System Design Analysis for Stunting Prevention in Indonesia

Risnandya Primanagara

, Amri Tablighi

and Samuel Wiguna

Department of Epidemiology and Statistics, Faculty of Medicine, Universitas Swadaya Gunung Jati, Indonesia

School of Computer Science, Bina Nusantara University, Indonesia

Keywords: Stunting, Prevention, Decision Support, System Thinking, Mobile.

Abstract: Background: Stunting is becoming a worldwide problem; in Indonesia particularly, stunting is a national

concern. Basic Health Research Indonesia indicated that there are 30,8% children in Indonesia whose growth

is stunted. Indonesia deployed a National Strategy to urge Stunting Prevention in the period of 2018–2024 as

an intervention towards the growing trend of stunting problems. One of the key concepts in prevention is

effective screening of children’s growth. This concept leads to a screening system that can and should be

developed. Methods: A Stunting Screening Decision Support System was designed to maintain children’s

growth data. This system was designed using the system thinking approach, which allows many sources and

components, in addition to those built into the system. Analysis: The system is intended to be widely used by

healthcare professionals using mobile technology. The growth data can be aggregated therein and would be

reported hierarchically. The aggregated reports will be essential for stunting prevention and will help

healthcare stakeholders to find a solution to stunting prevention. Discussion: Stunting prevention is a

combination of many aspects and elements. A decision support system can be effective for screening and

prevention of stunting. Healthcare stakeholders can use the reports from this system in many healthcare-

related aspects.

1 BACKGROUND

Stunting is becoming a worldwide problem. In

Indonesia particularly, stunting is a national concern.

In 2013, Indonesia’s Basic National Health Research

stated that for toddlers under five years of age, there

was a 37.2% prevalence of stunting. Even though this

declined in 2018, reaching only 30.8%, this is still a

considerably high number. Similar declining also

showed that infants under two years of age had a

prevalence of 32.8% in 2013, which lowered to

29.9% in 2018.

Some points still provide a challenge to stunting

rates in Indonesia. The number of low birth rates

recorded in 2018 were 6.2%. Low birth length was

calculated at 22.7% in 2018. Complete Basic

Immunisation was low, with 9.2% not getting any

immunisations (Tim Nasional Percepatan

Penanggulangan Kemiskinan (TNP2K), 2018).

Research findings on risk factors for stunting are

complicated and abundant. risk was reported, but not

limited to, calorie intake, illness duration, birth

weight, mother’s education and family income (Hadi

et al., 2019; Umar and Haryanto, 2019). Other

research shows that the reduction of poorer

households and effective health services are

improving stunting reduction for children under five

years of age (Rizal and van Doorslaer, 2019).

Maternal health, premature birth and exclusive

breastfeeding in the first six months, along with

sanitation are all risk factors. Different risks require

different approaches. Indonesia has different

demographics with a large disparity in the regions, so

interventions require a distinct approach between

provinces, regencies and cities (Beal et al., 2018).

To detect stunting, a grow chart created by the

World Health Organization is typically used in many

countries. In Indonesia, the grow chart used was is

provided in the KMS (Kartu Menuju Sehat) or Health

Target Card, but only the length for age or height for

age is used (Ohyver et al., 2017).

Indonesian people require adequate education,

and intervention is delivered through an internal

source. Therefore, a health cadre is involved in the

primary healthcare centre. A health cadre usually

consists of local citizens who live in the area and are

Primanagara, R., Tablighi, A. and Wiguna, S.

System Design Analysis for Stunting Prevention in Indonesia.

DOI: 10.5220/0009421800530056

In Proceedings of the 4th Annual International Conference and Exhibition on Indonesian Medical Education and Research Institute (The 4th ICE on IMERI 2019), pages 53-56

ISBN: 978-989-758-433-6

Figure 1: Design thinking on Stunting key aspect.

assigned to promote health in the area. They become

the main source of health information, including

information related to stunting issues. They develop

interpersonal communications among the citizens to

effectively ensure people’s use of healthcare

facilities. Good interpersonal communication can

promote rapid change in social behaviour

(Kementerian Kesehatan RI, 2018a).

In addition to the existence of health cadres, an

information system is proposed to assist in stunting

prevention (Ohyver et al., 2017). IT-based

technology determines the ability of persons in an

organisation that could amplify, complement,

leverage and improve their capabilities. In this

modern era, IT is very useful in knowledge

management (Jain, 2009). This system is designed to

improve problem-solving and decision-making that

can in turn promote a better system (Kementerian

Kesehatan RI, 2018b). To build such a value-added

information system, a design-thinking approach is

used. This is due to the interconnection between

stakeholders that is hierarchically built (Barnes,

2017).

1.1 Aim

The system is designed to handle decision

management using mobile technology. This system

will be used by health cadres as the primary frontline

for the people, and the data collected will be

hierarchically used by stakeholders for stunting

prevention measures.

The data will also include risk factor analyses,

along with child nutritional statuses relevant to the

region. This information will determine which region

needs special awareness from the correlated

stakeholders.

2 METHOD

The Stunting Screening Decision Support System

was designed to maintain children’s growth data.

This system was designed using the system-thinking

approach. Usage of system-thinking is built using an

interdisciplinary approach to support and connect

intuitive and high-impact decisions. To be precise, a

system that could widely be accepted was designed

and noted in eight steps of system-thinking (Arnold

and Wade, 2015).

Furthermore, the eight steps on system-thinking

were applied towards five key aspects of stunting

prevention provided by the National Strategy for

Stunting Prevention to ensure all interconnection is

considered, including all possible risk factors. The

key process is shown in Figure 1.

This approach allows many sources and

components, in addition to built into the system. The

designed system allows the loop of knowledge

between stakeholders to be maintained. From the

convergence of the health cadres, the engineered

systems can be built to match the intended factors.

The 4th ICE on IMERI 2019 - The annual International Conference and Exhibition on Indonesian Medical Education and Research Institute

Figure 2: Interconnections between aspects.

Figure 3: Mock-up of the system design.

2.1 Applications Mock-up

The interconnection between the stunting

environment was analysed and described in Figure 2.

The system is intended to be widely used by health

cadres through the use of mobile technology. The

cadre is designated to be a frontline for the people to

ensure the sustainability of the system. Furthermore,

a hierarchical assessment can be made from

appropriate stakeholders, so the system can be used to

make effective decisions in the prevention of

stunting.

A mock-up of the system can be found in Figure

3, where the system design is delivered and the

variables are used. The design is intended to enable

the assessment of information from gathered data in

order to be a hierarchically designed Decision

Support System.

System Design Analysis for Stunting Prevention in Indonesia

3 DISCUSSIONS

Interdisciplinarity is becoming a key concept related

to the system, in order to fulfil greater objectivity. A

challenge found in this system is the need for

effective teamwork to focus necessary attention

towards stunting prevention. This can lead to

stagnancy and bottlenecks with barriers to the guiding

philosophy. Complexity can be simplified by firstly

simplifying any contradiction found (Aragrande and

Canali, 2015).

System-thinking is more than context itself. A

complex system acts as a staging area to elicit

thinking itself. Furthermore, an extension for this

system needs to be examined to create better, more

precise system-thinking (Deep, Pathan and Mitra,

2018).

This health design can relate between health

providers and health recipients the convergency that

needs to be generated to ensure that the design is

embodied and generated by health professionals

alongside design engineers (Pannunzio, Kleinsmann

and Snelders, 2019).

4 CONCLUSIONS

Stunting prevention is a combination of many aspects

and elements. Interconnections between the elements

are led into this system. This decision support system

can come through for screening in stunting

prevention. The reports on this system design are

expected to be used by health stakeholders, who can

use the reports in many aspects of healthcare.

ACKNOWLEDGEMENT

The design of the system was formerly taken as part

of the IMERI Innovation Awards of 2019 and was

then developed into a research paper.

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The 4th ICE on IMERI 2019 - The annual International Conference and Exhibition on Indonesian Medical Education and Research Institute