Anang S.Otoluwa

Jakarta, January 13th 2020 Profile of Banggai

Our Vision: To make Banggai Regency as a center of economic growth, agricultural, and maritime Banggai Regency is located at based on local and cultural wisdom eastern end of Central Province of .

• Three stars hotels • Direct flight from Jakarta • Lots of adventures

Economic growth : 37.12 % (2016), 8.42 % (2017), 9.42 % (2018). Health and Nutrition situation in Banggai

Maternal and Infant Mortality Rate* Stunting in Children under 5yo (%)**

35.6 206 180 154 143

89 31.8

13 11 8 7 9

2015 2016 2017 2018 2019 2013 2018 MMR IMR stunting *Banggai Regency Health Profile **RISKESDAS

We have implemented health innovation programs since 2015 and since that, the main problem in health and nutrition indicators has been declined. Nutrition as center of development

Local Policy Innovation Partnership

1. Role of the village in • Posyandu pre-conception stunting prevention; (health class for pre- 2. Exclusive breastfeeding; conception women) 3. The task force of 1000 first day of life nutrition • MMS for both Pregnant women and pre-conception improvement; women 4. Integrated stunting prevention program in • 1 PK – 100 KK (each health local government long- officer responsible for term development plan; monitoring the health of 100 5. Posyandu pre-conception families)

As a center of development, we have strengthen our nutrition programs with local policies. We have also some innovations in health program and collaborate with several NGOs and university to help us achieve our goals Innovation and history of MMS MMS efficacy in Banggai MMS efficacy in Banggai showed by several studies result as below: • Improvement in mother’s hemoglobin level (Ardiansyah, 2017), • Increase of infant’s birth weight and length (Widasari, 2018), • Reduce oxidative stress (Yekti, 2018) and • Prevent the increasing of Sflit-1(Monoarfa, 2018). Upcoming MMS efficacy studies in Banggai :

• The effect of MMS from preconception period on blood glucose level in pregnancy in Banggai Regency (Erni Yusnita Lalusu) Implementation of multi-micronutrient supplementation (MMS)

MMS distribution using the same platform as iron-folic acid distribution. The only difference is that MMS distribution depend on PK (pembina keluarga) as the spearhead of the program

Preparation needed: 1. Number of targeted women in each village 2. Training for health worker 3. Monitoring form

Note: CHWs = community health workers (Kader); Pembina keluarga=health officer/worker

Implementation of MMS (Preconception) _2months after implementation_

Compliance Side effect MMS

98.6 1.4

92.95% 7 (1.4%) of 487 women report side effect

MMS implementation in Banggai started in April 2019 for pre-conception programs. For the first two consecutive months, the avarage pre-conception women who receive 4 MMS pills per month is 92.95%. And only 1.4% of that women report side effects

* Based on compliance report for two consecutive months (April and June) after implementation ** Based on Nutritional survey (PSG 2017) Implementation of MMS (Pregnancy) _2months after implementation_

Compliance Side effect MMS IFA

97.8 2.2

93.7% of 457 pregnant 26,1% pregnant women About 10 (2.2%) of 457 women taking 30 MMS pills taking 90 or more IFA pills pregnant women report side per month* during pregnancy** effect such as dizziness, vomit, and increased blood pressure after taking MMS*

* Based on compliance report for two consecutive months (June and July) ** Based on Nutritional survey (PSG 2017) Selected Publication Midwives Testimony Conclusion and Recommendation • IFA platform can be used to more effectively implement MMS given that MMS side effects are lower and compliance is higher.

• Study of MMS effectiveness is needed to back-up the routine program report. Terima Kasih