Give us raw food materials: Qualitative analysis of stunting prevention challenges at Mandala Health Center

Suhartina Suhartina* -  Department of Family Medicine, Universitas Prima Indonesia, Medan, North Sumatra, Indonesia
Chris Cahyani Lase -  Department of Public Health, Universitas Prima Indonesia, Medan, North Sumatra, Indonesia
Putranto Manalu -  Department of Public Health, Universitas Prima Indonesia, Medan, North Sumatra, Indonesia
Buenita Sinurat -  Department of Public Health, Universitas Prima Indonesia, Medan, North Sumatra, Indonesia
DOI : 10.30867/action.v11i2.2976

Stunting remains a critical public health concern in Indonesia, with long-term implications for children's physical and cognitive development, despite governmental efforts that have failed to meet national targets. This study evaluated the effectiveness of the stunting prevention program at the Mandala Community Health Center in Medan and identified the supporting and inhibiting factors in its implementation. A qualitative case study was conducted from February to April 2025, gathering data through in-depth interviews, observations, and document analysis with five key informants, including health officials, community health cadres, and mothers. Edward III’s implementation theory (encompassing communication, resources, disposition, and bureaucratic structure) guided the analysis, with thematic patterns identified and validity ensured via triangulation and member checking. The results revealed effective program socialization across levels, adequate budget allocation offset by challenges from processed food assistance over raw materials, strong implementer commitment, and consistent adherence to standard operating procedures. The study concluded that the program was administratively robust, but reliance on processed food posed a key barrier, recommending policy shifts to prioritize raw food provision for greater effectiveness.

Keywords : stunting prevention; policy implementation; health program evaluation

  1. Al Humaerah, M., Rahayu, M., & Zainuddin, Z. (2024). Analysis of stunting prevention through communication, information and education with empowerment. Jurnal Ilmiah Kesehatan Sandi Husada, 13(2), 396–402. https://doi.org/10.35816/jiskh.v13i2.1229
  2. Ariadi, S. (2023). Integrated handling to overcome stunting in rural areas in East Java, Indonesia. Masyarakat, Kebudayaan Dan Politik, 36(3), 436–450. https://doi.org/10.20473/mkp.V36I32023.436-450
  3. Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal & Child Nutrition, 14(4), Article e12617. https://doi.org/10.1111/mcn.12617
  4. Braa, J., Sahay, S., Lewis, J., & Senyoni, W. (2017). Health information systems in Indonesia: Understanding and addressing complexity. In J. Choudrie, M. Islam, F. Wahid, J. Bass, & J. Priyatma (Eds.), Information and communication technologies for development (pp. 59–70). Springer. https://doi.org/10.1007/978-3-319-59111-7_6
  5. Buthelezi, U. E., van Rensburg, A. J., Moshabela, M., Bucibo, S., Radebe, N., Luvuno, Z., Kathree, T., Bhana, A., & Petersen, I. (2025). A realist perspective on optimizing community health workers’ roles and functions to deliver integrated people-centred care. PLOS Global Public Health, 5(9), e0004926. https://doi.org/10.1371/journal.pgph.0004926
  6. Chotivichien, S., Jitaree, W., Phuengpan, W., & Hyder, S. M. (2025). Reframing nutrition policy for under-five children in Thailand: Beyond the first 1,000 toward 2,500 days. Indonesian Journal of Public Health Nutrition, 6(1). https://doi.org/10.7454/ijphn.v6i1.1089
  7. Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE Publications.
  8. Damari, B., & Riazi-Isfahani, S. (2018). Evaluating the women health volunteers program in Iran: A quarter century experience (1992–2016). Archives of Iranian Medicine, 21(12), 566–571.
  9. Danefi, T., Agustini, F., Sumartini, E., & Ratna Hidayani, W. (2024). An overview of the role of integrated healthcare center cadres in preventing stunting in babies toddler in Cikunir Village. Siklus: Journal Research Midwifery Politeknik Tegal, 13(2). https://doi.org/10.30591/siklus.v13i2.6568
  10. De Sanctis, V., Soliman, A., Alaaraj, N., Ahmed, S., Alyafei, F., & Hamed, N. (2021). Early and long-term consequences of nutritional stunting: From childhood to adulthood. Acta Biomedica, 92(1), e20211346. https://doi.org/10.23750/abm.v92i1.11346
  11. Ekholuenetale, M., Barrow, A., Ekholuenetale, C. E., & Tudeme, G. (2020). Impact of stunting on early childhood cognitive development in Benin. Egyptian Pediatric Association Gazette, 68(1), 31. https://doi.org/10.1186/s43054-020-00043-x
  12. Fertig, A. R., Loth, K. A., Trofholz, A. C., Tate, A. D., Miner, M., Neumark-Sztainer, D., & Berge, J. M. (2019). Compared to pre-prepared meals, fully and partly home-cooked meals in diverse families with young children are more likely to include nutritious ingredients. Journal of the Academy of Nutrition and Dietetics, 119(5), 818–830. https://doi.org/10.1016/j.jand.2018.12.006
  13. Hien, A., Somé, J. W., Sombié, O. O., Traoré, I., Zeba, A. N., Ouedraogo, G. A., & Meda, R. N.-T. (2024). Effect of a nutrition education intervention on food safety knowledge, attitudes and practices. Food and Nutrition Sciences, 15(5), 401–420. https://doi.org/10.4236/fns.2024.155027
  14. Hosen, S., Hamzah, S. R., Arif Ismail, I., Noormi Alias, S., Faiq Abd Aziz, M., & Rahman, M. M. (2024). Training and development, career development, and organizational commitment as predictors of work performance. Heliyon, 10(1), e23903. https://doi.org/10.1016/j.heliyon.2023.e23903
  15. Hudson, B., Hunter, D., & Peckham, S. (2019). Policy failure and the policy-implementation gap. Policy Design and Practice, 2(1), 1–14. https://doi.org/10.1080/25741292.2018.1540378
  16. Hume-Nixon, M., & Kuper, H. (2018). The association between malnutrition and childhood disability in low- and middle-income countries. Tropical Medicine & International Health, 23(11), 1158–1175. https://doi.org/10.1111/tmi.13139
  17. Jaya, P. H. I., Izudin, A., Aditya, R., & Saptoni, S. (2025). Exploring local experiences in reducing childhood stunting in Indonesia. Asia Pacific Journal of Social Work and Development, 1–24. https://doi.org/10.1080/29949769.2025.2485912
  18. Kementerian Kesehatan Republik Indonesia. (2021). Buku saku hasil studi status gizi Indonesia (SSGI) tahun 2021. Badan Litbangkes.
  19. Kim, S. S., Avula, R., Ved, R., Kohli, N., Singh, K., van den Bold, M., Kadiyala, S., & Menon, P. (2017). Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India. BMC Public Health, 17(1), 161. https://doi.org/10.1186/s12889-017-4088-z
  20. Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size in qualitative interview studies. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444
  21. Martha, E., et al. (2020). The empowerment of cadres and traditional birth attendants in early detection and prevention of stunting. The Indonesian Journal of Public Health, 15(2), 153–161. https://doi.org/10.20473/ijph.v15i2.2020.153-161
  22. Mubarok, S., Zauhar, S., Setyowati, E., & Suryadi, S. (2020). Policy implementation analysis. Journal of Public Administration Studies, 5(1), 33–38. https://doi.org/10.21776/ub.jpas.2020.005.01.7
  23. Niederdeppe, J., Boyd, A. D., King, A. J., & Rimal, R. N. (2025). Strategies for effective public health communication in a complex information environment. Annual Review of Public Health, 46(1), 411–431. https://doi.org/10.1146/annurev-publhealth-071723-120721
  24. Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research. Quality & Quantity, 52(4), 1893–1907. https://doi.org/10.1007/s11135-017-0574-8
  25. Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2019). Determinants of the stunting of children under two years old in Indonesia. Nutrients, 11(5), 1106. https://doi.org/10.3390/nu11051106
  26. UNICEF, WHO, & World Bank. (2023). Levels and trends in child malnutrition: Joint child malnutrition estimates (2023 edition). UNICEF & WHO.
  27. Vareilles, G., Pommier, J., Marchal, B., & Kane, S. (2017). Understanding the performance of community health volunteers involved in health programmes. Implementation Science, 12(1), 22. https://doi.org/10.1186/s13012-017-0554-3
  28. Wardani, N. E. K., Harumi, A. M., & Sholikah, S. M. (2023). Analysis of the 1000 HPK program toward reducing stunting. Malahayati Nursing Journal, 5(4), 969–986. https://doi.org/10.33024/mnj.v5i4.8242
  29. WHO. (2022). Global Health Observatory data repository / World health statistics.
  30. Wicaksono, F., & Harsanti, T. (2020). Determinants of stunted children in Indonesia. Kesmas: National Public Health Journal, 15(1), 48–56. https://doi.org/10.21109/kesmas.v15i1.2771
  31. Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE Publications.
  32. Yuliana, A. I., Nasirudin, M., & Qomariyah, S. N. (2023). Food safety education for PKK cadres through borax and formalin detection training. Community Empowerment, 8(10), 1584–1591. https://doi.org/10.31603/ce.10307

Open Access Copyright (c) 2026 Suhartina Suhartina, Chris Cahyani Lase, Putranto Manalu, Buenita Sinurat
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AcTion: Aceh Nutrition Journal
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