ANNEX COMPENDIUM OF GOOD PRACTICES to support achievement of Sustainable Development Goals for Children in Indonesia 2021 1 ANNEX: COMPENDIUM OF GOOD PRACTICES

2 Cover: © UNICEF/ UNI206455/Wilander CONTENTS

Glossary 4

SDG Goal 1: No Child Should Live in Poverty 6

SDG Goal 2: No Child Should Be Malnourished 14

SDG Goal 3: No Mother or Child Should Die of Preventable Causes 26

SDG Goal 4: Every Child Should Benefit from Effective and Inclusive Learning Environments 66

SDG Goal 5: Every Child Should Have Equal Access to Opportunities, Regardless of Gender 86

SDG Goal 6: Every Child Should Have Access to Clean Water and Sanitation 90

SDG Goal 16: No Child Should Live in Fear 102

SDG Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development 116

Link to the publication: www.unicef.org/indonesia/reports/compendium-of-good-practices

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GLOSSARY

ANH : Adolescent Nutrition and Health AMPL : Air Minum dan Penyehatan Lingkungan - water and environmental sanitation API : Annual Parasite Incidence Bappeda : Badan Perencanaan Pembangunan Daerah - Regional development planning agency BOK : Bantuan Operasional Kesehatan – Health operational assistance BOS : Bantuan Operasional Sekolah - School operational aid BAZNAS : National alms agency BDT : Basis Data Terpadu - Unified database for social protection BPD : Badan Permusyawaratan Desa - Village council CBA : Cash-Based Assistance CCE : Cold Chain Equipment CRBP : Child Rights and Business Principle CSR : Corporate Social Responsibility DHO : District Health Office DEO : District Education Office Dapodik : Data Pokok Pendidikan - Education Primary Data ECD : Early Childhood Development FSM : Fecal Sludge Management IFA : Iron Folic Acid IMAM : Integrated management of acute malnutrition IMCI : Integrated management of childhood illness IYCF : Infant Young Child Feeding LSE : Life Skills Education MoH : Ministry of Health MoV : Ministry of Villages, Development of Disadvantaged Regions, and Transmigration MoEC : Ministry of Education and Culture MoSA : Ministry of Social Affairs Madrasah : Islamic-based school MHM : Menstrual hygiene management MUI : Majelis Ulama Indonesia – Indonesian ulema council ORS : Oral rehydration solution ODF : Open Defecation Free O & M : operational and maintenance PKH : Program Keluarga Harapan – Family-based conditional cash transfer 4 © UNICEF/2019/veskadinda

Puskesmas : Pusat Kesehatan Masyarakat – Community health center Pustu : Puskesmas Pembantu - sub health center Polindes : Pondok Bersalin Desa – Village midwife clinic Posyandu : Pos Pelayanan Terpadu – Integrated health post PEO : Provincial Education Office PKK : Pemberdayaan Kesejahteraan Keluarga - Family welfare programme QI : Quality improvement RUTF : Ready to Use Therapeutic Food SAM : Severe Acute Malnutrition SBCC : Social and Behavior Change Communication Sekda : Sekretaris Daerah - District secretary SLB : Sekolah Luar Biasa – School for children with disabilities SDLB : Sekolah Dasar Luar Biasa – Primary School for children with disabilities SIAK : Sistem Informasi Administrasi Kependudukan - population information system STBM : Sanitasi Total Berbasis Masyarakat – community-based total sanitation UKS : Unit Kesehatan Sekolah – School’s health and hygiene promotion WASH : Water, Sanitation and Hygiene WIFS : Weekly Iron Folic Acid Supplementation ZIS : Zakat, Infak, Sedekah – Mandatory and voluntary alms

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1 Delivering Results for Children through a Locally Funded Aceh 7 Social Protection Programme 2 Cash-based Assistance in Lombok 2018-2020: West Nusa Tenggara 9 from Earthquake to COVID-19

6 Delivering Results for Children through a Locally Funded Social Protection Programme General topic area: Social protection Location: Aceh (Sabang City)

The Sabang District government, supported by UNICEF and Flower Aceh, launched Gerakan untuk Anak Sehat (Geunaseh) in 2019. Geunaseh is a locally funded social protection programme that forms part of an integrated programme on maternal and child malnutrition. UNICEF and Flower Aceh provide technical support for the formulation of policies and guidelines, behaviour-change communication and integrated information systems. Geunaseh aims to avert potential long-term health problems caused by malnutrition by supporting children through a social protection scheme that provides cash assistance to households, enabling them to meet their children’s nutritional needs and ensuring their access to essential health services. Summary of the Mandated by Sabang Mayor Regulation No. 21 of 2019, Geunaseh is a locally funded, Approach sub-national social protection programme seeking to create a vision of “Kota Sejahtera” (welfare city), in line with national priorities. Geunaseh began as a pilot programme, complementing other government social protection programmes to benefit children, such as: clean water and sanitation, positive parenting, integrated health management in early childhood and cash-based scholarship assistance for students aged 7-17. These combined initiatives make Sabang the only city in Indonesia with a social protection programme for all children under the age of 18. Cash-based assistance is distributed directly to households with children aged 0-6 who have a birth certificate and live in Sabang, as well as those whose children’s names are included on the family card of resident parents. Beneficiaries are able to withdraw cash worth IDR 150,000 (USD 10) per month through a local bank.

• Geunaseh reached 4,109 children in 18 villages during its initial phase. By June 2020 it had reached more than 5,227 children throughout Sabang. • In November 2019 the percentage of children with birth certificates rose to 98 per Key Results cent, from 92 per cent in 2018. 6 to 8 per cent of this trend occurred in villages in Achieved Sukakarya and Sukajaya sub-districts. • Children’s attendance at health clinics rose from 62 per cent in August 2019 to 92 per cent in July 2020.

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UNICEF and Flower Aceh are currently working with the Sabang District government to plan a five-year roadmap for Geunaseh, to ensure programme sustainability.

• Communication for development materials (funded by UNICEF) • Capacity building and regulation development (co-funded by UNICEF and Sabang Government): IDR 1,25 billion (USD 85,500). Cost • Development of management information system, including software and hardware (funded by UNICEF). • Direct cash assistance, targeting 5,000 children aged 0-6 years (funded by the Government of Sabang): IDR 9 Billion (USD 620,000) / year. Replicability/ up-scaling Surveying skills, programme management (including monitoring and Skills evaluation, administration), communication for development and community mobilization.

• Sabang City Government • Sabang Planning Board (Bappeda) Stake- • Sabang District Health Office holders • Geunaseh Secretariat • Village heads and volunteers • Civil society organizations

• Requiring birth certificates to access social assistance can motivate parents to legally record their children’s birth. It benefits both children (child rights) and government (improved population data). • Birth registries can be improved by engaging village authorities. Geunaseh encourages parents whose children are not registered to report to the head of the Lessons village. Learned • It is possible to increase children’s visits to community health centres through locally funded social protection programmes, further linking social policy and health care. • This locally funded social protection programme was effective in part due to the decentralized nature of development planning and budgeting in Indonesia. • Evaluation of the programme’s impact on poverty rates and child poverty is still needed.

Further • Website: www.sabangkota.go.id/ readings and information • Video: www.youtube.com/watch?v=CZPERlKXkbg

Contact • Andi Yoga Tama, Chief of Field Office – Banda Aceh ([email protected]) details • Faisal Azwar, S.T., M.T, Bappeda Sabang City ([email protected])

8 Cash-based Assistance in Lombok 2018-2020: from Earthquake to COVID-19 General topic area: Adaptive social protection, emergency cash-based assistance Locations: West Nusa Tenggara (North Lombok and East Lombok)

Between 2018 and 2020, UNICEF Indonesia has managed three emergency cash-based assistance (CBA) programmes as part of its country strategy action plan: “By mid-2019, through the provision of multi-sectoral cash-based assistance, the most vulnerable children aged 0-6 and their families, are better able to meet their immediate needs, including food security, health, education and water, sanitation and hygiene (WASH)”. These programmes are:

Programme Period Partner Multi-purpose cash (MPC) assistance to December World Vision affected households in Sigi District, Central 2018–June Indonesia (WVI) Sulawesi 2019 Emergency cash assistance to disaster- December Catholic Relief affected children, North Lombok (CBA 1) 2018–August Services (CRS) 2019 Emergency cash-based assistance, East November Catholic Relief Lombok (CBA 2) 2019– Services (CRS) Summary September of the Approach 2020

CBA 1 for disaster-affected children was a response to the severe earthquake that hit Lombok in mid-2018. The objective was to address the immediate needs of affected families with children up to age six or seven, pregnant women and breastfeeding mothers. The earthquake affected the community by disrupting livelihoods and reducing incomes: 28 per cent of those affected were unable to go back to work within three- to-six months, and 23 per cent were without work for six-to-12 months. Overall, 35 per cent earned less income due to: fewer working days, dismissal or the risky nature of their previous work. The multipurpose emergency cash intervention was flexible and unconditional, allowing recipients to access a range of basic goods and services. It was intended to complement and reinforce other UNICEF interventions related to strengthening public services by providing the financial means to affected families to gain access to food and non-food items as well as healthcare, education and WASH services. The intervention was carried out in partnership with World Vision International.

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CBA 1 targeted 4,200 beneficiaries in six villages in North Lombok. Payment was made in four tranches, with a total value of IDR 4,45 million (USD 304) per household. CBA 2 represented an expansion to East Lombok District, targeting 4,500 beneficiaries in eight villages in four sub-districts. UNICEF, with support from Catholic Relief Services and the Indonesian Post Office, distributed IDR 4 million (USD 274) to each beneficiary in three tranches at village distribution points. Unlike CBA 1, which focused mainly on cash disbursement, as part of CBA 2 UNICEF also carried out policy advocacy by: strengthening the capacity of local governments, advocating for standard operating procedures and guidelines on cash transfer and developing safety precautions during the COVID-19 pandemic. During CBA 1 and CBA 2, UNICEF conducted studies on relevant topics such as: • Qualitative study of emergency multi-purpose cash assistance in East Lombok • Remote COVID-19 insights study

CBA 1 • 4,469 households in six villages received cash-based assistance. • 33.41 per cent of the cash assistance was spent on food and 66.59 per cent on basic services and essential needs. • Three grievance redressal mechanisms were established, including through a hotline and U-report. • Five training sessions were held for partner organizations.

Key Results CBA 2 Achieved • 4,402 of households in eight villages received cash-based assistance. • 68 per cent of the assistance was used to pay for essential goods (e.g., food, WASH products, school equipment), while 32 per cent was used to access basic services (e.g., transportation to school/hospital, early childhood education (PAUD) enrolment, healthcare fees). • Five grievance redressal mechanisms were established. • Five trainings and two workshops on programme implementation were organized for partners. • Two learning visits were conducted with sub-national government.

Replicability/ Initiated in North Lombok, CBA 1 was expanded to East Lombok as CBA 2 with the aim up-scaling of improving access by affected households to basic goods and services.

10 CBA 1: • Programme management: IDR 676.9 million (USD 46,300) • Direct cash transfer: IDR 19 billion (USD 1,3 million)

Cost CBA 2: • Capacity strengthening for the government (training, knowledge exchange visit): IDR 69.4 million (USD 4,800) • Programme management: IDR 1.4 billion (USD 96,500) • Direct cash transfer: IDR 19.9 billion (USD 1,37 million)

• Surveying • Monitoring Skills • Mobile phone operation • Data collection • Professional background knowledge

• Ministry of Social Affairs (MoSA) • Bappeda of NTT province • Bappeda of East Lombok district • Provincial Social Affairs Office Stake- • District Social Affairs Office of East Lombok holders • East Lombok District Government • Village governments in four sub-districts • Community volunteers • Posyandu cadres

• In a post-disaster context, CBA is preferred (although people appreciate in-kind assistance) until markets normalize. Evaluation found that the assistance was primarily used to fulfil family needs: food security/nutrition, education and health- related spending for children were top priorities. • Children benefited the most. Targeting children as key beneficiaries proved to be a Lessons successful strategy since parents prioritized the needs of their children. Overall, the Learned benefits were enjoyed by children (53 per cent), other family members (41 per cent), mothers (5 per cent) and fathers (1 per cent). • Cash intervention helped women to make small investments, generate income and enhance their productive capacity. A gender evaluation study found that women rebuilt and expanded informal livelihoods, improving their chance of recovery, independence and resilience.

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• Information-sharing and frequent communication about programme milestones are necessary, e.g., to improve socialization. The whole community – beneficiaries and non-beneficiaries — should be informed about the programme, eligibility and exclusion criteria, disbursement frequency and required documentation. • Standard guidelines provided by national and sub-national governments and a reliable beneficiary identification system enhanced communities’ trust in village authorities, for instance for determining eligible beneficiaries. • Implementation of the COVID-19 ‘Safe Distribution Guideline’ by village and local governments effectively enhanced safety and reduced crowds during cash distribution. • Integration of ICT/Comcare application into the CBA project was very useful at registration and monitoring stages because data collection was more valid and reports were well recorded. Local governments were interested in this technology and have tested it during joint monitoring and learning

• Cash-based assistance for earthquake and tsunami affected children in Central Sulawesi and Lombok Province (2-pager) • The State of Children in Indonesia: Trends, Opportunities and Challenges for Further Realizing Children’s Rights (www.unicef.org/indonesia/reports/state-of-children-in- readings and indonesia-2020) information • UNICEF Annual Report 2019 (www.unicef.org/indonesia/reports/annual-report-2019) • Local news: Multifunction cash assistance distribution from UNICEF (www.senaru- lombokutara.desa.id/first/artikel/202-Distribusi-Bantuan-Tunai-Multiguna-Dari-Unicef)

• Annisa Srikandini, UNICEF Programme Manager ([email protected]) Contact details • Iyan Kusmadiana, Head of Subdirectorate Disaster Survivor Management, MoSA ([email protected])

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1 Scaling Up the Adolescent Health and Nutrition West Nusa 15 Programme “Aksi Bergizi” Tenggara (NTB) and East Nusa Tenggara (NTT) 2 Scaling up the Life-saving Integrated Management East Nusa 18 of Acute Malnutrition (IMAM) Approach in East Nusa Tenggara Tenggara (NTT) 3 Maintaining Adolescent Nutrition Services during the Central Java 22 COVID-19 Pandemic in Klaten District, Central Java

14 Scaling Up the Adolescent Health and Nutrition Programme “Aksi Bergizi” General topic area: Adolescent nutrition Locations: West Nusa Tenggara (10 districts) and East Nusa Tenggara (1 district)

In partnership with the Ministry of Health, Ministry of Religious Affairs, Ministry of Home Affairs, Ministry of Education and Lombok Barat District government, UNICEF has taken proactive measures to address the triple burden of malnutrition. This was achieved through pioneering work on adolescent nutrition (Aksi Bergizi) between January 2018 and March 2020 at 48 model schools – junior and senior high schools, Islamic schools and vocational schools. The programme started with qualitative, quantitative and landscape studies on adolescent nutrition and health programmes and related policies in Indonesia. The studies found severe prevalence of stunting (30 per cent), wasting (almost 10 per cent) and anaemia (almost 20 per cent) among adolescent girls. In Lombok Barat, a consultation workshop with national and sub-national stakeholders developed an adolescent nutrition programme that combines three evidence-based interventions:

Summary 1. Support for weekly iron folic acid supplementation (WIFS) targeting adolescent girls. of the Approach 2. Work with local governments, school management and teachers to promote the integration of nutrition and physical education into existing structures. 3. Development of a behaviour-change communication tool to improve food intake and physical activity patterns of adolescents, their families and communities. Implementation at schools began with training and socialization. Training of trainers was conducted for district facilitators from the School Health and Hygiene Promotion Advisory Committee, district planning board (Bappeda), district health office (DHO) and district religious affairs office. Provincial officials also participated in these trainings. The trained facilitators were then assigned to train teachers and members of adolescent peer support groups. Component one was conducted at schools through a 45-minute weekly session consisting of joint breakfast and tablet supplementation (15 minutes) and a 30-minute literacy session. Socialization activities were held separately as an extracurricular activity aimed at social and behaviour-change and promoting healthy school canteens.

• By February 2020, completion of the three components had reached 80 per cent, with the following breakdown: 97.3 per cent implemented joint breakfasts, 97.9 per cent completed WIFS, 100 per cent implemented weekly literacy session and 77 per Key Results cent completed nearly 200 social mobilization activities at schools. Achieved • West Nusa Tenggara (NTB) Province began replicating the activity in all schools on 14 February 2020. The vice-governor and head of an Indonesian women’s empowerment organization led the joint breakfast and iron folic acid (IFA) supplementation ceremony.

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• NTB Province aligned the programme with its flagship health programme “Generasi Emas” NTB (GENTB – NTB golden generation). The government provided funding to train 22 facilitators from 10 districts and cities, with technical support from UNICEF, in October 2019. In addition, the DEO of Lombok Barat allocated funds to invite more 7th-to 9th grade teachers to the training. • In 2020 the leader of Lombok Barat District issued regulation on adolescent nutrition, and the DEO developed a roadmap and budget for scale-up through ‘Sister Schools’. Model schools were instructed to pair with other school in the same sub-district and provide coaching; however, implementation was suspended due to the COVID-19 pandemic. • Despite the pandemic, Lombok Barat continues IFA tablet distribution through a peer support group, based on a circular letter from the provincial health office (PHO). Lombok Barat successfully engaged the peer support group and achieved high completion rates for component 1, an achievement widely acknowledged at the national and sub-national levels.

• In West Nusa Tenggara, Lombok Tengah, Lombok Utara and Lombok Tenggara districts allocated budget for scaling up and completion of training in October- November 2020. • East Nusa Tenggara allocated funds for scaling-up in 10 districts in 2020, but the funds were diverted to the COVID-19 response. Nevertheless, Kupang District produced 22 facilitators and trained 12 teachers and puskesmas staff in four sub- districts.

Replicability/ • Provincial budget: Training for facilitators IDR 35 million (USD 2,400); IFA up-scaling tablet procurement IDR 150 - 500 million (USD 10,600 – 34,100) / year • District budget: DHO to cover training and supportive supervision of Cost health and puskesmas staff; DEO to support teachers’ participation • Puskesmas: Transportation allowance for staff • Schools: teacher training IDR 10 – 25 million (USD 680 - 1,700) / school.

Skills Application of Aksi Bergizi training of trainer and teacher training modules

Stake- • Provincial and district health office, school managers, teachers holders

• School health units have been the main force driving multi-sectoral coordination and facilitating training for health workers and teachers. • The government needs to tailor programme implementation to the different characteristics of public, vocational and religious schools to ensure effective Lessons implementation. Learned • An effective mechanism must be developed to train district health and non-health service providers as facilitators. • Identify possible budgets from schools to strengthen teacher capacity to deliver the information.

16 • Provincial and district regulations are needed to ensure that the programme receives priority and sufficient budget allocation. • Monitoring and evaluation, including recording and reporting, of IFA tablet distribution are essential. • Linking the programme into the local policy agenda through GENTB enhanced programme ownership. • Ability to lead and develop a road map, budget, activities and standard operating procedures is crucial to ensuring timely and quality implementation.

• NTB official website: www.ntbprov.go.id/post/program-unggulan/aksi-bergizi-untuk- Further generasi-emas-ntb readings and • Information and Communication Office of Lombok Barat website: information www.diskominfo.lombokbaratkab.go.id/ • Lombok Barat District website: www.lombokbaratkab.go.id/

• Blandina Rosalina Bait, Nutrition Specialist UNICEF ([email protected]) Contact • Airin Roshita, Nutrition Specialist UNICEF ([email protected]) details • Denny Apriyanto, Bappeda West Nusa Tenggara ([email protected])

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Scaling up the Life-saving Integrated Management of Acute Malnutrition (IMAM) Approach in East Nusa Tenggara General topic area: Adolescent nutrition Locations: East Nusa Tenggara (Kupang City, Kupang, Timor Tengah Selatan)

UNICEF worked with the national and provincial health office (PHO) in East Nusa Tenggara (NTT) Province to model the IMAM programme at six community health centres in Kupang District from October 2015 to April 2018. Since 2017 the modelling has met three of four global SPHERE standards in Nutrition and Food Security, with cure rates above 75 per cent and defaulter and death rates below 15 per cent and 10 per cent, respectively. IMAM programme performance indicators between October 2015 and March 2018 can be seen below. SPHERE YEAR MINI- 2015 2016 2017 2018 MUM STAN- OCT- AVE- JAN- APR- JUL- OCT- AVE- JAN- APR- JUL- OCT- AVE- JAN- AVE- DARD DEC RAGE MAR JUNE SEPT DEC RAGE MAR JUNE SEPT DEC RAGE MAR RAGE % RECOVERY RATE (1) >75 17 17 48 36 38 63 46 80 86 72 78 79 76 76 DEFAULTER RATE (2) <15 83 83 40 56 55 34 46 11 6 13 11 10 7 7

DEATH <10 0 0 0 0 0 2 0.5 0 1 0 0 0.3 0 0 Summary RATE (3)

of the 1. Recovery Rate: Number of beneficiaries successfully discharged as recovered, divided by total discharges Approach 2. Defaulter Rate: Number of defaulters unconfirmed + Number of defaulters confirmed, divided by total discharges multiplied by 100 3. Death Rate: Number of beneficiaries who died whilst registered in programme, divided by total discharges multiplied by 100

The number of children under age five who attended the community health post each month between October 2015 and March 2018, and corresponding screening rates for severe acute malnutrition, have risen as shown below, significantly due to intensive community mobilization for early detection, referrer and follow up.

90 9000

80 8000

70 7000

60 6000

50 5000

40 4000

30 3000

20 2000

10 1000

0 0 FEB FEB FEB JUL DEC JUL DEC DEC OCT OCT OCT JUN JUN NOV NOV NOV JAN JAN JAN APR APR AUG AUG MAY MAY MAR MAR SEPT MAR SEPT 2015 2016 2017 2018 Number of children attended community health post SAM Screening Rate (%)

18 IMAM combines both facility-based and community-based outpatient treatment service for children with severe wasting. Mortality rates for children with severe acute malnutrition (SAM) are 11.6 times higher than those of well-nourished children. Children who suffer undernutrition early in life tend to do less well at school and to be less productive as adults, leading to low earnings as adults and inability to break out of poverty. UNICEF seeks to integrate the IMAM approach into routine health service delivery in Indonesia. In a country exposed to frequent disasters, the evidence accumulated will strengthen both routine nutrition service delivery and the capacity of district health authorities and families to mitigate the impact of shocks – such as rising food prices and natural disasters – on children’s nutritional status. In April 2018 UNICEF handed the IMAM programme in NTT over to the local government, which continued to use its own resources but received ongoing UNICEF technical support. Following the successful local evidence generation proving the effectiveness of IMAM, a roadmap to scale up IMAM across NTT Province was developed jointly by UNICEF and local government. The roadmap details activities, budget, mapping of potential budget sources at all levels, the expected role of stakeholders and standard operating procedures. The plan was to begin implementing the programme at five or six health centres with high rates of SAM and then expand to all 22 districts by 2020. UNICEF advocated for the inclusion of measures to address wasting and stunting in Indonesia’s medium-term development plan for 2018–2023, as well as providing intensive technical support to provincial health authorities to develop a ‘grand design’ for stunting prevention. The PHO included measures to address severe wasting as nutrition-specific interventions to prevent stunting. Treatment of severe wasting was also included as one of 25 composite indicators of stunting in NTT Province’s Convergence Action document, which is part of a national strategy on stunting prevention in priority districts. NTT Stunting Task Force was established in 2019, following a decree by the governor, with a mandate to coordinate efforts by government offices. The Task Force included IMAM as one of its innovative programmes in districts that have high stunting and poverty rates. UNICEF provided intensive technical assistance and advocacy to support the programme in Kupang as a pilot district, and in Kupang City and Timor Tengah Selatan District as the replication areas. UNICEF support included planning, budgeting, implementing, monitoring and evaluation as well as scaling up IMAM services to all public health centres in the respective districts. Measures to address severe wasting cases were included in official decrees on stunting prevention. Multi-stakeholder coordination was promoted through the convergence approach, in which village empowerment office played a role. In addition, advocacy was conducted to engage the women’s empowerment organization, from the provincial to the village level, to participate in case finding and follow up.

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• In NTT Province, the prevalence of wasting decreased from 15.5 percent in 2013 to 12 percent in 2018, while stunting prevalence also decreased from 51.7 percent to 42.62 percent (Riskesdas, 2018). It is important to note that since stunting is a chronic undernutrition problem, many determinants contributed to these results. • Kupang City, Sikka and Timor Tengah Selatan District scaled up IMAM at all health centres in 2018. They allocated funds to train healthcare workers on IMAM and infant young child feeding (IYCF), procure ready to use therapeutic food (RUTF) and equipment and conduct monitoring and supervision. Kupang City and Timor Tengah Selatan District also implemented family mid-upper-arm-circumference (MUAC) initiative to empower mothers and caregivers to monitor children nutrition status at home during the COVID-19 pandemic. • In Timor Tengah Selatan District IMAM service was extended to community health centres in villages, in anticipation of increased SAM cases due to the COVID-19 Key Results pandemic. Achieved • Family welfare programme (PKK) of NTT Province also scaled up IMAM in 22 villages across 22 districts/cities by 2020. PKK used its budget to procure RUTF and MUAC tape used to determine malnutrition in children and to conduct capacity building and community mobilization. • IMAM was included as a key intervention during the first 100 days of the newly elected governor in 2018, and as one of 25 composite indicators of stunting causes (aksi.bangda.kemendgari.go.id) and highlighted in the stunting reduction strategic plan. • Based on district head regulations, Village Funds in Kupang and Timor Tengah Selatan districts were allocated to address stunting and severe wasting, to: procure equipment, provide training on IYCF and give an allowance to parents of children with severe wasting to ensure completion of the treatment (https://dinkeskabtts.org). • District village empowerment offices included severe wasting topics in trainings for health cadres, notably screening for acute malnutrition.

All districts across NTT Province scaled up the programme in 2020. Some 200 health workers and PKK cadres in 22 cities/districts were trained online.

• 5-day training for 25 healthcare staff: IDR 66 million (USD 4,500) /district • Procurement of anthropometry kits including MUAC tapes: IDR 15 Cost million (USD 1,025) / district • Procurement of RUTF: IDR 250 million (USD 17,100) Replicability/ up-scaling • Training facilitation Skills • Monitoring and supervision • Programme management

• PHO Stake- • DPMPD/PKK holders • DHO • Puskesmas

20 • It is important to link the programme to policy agendas to obtain buy-in for political commitment and budget allocation. • The ability to lead and develop a road map, budget, activities, and standard operating procedures is essential to ensure timely and quality service by frontline staff. • The capacity of health workers, PKK cadres and other district and provincial officers must be strengthened to enable them to deliver quality IMAM services. Lessons Learned • Effective community mobilization can engage key stakeholders to support the programme and become local champions. • Incorporation of the IMAM approach into the existing health system and integration with other sectors is needed to ensure that IMAM services become an integral part of routine healthcare. • Increasing community knowledge and awareness of severe wasting, through different platforms, channels and events, proved beneficial.

Further • Bulletin of World Health Organization, 97:597–604. doi: dx.doi.org/10.2471/ readings and BLT.18.223339. information • DHO website: www.dinkeskabtts.org

• Blandina Rosalina Bait, Nutrition Specialist UNICEF ([email protected]) Contact • Hai Raga Lawa, Nutrition Officer UNICEF ([email protected]) details • Sherly Hayer SGz and Siti Romlah, SKM.MKes, Nutrition Staff, PHO East Nusa Tenggara ([email protected])

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Maintaining Adolescent Nutrition Services during the COVID-19 Pandemic in Klaten District, Central Java General topic area: Adolescent nutrition Location: Central Java (Klaten)

A study on dietary habits and physical activity commissioned by UNICEF in 2017 revealed that school-based physical activity among Indonesian adolescents was minimal; seldom more than 90 minutes a week. In addition, changes in dietary intake patterns have doubled the consumption of fat and processed foods. Adolescents’ dietary diversity was found to be poor; only 25 per cent consume rich sources of iron, foliate and other essential micronutrients such as plant- and animal-based foods. There is growing awareness that adolescent nutrition requires enhanced attention and investment in Indonesia. Nutrition-specific and nutrition-sensitive interventions need to be combined into an integrated, multi-sectoral response to achieve optimal nutritional status for adolescents. Initiated in 2018, Aksi Bergizi (AB) is an adolescent nutrition programme designed to address malnutrition by focusing on building healthy eating behaviours and engaging in physical activity. The programme consists of three components: 1. Weekly iron folic acid supplementation (WIFS) to control and prevent anaemia

Summary 2. Weekly sessions on adolescent nutrition and health (ANH) to improve adolescents’ of the knowledge and attitude about food consumption Approach 3. A comprehensive social- and behaviour-change communication (SBCC) strategy to empower adolescents to improve dietary practices and physical activity with support from their environment. Prior to its implementation, technical guidance on WIFS for school/madrasah and health centers was developed to complement the 2016 Ministry of Health (MoH) guideline. This was followed by dissemination to 124 teachers from 62 schools and 46 district facilitators. UNICEF and its implementing partner encouraged schools to hold a breakfast session before tablet consumption and record and report coverage and compliance with WIFS using a recommended format. Implementation started with capacity-building activities: • Training of trainers on ANH for district facilitators • ANH for teachers • Training for peer support to mobilize schools to promote key AB messages • Socialization of SBCC and healthy school canteen messages.

22 In Klaten District, prior to the COVID-19 outbreak (February 2020) 96.8 per cent of participating schools and madrasah implemented joint breakfast and WIFS sessions and 82.3 per cent implemented weekly ANH literacy sessions in class. In addition, 82.2 per cent had carried out school mobilization (through 189 activities), while 63 schools/ madrasah improved their school canteens. Since mid-March 2020 schools have been instructed to conduct home learning due to the COVID-19 pandemic, requiring rapid adaptation for all three AB components. WIFS was carried out by the COVID-19 village task force for all adolescent girls and the ANH component shifted to the home learning modality. By June 11 sessions of ANH literacy had been conducted and by July ANH training for teachers had been completed at all participating junior high schools.

• WIFS implementation during the pandemic reached almost 60,000 adolescent girls (13-18 years) including both students and out-of-school girls. The figure is 18.3 per cent higher than the initial target. Key Results • Nearly 1,200 students completed ANH literacy through home-learning. Achieved • A pool of 46 district facilitators were available in Klaten and prepared to help scale up AB in Central Java. • Improved coordination among health, education and religious affairs offices at both the district and provincial levels.

• Klaten District began to replicate in 10 junior high school in August 2020. Boyolali District, Salatiga and Yogyakarta City planned to replicate the programme, but were interrupted by the COVID-19 pandemic. • The national government has agreed to scale up the AB programme under the School Health programme nationwide in 2021.

• Training of trainers on ANH for district facilitators (5 days): IDR 1,115,000 (USD 76)/ person. • ANH for teachers (5 days): IDR 1,115,000 (76) / person. Cost Replicability/ • Peer support training (2 days): IDR 336 thousand (USD 30)/ person. up-scaling • Printing module for facilitators: IDR 250 thousand (USD 17)/ piece. • Printing module for students: IDR 15 thousand (USD 1)/ piece.

• Application of training modules Skills • Facilitation skills

• Provincial and district health offices Stake- • Provincial and district education offices holders • Provincial and district religious affairs offices

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• Official decrees and policies were critical to programme implementation and adoption because the project involves at least three different institutions (district and provincial health, education and religious affairs offices). Gaining this support calls for strong lobbying and advocacy skills, so in some cases pursuing this support may slow implementation. • The availability of trained facilitators from members of school advisory boards to drive Lessons the programme is key to achieving multi-sector coordination. These actors can serve Learned as the main facilitators for capacity building of district health workers and teachers and can be linked with the Government’s ‘Healthy Schools’ programme. • Adoption of an online system to conduct capacity building for health and non- health service providers could significantly reduce the budget at the early stage of programme launch, but robust mentoring is needed to support teachers during implementation at schools.

• YouTube Channel Aksi Bergizi Klaten: www.youtube.com/channel/UCuPkvMwyA- Iry7PxTpJJ5GQ Further • Aksi Bergizi Online Quiz and question bank: readings and https://bit.ly/KuisAksiBergizi and https://bit.ly/3fOsbwL information • Aksi Bergizi Facilitator Guidance Book: www.unicef.org/indonesia/media/1866/file • Aksi Bergizi Student Book: www.unicef.org/indonesia/id/media/1871/file

• Karina Widowati, Nutrition Officer UNICEF ([email protected]) Contact • Airin Roshita, Nutrition Specialist UNICEF ([email protected]) details • Bekti Sayekti, Public Health Unit, Klaten DHO ([email protected])

24 © UNICEF Indonesia /2018/Noorani25 ANNEX: COMPENDIUM OF GOOD PRACTICES

1 Improving the Quality of Integrated Management of Childhood Aceh 27 Illness at Primary Health Facilities through On-the-Job Training and Routine Facilitative Supervision 2 Improving the Quality of Care for Mothers and New-borns Aceh 30 at Health Facilities through Sustainable Point of Care Quality Improvement 3 Digital Monitoring Systems: Lesson Learned from Aceh Aceh 33 4 Mainstreaming an Integrated Approach to Address Maternal and Aceh 36 Child Malnutrition through Improved Planning and Budgeting 5 Family Based Monitoring of New-born Health West Nusa Tenggara 38 6 Technical Support for Cold Chain Equipment Service & East Nusa Tenggara 41 Maintenance in East Nusa Tenggara Province 7 Combining on-the-job training for malaria microscopist with East Nusa Tenggara 44 microscope services and maintenance to improve malaria diagnostic quality assurance in East Nusa Tenggara 8 Improving the quality of hospital care for mothers and new-borns West Nusa Tenggara 47 through point-of-care quality improvement (POCQI) at district hospitals 9 Acceleration of Malaria Control in Endemic Villages through Maluku 50 Community Engagement and Utilization of Village Funds 10 Community Empowerment and Mobilization through North Maluku 52 Participatory Learning and Action for Malaria Elimination 11 Promotion of Maternal, New-born and Child Health through North Maluku 54 Building Health Worker Capacity and Data Management at Community Health Centres 12 Improving Maternal and Neonatal Services through On-the-Job Papua 56 Training for the Integrated Management of Childhood Illness 13 UNICEF Support to Polio Outbreak Response in Papua Papua 58 14 Use of Human-Centred Design to Increase Routine Immunization East Java 61 Coverage 15 Optimizing the Triple Elimination Prevention Programme through East & Central Java 63 Private Services (midwives, clinics, hospitals) in Districts and Cities

26 Improving the Quality of Integrated Management of Childhood Illness at Primary Health Facilities through On-the-Job Training and Routine Facilitative Supervision General topic area: Good health and well-being Locations: Aceh (Langsa City, Sabang City, Singkil, Simeulue)

The UNICEF-supported pilot to improve the quality of integrated management of childhood illness (IMCI) through on-the-job training (OJT) was completed in Aceh Jaya District and Langsa City by the end of 2018. In 2019, the Ministry of Health (MoH) decided to replicate the training in three locations (Singkil, Simeulue, and Sabang City) using formal guidelines. ICMI is an integrated approach to addressing maternal and child malnutrition through local healthcare workers. The first step was to prepare qualified trainers at all levels. The MoH trained provincial master trainers in January 2019. Training for district health officials and mentors based at community health centres (puskesmas) was conducted in February- March 2019. Healthcare workers from sub health center (pustu) and village midwife clinic (polindes) received OJT to complete all 17 MoH modules between April and June 2019. One mentor was assigned to a maximum of three mentees. Pre-and post-tests were conducted to assess improvement in knowledge and skills, using a standardized MoH guideline. Upon completion of OJT, District Health Offices (DHOs) Summary and relevant professional organizations issued certifications. The whole process was of the supervised by provincial master trainers and DHO officials. Approach Facilitative supervision of post-training services was conducted during the third quarter of 2019 and continued quarterly throughout 2020. Advocacy with heads of puskesmas was conducted to ensure the availability of equipment and medicines and to support internal supervision. DHOs coordinated the monthly monitoring of IMCI data collected. A ‘WhatsApp’ group was formed to facilitate communication, technical consultations and reminders about monthly data collection. An evaluation was conducted in late 2019 at puskesmas, pustu and polindes. To stimulate demand, cadres at integrated health centres were invited to a workshop on increasing public awareness about danger signs for children that require immediate visits to a health facility. Topics covered also included the administration of proper medication, such as oral rehydration solution for children with diarrhoea. Some community health centres utilized their budget to provide incentives for their staff and village midwives who performed neonatal home visits using the IMCI approach to monitor infant health.

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Outputs: • 10 provincial master trainers in Aceh: three provincial health office (PHO) staff, three paediatricians from the Aceh branch of Indonesia’s Paediatrics Society, two midwives from the province’s Midwives Association and two nurses from the Aceh branch of the Indonesian Nurses Association. • 5 DHOs have at least two staff trained to conduct IMCI facilitative supervision. A total of 18 DHO staff were trained to conduct supervision utilizing standard MoH supervision tools. • 49 community health centres have at least two staff trained to serve as IMCI Key Results mentors; 103 IMCI mentors are prepared deliver OJT to other health workers. Achieved • 304 village midwives and nurses at 302 pustu and polindes were trained in IMCI through OJT • Each of 49 puskesmas received DHO supervision at least once per quarter. • Each pustu/polindes was supervised by a mentor at least once per quarter.

Outcomes: • The percentage of children under five visiting puskesmas implementing IMCI rose from 62 per cent in February 2019 to 94 per cent in June 2020. • An increased number of children with diarrhoea received oral re-hydration solution (ORS) - from 57 per cent in February 2019 to 96 per cent in June 2020

In 2020 scale-up was taking place in three learning districts

• Training puskesmas mentors: IDR 2,2 million (USD 150) / person • OJT: no cost (village midwives can join the IMCI OJT during the weekly visit to puskesmas -- with optional transport allowance and refreshment of IDR 750,000 (USD 51) / person • Printing IMCI flipchart and forms: IDR 450,000 (USD 31) Cost • Supervisory visits by DHO to puskesmas: IDR 1,5 million (USD 103) / visit • Supervisory visits by puskesmas mentor to pustu/polindes: IDR 150,000 (USD 10) / visit Replicability/ up-scaling • Workshop for cadres: IDR 150,000 (USD 10) /person • Understanding of and skills related to IMCI, as per guideline Skills • Mentoring skills

• Provincial Health Office (PHO) • District Health Office (DHO) Stake- • Community health center (puskesmas) officials holders • Puskesmas health workers • Pustu/polindes health workers • Professional organizations

28 • Through OJT, IMCI training can be performed at a low cost and without the need for Lessons classroom training. Learned • Routine supervision using a standard tool motivates health workers to improve the quality of their service.

Local media news: Further • https://www.ajnn.net/news/aceh-deklarasi-gerakan-perangi-stunting/index.html readings and information • https://aceh.tribunnews.com/2020/07/04/tingkatkan-pelayanan-kesehatan-anak-di- nagan-raya-unicef-latih-tenaga-medis

• Tira Aswitama, Health Specialist UNICEF ([email protected]) • Bobby Marwan Syahrizal, Maternal and Child Health Specialist UNICEF Contact ([email protected]) details • Lisna Andria, Child Health Coordinator Provincial Health Office/PHO Aceh (lisna. [email protected])

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Improving the Quality of Care for Mothers and New-borns at Health Facilities through Sustainable Point of Care Quality Improvement General topic area: Good health and well-being, maternal and child health Locations: Aceh (Langsa City, Peureulak, Aceh Timur and Bireuen)

Point of care quality improvement (POCQI) interventions were first conducted in 2019 at Langsa Hospital, selected due to the high number of maternal-child health (MCH) referrals - indicating a need for improvement in pre-referral case management. POCQI is a management approach used by health workers at model hospitals to ensure that patients receive quality care. While POCQI primarily focuses on re-organizing care using existing resources, it also contributes to addressing other related issues. It is a problem-solving approach applied in the local context of a health facility and usually does not require additional resources. The POCQI approach involves: • Establishing improvement teams to identify problems and implement solutions • Implementing a collaborative approach to ensure adherence to guidelines based on standards of care Summary of the • Conducting training of health providers in technical and quality improvement (QI) Approach methods to implement the quality improvement system • Continuous monitoring of performance through supportive supervision and self- assessments of the quality of care provided, to measure progress towards the achievement of higher standards (intense early in the intervention, followed by quarterly supervision to monitor continuity and identify new interventions) • Documentation and publication of QI efforts and recognition and celebration when standards are achieved • Scaling-up to all hospitals and health facilities and communities. Introduction and training of health workers and hospital managers was facilitated by staff trained by UNICEF and the MCH section of the Provincial Health Office (PHO). Six units at Langsa Hospital formed QI teams consisting of doctors, nurses, midwives and other relevant staff. The teams analysed clinical data at their units and identified gaps and possible solutions utilizing POCQI tools.

30 Initial POCQI interventions targeted simple interventions that did not require additional funds or resources: increasing breastfeeding at the hospital and reducing hypothermia. Introducing paediatric screening processes at the hospital’s outpatient clinics was also included. Capacity-building sessions for health workers were conducted on breastfeeding and management of hypothermia, facilitated by the Aceh branch of Indonesia’s Paediatric Society (IDAI). Site assessments were conducted to examine the conditions and facilities of the units. An intervention plan was developed by team members and implementation was monitored by hospital managers, district and provincial health offices, UNICEF and Yayasan Darah untuk Aceh. Progress was discussed every month; if no progress was achieved, the plan was adjusted. The success achieved by this simplified approach immediately improved job-satisfaction among health workers and kept them motivated to work as a team - working together to ensure continuous quality improvement. The changes began as easy and became more challenging over time as part of ensuring patient satisfaction with the care received. Gaps identified by the team were resolved through their own initiatives. An evaluation at Langsa Hospital was conducted by Ministry of Health (MoH) and Provincial Health Office (PHO) at the end of 2019. MoH officials were impressed by the process and the teams’ progress. Implementation of POCQI in Langsa Hospital is one of the success stories from Aceh. The team presented the intervention at the MoH annual national health meeting in 2019, and the MoH invited the hospital manager and health staff to share their experience during the national POCQI meeting. Team members also facilitated some regional POCQI training at the national level.

• Increased coverage of breastfeeding in delivery rooms (for early initiation), maternity wards, neonatal wards Key Results • Cases of hypothermia declined at units responsible for emergency new-born care Achieved • Paediatric screening was introduced at the outpatient clinic • Team members continued to use the POCQI approach to improve the quality of patient care.

• Scale-up to neighbouring district hospitals began in early 2020. • Zubir Mahmud Hospital in Aceh Timur and Sultan Azizsyah Hospital in Peureulak Replicability/ launched POCQI interventions in early 2020. up-scaling • In mid-2020, Bireuen District Hospital was selected by the MoH to replicate the programme due to the high number of maternal and neonatal deaths in the district.

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Cost • Training for health workers: IDR 450,000 (USD 30) per person

• Understanding of WHO-UNICEF POCQI guidelines Skills • Mentoring skills

• Provincial health office (PHO) • District health office (DHO) Stake- • Paediatrician association (IDAI) and Association for Obstetrics and holders Gynecology (POGI) • Hospital manager • Health workers in each unit

• POCQI created early success that immediately improved job-satisfaction among health workers and kept them motivated to work as a team. Lessons • Working together ensured a sustainable movement towards continuous quality Learned improvement • Quality improvement does not always require additional resources or funds.

Further POCQI Approach to Improve Breastfeeding at Langsa Hospital Fact Sheet, readings and information GoI and UNICEF

• Tira Aswitama, Health Specialist UNICEF ([email protected]) • Bobby Marwan Syahrizal, Maternal and Child Health Specialist UNICEF Contact ([email protected]) details • Dr. Sulasmi, Head of Public Health Department PHO Aceh ([email protected])

32 Digital Monitoring Systems: Lesson Learned from Aceh General topic area: Health monitoring Locations: Aceh (Banda Aceh City, Sabang City, Langsa City, Aceh Singkil, Aceh Jaya, Simeuleu)

Posyandu are integrated service posts created and managed by the government. The digital posyandu monitoring system (ePosyandu) was launched in 2019 using web-based technology platforms, Rapid Pro and ONA, to facilitate a real-time digital data-collection system that utilizes short message services (SMS) and digital data visualization. RapidPro delivers integrated messaging for child well-being, including: • Registration of pregnant women and caregivers of children under two years of age, conducted by health post cadres • Scheduled SMS reminders for posyandu visits, immunization schedules and child development milestones for caregivers, based on the child’s age. • SMS reminders on antenatal care and iron consumption to pregnant women, based on their trimester. Summary The ONA platform is used to facilitate monthly reporting of posyandu key performance of the indicators and yearly assessments, submitted by community health centre staff and Approach village midwives. Using a geo-tagging function, the system can facilitate both online and offline data collection with a high degree of accuracy and efficiency, minimizing human errors likely to occur in manual monitoring and reporting. Furthermore, all data is visualized on a dedicated website, supporting the monitoring process for health managers at all levels and offering insights for more accurate and timely evidence-based interventions. A complementary android application was developed to perform actions more quickly than the website and to facilitate the offline access. Mixed-method training activities were conducted by combining face-to-face training embedded into integrated management of childhood illness (MTBS) activities, cascade training delivered by implementing partners and e-learning via video, to scale up coverage beyond the initial districts of intervention.

• Through integrated messaging, ePosyandu engages with various community Key Results members ranging from caregivers to cadres, village midwives and health clinic staff. Achieved It allows for two-way communication between government and communities and reliably provides up-to-date information on their individual communication devices.

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• EPosyandu captures several key health indicators, such as number of visits and counselling practices, as well as specific data on maternal health, nutrition and immunization for mothers and children. The overall total of indicators determines the classification from the highest to the lowest categories:Mandiri (more than 80 per cent); Purnama (from 70 to 80 per cent); Madya (from 60 to 70 per cent); and Pratama (below 60 per cent). The indicators cover facilities, cadres, infrastructure, funding, governance, programme implementation and performance. • The web-based visualization shows over 98 per cent of reporting coverage and compliance as of December 2020. Local governments play a crucial role through their immense support and encouragement of community healthcare personnel and village midwives to report on posyandu conditions in their respective area.

• Scaling up was conducted in two cities, Banda Aceh and Langsa. • E-learning videos are available for scaling-up in UNICEF intervention districts, aiming to educate health practitioners about how to utilize the features. They contain tutorials and step-by-step explanations on how to classify and prepare monthly reports. The widespread usage of smart phones benefitted this effort.

• Development of website (funded by UNICEF) • Development of video tutorial (funded by UNICEF) • Data collection tools: Cost − ONA & RapidPro (funded by UNICEF) − Internet / SMS package: IDR 15,000 (US$1) / puskesmas Replicability/ up-scaling • Introduction & training at sub-national level (co-funded by UNICEF & local government): IDR 50 – 100 million (USD 3,400 – 6,800) /district

• Reporting Skills • Mobile phone operation • Relevant professional background knowledge

• Development planning agency Stake- • Provincial and district health offices holders • Puskesmas staff • Village midwives

• Rapid posyandu mapping is feasible. Integrated with the Ministry of Home Affairs village identification code, which has nationwide coverage, the geotagging feature of Lessons the posyandu monitoring system makes mapping accurate and reliable. Learned • Close monitoring improves posyandu performance. Capturing the real-time situation, more than 850 posyandu have been mapped and classified based on their activity status and capacity.

34 • District support increases reporting coverage. Collaboration among puskesmas staff, village midwives and district health officers facilitate smooth functioning of the ePosyandu monitoring system. • The ability to visualize data and facilities helps to identify problems. Within this system, it is feasible to track the situation and progress, informing the need for intervention. It also allows health managers access to numerical details. • Improved coverage is linked to data utilization. The technology helps to decrease human error and time consumption, compared to manual processes.

• ePosyandu Website: www.eposyandu.com/ Further • ePosyandu Mobile App: readings and www.play.google.com/store/apps/details?id=com.ikea.aceh.unicef.sip&hl=en_US information • ePosyandu Video Tutorial: www.youtu.be/f3IQbe1UnEM and www.youtu.be/RDgZjQVLoMI

• Suci Wulandari, Data Centre Specialist UNICEF ([email protected]) Contact • Tira Aswitama, Health Specialist UNICEF ([email protected]) details • Dr. Teuku Chik Mohamed Iqbal Fauriza, M.Kes, Head of Health Promotion Section PHO Aceh ([email protected])

35 ANNEX: COMPENDIUM OF GOOD PRACTICES

Mainstreaming an Integrated Approach to Address Maternal and Child Malnutrition through Improved Planning and Budgeting General topic area: Good health and well-being Locations: Aceh (Aceh Jaya, Sabang City, Singkil, Simeulue)

Launched in early 2019, the programme began with training for programme managers and planners at 44 government-run community-based health centres (pukesmas), including District Health Office (DHO) staff and programme managers from four districts. The training sought to deliver management guidelines developed by the Provincial Health Office (PHO) and introduce microplanning tools useful for situation analysis and Summary prioritization. In so doing training would build capacity for planning and budgeting and for of the applying a strategic approach to maternal and child malnutrition. Approach UNICEF worked with the DHO and development planning office to provide technical assistance and facilitate planning and budgeting process in puskesmas, including a review of the situation analysis and focus on problem areas in each village and providing input on potential interventions specific to each village’s priority needs. Consultations among village midwives, health post cadres and village leaders were also conducted to validate the data and gather input on possible interventions.

• 44 puskesmas staff trained on microplanning for improved planning and budgeting to address maternal and child malnutrition Key Results • 44 puskesmas conducted the planning and budgeting process Achieved • 44 puskesmas conducted a situation analysis utilizing the microplanning tool • Annual plans of puskesmas are more strategic with an increased budget allocation for the integrated approach to addressing maternal and child malnutrition.

• Replication is planned in four other districts, starting with knowledge-sharing, under coordination by the Aceh PHO. • Facilitated by the PHO, DHOs and district planning agency, training was delivered to 76 puskesmas programme managers and planners in December 2020 to inform the 2021 annual planning and budgeting process. Replicability/ up-scaling • Training (1 day): IDR 500,000 (USD 35) per person • Facilitation to each puskesmas: IDR 4.4 million (USD 300) per workshop Cost at puskesmas • Consultations with village midwives, health post cadres and village leaders: IDR 750,000 (USD 50) per session

36 • Puskesmas management Skills • Data analysis and programme management • Facilitation

Stake- PHO, DHO, district planning agencies, puskesmas programme managers holders and planners

• The use of a simple Excel microplanning tool to support situation analysis as part of the planning process enabled puskesmas to identify key problems, priorities and Lessons focus areas for each village under their responsibility. Learned • Technical assistance and facilitation from DHOs and district planners for puskesmas during the planning and budgeting process should be in line with district priorities and the availability of funding.

• Aceh Anti-Stunting Movement Declaration: www.nasional.republika.co.id/berita/ Further nasional/daerah/pnsm0e423/aceh-deklarasi-gerakan-perangi-emstuntingem readings and • Sabang City Government is Committed to Address Stunting in 2020: www. information kanalinspirasi.com/pemerintah-kota-sabang-komit-tangani-masalah-gizi-dan-stunting- di-tahun-2020/

• Tira Aswitama, Health Specialist UNICEF ([email protected]) • Bobby Marwan Syahrizal, Maternal and Child Health Specialist UNICEF Contact ([email protected]) details • Dr. Sulasmi, Head of Public Health Department PHO Aceh ([email protected])

37 ANNEX: COMPENDIUM OF GOOD PRACTICES

Family Based Monitoring of New-born Health General topic area: Maternal, neonatal and child health Locations: West Nusa Tenggara (West and East Lombok)

West Nusa Tenggara (NTB) has the third-highest neonatal mortality rate nationwide, with 33 deaths per 1,000 live births - compared to the national average of 22 per 1,000 live births (Bappenas, 2017). In early 2018 UNICEF began support to NTB’s Provincial Health Office (PHO) to improve the quality primary care and referral services for of new-borns and children. The effort was carried out in partnership with the provincial professional organization on public health (Ikatan Ahli Kesehatan Masyarakat). NTB’s quality improvement (QI) team raised the issue of family/community participation in new-born monitoring, given the critical importance of this period to ensuring child survival. The three partners agreed on a roadmap leading to adoption of the programme, including these steps: • Data collection and analysis on new-born death in all districts • Technical discussions with associations of paediatricians and obstetrics and gynecology (OB/GYN) on the danger signs that families could identify Summary of the • Technical discussion with the provincial family welfare (PKK) team on the important Approach role families can play in monitoring the health of their new-borns and the importance of complementary health staff visits • Family-based monitoring tools on new-born health and development • Workshop to obtain inputs from health staff at community clinics (puskesmas) and hospitals • Piloting and finalizing family-based monitoring tools • Training and workshops for puskesmas and village midwives • Coordination meetings with PKK to safeguard the innovation • Incorporating the tools into maternal-child health manuals as one package to be used for post-natal care counselling. Family-based monitoring tools on new-born health list 14 important symptoms to predict a potential risk to new-born health, such as on feeding pattern, urination and defecation, breathing and temperature. The tool allows families to easily observe their new-born’s health on a daily basis based on the indicators of risk (written in red) or good health (written in green). When risk is identified, families are advised to bring their new-born to a health professional as soon as possible for examination.

38 • 34 midwives in West Lombok and 40 midwives in East Lombok were trained through the collaborative effort of paediatricians, doctors, midwives and the public health association. • 575 mothers in West Lombok and 790 in East Lombok learned to use the family- Key Results based new-born health monitoring tool prior to being discharged from clinics or Achieved hospitals during the first two months. • 75 per cent of families in West Lombok and 60 per cent of families in East Lombok correctly understand how to use rapid assessment tools. • The family-based monitoring tool for new-borns increased families’ knowledge and led to technical discussions with village midwives.

• Replication at other puskesmas took place in East Lombok. • NTB’s Provincial Health Office (PHO) allocated funding in the 2020 budget to support widespread adoption of family-based monitoring tools for new-born health. • The innovation of engaging families in monitoring became especially essential during the COVID-19 pandemic, when new-borns and children had to remain at home, except in emergencies.

• Printing the form: IDR 72 million (USD 4,950) Cost • Distributing the form: IDR 3 million (USD 210) • Workshop dissemination: IDR 51 million (USD 3,530)

Replicability/ up-scaling • Reading Skills • Observation and analytical skills • Mentoring

• Paediatricians Association • Midwives Association • PHO/ DHO Stake- • Puskesmas holders • DPMD – Village offices • Family welfare programme (PKK) • District Development Planning Agency (Bappeda)

• PHO commitment to safeguard the innovation is essential. • The role of the provincial QI team in facilitating regular discussion on how to improve MNCH services at all levels is also important. Lessons • Close coordination with local stakeholders with the ability to reach families is Learned important. • Rapid assessment is needed to understand families’ challenges. • Home visits by integrated health staff to mentor families on using the tool is vital.

39 ANNEX: COMPENDIUM OF GOOD PRACTICES

Development and Planning Agency media feature: www.bappeda.ntbprov.go.id/ Further monitoring-dan-evaluasi-terpadu-program-kerjasama-pemerintah-ri-unicef-periode-2016- readings and information 2020-untuk-kelangsungan-hidup-perkembangan-dan-perlindungan-ibu-dan-anak-khppia- di-provinsi-ntb/

• Vama Chrisnadarmani, Child Survival and Development Specialist UNICEF ([email protected]) Contact • Bobby Marwal Syahrizal, Health Specialist UNICEF ([email protected]) details • Mohammad Abdullah, West Nusa Tenggara Public Health Practitioners Association (IAKMI) ([email protected])

40 Technical Support for Cold Chain Equipment Service & Maintenance in East Nusa Tenggara Province General topic area: Immunization – Cold chain equipment technical support Location: East Nusa Tenggara (NTT)

Every year NTT provides routine immunization services for around 250,000 children under two years of age. In 2016 UNICEF supported the NTT government to conduct mapping of its cold chain equipment (CCE) inventory, which revealed a gap between the amount of cold chain equipment available and actual need. In addition, much of the equipment was broken due to improper maintenance and service. Districts in NTT have limited numbers of qualified staff to provide technical assistance and conduct CCE routine maintenance and services at community health centres. Budget and human resource constraints have prevented the government from delivering conventional face-to-face training and capacity-building programmes. To address these challenges, UNICEF supported the NTT government to train trainers to conduct routine CCE service and maintenance, who then trained technical staff of the expanded programme on immunization (EPI). This was the first EPI innovation undertaken in Indonesia. The capacity-building activities involved a blended programme aimed at: 1. Improving EPI staff’s programme management and immunization skills 2. Ensuring that health facilities have sufficient CCE Summary 3. Reducing the amount of broken CCE through routine maintenance and service. of the Approach This approach sought to assist districts and health centres with CCE problems through on-the-spot assistance and/or virtual support. On-the-spot support was provided during cascade training at the district level and during routine supervision to districts and health centres. Virtual support was made available through online videos and direct access through WhatsApp. Districts with low fiscal capacity and a limited number of qualified EPI technical staff find it easier to adopt the latter approach. This programme consists of two main components: 1. Capacity-building programme on immunization management, conducted simultaneously with on-the-spot technical assistance for conducting routine CCE maintenance and service. 2. Provision of virtual technical support for routine CCE maintenance and service. The programme employed the ‘cascade’ method, with training flowing from the highest (provincial) level down to community-based health centres. For the province, capacity building began at a training of trainers (ToT) workshop that was also attended by district- level EPI staff. Next a series of regional follow-up trainings was conducted in districts in the outer islands. To support the ToT, one module and five video tutorials on routine CCE maintenance and service of were developed in 2019.

41 ANNEX: COMPENDIUM OF GOOD PRACTICES

In districts, UNICEF’s field office in Kupang supported the training, along with programme update workshops. These training activities have taken place regularly in all districts since 2016. Participating districts and the NTT government shared the cost. District governments pay to train health centre staff, while NTT Province supports visits by technical staff to districts. District-level activity combines programme updates and review, EPI workshops and supportive supervision to health centres to monitor the condition of all CCE. A newly developed module on routine CCE maintenance and service is now being used. UNICEF provided full support to NTT for developing and transferring training materials into modules and videos. The provincial EPI team can provide virtual technical assistance through various channels, such as Facebook, WhatsApp and YouTube. The programme uses standardized training materials and EPI supervision checklists.

• Improved capacity of districts and health centre staff to perform service and maintenance has reduced the amount of broken equipment. • Standardized training materials, supervision checklists and five video tutorials to support distance and online trainings were produced. • At least five CCE in each district were repaired and are in use by province and district staff. The lifespan of CCE is no longer jeopardized by improper service and maintenance. Key Results • Improved budget efficiency allowed increased funding allocations for new devices Achieved needed by health centres. • The gap between the actual and needed quantity of CCE in districts and health centres has narrowed. • The MoH’s vocational health college adapted CCE service and maintenance modules into its curricula. • A PHO staff member was named as “best innovative health staff” by the NTT governor for his contribution to CCE service and maintenance.

The innovation was acknowledged by the MoH immunization sub-directorate and adopted by all districts in NTT and NTB provinces, especially following the earthquake.

Cost • Technical skills on CCE service and maintenance

• Workshops, as needed • Printing of modules, as needed. Skills • Video production - no cost (free videos available online) Replicability/ up-scaling • Off-line training IDR 1,4 million (USD 100) person/day • Online training: IDR 150,000 (USD 10) / person

• National team: Technical assistance and supportive supervision • Provincial team: Resource person, technical assistance and supportive Stake- supervision of CCE service and maintenance holders • Districts: Technical assistance and supportive supervision related to CCE at health centres and hospitals

42 • Capacity building of district stakeholders is important to enable independent technical support for CCE maintenance. Lessons • Routine workshops are essential to upgrade the skills of technical staff, as new Learned versions of CCE become available every year. • Regular support from the national level is important to building capacity among provincial and district technical staff.

• Blog Article: Cold Chain Expert from East Nusa Tenggara www.indonesiaunicef. blogspot.com/2017/05/sang-ahli-cold-chain-vaksin-dari-ntt.html • “I want Children in East Nusa Tenggara to be Healthy”, BaKTINews No. 139 July- August 2017 www.bakti.or.id/sites/default/files/files/baktinews/BaKTINews%20 Edisi%20139.pdf Further readings and • Cold Chain video tutorials: information − Video 1 : www.youtube.com/watch?v=AJU0ZQz8yS8 − video 2 : www.youtube.com/watch?v=CK8_1ivNw_U − Video 3 : www.youtube.com/watch?v=hhoWpFXyH5I − Video 4 : www.youtube.com/watch?v=PQC4O1hqYaQ − Video 5 : www.youtube.com/watch?v=X9mo7sgTcyw

• Ermi Ndoen, Chief Field Office - Surabaya ([email protected]) Contact • Kenny Peetosutan, Health Specialist UNICEF ([email protected]) details • Moh Ruhul Amin, Immunization Specialist UNICEF ([email protected]) • Yosef Kupertino, East Nusa Tenggara PHO ([email protected])

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Combining on-the-job training for malaria microscopist with microscope services and maintenance to improve malaria diagnostic quality assurance in East Nusa Tenggara General topic area: Malaria elimination - diagnostic quality assurance Location: East Nusa Tenggara (NTT) – province-wide and focus districts

The programme aimed to tackle the high number of malaria cases in NTT Province. In 2015, NTT contributed to 20 per cent of nationwide cases. Several factors contributed to this trend, including weak malaria diagnostic capability, poor quality of malaria laboratories, inadequate number of frontline lab technicians and limited supporting facilities and compliance procedures. Together, these factors posed a serious challenge to meeting the 2023 malaria elimination target. UNICEF supported an NTT Province initiative to address these problems through two main areas of activity: 1. Microscope service and maintenance • In 2018 a training-of-trainers workshop was conducted and accredited by NTT Province for all districts, as well as specialists and technicians from private laboratories, on microscope service and maintenance. • The following year three modules and videos tutorials were developed Summary • Centre for Microscope Service and Maintenance was established at the provincial of the health laboratory. Approach • The province provided routine technical assistance through its health laboratory. • Districts adopted a similar approach.

2. On-the-job training for lab technicians • Microscopists from NTT participated in the QA Malaria field study in Aceh, facilitated by UNICEF. • In Kupang, UNICEF supported collaboration between the Provincial Health Office and its laboratory, the MoH-owned vocational health college and the NTT professional association of laboratory experts (PATELKI) to jointly conduct training and workshops for microscope technicians. • A customized on-the-job training curriculum was developed to improve the capacity of front-line lab technicians. • Combined on-the-job training for malaria diagnosticians and microscope services and maintenance is now conducted regularly.

44 In addition, virtual support was provided to districts and community health centres using three video tutorials. The provincial malaria elimination team also provides remote technical assistance via social media platforms. This is the first innovation in Indonesia’s malaria programme that combines supply side (ensuring the availability of good quality microscopes), skills improvement (innovative training for malaria diagnosticians), along with the added benefit of preventing human and technical errors. The programme is designed to be easily adaptable by districts with low fiscal capacity and a limited number of qualified laboratory technicians (level 1 and 2).

• 50 microscopes repaired annually since the activities began, leading to a reduced procurement budget. • Number of staff qualified to identify malaria in focus districts increased through on- the-job training: the number of districts with a qualified lab technician increased from two to 22. Key Results • One health laboratory staff member was named as ‘innovative health practitioner’ Achieved by the NTT governor for his contribution to technical support for routine microscope service and maintenance. • Quality assurance has become far more reliable, as reflected in the low error rate, down from 48 per cent to less than 5 per cent. • The number of annual malaria cases declined in Lembata, previously the most malaria-endemic district in NTT province.

• The innovation was acknowledged by the MoH’s malaria sub-directorate and adopted by districts in NTT. • The MoH’s vocational health college incorporated the malaria service and maintenance modules in their curriculum. • Professional organizations and district governments adopted this approach to maintain their members’ skills and competencies through independent and regular training and professional supervision support.

• Offline training: IDR 1,5 million (USD 100) /person/day Replicability/ Cost • Online training: IDR 150,000 (USD 10) /person/day up-scaling • Microscope services and maintenance Skills • Skill assessment

• Ministry of Health (MoH) • District and provincial health offices Stake- • District health laboratory holders • Community health centres • Hospitals

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Lessons Extending the duration of on-the-job training from three to five days led to improved Learned understanding of the material by participants.

• Helping Each Other through Microscope, BaKTINews No.144 January-February 2018 (https://bakti.or.id/bakti-news/baktinews-144-januari-februari-2018) Further • Video Tutorials: readings and information − Video 1: www.youtube.com/watch?v=6glUyyUhuys − Video 2: www.youtube.com/watch?v=QTHfYGUm6gg − Video 3: www.youtube.com/watch?v=xErhoqr7sP8

• Ermi Ndoen, Chief Field Office - Surabaya ([email protected]) Contact • Maria Endang Sumiwi, Health Specialist UNICEF ([email protected]) details • Dece Mery Natalia Pay, East Nusa Tenggara PHO ([email protected])

46 Improving the Quality of Hospital Care for Mothers and New-borns through Point-of-Care Quality Improvement (POCQI) at District Hospitals General topic area: Maternal and neonatal health Locations: West Nusa Tenggara (West Lombok, East Lombok, and Central Lombok)

West Nusa Tenggara (NTB) Province had the third highest number of neonatal deaths in the country, and was ranked 32nd for neonatal health (Bappenas, 2017). As part of UNICEF support to NTB’s efforts to address neonatal death, UNICEF partnered with public health association (IAKMI) in selected districts of East and West Lombok to improve the quality of new-born and maternal health and referral services. In July 2019, POCQI was introduced at Patut Patuh Patju Hospital (West Lombok) and Dr. Soedjono Selong Hospital (East Lombok). POCQI was developed by the WHO as a method to improve the quality of health services through systemic improvements. This problem-solving methodology highlights finding solutions using existing resources. No additional funding is needed. The goal of POCQI was to support quality improvement in maternal and new-born health at referral facilities. The three hospitals are located in focus districts of UNICEF’s MNCH programme and were selected based on consultation with local governments. To ensure that the POCQI approach would work required a process including: • Secure commitment from the provincial quality improvement (QI) team to utilize the approach in pilot districts and scale-up to other hospitals. Summary • Conduct assessments using WHO tools and discuss findings with district hospitals. The of the Approach assessments showed that the main causes of death in new-born were hypothermia and asphyxia, in addition to the retention of placentae in mothers giving birth. • Establish a QI team within the maternal and neonatal unit at target hospitals and obtain a commitment to improve quality services in the units. • Conduct training for both provincial and district/hospital teams on POCQI. The provincial QI team also attended a session on coaching methods. • Facilitate district QI hospital teams to develop a QI project in the unit with clearly defined outputs, outcome indicators and timelines. Continuous self- assessments were conducted by the QI hospital team to identify progress and challenges to meet targets. • Mentoring and monitoring were conducted by the provincial QI team to identify progress in unit performance and discuss challenges with the hospital team and management. • Celebrate and document POCQI progress achieved and share at the provincial level. • Scale-up to other district hospitals. In early July 2020, MoH, PHO and UNICEF conducted monitoring and evaluation of the progress made and found that considerable progress had taken place.

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• Hypothermia cases in new-borns declined from 15.29 per cent to 6.45 per cent within 11 months of POCQI implementation • No deaths occurred due to hypothermia • Improved quality of early initiation in delivery room • Decreased cases of placental retention (from 15.6 to 3.18 per cent) within 11 months of POCQI implementation • No maternal death due to postpartum haemorrhage or placenta retention was Key Results recorded where POCQI was being implemented Achieved • No re-admission due to late postpartum haemorrhage or retention of the placentae occurred • The POCQI approach is continuously used by QI teams in maternal /neonatal units and being introduced to other units at district hospitals • In East Lombok, the district hospital developed a POCQI project to reduce asphyxia cases in delivery rooms and to increase the weight of low birthweight babies using Kangaroo care (a technique that keeps babies in skin-to-skin contact with mothers or fathers) to keep the babies warm and promote/support breastfeeding.

• In West Lombok, scale-up to two other hospitals is ongoing and another four hospitals received training on POCQI in October 2020. • In mid-2020 Praya Hospital of Central Lombok District was selected for POCQI training due to high numbers of neonatal and maternal deaths in the district. Central Lombok is one of 120 focus districts targeted by UNICEF due to its high rates of infant and maternal mortality. • In the 3rd quarter of 2020, four other district hospital teams were trained on POCQI using a combination of off-line and online methods.

• Off-line training: IDR 585 thousand (USD 40) / person Cost Replicability/ • Online training: IDR 870 thousand (USD 59) / person up-scaling • Understanding of WHO-UNICEF POCQI guideline • Simple data analysis Skills • Related clinical knowledge • Mentoring skills

• Paediatric Association • Obstetrics and gynecology (OB/GYN) Association Stake- • Midwife Association holders • Provincial and district health offices • Provincial and district hospitals

48 • Commitment from provincial health authorities and hospital management to safeguard the interventions is essential. • Mentoring and monitoring visits by provincial and national health authorities increased team spirit among QI teams. Lessons • Team celebrations of progress also boosted QI team spirit to continue working to Learned achieve better outcomes. • Recognition from management (even as simple as providing an opportunity to present progress during meetings) motivated the QI team • Regular discussion creates solid teamwork for improving systems and services to achieve targets.

Bappeda NTB official news: Further readings and www.bappeda.ntbprov.go.id/monitoring-dan-evaluasi-terpadu-program-kerjasama- information pemerintah-ri-unicef-periode-2016-2020-untuk-kelangsungan-hidup-perkembangan-dan- perlindungan-ibu-dan-anak-khppia-di-provinsi-ntb/

• Vama Chrisnadarmani, Health Specialist UNICEF ([email protected]) Contact • Bobby Marwal Syahrizal, Health Specialist UNICEF ([email protected]) details • Mohammad Abdullah, West Nusa Tenggara Public Health Practitioners Association (IAKMI) ([email protected])

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Acceleration of Malaria Control in Endemic Villages through Community Engagement and Utilization of Village Funds General topic area: Malaria Location: Maluku (Maluku Barat Daya)

Malaria endemicity was mapped from the district to the village level. Mapping activity was held in highly endemic areas within the geographic/ administrative boundary (such as sub-district or island). A field team consisting of health staff from the provincial, district and community levels was deployed to observe potential breeding sites and local customs or habits that could result in malaria transmission in these villages. The observation was conducted together with community and religious leaders. A transect walk provided the opportunity to assess local knowledge on malaria’s host-vector environment and inter-linkages. Prompt diagnosis and treatment was also emphasized as vital to reducing transmission and mortality. Summary At the end of the visit, meetings were conducted to discuss findings. Leaders were of the Approach asked to present their village map and identify potential breeding sites. Challenges shared included local customs, seasonal activities (nutmeg/clove harvest) and access to healthcare. Solutions were formulated from the bottom up, including potential funding from the Village Fund, which allows for use in malaria-control although village leaders were not aware of this, as allowed usages of Village Funds change yearly. A memorandum of understanding between the District Health Office (DHO) and Community Village Empowerment Office was developed to accelerate malaria control. This approach was adapted and implemented by a civil society organization (PERDHAKI) carrying out malaria interventions in the same district. The DHO then assigned areas of work based on level of endemicity, and support was provided to highly endemic villages.

• Accelerated malaria control in Maluku Barat Daya, a highly endemic district with an annual parasite incidence (API) of 14.09 per cent in 2017, led to its classification as moderately endemic district, when the API dropped to 1.8 per cent in 2018 and just 1 Key Results per cent in 2019. Achieved • 27 participants from all seven villages in Damer Island and Maluku Barat Daya District partook in the activity. This led to strengthened cross-sectoral commitment to controlling and eliminating malaria on the island through increased knowledge and ownership.

The approach could be adapted for use in quarterly mini-workshop at community health Replicability/ centres, inviting head of villages or representatives from PERDHAKI’s programme to train up-scaling ‘malaria cadres’.

50 • Facilitator (four-day visit): IDR 1 million (USD 68) /person/day Meeting (20-30 participants): IDR 9 million (USD 615)/ meeting Cost • Flight/boat ticket – based on location (may include rental car and chartered boat).

• Knowledge about malaria transmission and vector control Skills • Malaria treatment guidelines

• Provincial and district health offices • Provincial and district development planners Stake- • Community-based health centres holders • District Community Village Empowerment Office • NGOs and professional associations

• The strategy of targeting highly endemic areas, identifying problems and developing needs-based solutions proved to be effective. Lessons • The programme improved local knowledge about malaria transmission, control and Learned prevention. • Coordination and collaboration among stakeholders were strengthened through a clear division of tasks and commitment to the elimination goal.

• Guideline for cadres in special risks areas, MoH, 2020 www.malaria.id/p/buku-tahun-2020.html Further • Malaria Case Management Pocket Book, MoH, 2020 readings and information www.malaria.id/p/buku-tahun-2020.html • Village Minister Regulation No 7 of 2020 www.kemendesa.go.id/berita/view/publikasi/376/permendes-no7-tahun-2020

• Sisca Wiguno, Malaria/EPI Officer UNICEF ([email protected]) Contact • Maria Endang Sumiwi, Health Specialist UNICEF ([email protected]) details • Risa E. Lating, Malaria Officer PHO Maluku ([email protected])

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Community Empowerment and Mobilization through Participatory Learning and Action for Malaria Elimination General topic area: Health – Malaria, community-based approach Location: North Maluku (all 10 districts)

Given its rural and remote setting, low fiscal capacity and limited human resources North Maluku Province required a unique approach to malaria control. The national roadmap for malaria elimination categorizes provinces into five regions for certification. North Maluku Province is grouped with provinces in Kalimantan Island (one level above other eastern provinces), which were expected to eliminate malaria by 2027. In 2008 Indonesia adopted a village-based ‘participatory learning and action’ (PLA) approach, stressing community-based malaria control. UNICEF, the Ministry of Health and the Provincial Health Office provided training for village facilitators to support PLA activities. The training focused on key issues such as: (1) enhanced malaria awareness through mapping of malaria cases and deaths; (2) understanding the malaria lifecycle, symptoms, transmission and conditions conducive to exposure and infection; (3) identifying breeding sites through a village transect walk; and (4) development of village action plans using available resources. In North Maluku, UNICEF provided various forms of supports under the framework of the previous country program document, including trainings and roll out until 2014, supportive supervision, coordination, monitoring and evaluation until 2016, and facilitation Summary of advocacy meeting and refreshment training until 2019. of the Approach Village facilitators were responsible for the implementation in partnerships with village leaders. Village mapping is an important part of the PLA approach. PLA does not require sophisticated tools, most of the learning tools are readily available. The approach can be easily adapted to different local conditions. Since mapping relies heavily on local knowledge, participatory techniques such as brainstorming, role play and group discussion were employed to ensure participation by residents. Gradually, several environmental improvements were observed: latrines were built or renovated to minimize open defecation and reduce malaria risk; drainage systems were introduced to reduce stagnant water and connect a lagoon to the sea, to control salinity; a swamp was filled to reduce larval breeding. PLA also improved community knowledge and awareness about malaria, particularly on symptoms, the importance of health- seeking behaviour and the quality of services. The project triggered political and financial commitment by local authorities. Local budgets to support malaria control were allocated; district malaria centres were established; local regulations on malaria were issued; and a school curriculum on malaria control was created in cooperation with the District Education Office and implemented at all elementary schools.

52 • The first training was for 30 PLA facilitators in South Halmahera District. • After being replicated in all districts in North Maluku, by 2019 a total of 1,514 facilitators had been trained to carry out PLA. • The PLA approach to malaria control has been implemented in 537 villages across the province’s 10 districts. Key Results Achieved • From 2015 to 2019, the annual parasite index gradually declined (from 2.8 per cent to 0.5 per cent), and the positive slide rate declined sharply: from 12 per cent to 1.2 per cent. • Overall, North Maluku is now a province with low endemicity status. Nine out of 10 districts have low malaria endemicity with API values below 1 per cent. Only East Halmahera District has moderate endemicity (1.87 per cent).

The PLA approach to malaria control was replicated in all sub-districts of South Halmahera and all districts in North Maluku and Maluku provinces

• A 6-day district PLA training : IDR 4,500,000 (USD 307) per person Cost • A 5-day village facilitator training : IDR 2,500,000 (USD 170) per person • Community meetings: IDR 1.5 million (USD 103)

• Communication Replicability/ Skills • Facilitation techniques up-scaling • Community participation, planning / organizing

• Provincial and district health offices • Sub-district community health centres Stake- • Private sector and state-owned companies holders • Village governments • Sub-district governments • Community, religious, cultural leaders

• PLA contributed to empowering local communities to undertake malaria control, triggering political and financial commitments; environmental interventions to minimize exposure and breeding sites; enhanced treatment-seeking behaviour and Lessons major reductions in malaria incidence and deaths. Learned • Using the PLA approach creates demand for malaria-control programmes, as well as for access to high quality malaria services. Thus, service providers have to improve service coverage and quality.

Trainers’ guide to PLA Further readings and • www.participatorymethods.org/ information • www.researchgate.net/publication/288832171

• Badwi M Amin, Health Specialist UNICEF ([email protected]) Contact • Maria Endang Sumiwi, Health Specialist UNICEF ([email protected]) details • Sunarty Arsan, Provincial Health Office (PHO) North Maluku ([email protected])

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Promotion of Maternal, New-born and Child Health through Building Health Worker Capacity and Data Management at Community Health Centres General topic area: Maternal, neonatal and child health Locations: North Maluku (Tidore City and North Halmahera)

During 2018 and 2019 UNICEF supported governments in Tidore City and North Halmahera District to build the capacity of healthcare workers at 26 community health centres. In the remote areas targeted, neonatal infections often go undetected or treatment comes too late due to the long distances to health facilities, resulting in a high number of preventable deaths. UNICEF worked with the two governments to implement integrated management of childhood illness (IMCI) for new-born babies (aged 0-2 months). The main objective was to enhance the capacity of healthcare workers at primary health facilities to carry out IMCI. The two components of the programme were training and internships. Training modules covered detection and treatment of infectious diseases. Training activities were conducted to produce pool of trainers, who then were assigned to facilitate an internship programme for midwives working in target locations. The programme produced more than 100 trainers, including healthcare workers and provincial and district health office Summary staff. of the Approach The internship programme was designed to enhance the skills of healthcare workers to implement IMCI procedures, especially when referral to a larger hospital is not viable. Many of the participating puskesmas are located on remote islands with poor transportation access. In each puskesmas a mentor was assigned to help up to three interns. Internships lasted for up to two months, during which participants were trained to apply all 17 IMCI procedures described in modules sanctioned by the Ministry of Health. The trainees learned various skills, such as how to apply a simplified regimen to treat infectious diseases. UNICEF encouraged this approach, which combines injection and oral treatment for a period of 5-7 days, as it is easier to perform than the approach that calls only for injection. During the project a mechanism for reporting from puskesmas to DHO was developed. Each case was recorded in a standardized reporting format at puskesmas and reported monthly for monitoring and evaluation and to allow health officials to identify positive or negative trends in new-born infections.

54 • Increased capacity of 46 midwives and healthcare workers at two pilot locations to detect and treat bacterial infections among new-borns. • Improved data collection and reporting to the PHO. • More than 100 mentors completed formal training and are available to replicate the Key Results work across North Maluku Province. Achieved • Throughout project implementation, the PHO’s health promotion section provided active support through campaigns and awareness-raising. • Partnerships were developed with private firms (BPRS Bank, North Halmahera Mining) and the state electricity company (PLN) to support certain components of the work.

A workshop inviting representatives from 10 districts, with a view to scaling up the initiative, was conducted in 2019. Two local governments, Ternate City and West Halmahera District, committed to replicating the project in 2020, but implementation was interrupted by the COVID-19 pandemic.

• Five-day training of trainers: IDR 800,000-1,450,000 (USD 57 - 98) per person Cost • Two-month internship programme: IDR 500,000 (USD 35) per person Replicability/ • Printing of modules: IDR 15,000 (USD 10) per piece up-scaling • Application of training modules Skills • Mentoring skills

• Provincial health office (PHO) Stake- • District health office (DHO) holders • Puskesmas management • Health workers/midwives

• The simplified procedure for addressing neonatal infections was very useful since it Lessons allows midwives to combine injection and oral treatment. Learned • Improved data utilization by the DHO requires timely data collection by puskesmas.

Further • On-the-job training module on IMCI readings and information • On-the-job training guideline on IMCI in puskesmas

• Yuliana Hasim, Health Officer UNICEF ([email protected]) Contact • Badwi M Amin, Health Specialist UNICEF ([email protected]) details • Nurhayati Buamona, North Maluku PHO ([email protected])

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Improving Maternal and Neonatal Services through On-the-Job Training for the Integrated Management of Childhood Illness General topic area: Managing childhood illness Locations: Jayapura City and Biak City

The World Health Organization recommends the integrated management to childhood illness (IMCI) as a cost-effective approach for reducing maternal and neonatal mortality rates, especially in less-developed countries with limited resources. In Indonesia, not enough health staff were trained to use IMCI, limiting quality implementation. IMCI training for health staff generally demands significant funding and requires that health staff be absent from their post for about two weeks. In some cases, this is not feasible for local governments or District Health Offices in Indonesia. UNICEF and the Ministry of Health sought to resolve this situation by modifying the Summary training curriculum used for the traditional method into a method using on-the-job training of the (OJT). Instead of being delivered in the classroom, training took place at the workplace, Approach integrated into daily routine activities. Facilitators and trainees worked together for around two months to ensure the complete transfer knowledge and skills. This initial round of training prepared the participants for facilitating further training for other colleagues at the facility, using the same method. This process continued until all health workers at the facility had received IMCI training. This method was accepted and implemented quite well by the DHO Jayapura and Biak. One participant noted that the training not only improves health workers’ skills, but also makes a positive contribution to other aspects of the facility’s work, such as the flow of MNCH services and reporting and recording processes.

• Around 150 health workers were trained and certified on the IMCI approach in Jayapura and Biak. Key Results • The capacity of health worker to recognize and manage new-born and child illness Achieved has improved. • Improved service and data management at health centres.

Since most districts in Papua already have trained IMCI facilitators, replication requires a refresher workshop to update staff about the OJT method.

Replicability/ • Three-day workshop for district IMCI facilitators: IDR 2 million (USD 150) up-scaling per participant Cost • On-the-job training: IDR 1 million (USD 75) per participant • Printing and training material: IDR 580,000 (USD 40) per participant • Certificate: IDR 125,000 (USD 8.5) per participant

56 • Facilitation Skills • Mentoring • IMCI techniques

• Provincial and District Health Offices Stake- • Puskesmas management holders • Health workers

• OJT approach is workable and does not reduce the quality of IMCI services Lessons • It is very important that the DHO conduct regular supervision and monitoring Learned • There is an opportunity to improve MNCH services and data management during the process.

Further • On-the-job training module on IMCI in Puskesmas readings and information • On-the-job training guideline on IMCI in Puskesmas

• Yohan Prasetyo, Health Officer UNICEF ([email protected]) Contact • Bobby Marwal Syahrizal, MNCH Specialist UNICEF ( [email protected] ) details • Dr. Leonora Komboy, DHO Biak ([email protected]) • Dr. Farid Yusuf, DHO Jayapura ([email protected])

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UNICEF Support to Polio Outbreak Response in Papua General topic area: Health and well-being Location: Papua

After being declared polio-free by the World Health Organization (WHO) in 2014, new cases of polio emerged in Papua in January 2019. Three children were confirmed positive with polio virus, one of whom suffered from acute flaccid paralysis (AFP). In response, Yahukimo District, at the centre of the outbreak, declared polio to be an outbreak in a decree issued by the district head. The Ministry of Health quickly responded by conducting two weeks of ‘outbreak response immunization’, followed by two rounds of supplementary polio immunization activities (SIA), as well as increasing surveillance sensitivity and expanding environmental surveillance in Papua throughout 2019. To ensure that at least 95 per cent of children younger than 15 years were immunized, UNICEF provided comprehensive support in 17 of 29 cities/districts. Several practical steps and strategies were devised to adapt to geographic-, security- and resource-related challenges. Coverage for the first round stood at 77.26 per cent, but the target was eventually met by December 2019 when, after a tremendous effort, over 95 per cent of children were successfully vaccinated in the second round. This represented by far the highest immunization coverage in the province’s history. A WHO-affiliated outbreak response assessment team confirmed this achievement. A May 2020 letter from the WHO Regional Director concluded that Papua is again free from Summary polio, based on an assessment conducted from April to May 2020. of the Approach UNICEF’s approach to the polio outbreak called for: 1. Technical and managerial support • Funding support to mobilize the polio SIA team, using air transport to access hard-to-reach areas in Yahukimo • Support for a logistics consultant and EPI consultant for the Yahukimo special operation • Provision of a provincial-level communication for development (C4D) consultant and immunization consultant • Developing print and electronic information, education and communication materials and widespread distribution • Providing an electronic monitoring and evaluation system through Rapid Pro and ONA tools • Placing field officers in 15 districts to improve microplanning, vaccine and cold chain management and social mobilization activities • Deployment of a special high-level team including WHO, the Provincial Health Office (PHO) and Centers for Disease Control to accelerate SIA in remote districts • Providing special technical assistance and training to health and church cadre in the high-risk security district of Nduga.

58 2. Social mobilization • Facilitating social mobilization activities involving local leaders, church leaders and community leaders • Involving Papua Province Police, the youth groups, boy scouts and several professional organizations in a series of mobilization activities, through social media • Using provincial and district commemoration events to promote the polio campaign.

3. Advocacy • To create an enabling environment supportive of the goals of polio SIA • Advocated with religious, local and community leader and local tribes • Facilitated coordination meetings with local and church leaders • Initiated the establishment of a Papua Health Advisory Group.

Despite no cases of AFP since February 2019, the MoH decide that the second phase of polio response was still needed, since vaccination coverage prior to the outbreak tended to be low. The second phase focused on completing the basic immunization status of children under three years with the aim of: 1. Increasing immunity to polio and other diseases that can be prevented by immunization (penyakit yang dapat dicegah dengan imunisasi or PD3I), 2. Improving the quality and sensitivity of AFP and other PD3I surveillance 3. Expanding the distribution range of IPV (inactivated polio vaccine) and OPV (oral polio vaccine) to all regions in Papua and West Papua 4. Accelerating the implementation of routine immunization programmes.

UNICEF collaborated with WHO and the PHO in the design of a support strategy that involved: 1. Analysis of immunization data targets, including potential coverage and capacity of all available resources (human, access, cold chain, and support from local governments) 2. Conducting intensive technical support by placing field officers and strengthening at least one community health centre to serve as a learning centre for other centres in 15 priority districts 3. Capacity development of immunization programme managers in districts, including in electronic reporting and surveillance systems 4. Involvement by communities and immunization support groups to carry out social mobilization

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• From the total target of 895,886 children under 15 years of age, 77.24 per cent were vaccinated in round 1 and 95.76 per cent in round 2. This is the highest polio immunization coverage in the history of Papua (PHO, 2019). • In Yahukimo District, the centre of the outbreak, coverage rates for the first and Key Results second rounds of bivalent oral polio vaccine were 30.20 per cent and 91.5 per cent, Achieved respectively. • The Yahukimo special operation successfully reached 62 landing spots and delivered polio SIA in 466 villages. • The Papua Government adopted UNICEF’s social mobilization strategy for use in its COVID-19 risk communication and engagement strategy.

In 2020 UNICEF and three implementing partners (GAPAI, YP2KP and doctorSHARE) committed IDR 6 billion (USD 410,000) to support all activities, including placement of field officers in 15 districts. Districts are required to fund sustainable outreach services, procure equipment, train district immunization officers and establish on-the-job training centres.

• Immunization in the highlands: IDR 95,000 (USD 6,5) / child • Immunization in the lowlands: IDR 43.500 (USD 3) / child Cost • Training for health workers: IDR 15-20 million (USD 1,000- 1,367)/person/ year. Replicability/ • On-the-job training (two weeks): IDR 2 million (USD 137) /person up-scaling

• Provincial Health Office • District Health Office • Community health centres Stake- • Local governments holders • WHO • Professional organizations • Non-governmental organizations/partners

• Geographical challenges to expanding immunization coverage were overcome through strategic planning and the allocation of adequate time to manage all resources. • The strategic plan developed during the polio SIA for reaching hard-to-reach areas - Lessons addressing human resources, time, cost and social mobilization and advocacy - will serve Learned as a valuable resource and reference tool for improving routine immunization planning. • Social mobilization, with an emphasis on local contexts and combining various media, will become a strategic approach for accelerating efforts by immunization programmes to reach areas characterized by high levels of social and cultural diversity and security issues.

Further • Health Minister Regulation No.12 Year 2017 on Guidance on Immunization readings and information • Polio Outbreak Response Assessment Final Report

• Husny Muttaqin, Immunization Officer UNICEC ([email protected]) Contact • Kenny Peetosutan, Health Specialist UNICEF ([email protected]) details • Yasman, Papua PHO Immunization Program Responsible Officer ([email protected])

60 Use of Human-Centred Design to Increase Routine Immunization Coverage General topic area: Immunization Locations: East Java (Surabaya City, Madiun City, Blitar, Ponorogo, Bangkalan and Probolinggo)

Despite government efforts to immunize all children, by 2018 the national measles-rubella campaign had coverage of just 71 per cent. Low coverage was partly due to concerns over its safety and general vaccine safety concerns, as well as issues around equity and access to immunization. Although Indonesia’s health system reaches most children, some 4.9 million each year with immunization and other services, alarming gaps in coverage have emerged. Unvaccinated children put the entire community at risk for disease outbreaks that could be prevented by immunization.

Summary Human centred-design (HCD) helps to enhance strategies focused on how and why of the people do or do not engage with health services, as a means to achieve optimal results. Approach The HCD approach assists understanding of the causes, barriers and roots of health- seeking behaviour and what might be done to increase service use. It offers a structured process for working directly with service users and health workers to address challenges related to coverage and quality of care. The initiative used an HCD lens to understand motivations and constraints related to the provision of immunization services in Indonesia, which differ in each province and region and require that solutions be tailored to local problems. The HCD process is suitable for Indonesia: a diverse country with a broad geography, decentralized decision-making and the need for districts, cities and provinces to design effective interventions.

• Collected information on the underlying reasons and obstacles that occur in carrying out routine immunizations. • Identification of needs, limitations, obstacles and barriers to knowledge and ideas for interventions to implement a good immunization routine. • Identification of relevant social dynamics, institutions and values that can help implement immunization targeting all children. • Mapping of concerned caregivers, health workers, decision makers, and community Key Results leaders participating in the process Achieved • Mapping of the ongoing immunization service system to identify obstacles and opportunities for immunization officers. • Developed a plan to reach households whose children have not been immunized, hard-to-reach areas such as slum or remote areas, or areas where immunization faced rejection. • Active participation from the most relevant stakeholders, both government and non- government institutions. 61 ANNEX: COMPENDIUM OF GOOD PRACTICES

A workshop inviting representatives from 32 districts/cities with a view to upscaling the initiative was conducted in 2020. The local governments are now committed to replicate the HCD approach to increase the coverage of routine immunization in 2021.

• Training on HCD Cost • Printing of module and guideline (optional)

Replicability/ • Application of HCD training modules up-scaling Skills • Facilitation and mentoring skills

• Provincial Health Office • District Health Offices Stake- • Community health centres holders • NGOs and associations • Target groups representing users and community.

• HCD allows for a process of finding solutions to expand immunization coverage by involving the community and considering local community context. • Community members feels more valued when they can express opinions about how to solve immunization problems. Lessons • People are invited not only to see obstacles but also to look at supporting factors. Learned • HCD helps to understand the underlying reasons and barriers to immunization, particularly geographic and societal barriers, as well as avoiding generalization of the problem. • Improve the ability of health services access how and why people are involved, or not involved, and the services to achieve results.

• Human Centred Design Training Module Further • Demand for Health Services Field Guide readings and information • Demand for Health Services Workbook • Companion Workbook & Process Poster for “Demand for Health Services”

• Armunanto, Health Specialist UNICEF ([email protected]) Contact • Kenny Peetosutan, EPI Specialist UNICEF ([email protected]) details • Dr. Nyoman Anita Damayanti, drg, MS; focal point partnership UNICEF-University of Airlangga ([email protected])

62 Optimizing the Triple Elimination Prevention Programme through Private Services in Districts and Cities General topic area: Maternal, neonatal and child health Locations: East Java (Surabaya City, Malang City, Malang, Jember, Banyuwangi), Central Java (Semarang City, Surakarta City, and Brebes).

Triple elimination is an Indonesian strategy for addressing HIV, syphilis and hepatitis B through maternal and child health services. It is now integrated into maternal and child health (MCH), family planning and adolescent health services. Women seeking these services also receive information about triple elimination. Health personnel are required to test all pregnant women for HIV, syphilis and hepatitis B at least once, as part of antenatal care. Increased access to service providers and timely interventions are expected to contribute to the prevention of mother to child transmission. UNICEF collaborates with Airlangga University to support the provincial government Summary and five districts/cities in East Java (Surabaya City, Malang City, Malang, Jember and of the Banyuwangi) in implementing the triple elimination programme. The objectives are to Approach engage private service providers (midwives, clinics, hospitals), to strengthen coordination between the MCH and Diseases Prevention and Control (P2P) units at local health offices, and to increase the capacity of health workers. PHO decree is issued instructing local government to conduct on-the-job training for health workers and to develop a referral mechanism. Every pregnant woman who tests positive for HIV, syphilis or hepatitis B must receive standard management and follow-up. Logistical planning required for these services is carried out in stages, from the central to the provincial and district levels. The analysis of the results of monitoring, evaluation, and supervision is carried out periodically.

• Increased capacity of health workers and improved facilities, including from private service providers, to implement the triple elimination programme. Key Results • Enhanced participation from private service providers at district level in the triple Achieved elimination programme. • There is an increase in the quality of maternal and child health services according to standards.

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A workshop involving representatives from 33 districts/cities from East Java Province and 32 districts/cities from Central Java Province with the aim of replicating the programme was planned for 2020, but implementation was interrupted by the COVID-19 pandemic, which is consuming the main share of the health budget.

• Budget for training and coaching (local budget allocation) Cost • Printing of module and guideline (local budget allocation) Replicability/ up-scaling • Application of training modules Skills • Mentoring skills

• Provincial Health Office Stake- • District Health Office holders • Indonesian Medical Association (IDI) • Indonesia Midwives Association (IBI)

• The programme can serve as a reference point for local governments, health workers and other stakeholders implementing programmes to eliminate mother-to-child Lessons transmission. Learned • Networks and cross-program partnerships in districts/cities play a crucial role in enhancing participation from private service providers.

Further • Triple Elimination Module (PDF). readings and • Management of pregnant women for early detection (Laboratory Examination) in early information management of HIV - syphilis - hepatitis B (PDF).

• Armunanto, Health Specialist UNICEF ([email protected]) • Dr. Nyoman Anita Damayanti, drg, MS; partnership focal point UNICEF-University of Contact Airlangga ([email protected]) details • Dr. dr. Sutopo Patriajati, MM, MKes; partnership focal point UNICEF-University of Diponegoro ([email protected])

64 © UNICEF / UN0200189 / Oorsouw65 ANNEX: COMPENDIUM OF GOOD PRACTICES

1 Holistic, Integrative Early Childhood Development - From East Nusa 67 Policy to Practice: An Approach That Works Tenggara 2 Modelling Inclusion and Participation of Children with South 71 Disabilities in a Decentralized Education System Sulawesi 3 Back-to-School Movement: Multi-stakeholder Initiative South & West 74 on Out-of-School Children in West and South Sulawesi Sulawesi 4 Improving Early Grade Literacy in Rural and Remote Papua & West 78 Schools Papua 5 Role of Community Forums in Village Education and Central Java 82 Village Governments in Improving School Attendance

66 Holistic, Integrative Early Childhood Development - From Policy to Practice: An Approach That Works General topic area: Early childhood education, development Location: East Nusa Tenggara (Kupang)

Baseline findings of a study conducted in early 2017 found that most early child education and development centres are community-based, under-funded and receive only limited operational support from either communities or governments. The baseline study revealed several challenges to achieving quality holistic, integrative early child development (HI-ECD) at each centre. Most centres lacked trained staff and basic teaching and learning materials. Also lacking were adequate water, sanitation and hygiene facilities, posing a health risk for young children. Safety and security measures for children were often unavailable or inadequate. Nutrition services were non-existent – no nutritious food was given to children and no information about child nutrition was given to parents. Coordination with health services was poor. Parents had limited access to parenting classes. Working with HI-ECD policymakers and regulators, 100 HI-ECD centres in rural and remote areas across all 24 sub-districts of Kupang District were targeted to improve the quality of HI-ECD service delivery. The programme developed a model mentoring system that strengthens teaching and learning and integrates health; nutrition; water, sanitation and hygiene; child protection; and parenting education. In addition to improvements in Summary HI-ECD quality and practices, the programme: improved learning environments, increased of the Approach both local government funding and support and community and parent involvement and developed tools and resources to support implementation and sustainability. HI-ECD services were strengthened as a result of several approaches: • Provision of resources and opportunities to increase learning and improve practice: teacher training/mentoring system • Teacher training: Training for both teachers and mentors focused on many topics, but the main emphasis for teachers was on the 2013 national early childhood education (ECE) curriculum, including achievement and development standards, building mentorships and classroom methodology. • Cluster meetings: One centre provided opportunities for HI-ECD teachers to gather together and plan activities, discuss issues, practice skills and gain new knowledge. • Mentoring system: Mentors worked directly with teachers, centre managers, village heads and communities to achieve programme results. The mentoring module developed through this programme can be used in a variety of ways.

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ECE supervisors can use it to strengthen their approach to supervision and build relationships with managers and teachers; cluster head teachers can use it to guide teacher discussions and build community in the clusters; managers can use it to build a community of learning with all teachers at their ECD centres; and if districts adopt the approach, they can use it for individual teacher mentoring. • Improving standards: Two processes were identified to help managers and teachers identify areas to be strengthened: self-assessment and standard operating procedures. To allow HI-ECD centres to understand what is required to have a quality HI-ECD centre, a self-assessment tool was created. • Parenting and community engagement: UNICEF supported HI-ECD centres to create school committees for coordination with management, as well as parent-teacher associations (PTA) allowing parents and teachers to plan together, discuss issues, and/or learn about topics of interest. Mentors were encouraged to participate in the village planning process of their HI-ECD centres and to work with managers and teachers to strengthen their ability to advocate for their centres. This multi-pronged approach helped increase communities’ sense of ownership and interest in HI-ECD centre activities and status (such as facilities or accreditation). • Resource development: 10 modules of the ECE curriculum were revised to make them more teacher/user- friendly in the local context, but also easily adaptable by other districts/provinces (e.g., by changing some pictures and specific examples) without the need to modify the content. Other resources developed for the programme included: a set of 30 children’s books written by mentors and ECD-centre teachers; guidelines for use of learning materials. including sample activities and how to adapt them for use with children with disabilities; and a module on implementing a “garden-canteen- cooperative” into the ECD-centre community and supporting character development (offering basic indicators for children, parents, and teachers).

Better development outcomes for children: • Children attending the intervention schools showed clear improvement (according to a system for measuring early learning quality and outcomes) compared to children attending non-intervention schools and children not attending school.

Key Results Safer environment at ECD centres (100 intervention centres) Achieved • 93 per cent improved their playgrounds to meet safety standards • 100 per cent developed standard procedures on child safety • 83 per cent improved access clean water at their facilities • 93 per cent improved their sanitation facilities and provided accessible toilets, handwashing facilities and waste disposal systems.

68 Improved management • 100 per cent of HI-ECD centres developed standard procedures to guide in school management and operations • 100 per cent of teachers prepares weekly development plans and daily lesson plans • 100 per cent of schools established a school committee and conduct routine parent- Key Results teacher meetings Achieved

Better engagement with parents and communities • Parent participation in parent-teacher conferences rose to 85 per cent • Communities have shown increased support to their ECD centres; more centres (82 per cent) were allocated funding through Village Funds.

• 5-day training for 140 ECD teachers & mentors: IDR 892 million (USD 61,000) • 2-day quarterly refresher training for ECD teachers: IDR 62.5 million (USD 4,300) • 2-day ECD managers training (for 125 persons): IDR 235 million (USD Cost 16,100) • Mentor salary (24 mentors): IDR 72.5 million/month (USD 5,000) • Monthly PTA meeting at each ECD centre: IDR 500 thousand (USD 34) / Replicability/ month up-scaling • Monthly HI-ECD task force meeting: IDR 9.5 million (USD 650) / month

• Planning Skills • Mentoring • Monitoring

• Directorate of Early Child Education, MoEC Stake- • Ministry of Foreign Affairs and Trade (MFAT), New Zealand holders • Yayasan Alpha Omega (YAO)

• The number of mentors required should be determined by the number of sub-districts and HI-ECD centres and the size of the sub-district (some may need more than one mentor). Mentors in Kupang had the most impact when they were living and working locally (i.e., not based at a DEO or commuting from a different location). • Each district should support the development of at least one “A” accredited HI-ECD Lessons centre that can serve as a hub for on-the-job professional training. A comprehensive Learned professional development experience for teachers should be developed, including guided classroom observation and afternoon workshops on key topics. • The MoEC could support districts to create and implement HI-ECD task forces. It could also facilitate links with PEO to create such task forces at the provincial level, although PEO cannot legally do so independently.

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• Some indicators of the programme self-assessment tool have already been incorporated into the national accreditation system (Sispena 2018). The tool is also a good way for HI-ECD communities to take a critical look at their own programmes. Mentors can share the tool at cluster meetings and support individual HI-ECD centres to apply it.

Resources available on the MoEC website “Ruang Guru PAUD” were developed based on this pilot programme: • ECE mentoring programme: https://s.id/ece-mentoring • Module: Mentoring Waikato https://s.id/modul-waikato • Replication guidelines PAUD HI-ECD Kupang: https://s.id/replikasi-kupang

Videos: • The mentoring system (4.46 minutes) www.youtube.com/watch?v=wquvSN20pFs&t=29s • The overall programme and advocacy (5 minutes) Further www.youtube.com/watch?v=1vt4OtZ1Bn0&t=47s readings and • HI-ECD programme from a teacher’s perspective (3 minutes) information www.youtube.com/watch?v=KE05Z_dn9Ew • HI-ECD programme from a child’s perspective (1.5 minutes) www.youtube.com/watch?v=_bFs4Ydm9MY&t=15s • STEAM (Science, Technology, Engineering, Art and Mathematic) Training for ECD Teachers in Kupang (5 minutes) www.youtube.com/watch?v=NjPUP473Z-c&feature=youtu.be

Publication: • “Holistic, Integrative Early Childhood Development (HI-ECD) Programme Kupang, NTT, Indonesia: From Policy to Practice: An Approach That Works” • Baseline and Endline Study on HI-ECD Programme in Kupang 2017 and 2020

• Yudhistira Yewangoe, Chief Field Office – Kupang ([email protected]) Contact • Nugroho Indera Warman, Education Specialist UNICEF ([email protected]) details • Imannuel Buan, Head of Education and Culture Agency (DEO) – Kupang District

70 Modelling Inclusion and Participation of Children with Disabilities in a Decentralized Education System General topic area: Inclusive and equitable quality education Locations: South Sulawesi (Bone and Pangkajene Kepulauan)

UNICEF, with Helen Keller International Indonesia as implementing partner, supported the governments of Pangakajene Island (Pangkep) and Bone to pilot an inclusive education (IE) programme in elementary schools from 2018 to 2020. The objectives were to: (1) strengthen the role of district-level IE working groups in coordinating and implementing the programme and (2) build awareness and capacity of school management, teachers and stakeholders. The project targets 62 schools in Bone and Pangkep districts, consisting of 75 per cent public schools and 25 per cent religious-based schools. The South Sulawesi governor issued a decree on IE in 2011, followed by mayoral/district head decrees in some regions. To implement these decrees, multi-sectoral working groups were formed, consisting of representatives from various government offices who were tasked with developing an overall strategy to guide programme implementation. Nevertheless, it has proven challenging to ensure access to IE for every disabled child. Most children with disabilities (e.g., children with visual, hearing, intellectual or physical disabilities) are still enrolled in the few available special schools for the disabled. Mainstream schools are unlikely to admit them, mainly because teachers are not trained, and the schools lack the necessary facilities and curriculum. Summary of the When the project started in 2018 the two target districts were already at different stages Approach of progress. Pangkep had been declared as an inclusive district in 2014, while the Bone government had only issued a bylaw on fulfilling and protecting the rights of children with disabilities. UNICEF’s intervention sought to support the multi-sectoral working groups to address IE at target schools. To do so, three inter-linked strategies were devised: policy advocacy, capacity building and a public campaign. UNICEF and Helen Keller International supported the working group to strengthen coordination and advocacy for high-level support. Training of trainers was conducted to produce facilitators, who then trained teachers in target schools on IE implementation, including how to identify children with disabilities, understand their needs, communicate with them, manage their behaviour and select appropriate learning method for these students. IE working group is led by the development planning agency (Bappeda) and the members came from key partners such as offices on education, religious affairs, social affairs, statistics, women’s and children’s empowerment and village empowerment. The group held quarterly coordination meetings to discuss progress and implementation issues and developed an overall IE strategy to serve as an umbrella document for all agencies involved.

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The primary beneficiaries are schools and enrolled students. Pangkep District government, however, understands the importance of reaching those who are out of school and attempts to collect village-level data on school-aged children with disabilities. Assisted by NGOs and private partners, a joint team was dispatched to collect household level data in pilot villages. This ad hoc effort was successful in collecting the data, but coverage was limited, and the effort is not sustainable. In the two districts, campaign activities attracted participation from a wide range of stakeholders. In Pangkep a large-scale campaign and sporting event were held in 2019 involving around 200 students with disabilities. In Bone, the working group actively engaged religious leaders to promote IE.

• Training of trainers produced 18 facilitators, four provincial trainers and 14 district trainers. • 619 teachers received IE training, enabling them to identify forms of disability, develop appropriate teaching practices and manage classrooms. • Over 25,500 students (48.3 per cent female) benefitted from the adoption of inclusive teaching methods such as adaptive learning for students with special needs, the Key Results use of specific learning tools and the provision of disabled-friendly facilities, allowing Achieved students with disabilities to fully participate in learning, sports and social activities. • 549 elementary school students with disabilities identified by teachers at 66 schools were exposed to an inclusive culture through inclusive school policies and evolving inclusive practices. • The working group produced a comprehensive strategy for the four-year period 2017- 2020. The strategy facilitated inter-agency coordination, to ensure alignment and effectiveness of activities set out in Indonesia’s medium-term development plan.

Replication was discussed with the South Sulawesi government and three districts (Talakar, Maros, Bulukumba) were nominated as targets in 2021.

• Training of trainers: IDR 12 million (USD 820)/ training • Training for teachers: IDR 12 million (USD 820) /training Cost • Working Group coordination meetings (APBD): IDR 1 million (USD 68)/ meeting Replicability/ • Application of training modules up-scaling Skills • Application of inclusive learning methods

• District development planning board • District education offices Stake- • Provincial religious affairs office holders • School management (headmasters, officials, teachers) • Schools supervisors/inspectors

72 • Improved coordination between provincial and district levels has resulted in a smooth replication process. Had school inspectors engaged at an earlier stage of project implementation, coordination would have been stronger. • There is a need to develop a monitoring and evaluation framework for the overall Lessons strategy. Currently, it consists primarily of activities that are planned, funded, and Learned conducted independently by each respective agency. • A systematic, rather than ad hoc, approach can be more effective to collect data on school-aged children with disabilities at village or household level. The approach should consider data collection using a reliable data platform and involving village officials in a sustainable manner.

UNICEF media features: • https://www.instagram.com/p/CEUCykkBcfb/?igshid=ybylqbhgeazv Further • https://www.facebook.com/172180876204559/ readings and posts/3232562166833066/?vh=e&extid=OhYitHPrg8lKo3FN&d=n information • https://www.youtube.com/watch?v=gwj_Mxb1hrk Local media features: • https://www.facebook.com/PangkepTelevisi/videos/321194165738224/

• Henky Widjaja, Chief Field Office – Makassar ([email protected]) • Anissa Elok Budiyani, Adolescent Development Officer ([email protected]) Contact details • H. Mukhlis Mansur, S. T. – Head of Sub-Directorate Programme and Evaluation – Directorate of Special Education and Community Learning (PMPK), Ministry of Education, Research, and Culture ([email protected])

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Back-to-School Movement: Multi-stakeholder Initiative on Out-of-School Children General topic area: Out-of-school children Locations: South Sulawesi (Bone and Takalar), West Sulawesi (Mamuju)

Nationally, over 4 million (7.9 per cent) of Indonesia’s school age children do not attend school, according to 2019 data. Figures in South and West Sulawesi were higher, 9.2 per cent and 11.1 per cent, respectively, mostly for children of upper secondary school age (16-18 years). The out-of-school children (OOSC) programme aims to ensure that children gain an education, either through formal, non-formal (i.e. community learning centres (PKBM) or informal channels. The programme adopted a comprehensive approach to engage district and village governments, as well as communities, private sector, and CSOs to provide second learning opportunities for OOSC. In South Sulawesi, Bone and Takalar were selected as target districts for the programme implementation. Bone had the fifth-highest number of OOSC (18,600 or 11.4 per cent of eligible students), while Takalar ranked seventh with 6,400 OOSC (10.4 per cent). In West Sulawesi the capital district of Mamuju, where 10.3 per cent of children were not in school, was selected. When UNICEF launched the programme, authorities in these districts already considered out-of-school children as an important issue, acknowledging its far-reaching implications on child well-being and human development. By 2016, OOSC had been included in medium-term planning documents and policies of Mamuju District. The district head Summary issued decrees stipulating the formation of technical teams, development of action plans, of the Approach budget allocations and participation by sub-district and village governments to address OOSC. Similar initiative took place in Bone and Takalar in 2018 and 2019 respectively. These districts had also already launched the ‘Back-to-School Movement’, a flagship programme that attracted participation by a wide range of stakeholders (e.g., school leaders, village governments, community leaders, and women’s and community organizations). As a follow-up to the regulations, a district action plan was devised consisting of activities to be implemented by relevant agencies and coordination and monitoring measures to ensure their effectiveness and alignment with the district government development plans. District heads also issued decrees related to village information systems, obliging village governments to adopt a community-based development information system (Sistem Informasi Pembangunan Berbasis Masyarakat or SIPBM) as an integrated data platform and to allocate funds accordingly. Despite this strong commitment, targeting OOSC remained challenging. Identifying who and where the children were was not easy, especially for hard-to-reach groups. The SIPBM played a crucial role in this regard. Target districts adopted SIPBM as a data management platform, and UNICEF helped to optimize its use for targeting OOSC. The availability of real-time data has enabled accurate target-setting and effective interventions.

74 UNICEF facilitated the adoption of SIPBM into local systems through a series of capacity building and mentoring sessions for officials and operators. Targeted village governments contributed by allocating funds for training, procuring servers and administrative costs. Officials from target villages (six villages in Bone and four each in Mamuju and Talakar) were trained to operate SIPBM and analyse the data. SIPBM records detailed information on individuals (e.g., name, address, reasons for school drop-out, and family socio- economic background). It also collected information on vulnerable groups at risk of discontinuing their education, such as children with disabilities or involved in child labour, victims of abuse, bullying, natural disasters or child marriage and children from poor families. Following advocacy efforts in target villages, village regulations and village head decrees were issued stipulating the allocation of Village Funds to help the identified OOSC to enrol back in formal or non-formal school, and in some cases to manage community schools or other relevant learning activities. A village education team was established in each village to verify and validate the SIPBM data, design and implement Back-to-School campaign and outreach activities and conduct monitoring. The overall advocacy strategy aims not only to help out-of-school children, but to prevent children in high-risk groups from dropping out of school, especially after completion of primary or junior secondary school. Using up-to-date SIPBM data, village governments were able to design a variety of programmes for OOSC. In Welado Village, for example, school attendance was made a condition for receipt of funds from social assistance programmes. The government of Dungkait Village allocated funds to establish and manage its own PKBM. Local governments also formed partnerships with religious-based charitable organizations, the private sector, state-owned companies and different units of the national police or armed forces that were willing to provide cash or in-kind contributions.

• SIPBM was adopted as the sole platform for data collection, updating and targeting out-of-school children. It was installed in all target villages and is connected to a server run by district authorities. • The number of school returnees has increased. In Bone approximately 3,000 children Key Results returned to school per year. In Takalar, the number ranged between 1,789 (2018) and Achieved 1,659 (2019), while in Mamuju 7,000 out of 9,725 OOSC returned to school, mostly to PKBM (2019). • Non-government organizations and the private sector are engaged in the programme through contribution of various types of assistance for OOSC, either directly or through local governments.

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Replication is underway in South Sulawesi. UNICEF facilitated the development of a provincial action plan to guide up-scaling the programme in all districts. The document (Action Plan for the Acceleration of Out-of-School Children Reduction in South Sulawesi 2020-2023) has been enacted through Governor Decree Number 71/2020. The target is that 75 per cent of districts in South Sulawesi adopt the OOSC action plan by 2023.

• SIPBM training and data collection • Procurement of server Cost • Workshop to develop district and village action plans • Mentoring for village stakeholders on universal education • Monitoring and supervision

Replicability/ • SIPBM data collection using Android-based application up-scaling • Management of SIPBM data platform Skills • Campaign and outreach • Establishment of relevant learning activities • Stakeholder management to engage partners

• District government, to ensure regulatory framework, action plan and adequate budget allocation • Village governments, to adopt and operate SIPBM and allocate Village Stake- Funds for education access for OOSC holders • PKBM and school management • Community leaders, to validate information and support the campaign • Private sector, to contribute and to address child labour.

• Targeting is key to reaching out-of-school children, SIPBM can play a crucial role in data collection and targeting. • There is huge potential for private-sector buy-in and contributions to this programme. Engagement with the private sector must be done systematically. Lessons Learned • Consultation with local communities is important for identifying potential solutions they may undertake to address OOSC problem in their areas. • PKBM are often located far from the target villages or in the subdistrict capital, and this has created new barriers for OOSC who have decided to return to school through non-formal channels.

Bone District official media feature: Further • www.bone.go.id/2020/10/03/wakil-bupati-bone-advokasi-gerakan-lisu-massikola- readings and information paimeng-untuk-raih-rekor-muri/ • www.sipbm.kemendesa.go.id/portal

76 • Siti Eliza Mufti, Education Specialist UNICEF ([email protected]) • Suhaeni Kudus, Education Specialist UNICEF ([email protected]) • District officials: − Bone: Hj. Samsidar, SPi., MSi - Secretary of Bappeda ([email protected]) − Takalar: Drs. Rahmansyah Lantara, MSi. – Head of Bappelitbangda (ancha_ [email protected]) Contact details − Mamuju: DR. Hj. Khatmah Ahmad, SPi., MSi. – Head of Bappepan ([email protected]) • Vivi Andriani – Directorate of Religion, Education, and Culture of Bappenas ([email protected]) • Ir. Eppy Lugiarti, MP – Directorate of Social and Cultural Development of the MoV ([email protected])

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Improving Early Grade Literacy in Rural and Remote Schools General topic area: Foundational learning skills Locations: Papua (Biak Numfor, Jayapura, Jayawijaya and Mimika) West Papua (Manokwari and Sorong)

In support of the Indonesian government’s efforts to address the education gap in Papua and West Papua provinces, UNICEF with support from the Australian Government’s Department of Foreign Affairs and Trade implemented an education programme initiative for remote and rural areas in Papua and West Papua Provinces. Aiming to test approaches for improving learning outcomes in early grade literacy in rural and remote areas, the pilot targeted 120 schools in six districts and compared them with a control group. Two models were tested. Model A, for rural and remote schools, combined cluster training with school-based support and supervision by mobile training teams. Model B, for remote and isolated schools, provided on-the-job training (OJT) in schools. The programme structure was based on two pillars: • Pillar 1 (school level): to address challenges to quality teaching and learning due to Summary the low capacity of teachers and the scarcity of reading material. As identified in a of the baseline study, around half of all teachers in target districts never received training Approach to teach reading. Similarly, half of the teachers did not develop or use lesson plans for their teaching. The programme set out to improve the quality of teaching, design and delivery of a range of culturally relevant learning materials; introduce a system for assessing student progress in reading; raise awareness through community campaigns and initiatives and support school principals and school committees to prepare school plans, including guidance on planning and utilization of the schools’ operational funds. • Pillar 2 (government and system level): to raise awareness among parliamentarians and education officials; disseminate evidence about the effectiveness of the models; and provide technical support for the inclusion of early grade reading in district planning and budgeting. The goal is to promote planning and budgeting decisions that would increase the quality of basic education.

1. Changes in teacher behaviour and classroom practices: Improved classroom environment; shift from teacher-centred to student-centred approaches; more structured and well-targeted processes of teaching and learning, using lesson plans and student assessment; increased teacher motivation. Specifically: Key Results Achieved • Sharp improvement in the classroom environment using reading corners and learning materials displayed on bulletin boards, correlating positively with improvements in students’ reading ability. The mid-line study showed that 75 per cent of the classrooms had reading corners as compared to just 20 per cent in the baseline.

78 • Significant shift from teacher-centred to student-centred approaches, such as greater use of positive discipline increased student agency in learning. • The use of lesson plans in intervention schools increased from 53 per cent to 88 per cent in Model A schools and 49 per cent to 87 per cent in Model B. In contrast, use of lesson plans in control schools declined from 76 per cent to 69 per cent. • 75 per cent of teachers were able to conduct student assessments regularly and Key Results systematically to check skill levels and inform literacy activities due to the training Achieved they had received. 2. Improved reading and comprehension skills for grade 2 and 3 students in all intervention schools compared with non-intervention schools: Percentage of non- readers dropped from 62 to 26 per cent; oral fluency increased from 5.6 to 12-13 words per minute; reading comprehension increased from 6 to 18 per cent. 3. Governments in target districts used programme evidence and implemented strategies to improve early grade literacy: Dissemination of the mid-line evaluation findings created substantial interest in replicating the programme.

National level support for the development of a policy framework for adoption of the early grade literacy model led to the issuance of Ministry of Home Affairs’ (MoHA) circular letters in 2018, encouraging provincial and district governments to implement education literacy. A replication guideline was developed and shared with district education offices. By 2020, replications were ongoing in Supiori and Mamberamo Tengah districts as well as more new schools in intervention districts.

The costing was based on whether Model A, B, or mixed model would be implemented. Following is a tabulated estimation of the annual costing per 5 schools and a calculation of per-school and per-student costs.

Estimated Cost in IDR Activity Model A Model B Replicability/ Training of trainers (2) 70,400,000 75,200,000 up-scaling In-house teacher training 124,000,000 163,000,000 Bi-weekly teacher working group meetings 118,000,000 126,000,000 Training for school committees (2) 30,800,000 48,800,000 Cost Quarterly training of principals working group 37,200,000 64,200,000 Mentoring 27,000,000 148,500,000 Campaign activities (2) 20,000,000 20,000,000 Establishing reading corners 30,000,000 30,000,000 Subtotal 458,200,000 675,700,000 Per school without reading materials 91,640,000 135,140,000 Reading materials per school 10,401.215 10,401.215 Per school with reading materials 102,041,000 145,541,000 Cost per student (assuming 100 students per 1,020,410 1,455,410 school)

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• Training facilitation Skills • Planning and budgeting

• District Education Office • Village Empowerment Office • District Planning Board (Bappeda) Stake- • District Library Office holders • Parliamentarians • Village heads • School supervisors • School principals and teachers

Technical lessons: • Teaching literacy is most effective and sustainable if implemented across all primary grades, not only the early grades. • Regular nationwide assessment on literacy is needed to provide data on students’ literacy achievements and undertake advocacy to district governments. • Ongoing engagement with curriculum development at the national level is essential to ensuring that pre-literacy skills are built into the earliest moments of primary education.

Political lessons: • Providing high-quality evidence of the potential for learning is critical to developing ownership among parliamentarians • Demonstrating the practical details of implementation in the most challenging Lessons context enables policy influence; Learned • Recognizing and designing a distinctive approach for the context of Papua was critical to success in that province. • Analysis of the causal chain linking various determinants of the high rate of absenteeism with specific policy and policy implementation gaps is needed to enable the development and pursuit of targeted policy recommendations.

Management lessons: • Partnerships with CSOs are critical and transformative, changing government views about what is needed to implement change in isolated remote and rural areas. • Costing for replication needs to be built in at an early stage so that governments know what is required for planning and budgets. • The pathway from pilot to scale depends on sound design, generation of evidence on a priority issue and provision for replication if the pilot is successful.

80 • Programme site: www.unicef.org/indonesia/documents/rural-and-remote-education-initiative Further • Mid-line Study for Rural and Remote Education Initiative for Papua Province : www. readings and information dfat.gov.au/sites/default/files/australia-unicef-rural-and-remote-education-initiative-for- papuan-provinces-midline-study.pdf • Video of the programme : www.youtube.com/watch?v=dAXef9OJ1YU

• Aminuddin Ramdan, Chief of Field Office - Jayapura ([email protected]) • Abdullah Modhesh, Education Specialist UNICEF ([email protected]) Contact details • Prostasius Lobya, Secretary of Provincial Education Office Papua Province ([email protected]) • Amelia Ibo, Secretary of District Education Office Jayapura

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Role of Community Forums in Village Education and Village Governments in Improving School Attendance General topic area: Inclusive education, out-of-school children Location: Central Java (Brebes)

In Brebes the back-to-school movement (Gerakan Kembali Bersekolah or GKB) is a community -based effort that originated with a small Facebook community concerned about the large number of school-age children who are not in school. The government eventually strengthened the movement and transformed it into a district-level community forum for education (FMPP). While the immediate goal was to address out-of-school children (OOSC), in the long run the movement is intended to help improve the human development index and tackle inter-generational poverty. In 2018 OOSC in Brebes numbered approximately 17,000, an average of 993 in each sub- district, comprised of: • Elementary school dropouts (15 per cent) • Failure to transition to junior high school (32 per cent) • Junior high school dropouts (13 per cent) • Failure to transition to senior high school (36 per cent) • Senior high school dropouts (4 per cent)

Several factors were identified as drivers behind these statistics: the need to work to help Summary parents or to migrate, inability to pay school fees, enrolment in Islamic boarding schools, of the Approach illness, marriage, having a disability or simply lack of motivation. In 2016 the District Head issued a decree aimed at addressing the issue of OOSC, calling for: coordination among district government agencies; establishment of FMPP, using a bottom-up approach; policy development; and budget allocation. Collaboration with UNICEF on OOSC began in 2017 in four pilot villages, where FMPP were formed and collaborated with village governments. UNICEF used community-based development information systems (SIPBM) to collect real-time data as the basis for developing community action plans. These community forums have been effective because of their ability to map out and reach OOSC, even at the neighbourhood level. Collaboration between FMPPs and village governments works well because interventions are developed based on valid data. The role of village governments is also crucial for securing financial support from the Village Fund. Village and district government officials select FMPP management. FMPP members are chosen by the community and consist of representatives from community leaders, youth leaders, religious leaders, women leaders and local residents. Community participation in FMPP activities has contributed to improved targeting.

82 FMPPs are involved in preparing annual village plans, collecting OOSC data and formulating activities to address OOSC. The aim is to advocate for commitment by village governments to ensure that all children in the village can complete high school education or the equivalent, either in formal or non-formal education institutions, with financial support from Village Funds, the private sector or donors.

• 12,212 (of a total approximately 17,000) OOSC, had returned to formal or non-formal education as of 2016. • In the four pilot villages all OOSC returned to school (81 children in Parereja, 221 in Key Results Cenang, 18 in Benda, eight in Pepedan). Achieved • Villages developed innovative strategies to encourage children and adolescents to become learners. • Village development plans were created, and Village Funds allocated to handle OOSC.

The four pilot villages have become models for addressing OOSC at the village level. Replication to other villages in the district can be facilitated by the local district government, involving four activities: 1. One-day workshop (on the Return-to-School Movement) 2.` Apprenticeship in a pilot village 3. Data reconfirmation 4. Mentoring These activities are carried out after the village seeking to replicate has collected data using the SIPBM application. Replicability/ • FMPP capacity development IDR 20 million (USD 1,500) / village up-scaling Cost • District level replication IDR 900 million (USD 61,500) / year

• Mastery of SIPBM application Skills • Mentoring and capacity building

• FMPP and GKB teams in districts, sub districts, villages • District Regional Planning Agency Stake- • District Community Empowerment Office holders • District Education Office • District Social Affairs Office • District Religious Affairs Office

• Newly formed FMPP teams will require some assistance. Lessons • Policies and regulations are needed to strengthen the role of FMPP. Learned • Resource mobilization innovations are needed, e.g., through collaboration between FMPP and Islamic boarding schools.

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• Community-Based Information System of Brebes District (sipbm.brebeskab.go.id/)

Further • Back to School Website of Brebes District (gkb.brebeskab.go.id/) readings and • Back to School Website of Parereja Village (parereja.desabrebes.id/) information • Back to School Website of Cenang Village (cenang.desabrebes.id/) • Community Forum Website on Back to School Movement (fmppbrebeskab.com/)

• Suhaeni Kudus, Education Specialist UNICEF ([email protected]) Contact • Rela Rahayuningsih, S.Sos, M.Si; Planning, Research and Development Agency details (Bappelitbangda) Brebes ([email protected]) • Bahrul Ulum, SE, M.Si; Community forum for education ([email protected])

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1 Reducing Child Marriage through Life Skills Education South & West 87 in Schools and Strengthening School-Based Health Sulawesi Platforms

86 Reducing Child Marriage through Life Skills Education in Schools and Strengthening School-Based Health Platforms General topic area: Child protection Location: South Sulawesi (Bone)

Child marriage is persistently high in South Sulawesi: nearly 34 per cent of women aged 20-24 are married before the age of 18, higher than the national rate of 25.7 per cent (BPS 2017). On average, some 6,500 cases of child marriage per year occur in the province (BPS 2016). The provincial government has taken measures to address the issue by developing an action plan that engages government and non-government stakeholders to undertake preventive measures. One notable strategy is to encourage children to become reporting agents and pioneers who actively avoid risky behaviours that can lead to child marriage. To complement government efforts, UNICEF developed an intervention strategy based on the life skills education (LSE) framework. Drawn from a set of core life skills conceptualized by United Nations agencies and the collaborative for academic, social and emotional learning, LSE covers three categories: (i) cognitive (critical thinking and problem-solving skills; (ii) personal (skills for awareness, drive and self-management); and (iii) interpersonal (skills for communication, negotiation, cooperation and teamwork, as well as inclusion, empathy and advocacy). Summary LSE addressing sexual and reproductive health, menstrual hygiene management and of the Approach child marriage forms the core framework of UNICEF’s intervention, known as ‘BERANI’. Implemented in Bone District since May 2019, BERANI employs a multi-sectoral approach to improve the life skills of adolescents and address the enabling environment that perpetuates child marriage. The aims are to ensure that girls have access to education and to address gender and social norms that lead to child marriage. Bone District was selected as a pilot location because it has the highest prevalence in the province: 25 per cent (more than double the provincial average). The District Religious Affairs Office registered 127 cases in 2016 and 2017 and 191 cases in 2018 on average a 20 per cent annual increase. Child marriage prevalence negatively affected Indonesia’s ranking on the Human Development Index (HDI). In 2017, the HDI for Bone was 64.16, to which low scores on expected years of schooling and school attendance, especially among girls, also contributed. In partnership with Bone’s district government and local NGO partner, BERANI was piloted in six sub-districts, targeting religious and community leaders, schools/teachers and adolescents. The programme sought to reach at least 3,000 adolescents in 12 schools and 2,000 religious leaders and community members.

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• 4,812 children received LSE training in pilot and replication schools, higher than the initial target. Programme evaluation found that all but one of 2,328 girls were prevented from entering child marriage. • Training activities produced a pool of 25 district trainers and 60 teacher facilitators. • Principals and vice principals at 12 schools were trained on LSE management and supported the allocation of two additional hours for LSE in the school curriculum • 7 memoranda of understanding on the development of school’s health and hygiene promotion (UKS) were reached between schools and community health centres. Key Results • Four Circular Letters were issued: (i) Bone Regent, on the selection of participating Achieved schools and (ii) the public health improvement initiative; (iii) head of education office (DEO), on additional two hours for LSE in pilot schools; (iv) head of Religious Affairs Office, on preventing child marriage at Islamic schools. • During the COVID-19 pandemic, training sessions for students in 86 classrooms for grades 7 and 8 at 12 pilot schools implemented 22 sessions of LSE modules through online platforms and the state-owned radio station (RRI). • Also, during the pandemic, the Bone government partnered with RRI to hold 20 LSE sessions. The radio education programme reached 20,617 junior high school students listeners (5,908 boys and 14,609 girls).

• 12 pilot schools and 14 replication schools/ madrasah are committed to continue LSE implementation. • The district education office and religious affairs office appointed and allocated funding for 14 replication schools - seven public schools and seven Islamic schools adding 1,295 additional beneficiaries. • A draft District Head Decree on LSE as local content in the elementary and secondary school curriculum was being discussed in late 2020. The draft calls for inclusion of LSE in the school curriculum and for LSE completion to be recorded in the country’s basic education database. • Sustainability at the policy level is foreseen. The Development Planning Agency has Replicability/ drafted a district strategy document on preventing child marriage and is preparing to up-scaling draft a similar local regulation, in part to achieve child- friendly district status of the highest category. • Six villages drafted regulations on preventing child marriage, which were under review by the respective village councils in late 2020.

• 4-day training of master trainers: IDR 2 million (USD 137)/person • 4-day training of teachers: IDR 4.5 million (USD 307)/person • 1-day training on LSE management for school principals: IDR 1.2 million Cost (USD 82)/person • Printing of teacher modules: IDR 25,000 (USD 1.8)/piece • Printing of student workbooks: IDR 45,000 (USD 3)/piece.

88 • Mentoring Skills • Application of LSE modules

• District development planning board (Bappeda) • District Education Office Stake- • District Religious Affairs Office holders • School principals and teachers • UKS advisory board.

• Key factors behind successful implementation of LSE for adolescents are strong commitment from local government, school principals and teachers. • Collaborative efforts between the UKS advisory board, school principals and sub- Lessons district community health centres facilitated accelerated implementation of the UKS Learned strategy in schools • Sound government policies should include active engagement by the larger society in their implementation.

• LSE Module: bit.ly/modulpkh_bone Further • LSE Videos in Covid-19: www.youtube.com/channel/UCPPbJaJ9882AoI4Vy3OAV0w/ readings and information videos • MHM Story Book: bit.ly/buku-rahasia2dunia

• Amelia Tristiana, Child Protection Specialist UNICEF ([email protected]) Contact • Derry Ulum, Education Officer UNICEF ([email protected]) details • Hj. Samsidar, SPi., MSi - Secretary of Bappeda Bone ([email protected])

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1 WASH Innovative Financing for the Poorest West Nusa 91 Tenggara 2 Strengthening the community-based total sanitation East Nusa 94 (STBM) implementation by utilizing cultural norms Tenggara 3 WASH in Schools and Health Care Facilities in a Central 97 Disaster-Recovery Programme Sulawesi 4 Twinning Programme: Horizontal Learning on Fecal South 99 Sludge Management (FSM) Sulawesi

90 WASH Innovative Financing for the Poorest General topic area: Access to water and sanitation, eliminating open defecation, equity Locations: West Nusa Tenggara (Mataram City, Bima City, Bima, Dompu, Sumbawa, West Sumbawa, East Lombok, West Lombok, North Lombok, and Central Lombok)

West Nusa Tenggara (NTB) Province initiated an open defecation-free (ODF) programme, known as BASNO, several years ago. Although the programme was planned as a movement driven by community spirit, the results were modest. By April 2021, only 64 per cent of villages and one district out of 10 had achieved ODF status. A key factor hindering progress was the province’s limited financial capacity in reaching the poorest. Bappeda NTB Province data for 2019 show that only 0.54 per cent of NTB’s annual budget was allocated for clean water and sanitation. An opportunity to accelerate the movement emerged when in 2015 Indonesia Ulema Council (Majelis Ulama Indonesia or MUI) issued a fatwa (decree) allowing for the mobilization of ZIS to support the provision of access to water and sanitation for the poorest. The fatwa became a legal basis for the provincial branch of the National Alms Agency (BAZNAS NTB) to support the BASNO programme. In 2017, with support from UNICEF, Bappeda began to work closely with BAZNAS NTB to develop a joint programme consisting of interventions to improve access to proper sanitation for the poor and improve unhabitable houses and their sanitation facilities. To Summary ensure proper targeting, Bappeda developed a provisional village beneficiary list, in part of the through consultation with the PHO, based on a poverty data map. During the first three Approach years, BAZNAS bore all implementation cost, contributing IDR 3.7 billion (USD 253,000) in 2017, IDR 4.5 billion (USD 307,700) in 2018 and 2019; and IDR 5.7 billion (USD 360,000) in 2020. District level BAZNAS were assigned to verify provisional beneficiary lists, in collaboration with other authorities. Verification by the DHO was mainly related to the availability of a latrine facility in a household, whereas BAZNAS considered criteria aligned with Islamic law to ensure recipient eligibility. Construction of latrines and house improvements were jointly supervised by village governments, sanitarian, and appropriate health and military personnel. During the course of the project, UNICEF provided technical assistance to Bappeda and the water and environmental sanitation (AMPL) working group and their coordination with BAZNAS. UNICEF conducted advocacy in districts to encourage the adoption of this innovative financing and promote equity and inclusion in WASH. UNICEF also supported capacity building for the AMPL working group and programme monitoring and evaluation in 2018. In early 2020, UNICEF supported the drafting of technical guideline for replication that were disseminated in 10 districts/cities.

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• At least 7,776 adults and children in 36 villages benefitted from latrine construction and improved access to clean water. • 888 family latrines were built and 654 unhabitable houses were renovated and equipped with decent latrines: − 2017: 200 houses, 361 latrines Key Results − 2018: 195 houses, 277 latrines Achieved − 2019: 250 houses, 250 latrines • Project locations continued to expand over the last three years. Beginning in six villages in six districts, the programme expanded to 10 villages across 10 districts in the following year. • Bappeda issued a circular in 2020 calling on district governments to replicate the programme.

Replication is underway in five locations: 1. Sumbawa City: Hijrah Village in Lape Sub-district achieved ODF status through a local Zakat Management Unit -funded project. 2. East Lombok: District BAZNAS allocated IDR 177 million (USD 12,100) for the provision of clean water pipes in Bilok Petung Village. Replicability/ up-scaling 3. Mataram City: Local BAZNAS funded replication in Sayang-Sayang Village 4. North Lombok and West Sumbawa districts are replicating the programme with support from district and UNICEF cross-learning efforts.

• Latrine construction IDR 3 million (USD 205)/unit Cost • House renovation IDR 35 million (USD 2,400)/house

• Planning and development of latrines and safe housing Skills • Coordination and supervision

• Provincial and district BAZNAS • Provincial and district Bappeda Replicability/ • Provincial and district AMPL working group up-scaling Stake- • Provincial and district health offices (PHO and DHO) holders • Public Works and Housing Office • Village government • Sanitarian • Community health centre

• The inclusion of BAZNAS as members of AMPL working groups strengthened coordination with government offices. Lessons • The fatwa from MUI and circular letter from the NTB Governor laid a strong Learned foundation for programme implementation and replication. • UNICEF received a pledge of appreciation from the governor in 2019 for its contribution to the poverty-reduction programme through support for BASNO.

92 • Bappeda and BAZNAS NTB, with UNICEF support, shared the good practice at an advocacy/horizontal learning session in Makassar in Feb 2019. • When finalized, technical guidelines for programme implementation can become a model for similar guidelines at the national level.

Website: • www.unicef.org/indonesia/id/stories/sanitasi-aman-untuk-feby • www.unicef.org/indonesia/baznas-x-unicef • bappeda.ntbprov.go.id/nusa-tenggara-barat-menuju-buang-air-besar-sembarang-nol- basno-2023/ Further readings and information Media feature: • www.suarakarya.id/detail/95454/BAZNAS-UNICEF-Berkolaborasi-Bangun-Fasilitas- WASH-Untuk-Anak-Anak-Korban-Gempa-Palu-NTB • www.pamsimas.org/gubernur-ntb-beri-piagam-kepada-pamsimas/ • www.nawasis.org/portal/berita/read/rangkul-baznas-ntb-amankan-rp-4-5m-untuk- dukung-basno/51505

• Rostia La Ode Pado, WASH Officer UNICEF ([email protected]) Contact • Muhammad Zainal, WASH Specialist UNICEF ([email protected]) details • Taufik, AMPL Working Group, Bappeda West Nusa Tenggara ([email protected])

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Strengthening the community-based total sanitation (STBM) implementation by utilizing cultural norms General topic area: Access to water and sanitation, eliminating open defecation Locations: East Nusa Tenggara (East Sumba and Southwest Sumba)

In rural East Nusa Tenggara, one out of three households lacked access to a latrine, according to 2017 data. In urban areas, the rate was 29.09 per cent. Only households in Kupang City and Alor District had 100 per cent access to latrines. UNICEF has worked with the East Nusa Tenggara government on a programme to eliminate open defecation and promote safe sanitation management since 2013. The goal was to create environments capable of fulfilling children’s basic rights by encouraging districts to achieve open defecation-free (ODF) status and improved sanitation management. Specifically, UNICEF supported the local government in East Sumba and Southwest Sumba districts to implement community-based total sanitation (STBM), which employs advocacy, campaigns, capacity building, mentoring and empowerment to accelerate efforts to achieve an open defecation free (ODF) district. The strategy also includes policy advocacy and socio-cultural advocacy to support community- based movements (Stop Ta’i Wewar/Tai’ko Wewara) that rely on traditional beliefs to promote ODF, including through prohibitions and sanctions. Reliance on cultural norms feared and respected by the Sumbanese led to success in engaging community and religious leaders and village STBM teams, even in remote and mountainous areas of the island. Summary For the Sumbanese, the programme was seen as waging a war against open defecation. of the When war breaks out, heroes emerge. UNICEF and the water and environmental sanitation Approach (AMPL) working group identified and nurtured influential figures to lead the movement. For example, the Kahali Subdistrict head is a progressive figure who demonstrated strong leadership in mobilizing stakeholders: traditional and community leaders, religious leaders, neighbourhood associations and even village officials representing the military and police. He instructed village heads to support the programme and allocated funds to build latrines, in co-operation with state-run community health centres. Local church leaders used the pulpit to echo the spirit of ODF and went further by publishing a collection of sermons supporting the end of open defecation and promoting behaviour change, using biblical symbols and narratives. Customary sanctions, such as placing a black flag in front of houses without latrines, were imposed to name and shame non-compliant households and build awareness. Women conducted a joint saving scheme (arisan) to raise funds for building toilets in their neighbourhoods. In 2015, Kahali sub-district government began a neighbourhood-based movement constructed around the narrative that family toilets must be made available to enhance the safety of women and children. A team was formed to ascertain whether the new latrines were being used by residents and to conduct a campaign targeting non-ODF villages. The sub-district achieved ODF status in 2017.

94 • In East Sumba, the number of ODF villages rose from 27 to 47; one subdistrict also achieved ODF status. • The AMPL in Southwest Sumba District allocated IDR 70 million (USD 4,800) to sustain the programme. Key Results • A partnership model was developed involving community health clinics and village Achieved governments, supported by the health sector and Village Funds, respectively. • A network of concerned civil society groups and religious and traditional leaders was developed to continue the movement. • The programme’s success has been widely acknowledged. UNICEF Malaysia supported a knowledge exchange visit to these districts.

In Southwest Sumba: • Health operational assistance (Bantuan operasional kesehatan or BOK) amounting IDR 70 million (USD 4,800) was allocated and detailed steps for achieving ODF status is included in development plans. • In some villages, replication is ongoing using local resources, for example in Wewewa Utara Sub-district. • The AMPL network facilitated knowledge-sharing between Southwest Sumba and Kupang District, inviting a sanitation entrepreneur association.

In East Sumba: • BOK totalling IDR 1.7 billion (USD 116,200), IDR 7.5 million (USD 513)/village, is allocated. • The District Health Office (DHO), community health centres and village governments formed partnerships to improve the quality of latrines, increase supply of clean water and undertake monitoring and evaluation. Replicability/ up-scaling • Latrine construction/rehabilitation • Coordination and supervision Cost • Health promotion staff salary • Knowledge exchange

• Latrine construction Skills • Community-based total sanitation • Stakeholder engagement

• Provincial and district development planning agencies (Bappeda) • AMPL Working Group Stake- • DHO holders • Village government • Community leaders • Sanitarian

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• The strong commitment and leadership shown in East Sumba and Kahali Subdistrict resulted in effective programme implementation. • Programme financing using local resources, especially Village Funds, was key to accelerating results. • Sharing success stories in various forums and to a wider audience to motivate other Lessons villages for active participation, resulting in scaling-up. Learned • To be effective, the programme must be well staffed. For example, Kahali Subdistrict recruited sanitarians, health promotion staff and public health staff to assist the programme. • Effective collaboration between DHOs, community health centres and village governments enhance programme implementation and results.

Local government report: • East Sumba and Southwest Sumba CLTS Rapid Assessment Protocol (CRAP) Tools Report (2020) Further readings and Local government media features: information • www.bappelitbangda.nttprov.go.id/portal/index.php/item/527-diseminasi-hasil- pelaksanaan-clts • www.bappelitbangda.nttprov.go.id/portal/index.php/item/500-upaya-sinergisasi- program-ampl-tahun-2020

• Rostia La Ode Pado, WASH Officer UNICEF ([email protected]) Contact • Muhammad Zainal, WASH Specialist UNICEF ([email protected]) details • Tanda Sirait, AMPL Working Group, Bappelitbangda East Nusa Tenggara ([email protected])

96 WASH in Schools and Health Care Facilities in a Disaster- Recovery Programme General topic area: Sub-national WASH support Locations: Central Sulawesi (Palu City, Sigi, Donggala)

In response to the earthquake that struck Central Sulawesi in 2018, UNICEF partnered with CARE Indonesia to implement WASH interventions in damaged schools and healthcare facilities. The aim was to fulfil children’s right to clean water, sanitation and hygiene in three affected districts. Working closely with the three local governments, the programme was conducted in 50 schools and at three district community health centres (puskesmas) from March 2019 through February 2020. CARE engaged with local partners, utilizing close relationships with affected communities to increase access to WASH facilities at targeted schools and healthcare facilities. The following activities were conducted: Summary of the • Training for students on menstrual hygiene management and health and hygiene Approach promotion, including through the appointment of student champions called ‘little doctors’. • Enhancing the role of school health units and helps to reduce student absenteeism due to illness. • Rehabilitation of latrines at schools and community health centres and a campaign to improve student behaviour related to urination and defecation. • Construction of child-friendly handwashing facilities at schools to improve children’s handwashing habits. • Development of standard procedures for maintaining WASH facilities at community health centres

• School’s health and hygiene promotion-related (known as UKS) activities in 49 elementary schools were supported by 98 trained ‘little doctors’. Water and sanitation committee members in 50 schools were also trained to oversee maintenance of WASH facilities at schools as well as hand hygiene practice and facilitate the involvement of all school residents in the programme. Key Results • New toilet facilities were built in nine schools and latrine renovation was completed at Achieved 41 schools. Twelve schools received both new and rehabilitated latrines. Post-activity monitoring (PAM) shows that the 8.2 per cent of students who previously practiced open defecation had totally ceased this behaviour. • After child-friendly handwashing facilities were built in 27 schools, PAM showed that 97.4 per cent of children now regularly wash their hands.

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• 50 schools and three healthcare facilities were given standard guidelines for maintaining WASH facilities, approved by the District Health Office, covering matters such as washing areas and clean water systems and latrines to prevent disease transmission. • Health centres also held workshops with local stakeholders to develop contingency plans to address risks of disaster.

• Training for WASH Committee in 50 schools: IDR 39,340,000 (USD 2,690) • Little doctors training in 50 schools: IDR 128,600,000 (USD 880) / 100 students. Cost • Reconstruction and rehabilitation of WASH facilities in 50 schools and 3 puskesmas: IDR 1.6 billion (USD 109,400) • Puskesmas SOP development IDR 10,580,000 (USD 723) • Printing of knowledge-management product: IDR 12 million (USD 820)

• Training facilitation Replicability/ up-scaling Skills • Project management • Communication

• Healthcare facilities staff • District health office Stake- • Provincial health office holders • Village chiefs • School management and students • Community / civil society

• The process of designing handwashing and toilet facilities should engage children and school stakeholders, both to understand their needs and ensure optimal usage. When designs were not fully comfortable, students demanded a renovation to adjust the newly built facilities which will increase the costs and delay the utilization. • Optimal involvement of the local government, especially the village chief and the community Lessons near schools, is necessary to ensure a sense of shared ownership of the programme. Learned • The availability of WASH facility SOP and WASH Committee is required to ensure the sustainability of WASH in school infrastructures • Contingency planning workshop activities at healthcare facilities should not only involve staff, district and provincial health officers and academics, but also need to engage villages and local communities since they play a vital role in disaster management.

Further WASH in schools and Health Care Facilities in Palu, Sigi, Donggala (Pasigala) Programme, readings and information 2020

• Fauzan Adhitia, WASH Cluster Coordinator UNICEF ([email protected]) Contact • Enrico Rahadi Djonoputro, WASH in Emergency Officer UNICEF ([email protected]) details • Andi Arno, Sigi District Education Office • dr. Rika F. Sakaruddin, Sigi District Health Office

98 Twinning Programme: Horizontal Learning on Fecal Sludge Management (FSM) General topic area: Safely managed sanitation Locations: South Sulawesi (Palopo City, Parepare City, Pinrang)

Fecal sludge management (FSM) is an integral part of systems enabling safe and sustainable sanitation management. In Indonesia, on-site sanitation is the option normally used by communities; therefore, a well-managed FSM supported by well-capacitated institution with clear operation and procedures is essential. However, in the 24 districts of South Sulawesi, only seven cities/districts have fecal sludge treatment plant with low performance issues related with gaps on management capacity; budgeting; and operations and maintenance. The horizontal learning approach used in the ‘Twinning’ programme represented an effort to close these gaps. Twinning refers to a peer-to-peer or horizontal learning effort that was initially developed by Indonesia’s Settlement Wastewater Treatment Association (FORKALIM) to address and improve capacity of local governments on FSM. This programme uses a mentor-mentee approach guided by a well-defined and agreed timeframe. The ‘mentor’ is a city/district with expertise and capacity for innovation that could serve as a reference point for successful FSM. ‘Mentees’ are cities or districts that agree to participate in a capacity-building programme under the mentor to improve their knowledge and expertise for treating and managing domestic wastewater. The programme’s objective is to accelerate the dissemination of knowledge and experience Summary on governance and technology-related topic on FSM and increase mentees’ knowledge of the Approach and skill on the topic. Limited capacity among human resources is common to sanitation operators across the region, and it has been found that capacity improvement is most effective through peer-learning with fellow experienced operators. Thus, the twinning programme facilitates mentee districts to learn from more experienced mentor districts through an intense and highly focused learning programme. UNICEF’s role has been to pair sanitation operators with expertise and willingness to share it with sanitation operators seeking to improve their capacity and knowledge. After analysis, three cities/districts were selected in South Sulawesi Province (Palopo City, Parepare City and Pinrang). These three mentees were paired with mentor districts Gresik and Sidoarjo in East Java, based on similarity of needs and challenges faced. Specific topics were agreed based on diagnostic results. Palopo focused more on institutional improvement, while Parepare and Pinrang focused on improving operations and maintenance (O&M) of fecal sludge treatment plant which is essential to ensure that the sludge can be treated and safely disposed to the environment. Three or four rounds of learning visits were planned to mentor and mentee districts, respectively, with follow-up action plans to be developed over the course of six to eight months. Assistance and support were provided to the mentees to ensure substantial improvements in the short and medium-terms.

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• As of September 2020, the programme had resulted in significant improvement in faecal sludge management in the three mentee districts. • In Parepare, technical improvements were completed in the treatment plant (sludge receiver, aerobic/anaerobic chambers and Imhoff tank). Non-technical improvement was also made, such as developing standard O&M procedures. These improvements were stated in their action plan and followed up during a series of consultations with Sidoarjo mentor district. Another key result for medium-term follow-up is institutional Key Results reorganization, which requires multi-stakeholder agreement and high-level approval by Achieved the district. • In Pinrang District, significant technical and institutional improvements were made, (e.g., adding a rooftop to the chambers and refining O&M procedures, based on their action plan and consultations with Sidoarjo mentor district. • In Palopo, with a focus on the institutional improvement, a standalone sanitation operational body was formed under the District Public Works Office and approved by a mayoral decree. This is a major change that will affect planning and budgeting capacity and lead to improvements in manpower, O&M, and services.

It is expected that enhanced knowledge and capacity of mentees have prepared them to mentor other districts, at least within the province. The province could play the role of ‘knowledge broker’ for its districts and organize similar horizontal learning, since intra- province twinning replication is likely to be more cost-effective. Therefore, support at the provincial level is essential to ensuring that learning processes are accountable, institutional support can be provided and future follow-up and replication can take place.

• Multiple visits between six districts (mentors and mentees) in two provinces: IDR 585 million (USD 40,000) Cost • Due to the COVID-19 pandemic, the actual cost was 40 per cent lower than the initial budget. Replicability/ • Intra-province twinning among districts could be more affordable. up-scaling • Provincial and district sanitation planning • Knowledge of management, operations and technology of domestic Skills wastewater treatment • Government planning and budgeting process • Mentoring skills

• Provincial Water and Environmental Sanitation (AMPL) Working Group Stake- • District AMPL Working Group holders • Private sector, for sanitation services • FORKALIM

100 • Comprehensive improvement. Through mentoring, the three districts were able to identify the root challenges of FSM, which are interconnected and often complex. This highlighted the need for significant improvements, requiring comprehensive technical and non-technical support at all levels (i.e. facility to institutional arrangement level). In the end, the three districts had to include matters outside the initial focus of their action plans in order to make significant improvements. • Collaborative process. The degree of success in creating change differed in the three mentee districts, highlighting the importance of multisectoral collaboration, since many of the issues faced should be addressed by involving various offices in the district or support from the province. Lessons • Strong support from decisionmakers. In addition to greater collaboration, strong Learned support from senior decisionmakers in the districts (mayor/regent/local parliament) is also essential, as some fundamental improvements require budgeting consideration in upcoming annual government plans. • Cost effective and systematic cross-learning interventions for scaling-up. COVID-19 posed both challenges and opportunities related to a more affordable horizontal learning option which is relevant for replicability. As the interactions during the pandemic were conducted virtually, the Twinning provided a great example on how an effective learning still can be conducted through combination of in-persons and remote process. Thus, this experience created an innovative good practice that the program could be replicated beyond the pandemic situation in a cost effective manner.

Further Bermitra Mengelola Lumpur Tinja (Catatan Pembelajaran Twinning Program Pengelolaan readings and information Air Limbah Domestik di Sulawesi Selatan), Yayasan BaKTI, 2020

• Wildan Setiabudi, WASH Officer UNICEF ([email protected]) • Maraita Listyasari, WASH Specialist UNICEF ([email protected]) Contact • Prasetyo, Director for Sanitation, Ministry of Public Works and Housing details ([email protected]) • Asdar Muhammad, Bappelitbangda South Sulawesi ([email protected])

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1 Improving the Well-Being and Protection through South Sulawesi 103 Bullying Prevention 2 Birth Certificate for All: Innovations to Improve Birth South Sulawesi 106 Registration Systems 3 Village Social Welfare Centres as Service Hubs for South Sulawesi 109 Protecting Vulnerable Children and their Families 4 Increasing Access to Social Welfare and Protection East & Central 111 Services for Vulnerable Children and Families through Java Sub-national Integrated Child Welfare and Protection Services

102 Improving the well-being and protection of school children through bullying prevention General topic area: Anti-bullying Locations: South Sulawesi (Makassar City and Gowa)

The Roots programme is an evidence-based, adolescent-driven anti-bullying intervention model developed based on recommendations by a joint workshop involving government, universities and youth and community groups. The approach was documented in a comprehensive module entitled ‘Roots as a Bullying Prevention Programme for Junior High Schools’ developed by UNICEF, the Setara Foundation and Indonesia Mengabdi Foundation (YIM) as well as the provincial governments of South Sulawesi and Central Java. The programme involves the entire school community in promoting a safer school environment. The modules are designed for junior high school (SMP) students aged 12-15 years old. Students are invited to nominate and vote for influential peers in their network as agents of change. Selected agents of change participate in 15 training sessions on the Roots modules, where they are taught to understand and identify different forms of bullying and then to develop and implement strategies to address them. Teachers also receive training to improve their skills on positive discipline and bullying prevention. Upon completing all 15 training sessions, a ‘Roots Day’ celebration is held as the closing event. On this occasion teachers, agents of change, and students gather together to reflect on what they have learned during trainings and the experience of preventing bullying and influencing their peers. The celebration concludes with school declarations to prevent bullying. Summary of the In 2017 Roots was piloted at two junior high school in Makassar and two junior high school Approach in Gowa. As implementing partner, YIM provided training for 10 facilitators from its staff and Child Forum members. The facilitators were then assigned to implement and monitor school- level activities. Pilot activities successfully reached 3,568 students and brought about significant behaviour change; for example, bullying perpetration and victimization declined by 29 per cent and 20 per cent respectively. In 2019 the Provincial Women’s Empowerment and the Child Protection Office used this evidence to replicate Roots in Makassar City, Maros, Gowa, Luwu Timur and Bulukumba. Twenty facilitators were trained to implement Roots in one target school in each district. Makassar Education Office funded training for teachers at five schools and Roots implementation in two schools. Some adjustments were made during programme implementation, such as the inclusion of ‘character-based education concepts and values’ in modules for Islamic school students. In response to the COVID-19 pandemic, Indonesia Mengabdi Foundation produced a video guideline on ‘Roots in the New Normal’ to help teachers deliver bullying prevention topics online. By addressing bullying prevention, the Roots programme fills an existing gap, since prevention is not comprehensively addressed by Education and Culture Ministry regulations for handling of cases of violence at schools. In 2020 the Ministry awarded Indonesia Mengabdi Foundation a grant to replicate Roots in 50 schools in South Sulawesi and Central Java.

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• 10 facilitators were trained and 40 agents of change in four pilot schools were selected as agents of change and received 15 sessions of Roots training. • 3,568 students in four pilot schools benefitted from the programme through their participation in Roots Day celebrations and the anti-bullying declaration. Key Results • Assessment at four pilot schools showed increased positive behaviours among Achieved students. Bullying perpetration decreased by 29 per cent and bullying victimization by 20 per cent. • Teacher capacity to handle bullying cases with a positive approach improved. • Bulukumba Child Forum adopted Roots into its annual work programme. Twenty children in Bulukumba District participated in Roots sessions.

South Sulawesi Province • Office for Women Empowerment and Child Protection funded the second round of facilitator training, which produced 20 facilitators from five districts. • From 2019 to 2020, the Child Forum facilitated Roots implementation at two junior high schools. Makassar City • In 2019 the District Education Office (DEO) allocated IDR 70 million (USD 4,800) to organize one day of training for 20 teachers from five schools and implement Roots sessions for 50 students at two schools. • DEO committed to sustain the Roots and positive discipline approaches using school operational funding in the 2021 budget. Replication at school level

Replicability/ • A student organization in Gowa and Maros adopted the agent of change group as an up-scaling extracurricular activity. • At one school in Gowa the headmaster issued a decree appointing the agents of change as peer counsellors to monitor bullying.

• 3-day training for 30 facilitators: IDR 1-1.2 million (USD 68-82)/person • Trainer fees: IDR 12 million (USD 821) /package Cost • Printing of module and guidelines: IDR 12 million (USD 821)/package • Roots training at schools (14 meetings): IDR 5 million (USD 342)/school

• Application of training modules • Mentoring skills Skills • Improved teacher skills to deliver character-based activities • Improved teacher skills to prevent school-based violence

104 • Provincial and district health office (PEO and DEO) • Women’s Empowerment and Child Protection Office • Religious Affairs Office Stake- • Child Forum holders • School management • Teachers • Student organizations

• The focus on improving cooperation with the education offices and involving teachers as facilitators helped to ensure the sustainability of the bullying prevention programme. • It will be important to forge stronger links between the Roots programme and the character-based education values promoted by the MoEC. Lessons • Improving teacher skills on positive discipline produces a more effective response to Learned reports or allegations of bullying. • Enhanced coordination with school management contributes to the development of child-friendly regulations. • The potential for implementing Roots online should be assessed in the context of the COVID-19 pandemic.

• Roots Module of Prevention of Bullying for Junior High School, Government of Further Indonesia and UNICEF, 2017. readings and information • Positive Discipline Module for Elementary, Junior High School, and Senior High School, UNICEF and Indonesia Mengabdi Foundation

• Amelia Tristiana, Child Protection Specialist UNICEF ([email protected]) Contact • Derry Ulum, Education Officer UNICEF ([email protected]) details • Dr. Farida Aryani, M.Pd; Yayasan Indonesia Mengabdi ([email protected])

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Birth Certificate for All: Innovations to Improve Birth Registration Systems General topic area: Access to birth registration, legal identity Locations: South Sulawesi (Makassar City and Gowa)

Efforts to improve access to birth registration in Makassar City and Gowa District have proven challenging. Makassar has a population of 1.6 million, including many living on islands, while Gowa District’s population is spread over 169 villages in 18 sub-districts, including remote and mountainous locations. Official data from 2016 revealed that main factors behind low birth registration coverage in South Sulawesi included: the perceived high cost (cited by 18.4 per cent of urban dwellers), lack of understanding about the importance of birth certificate (15.6 per cent of rural residents), and long distances from home to the Civil Registry Office (9.4 per cent of rural residents). These challenges have contributed to the low birth registration coverage in the two districts: 44 per cent in Makassar (2014), 23 per cent in Gowa (2015). Children without a valid birth certificate cannot benefit from social protection programmes such as subsidized health insurance premiums, the Indonesia ‘health card’ or local health insurance. From 2017 to 2019 UNICEF supported the Makassar City and Gowa District governments to expand birth registration coverage. The effort targeted marginalized groups, such as those living in remote areas, and disadvantaged children (i.e., children from poor families, living in slum areas, with disabilities or having a disabled parent, in conflict with the law, Summary in institutions and children with a stigmatized disease. of the Using data from Indonesia’s population administration information system, Makassar City Approach focused on seven sub-districts where birth registration coverage was extremely low; Gowa selected eight priority sub-districts using the same criterion. The programme attempts to bring services closer to disadvantaged children and underprivileged groups. Makassar City launched the KUPAS TAS programme in 2017 to accelerate birth registration through school visits and temporary service points at strategic locations. Two teams, comprising 100 personnel (staff and volunteers), were dispatched to target locations on the mainland and nearby islands. The team set up one-stop-service booths where clients could access information, register, have their documents verified and obtain a printed birth certificate. Another successful approach was direct outreach to specific locations, by age groups. Community clinics and hospitals provide service for new-borns, integrated healthcare centres for children up to age five and children aged four to 18 years were reached at schools. Civil Registry Offices partnered with a wide range of concerned organizations - children’s and women’s groups, special education schools, social workers organizations that support children with special education needs or stigmatized diseases - to address different forms of vulnerability. UNICEF’s role was to facilitate and support this collaboration between non-state institutions and local governments.

106 Civil Registry Offices in Makassar City and Gowa District launched an online registration system in 2018 that connects civil registration officers to participating hospitals and community health centres. Partner institutions are required to provide manpower and necessary equipment. Over 50 staff were trained as operators, responsible for submitting online applications and verifying supporting documents (e.g. ID-card, family certificate). This process has made it possible for clients to receive a birth certificate and identity card for the baby and an updated family certificate before leaving the hospital or health centre.

• Birth registration coverage increased dramatically: in Makassar City from 58.5 per cent (2016) to 95 per cent (2019) and in Gowa from 40.4 per cent (2016) to 99.6 per cent (2019). Both figures are higher than the national target of 85 per cent. • The 15 priority sub-districts experienced a significant increase in birth registration coverage from an average of less than 50 per cent (2014) to over 93 per cent (2019). • A pool of over 60 staff from partner hospitals and health centres were trained to operate the online civil registration system. Key Results • Possession of civil registry documents enhanced the eligibility of marginalized Achieved and vulnerable groups to access government-funded health and social protection programmes. • The ease of obtaining a birth certificate for their new-borns encouraged more mothers to give birth at a healthcare facility, attended by skilled healthcare workers. This has contributed to decreasing the risk of maternal and infant mortality. • Improving birth registration coverage and systems strengthened team- building among staff at Civil Registry Offices, as the service became more client-oriented, and enhanced coordination with partner organizations.

The Civil Registry Office in Makassar replicated the approach to improve its recording of deaths.

• Development of an online system per package • Online application training for operators per person • MoU and SOP development per package Cost • Visit and outreach/village or service point

Replicability/ • Coordination meeting and supervision per person up-scaling • Procurement of server per unit • Internet connection per package

• IT and data management • Online application Skills • Population data analysis • Mapping and targeting • Coordination and stakeholder engagement

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• District Civil Registry Offices • District Health Offices Stake- • Concerned non-government organizations holders • Sub-district and village governments • Community and religious leaders

• The collaborative approach used here to expand birth registration coverage facilitated more effective partnerships among various institutions, including unlikely Lessons actors such as the Indonesian Navy and National Police. Learned • Standard operating procedures at Civil Registry Offices has become more client- oriented and proactive.

Further Akta Kelahiran Untuk Semua: Menjangkau Anak Rentan dan Marginal di Makassar dan readings and information Gowa, GoI, UNICEF and BaKTI, 2020.

• Amelia Tristiana, Child Protection Specialist UNICEF ([email protected]) Contact • Astrid Gonzaga Dionisio, Child Protection Specialist UNICEF ([email protected]) details • Chaidir, Makassar Civil Registry Office ([email protected])

108 Village Social Welfare Centres as Service Hubs for Protecting Vulnerable Children and their Families General topic area: Child protection Location: South Sulawesi (Gowa)

Integrated child welfare service (PKSAI) was established in Gowa District in 2016 as a pilot project, based on a decree by the district chief and with support from UNICEF. Their mandate is to address child and family vulnerability by using an integrated, multi- sectoral approach to intervene in cases involving violence, abuse, exploitation or neglect of children. The decree also stipulates that PKSAI be funded by the district government budget. Although budget allocations scarcely cover their activities especially considering the district’s vast size local funding for PKSAI demonstrates local governments’ strong commitment to providing child welfare services. A project evaluation conducted in 2018 showed that the intervention had yielded significant results. PKSAI was deemed successful in delivering services related to prevention, early detection and rehabilitation. Using the balanced scorecard method, the evaluation showed significant increases with respect to: types of service (from 16.7 per cent to 100 per cent); organizational structure (27.8 per cent to 88.9 per cent), human resource availability (13.3 per cent to 46.7 per cent) and data management (none to 33.3 per cent). Summary of the Moreover, PKSAI engaged effectively with several sectoral agencies in the district, Approach improving overall accessibility to services. PKSAI also reached vulnerable children and their families, using the Unified Database, and referred cases to the agencies concerned. As of November 2019, PKSAI Gowa had managed over 900 cases, most of which were followed up by service providers. In handling these cases, PKSAI developed a standard operating procedure from registration to case management to referral, monitoring and termination, sometimes including case conferences supported by trained social workers. A significant step toward expanding PKSAI coverage in Gowa District would be to link it with village-level service hubs. To bring services closer to communities, PKSAI formed a partnership with, and strengthened the role of, village-based social welfare centres (puskesos). These centres, established by district health decree in 2018, serve as village- level integrated referral services. Puskesos are a Ministry of Social Affairs-led initiative, initially intended as a referral service for its flagship social protection programmes. Since then they have evolved to provide referrals for a wide range of programmes and services, including education, health, livelihoods, civil registration and more. UNICEF and implementing partner Yayasan BaKTI provided technical assistance to strengthen puskesos as PKSAI service hubs in villages. Following a consultation with Gowa’s district government three villages were selected as pilot locations.

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Puskesos staff and clients acknowledged that the impact on protection and fulfilment of child rights has been significant, as indicated by the increased number of programme beneficiaries and improved access to information and services. Villagers can access services in their own village, avoiding the burden of traveling long distances to the district capital. Puskesos can effectively respond to cases involving vulnerable children and their families and offer an integrated and timely referral to PKSAI.

• Improved capacity of three puskesos staff on case management, referral and data management of cases involving vulnerable children and their families. Key Results Achieved • PKSAI have handled over 900 cases involving vulnerable children and their families. PKSAI and puskesos hubs provided services related to health and education cards, birth certificates, scholarships and other social assistance.

In 2020 the Gowa District Social Affairs Office expanded collaboration between PKSAI and puskesos by adding to the number of participating villages. Five village governments allocated budget for integrating puskesos as PKSAI service hubs.

• Training on puskesos and PKSAI management and development of standard operating procedures Cost • Training on the ‘Primero’ case management platform • Institutionalization of PKSAI (annual budget to cover human resources, Replicability/ case management, monitoring and evaluation) up-scaling • Data management and analysis Skills • Managerial skills (budgeting, coordination) • Case management skills

• District: District Social Affairs Office, Women and Children Stake- Empowerment Office, Civil Registry, District Education Office, District holders Health Office and other service providers • Village: village government, puskesos

• Accurate data can help in the planning and monitoring of development programmes in villages. Lessons • The success of PKSAI operation relies heavily on leadership of and participation by Learned the core management team. • Multi-sectoral collaboration among service providers is crucial to the delivery of child protection services.

Further • PKSAI Development Guidelines in South Sulawesi, GoI and UNICEF, 2019. readings and information • PKSAI Model Infographic, UNICEF

• Amelia Tristiana, Child Protection Specialist UNICEF ([email protected]) Contact • Astrid Gonzaga Dionisio, Child Protection Specialist UNICEF ([email protected]) details • H. Syamsudin Bidol S.Sos., M.Si., M.H, Gowa Social Affairs Office

110 Increasing Access to Social Welfare and Protection Services for Vulnerable Children and Families through Subnational Integrated Child Welfare and Protection Services General topic area: Vulnerable children (prevention and response services) Locations: East Java (Tulungagung) & Central Java (Surakarta City and Klaten)

Through collaboration with the Ministry of Social Affairs (MoSA), UNICEF developed a service model focusing on vulnerable children and their families in districts and cities. The Integrated Social Welfare Services for Children (PKSAI) model was initiated in 2015 and piloted in three districts and two cities in Central Java, East Java and South Sulawesi provinces and then expanded to 111 districts and cities throughout Indonesia. PKSAI development sought to strengthen child protection systems to address the following issues: (1) child protection system emphasizes response over prevention; (2) child protection issues are complex but services are partial, fragmented, often overlapping and poorly coordinated; (3) child protection system is highly decentralized under local government systems with limited capacity (4) the need to increase professionalism and ensure that interventions are informed by the latest knowledge and data. PKSAI was established in Tulungagung in December 2015, Klaten in July 2016 and Surakarta in September 2016. It is expected to improve the linkages between: (1) child protection services (case management, medical service and medico-legal, psycho- Summary social, education, alternative care, Child Social Welfare Agency, legal aid etc.); (2) family of the support services (family counselling, child and family strengthening sessions, psycho- Approach social service, economic empowerment etc.); and (3) social protection services such as different types of government cash transfers and assistance. UNICEF support to PKSAI’s institutional development in these districts consisted of: developing a strategy to provide integrated services, improving operations and case management, regulating organizational structures; building capacity of human resources for improved data management and local government policy on PKSAI. Six main activities and milestones were set during the five-year programme (2016-2020): 1. Advocacy with regents/mayors and district house of representatives (DPRD) to gain political commitment and ensure full adoption and implementation of PKSAI. 2. Support the formation of PKSAI as a government-supported service structure, complete with organizational structures and staffing. 3. Support the development of standard operating procedures for handling cases and data management, for internal PKSAI operations and referral services.

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4. Capacity building for PKSAI team (inter-agency staff, PKSAI managers, social workers and para social workers, and other service providers including NGOs). Training covered conceptual framework, case management, management of data and information and child protection. Another element of capacity building was coaching sessions on case management and data management using Primero and ADSR (covering child vulnerability data) as well as exchange learning and study visit to pilot sites. 5. Support the development of a data management system that includes data on vulnerable children and response to cases. 6. Development of a costing model guideline. The guideline is being adopted into the local context by PKSAI Tulungagung and used as a reference for PKSAI budgeting in 2020–2021.

• Regulations are issued as the legal basis for establishing PKSAI, including district head/mayoral decrees and regulations. • PKSAI structures are well established by mayor/regent decrees, consisting of the social affairs office and other offices; referral services; and non-government organizations as partners. • PKSAI staff are trained on case management, data management systems and soft skills (psychosocial, counseling and gender). Province-level technical assistance teams were established to assist new districts. • Over 1,000 cases were handled at three PKSAI from 2016: 132 cases in 2016, 438 in Key Results 2017, 306 in 2018, 150 in 2019 and 185 cases in 2020 (as of June). Achieved • Local government budget is allocated for PKSAI, the number of which varies considerably between IDR 100-900 million (USD 6,800-61,500). • Standard procedures for PKSAI operation were legalized by regent/mayoral decrees. Regular monthly and quarterly meetings are held in all three locations to report progress by each office or institution involved in PKSAI. • PKSAI developed an early detection/early response mechanism for villages. PKSAI in Tulungagung and Klaten established links to services with community-based services on child protection (Perlindungan anak terpadu berbasis masyarakat or PATBM) and in Surakarta with integrated services posts (or PPT).

Four districts (Jombang, Trenggalek, Sidoarjo, Pasuruan) and two cities (Pasuruan and Kediri) in East Java began replicating PKSAI in 2020.

• PKSAI development workshop: IDR 20 million (USD 1,370)/district • Policy and regulation advocacy and development: IDR 10 million (USD 684)/district Replicability/ • SOP development: IDR 10 million (USD 684)/district up-scaling • Case management training workshop: IDR 2 million (USD 137)/person. Cost • Primero training: IDR 2 million (USD 137)/person. • ADSR (vulnerable data management) workshop and data collection: IDR 26 million (USD 1,777)/district. • Costing workshop: IDR 2 million (USD 137)/person. • IRC materials development: IDR 20 million (USD 1,370)/district.

112 • Case conference and inter-agency coordination: IDR 500,000 - 1 million (USD 34-68) / meeting (approximately 12 meetings per year). • Staffing: social worker, data and admin staff, psychology (depend of unit costs in each district).

• Advocacy, policy and development of standard procedures • Costing and budgeting Skills • Facilitation, case management and psychosocial • Data information management system (Primero and ADSR)

• Provincial and district social affairs office Stake- • Provincial and district women’s empowerment and child protection office holders • Bappeda at the province and district • Local NGOs

• One of the keys to success was strong government ownership at all levels from conception stage through implementation. • The success of PKSAI operations is largely determined by institutional readiness, management, human resource support and funding, along with commitment by district heads and the government apparatus. • Intensive support from UNICEF and its partners contributed to the sustainability of PKSAI. Host governments will need to develop policies to ensure sustainability of future PKSAI services. Lessons • PKSAI should be included in planning documents, especially the RPJMD and strategic Learned plans of the offices involved. • PKSAI sustainability depends on available budgets. PKSAIs should advocate with provincial governments for the allocation of funds for mandatory basic social basic services to strengthen PKSAI. • The strengthening of capacity and engagement of provincial government in the establishing of PKSAI is crucial to ensuring its scale-up to all districts/cities. • Enhanced coordination with a network of service units – including all relevant district offices, child protection unit of the district police, hospitals, think tanks and universities, legal aid foundations and CSOs – contributes to PKSAI services.

• Surakarta Mayor Decree Number 1-I/2017 on PKSAI • District Regulation Number 23/2017 on Child Protection Implementation System Further • Klaten District Head Decree Number 23/2016 on PKSAI readings and information • PKSAI Klaten Pocket Book, UNICEF, Yayasan Setara, LPA • Implementing Guideline PKSAI, MoSA and UNICEF, 2017 • Surakarta PKSAI Guideline Book, Surakarta City Government, 2020

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• Naning Pudji Julianingsih, Child Protection Specialist UNICEF ([email protected]) Contact • Winarno, Child Protection Office Tulungagung ([email protected]) details • Evi Harmani, Social Affair Office Surakarta ([email protected]) • Hari Suroso, Social and Child Protection Office Klaten ([email protected])

114 © UNICEF/2019/veskadinda115 ANNEX: COMPENDIUM OF GOOD PRACTICES

1 Strengthening Sub-National Government to Effectively Aceh 117 Engage with Business to Achieve Results for Children 2 Adolescent Empowerment and Disaster Risk Reduction East Nusa Tenggara 120 (DRR) (NTT), Lampung, Central Java and Central Sulawesi

116 Strengthening Subnational Government to Effectively Engage with Business to Achieve Results for Children General topic area: Modelling child-focused public/private engagement and partnership Location: Aceh (Aceh Singkil)

UNICEF supported the development planning agency (Bappeda) of Aceh Singkil to effectively engage with private businesses to improve results for children. UNICEF provided technical assistance and a consultant to ensure that the district’s development and business agendas were aligned to prioritize children by: • Applying child rights and business principles and related tools to develop awareness and build a business case • Improving young peoples’ participation by including adolescent groups in the analysis, planning and design of the corporate social responsibility (CSR) framework. Youth Summary participation also extended to their representation, through the child forum and of the student councils, in the corporate social responsibility (CSR) framework and forum, Approach thus ensuring their active role in both planning and monitoring. Youth integration was implemented under a 2019 Sharia Law on Corporate Social and Environment Responsibility, while the specific regent decree on CSR Forum is being drafted. • Geospatial information system (GIS) mapping overlay analysis was used to identify overlapping conditions and key deprivations faced by children and families and to determine the CSR implementation location. • Developing technical guidance (handbook/notes/tools) for Bappeda and the CSR Forum on how to conduct participatory engagement, align priorities and undertake monitoring & evaluation.

• 20 adolescents involved as representatives during the first phase of activity, ensuring a child-focused and inclusive CSR Forum. Until end of December 2020 more than 50 adolescents are trained for Adolescent development and participation (ADAP) whereas 20 adults trained as adolescent facilitators on how to work with adolescent representing officials from sub-national government and businesses. • Child Forums institutionalized in villages and districts under Regent Decree No. 240 of 2019, which declared that children’s interests must be accommodated through the CSR Key Results programme. Achieved • 9 MoU signed between sub-national government and companies as result of Public – Private Partnerships focusing on Education, Health, Economic Empowerment and Environment (7 palm oil companies, 1 provincial government owned bank, and 1 state own enterprise). • Improving Bappeda’s information system with GIS-based mapping software and training. In minimum, 15 maps have been developed with 10 overlay mapping such as concession against stunting; malnutrition, open defecation free (ODF) and human development index (HDI).

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A knowledge-sharing forum - on lessons learned, guidance and tools and showcasing the use of GIS-based mapping for analysis and decision making was completed in December 2020. In collaboration with district government organizations, this provincial-level event should enable Aceh Singkil’s District Development Planning Board to share the approach with other sub-national governments throughout Aceh and other provinces. In December 2020, UNICEF has received request from other local governments to replicate this assistance; Meulaboh City in Aceh Barat and a district in North Sumatera as they aim to achieved Child-Friendly District/City status.

• Field consultant • ToT for child facilitators • ADAP training for adolescents Cost • Handbook and new tools publication • GIS-mapping software and training Replicability/ • Coordination meeting up-scaling • Understanding of government and business systems • Understanding of child rights and business principles Skills • Understanding of business compliance, standards and regulations • Strong Stakeholder analysis and engagement

• Bappeda • District government • Association of district government Stake- • Business leaders holders • Managers of human resources, sustainability and CSR • Civil society organizations • Child forum • Adolescents (student councils)

• Evidence generated for business to understand their adverse impact on children are critical to build strong case. • Strong stakeholder analysis to identify champion, influencer and strong leadership in government and business are essential. • Children as future generation are strategic issues for business Lessons Learned • Business need intensive technical assistance to help them improve their business process and commitment to district development. • Adolescents can be key stakeholders in the processes of planning, designing and monitoring and evaluation. • CSR structure can become more effective by ensuring the participation of adolescent groups as key stakeholders.

118 • Encouraging engagement by adolescents in surrounding villages and engaging employee’s children can achieve a more child-inclusive programme. Involving employees as facilitators of Child Forums could encourage alignment of the CSR programme in fulfilling children’s rights. • Using GIS mapping from the outset improves needs assessments and initial mapping of potential correlations between key deprivation and business impacts on Lessons communities and the environment. Learned and Replication • Alignment between budgeting period of government and businesses, as it may fall in different period such as calendar year and fiscal year. For business to budget and include development priorities, missed the budgeting window will lead to business unable to execute their commitment or plan. • Business operates in sub-national are mostly subsidiary of national or global entity, holistic advocacy is needed to ensure their holding or headquarter are endorsing the commitment too.

Further Aceh Singkil District Head Signed MoU on CSR readings and www.aceh.tribunnews.com/2020/11/19/bupati-aceh-singkil-dan-pimpinan-perusahaan- information teken-mou-penyaluran-csr

• Lukita Setiyarso, Partnership Officer UNICEF ([email protected]) Contact • Andi Yoga Tama, Chief of Field Office - Banda Aceh ([email protected]) details • Musa, S. Hut, M.Si, Bappeda of Aceh Singkil (email [email protected])

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Adolescent Empowerment and Disaster Risk Reduction (DRR) General topic area: Adolescent Development and Participation, DRR Locations: East Nusa Tenggara (Kupang City), Lampung (Bandarlampung City), Central Java (Boyolali), Central Sulawesi (Palu City, Sigi, Donggala)

A programme was launched to build the capacity of adolescent girls and boys to be better prepared before, during and after an emergency. Using the Adolescent Kit for Expression and Innovation, adolescents mapped potential risks, developed stories on the pressing issues that affect them and presented them at community events, village council Summary meetings and school events. They also spearheaded innovative solutions for these issues of the and engaged with policymakers and community members to mobilize the resources Approach needed for those solutions. Building on this experience, the Ministry of Education and Culture is strengthening adolescent participation in conducting assessments in safe schools. Additionally, capacity-building support is being provided to the Ministry’s Emergency Response Personnel to better equip responders to implement adolescent- specific activities in affected areas.

• Skills and competency building among adolescents. • Adolescents regarded as positive member of society. Key Results • Village and District leaders agreed to include adolescents in planning processes. Achieved • Inclusive disaster risk reduction (DRR) process. • 88% of adolescents reported increased confidence to speak up.

• Bandar Lampung City and Pringsewu District allocated budget to Child Forum to scale-up the programme in 2018. • The Adolescent Kit methodology is used in emergency responses such as Central Sulawesi earthquake and Mount Agung eruption response. • The Adolescent Kit has been integrated within the UNICEF-supported Life Skills Education curriculum for junior, senior, and vocational high schools, including madrasah. The teacher training component is available on guru belajar platform: www.gurubelajar-lse.simpkb.id/ Replicability/ up-scaling • Printing and distribution of Adolescent Kit for Expression and Innovation • Capacity building for teachers and government officials • Training of trainers for youth facilitators (including refresher training) Cost • Roll-out of Adolescent Kit methodology (including travel allowance for youth facilitators, additional supplies, refreshments) • Documentation and communication assets • Campaign and advocacy to local stakeholders

120 • Creativity • Decision-making • Problem-solving • Communication Skills • Critical thinking • Empathy and respect • Cooperation and teamwork • Stress management

• Adolescents • Youth Facilitators from the Child Forum or other platforms Stake- • Parents holders • Teachers • Village and District officials

• Investment in facilitator capacity building is critical • Investment in the enabling environment (adult stakeholders) is also critical to ensure Lessons adolescents can not only feel empowered, but also take action. Learned • Platforms for adolescent participation are available in Indonesia but vary greatly in terms of providing real opportunities for adolescents to meaningfully participate.

Further • Social Media: www.instagram.com/explore/tags/adolescentcircles/ readings and • Blog: www.unicefindonesia.blogspot.com/2017/06/adolescents-take-action-adults- information listen.html

• Ticiana Garcia-Tapia, Youth & Adolescent Development Specialist UNICEF, Contact ([email protected]) details • Febryanthie Apituley, Education Officer UNICEF ([email protected])

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122 123 ANNEX: COMPENDIUM OF GOOD PRACTICES

May 2021

UNICEF World Trade Center II, 22nd Floor, Jl. Jend. Sudirman Kav. 31 Jakarta 12920, Indonesia. Tel: +62 21 5091 6100

Fax: +62 21 571 1215

Email: [email protected]

Website: www.unicef.or.id

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