The Government of Indonesia promotes a balanced diet because consuming a wide variety of nutritious foods can supply the necessary nutrients for healthy growth and development. However, during the first 1000 days of life (spanning pregnancy up to the child’s second birthday), nutrient needs are very high and it is not always possible to meet these needs through a balanced diet. Studies have shown that not all Indonesians can afford nutritious foods such as milk, meat, eggs, or fish that would provide these nutrients, while others lack the awareness of their importance. In addition, they showed that the consumption of fortified products like fortified blended foods or micronutrient powders (MNP) as part of the overall diet is the most cost-effective way to increase nutrient intakes.
Fortifying home-made foods is an approach called home fortification: a simple and effective way to improve the diet quality of nutritionally vulnerable groups, such as young children. It aims to ensure that their diet (complementary foods and breast milk combined) meets their nutrient needs. Different products have been developed. Micronutrient powders (MNP) are a vitamin and mineral powder in single serve sachets that are added to foods prepared at home to increase vitamin and mineral content. The Ministry of Health already distributes MNP (Taburia) but in a limited area only and no commercial home fortification products are currently available in Indonesia. Small-quantity lipid-based nutrient supplements (SQ LNS) contain vitamins and minerals + essential fatty acids, macrominerals (such as calcium), protein, and energy (about 120 kcal), and therefore provide even more nutrients. MNP+ are MNP with added protein and essential fatty acids.
A stakeholder workshop with policy makers, academia, NGO’s and private sector was held to discuss the latest scientific and programmatic findings and to assess whether there is a need for expanding home fortification efforts in Indonesia. In particular, it aimed to build consensus on the needs and next steps for home fortification in Indonesia, considering both delivery free-of-charge through the public health system and market-based approaches.
There was strong consensus among participants of the workshop with regard to the extent of the stunting problem in Indonesia, the need to address this urgently through public-private partnerships combining public and commercial distribution channels, and to include home fortification in integrated programs of optimized IYCF (including promotion of locally available nutrient-dense foods and fortified foods), food security, and clean water and hygiene and sanitation. However, it was also acknowledged that home fortification is not an intervention for malnourished children, but a supplementation of the diet of normal children. MNPs are widely acknowledged for their ability to reduce stunting but there is no doubt they are not sufficient to reduce stunting. Therefore, participants agreed on the need to explore the possibilities to use LNS in the Indonesian context. In order to ensure success, home fortification interventions need to be supported by a strong and well-designed communication component to explain how the use and benefit of home fortification products.
The role of the government should be to be actively involved in the review of standards, composition and effectiveness of home fortification. Focus of government programs should be on poor rural children, while the rest should be covered through commercial distribution. Strengthening of the posyandu, in particular nutrition training for midwives and training in correct measurement of length and height were seen as crucial for the government program.