nutrition Not Breastfeeding in Indonesia conducted by the University of
or “Bootcamps”
Padjadjaran in 2015
■ SUN working group meetings
■ Champion recruitment, training, and activation to ensure that champions use their influence
to deliver consistent advocacy messages (last round conducted in 2017)
■ Medical association events,
■ Global advocacy events (e.g. Indonesia World Breastfeeding Week, Nutrition Month)
■ Nutrition Reportengagement (e.g. Parliamentary seminars)
Parliamentarian
■■ Studiesengagement
Media on the impact of conditional
strategy cash transfers on health and nutrition
+ activities
■■ Recommended
Social studies include:
media engagement + activities
While■advocacy
Costingwill
studies
help to guide budget decisions
keep stunting reductionatasthe district there
a priority, level is also a need to stimulate
behaviour change focusing on the actions that need to be taken by a mother, her family, her
employer, community and many others in support of stunting reduction and MIYCN practices.


ROADMAP
AND BEHAVIOUR
FOR DEVELOPING
CHANGEAN
COMMUNICATION
41

Developing An Advocacy and Behaviour Change Communication Strategy For Stunting Reduction

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1

ROADMAP FOR DEVELOPING

ROADMAP FOR DEVELOPING

Figure 1. The process for Policy Change

Existing networks for advocacy in Indonesia:

■ SUN networks and working groups

■ Identify the “moderator” or main coordinator for the Advocacy strategy

■ Investing in human capital and human resources

Global best practices show that the first stepADVOCACY

Figure 1. The process for Policy Change

Existing networks for advocacy in Indonesia:

■ SUN networks and working groups

■ Identify the “moderator” or main coordinator for the Advocacy strategy

Examples of effective message

■ Referencing global commitments – e.g. Indonesia’s progress in achieving the nutrition-

Government Agencies Scien��c

Communication materials assessmentADVOCACY

efforts deliver consistent and accurate information.Policy Briefs

■ Identify the “moderator” or main coordinator for the Advocacy strategy

Here are examples of such studies or sources of evidence from Indonesia:

Why do we need behaviour change

Improve skills. By focusing on teaching or Assem�ly

Partnership & alliances in the health

ADVOCACY INTERPERSONAL COMMUNICATION

■ INGO networks (e.g. SUN Civil Society Alliance)

■ Identify the “moderator” or main coordinator for the Advocacy strategy

■ Identify the “moderator” or main coordinator for the Advocacy strategy

3. DEVELOP COMPELLING, TARGETED, AND TESTEDĂƚĂĨƌŽŵƌŽƵƟŶĞŵŽŶŝƚŽƌŝŶŐƐǇƐƚĞŵƐĂŶĚƐƉĞĐŝĂůƐƚƵĚŝĞƐ

In defining its objectives, an advocacy program

Planning for the advocacy strategy and

defining advocacy goals

■ What has been done in Indonesia:

See Appendix C for the Process to Achieve Advocacy Goals

Here are examples of such studies or sources of evidence from Indonesia:

Na�onal Assem�ly Scien��c

A committee or an ultimate decision-making body on advocacy and behaviour change communication

■ INGO networks (e.g. SUN Civil Society Alliance)

■ Investing in human capital and human resources

Stage ■one (e.g. Stunting reduction

This campaign should be created by a professional communication organization, based on

Organiza�on Interna�onal Status

Monitoring and Evaluation

■ Investing in human capital and human resources

The process to achieve advocacy

Mass media stunting Na�onal Assem�ly Scien��c

Figure 1. The process for Policy Change

Here are examples of such studies or sources of evidence from Indonesia:

breastfeeding in Indonesia: secondary analysis BUILD ofDEVELOP

Existing networks for advocacy in Indonesia:

■ SUN networks and working groups

■ Identify the “moderator” or main coordinator for the Advocacy strategy

FOR STUNTING REDUCTION IN INDONESIA

FOR STUNTING REDUCTION IN INDONESIA

ROADMAP FOR DEVELOPING AN ADVOCACY AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY

FOR STUNTING REDUCTION IN INDONESIA

FOR STUNTING REDUCTION IN INDONESIA

ROADMAP FOR DEVELOPING AN ADVOCACY AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY

FOR STUNTING REDUCTION IN INDONESIA

FOR STUNTING REDUCTION IN INDONESIA

ROADMAP FOR DEVELOPING AN ADVOCACY AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY

FOR STUNTING REDUCTION IN INDONESIA

FOR STUNTING REDUCTION IN INDONESIA

ROADMAP FOR DEVELOPING AN ADVOCACY AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY

3. DEVELOP COMPELLING, TARGETED, AND TESTEDĂƚĂĨƌŽŵƌŽƵƟŶĞŵŽŶŝƚŽƌŝŶŐƐǇƐƚĞŵƐĂŶĚƐƉĞĐŝĂůƐƚƵĚŝĞƐ