Securing a Health and Nutrition-Conscious Young Generation
through the School and Community Education System for Society 5.0
by Jesus C. Fernandez, PhD
Deputy Director for Program
SEAMEO RECFON
Abstract
The creation of a Society 5.0 would require quality human resources that are forward-looking,smart, responsible and practice an active and healthy lifestyle. Balanced nutrition contributes
to producing this kind of human resources that are critical in bringing about faster economic
growth and reducing social problems for society members.
SEAMEO RECFON promotes balanced nutrition from early childhood to adolescent-aged school
children through its two flagship programs, namely: Early Childhood Care, Nutrition and
Education (ECCNE) and Nutrition Goes to School (NGTS). Launched in late 2016, the NGTS
program is a school-based multisectoral program designed to build character and improvestudents’ learning outcomes and active participation in school activities by practicing proper
nutrition, hygiene and sanitation. It is being piloted in 6 districts in East and West Java, andWest Kalimantan provinces in Indonesia involving 55 primary, junior high and vocational
schools. The ECCNE program was conceptualized in 2017 as a community-based multisectoralintervention program aimed at providing a model of integrated implementation of essential
components of childcare and parenting to ensure optimal psychomotor, cognitive andaffective growth and development of a child. It is being piloted in one district each in East Java,West Kalimantan and Central Sumatra provinces in Indonesia involving 54 community earlychildhood education centers. These programs are SEAMEO RECFON’s modest attempts tocontribute to Sustainable Development Goals Target 2.2 and SEAMEO Priority Areas 1 and 2.
This paper presents the experiences and contributions of SEAMEO RECFON’s ECCNE and NGTS
programs thus far in Indonesia to help secure a health and nutrition-conscious young
generation to support the creation of a Society 5.0.

Introduction
Malnutrition is a global and multisectoral concern that affects human capacities to contribute to national
development. The so-called triple burden of malnutrition, (i.e. underweight, overweight, and nutrient
deficiencies) does not discrimite age, socioeconomic class and gender that could result to different types
of illness and mortality. These forms of malnutrition can co-exist in the same individuals, withinhouseholds and communities across different countries and regions. Thus in 2015, the UN member statesagreed to “end malnutrition in all its forms” as Target 2 under the Sustainable Development Goal (SDG)
2 by 2030. SDG 2 focuses on ending hunger, achieving food security, improving nutrition and promoting
sustainable agriculture. The UN also declared 2016-2025 as the Decade of Action on Nutrition toaccelerate the implementation of this target globally towards a healthy and productive population.

Under-five and school-aged children up to adolescence are considered among the sectors of the societythat are most vulnerable to malnutrition. Malnourished children are most likely to experience slow orpoor brain development which then affect their performance in school. In the long run, this may limit
their opportunities to find a decent job during adulthood and thus affect the country’s economic growth.
Southeast Asian countries experience varying forms of malnutrition. The 2018 Global Nutrition Report
indicates that overweight is prevalent in Brunei Darussalam, anemia in Singapore, stunting in thePhilippines, overweight and anemia in Thailand, stunting and anemia in Cambodia, Indonesia, Lao,
Myanmar, Timor Leste and Vietnam, and overweight, anemia and stunting in Malaysia.
In support of the SDGs, the Southeast Asian Ministers of Education Organization (SEAMEO) identified
seven priority areas in 2015 wherein the mandates and expertise of its 26 specialist centres could be fully
tapped. The seven priorities are (1) Achieving Universal Early Childhood Care and Education, (2)Addressing Barriers to Inclusion, (3) Promoting Resilience in the Face of Emergencies, (4) Promoting
Technical and Vocational Education and Training, (5) Revitalizing Teacher Education, (6) Promoting
Harmonization in Higher Education and Research, and (7) Adopting a 21st Century Curriculum.
As one of the specialist centres of SEAMEO, the Regional Centre for Food and Nutrition (RECFON) initiatedtwo flagship programs under its Second Five-Year Development Plan (2016-2021) to address the first andthe second priority areas, namely: Early Childhood Care, Nutrition and Education (ECCNE) and Nutrition
Goes To School (NGTS), respectively. These programs are also the Centre’s modest attempts to contributeto achieving SDG Target 2.2. SEAMEO RECFON believes that promoting proper nutrition to the young
generation could help them secure a better future and allow them to respond to the demands of theIndustrial Revolution 4.0 and conform to the vision of Society 5.0.
The ECCNE and NGTS programs subscribe to the life-cycle approach to nutrition development of
individuals from early childhood to adolescence. The Centre sees the critical role of the school andcommunity education systems to achieve this.

General Approach , Framework, Intervention Type and Coverageof SEAMEO RECFON’s Flagship Programs on ECCNE and NGTS
Approach. SEAMEO RECFON adopts mitigation and prevention approaches for its flagship programs incombatting malnutrition among the under-five and school-aged children. The ECCNE Program focuses on
the mitigation approach towards preventing the effects of malnutrition among under-five children during
the later stage of their life. On the other hand, the NGTS Program deals with prevention approach to avoid
new born becoming malnourished by providing nutrition education to adolescent school children who
would eventually become parents.
Framework. Both programs operate within the Demand, Supply, Policy and Information System (DSPIS)
framework (Fig.1). The programs are expected to respond to and/or create the demand for target
stakeholders to choose healthier and nutritious foods that could be made available within and in theimmediate vicinity of the school and community learning centres. The programs are also expected toensure that target stakeholders have access to supplies of safe, affordable, locally available and nutritious
foods as wells as clean water and environment. The programs believes that having practical and easy to
implement policies to create an environment conducive to practicing good health and nutrition habits inschools and community learning centres among its stakeholers is critical. The information system ismeant to facilitate the creation of communication platform for sharing, monitoring and evaluating
program experiences and lessons learned for improvement and scaling up eventually.

Figure 1. The DSPIS Framework for NGTS and ECCNE Programs
Interventions. The activities of ECCNE and NGTS programs are combination of nutrition-sensitive andnutrition-specific interventions. These interventions are carried out through the community
development, capacity building, knowledge management, and research mandates of the Centre.
Coverage. SEAMEO RECFON is currently piloting the two flagship programs in Indonesia. The ECCNE
Program is being piloted in four sites in Indonesia, namely: Malang in Central Java Province, Sambas inWest Kalimantan Province, East Lombok in Nusa Tenggara Province, and Jambi in Central Sumatra
Province. It involves early childhood education (ECE) teachers, community health workers and mothers
for nutritional development of under-five children. The NGTS Program is being implemented in six sites,
namely: Sambas in West Kalimantan Province, Klaten in Central Java, Malang in East Java Province, andBogor, Cimahi and Cirebon in West Java Province. It involves school teachers and principals, local
education and health officers, and academic institutions for nutrition literacy of primary, secondary andvocational school children. The NGTS Program is expected to end its piloting period in Indonesia in 2021
while the ECCNE Program in 2022.

Several efforts have been made to initiate the implementation of NGTS and ECCNE Programs in other
Southeast Asian countries. These countries include Cambodia, Lao PDR, and Myanmar for ECCNE Programin 2018 and Timor Leste for NGTS Program in 2019. Both programs have been endorsed by the 11
Ministers of Education of Southeast Asian countries for scaling up during their 50th annual SEAMEO
Council Meeting in July 2019 in Kuala Lumpur, Malaysia.

The ECCNE Program: Ensuring Optimal Growth and Developmentof Under-Five Children
Early childhood development interventions, especially during the first 1,000 day in the life of a newborn,are essential in paving the way for better health and learning capacity, increased potential for livelihood
generation during adulthood, poverty reduction, fewer inequalities, and more peaceful societies (The2016 Lancet Early Childhood Development Series). These interventions could include promotion of
optimal infant and young child feeding, healthy home care and nutritional support, disease prevention,
management of childhood illness, and high-quality early childhood care and education (ECCE) programs.
These, however, present challenges for most national governments in Southeast Asia.
SEAMEO RECFON’s ECCNE program is a community-based multisectoral intervention program aimed atproviding a model of integrated implementation of essential components of childcare and parenting toensure optimal psychomotor, cognitive and affective growth and development of a child. It is acollaborative endeavor with other two SEAMEO Centres, namely: Regional Centre for Early Chilhood Care
Education and Parenting (CECCEP) and Regional Centre for Tropical Medicine (TROPMED) Network.
The ECCNE Program was conceptualized in 2017 but implementation fully took off in 2018. Its frameworkhas five components that are necessary to achieve an integrated approach to optimal child growth anddevelopment (Fig.2). These are arranged in a form of a house that represents a family, a household, aschool, or a community where they could and should operate. A house is supposed to serve as a nurturing
environment for a child’s growth and development, and security.

Figure 2. ECCNE Program Framework
Specifically, the program aims to:
1. Formulate strategies, approaches and guidelines for each program component and integratethem to form a single ECCNE model;

2.
3.
4.
5.

Generate evidence of the effectiveness of the strategies and approaches for each component;
Advocate the use of the ECCNE model to relevant stakeholders for adoption;
Build the capacity of stakeholder to implement the ECCNE model; andEstablish mechanisms for the sustainable implementation of the ECCNE model

The ECCNE Program has the following activities that are categorized into nutrition-sensitive andnutrition-specific according to the DSPIS Framework:
Classification in
DSPIS
DemandNutrition-Specific

Nutrition-Sensitive• Generation and implementation offood-based recommendations forunder-two children from locallyavailable nutrient-dense foodsources• Supplementary feeding• Learning Module Development• Capacity Building of EC Educators,
Parents & Community HealthWorkers on ECCNE• ECCNE Working Group Formation andFunctioning• ECCNE Working Group Formation andFunctioning• Advocacy to mainstream ECCNE
through partnership with local
governments and academic
institutions in program sites• ECCNE Working Group Formation andFunctioning

SupplyPolicy-Information
System-• Online Mapping of Early Childhood
Educators’ Competencies on ECCNE• ECCNE Working Group Formation andFunctioning

In Indonesia, the ECCNE Program supports the Presidential Regulation No. 60 of 2013 on Integrative
Holistic Early Childhood Development as well as the National Strategy on Accelerating Stunting
Prevention 2018-2024. After two years of implementation, the ECCNE Program has the following
accomplishments per activity type:
1. Online mapping of early childhood education (ECE) teachers’ competencies in ECCNE
A total of 17,821 ECE teachers in 484 out of 514 districts (94%) across all provinces of Indonesia
have been surveyed on their ECCNE competencies in October 2018. Interestingly, 77.3% of theseteachers have not received any training on nutrition which provided the strong justification for
SEAMEO RECFON to conduct series of capacity building activities in the ECCNE program sites.
2. Capacity building of ECE teachers, community health workers and mothers on ECCNE

•

•

•
•

Training of eight nutritionists and healthcare staff from two districts, 80 cadres and 480
mothers with under-two children on stunting prevention in February 2019 and March
2019 in Malang City and Sambas District, respectively
Training of 36 ECE teachers from 18 ECE centres in Sambelia and Pringabaya Subdistricts,
East Lombok District and West Nusa Tenggara District on ECCNE in disaster-prone areas
in February and April 2019
Training of 21 Master Trainers from Sambas, Malang and Tanjung Jabung on ECCNE under
the concept of Holistic-Integrative Early Childhood Education in September 2019
Training of Trainers on ECCNE under the concept of Holistic-Integrative Early Childhood
Education for 78 ECE teachers from Sambas and Tanjung Jabung in September 2019

3. Development of ECCNE learning materials••

Two learning modules have been developed and published, namely: ECCNE for Stunting
Prevention in February 2019, and Guidelines for ECCNE in Disaster-Prone Areas in April
2019
A series of 8 modules on Holistic and Integrative Early Childhood Care Education havebeen finalized for printing in February 2020

4. Establishment of ECCNE Models
Three ECCNE models have been established, namely:•••

Health Centre-based ECCNE Model for Stunting Prevention in Malang and Sambas
Districts starting in 2018
ECCNE Centre-based ECCNE Model for Stunting Prevention in Malang, Sambas andTanjung Jabung Districts starting in 2019
ECCNE Model for Post-Disaster Recovery in East Lombok District starting in 2018

Another model, Daycare-based ECCNE model, has been recently conceptualized and is expected
to be implemented in 2020 in Jakarta City.
5. Advocacy to Mainstream ECCNE Program through Partnerships
SEAMEO RECFON signed Memorandum of Understanding in 2018 with three academic
institutions, one district government and one civil society group to implement the ECCNE
Program. These institutions include the University of Brawijaya and Malang Health Polytechnic
Institute in Malang, East Java, Sambas District Government and Pontianak Health Polytechnic
Institute in West Kalimantan, and HIMPAUDI which is based in Jakarta.
SEAMEO RECFON has formulated a policy brief in 2019 on its research on formulation of local
specific food-based recommendations (FBR) for stunting prevention in ECCNE program sites andhad submitted it to the Ministry of Health of Indonesia for consideration. Details of the research
is discussed under No. 7.

6. ECCNE Working Group Formation and Functioning
The ECCNE Program has created its Indonesian Working Group on 9 July 2019 whose members
come from government education and health agencies, academic institutions, civil society group,
research organizations including SEAMEO RECFON. The Working Group is expected to carry out
mapping of competencies of ECE teachers, develop ECCNE learning materials and models, anddocument ECCNE best practices.
7. Formulation of local specific food-based recommendations (FBR) for stunting prevention in
ECCNE program sites
Using linear programming approach through Optifood software, the ECCNE Program teamdeveloped and tested optimized local specific food-based recommendations (FBRs) among 240
under-five children in two sites (i.e. Malang and Sambas) as intervention group for six months in2019 and compared the results with another 240 under-five children as control group (Fig. 3).

Nutrition education
session by
Nutritionist in
Community HealthCenters (CHC)(1 CHC = 4 Villages)

Monitoring of FBR
implementation by
Cadres twice a month(1x home visit and 1x
during the nutrition
education session)Community
Nutritionist
compiles themonitoring resultsfrom Cadres once amonthAssistance by Local Academe(POLTEKKES and District Health
Office)Figure 3. Implementation Scheme of Food-based Recommendation Promotion
And Nutrition Education in Two ECCNE Program Sites for Six Months

The study showed positive benefit in terms of improved dietary diversity score and nutrient
intakes among children in the intervention group. Additionally, the positive and significant benefitof CFR in terms of anemia and linear growth was observed in Sambas district in West Kalimantan
Province where the ratio of animal protein from animal source foods (ASF) to plant protein is 3:1
as compared to Malang where the ratio is 0.9:1. At the end of six-month promotion of optimized
FBRs in Sambas, significant differences were found among children under control (C) andintervention (I) groups in terms of stunting cases (C=33.5%, I=23.9%) and anemia cases (C=43.5%,
I=23.9%).

In 2018-2019, ECCNE Program Coordinator and team members have been providing technicalassistance to Ministries of Health of Cambodia, Lao PDR and Mynmar in formulating FBRs forunder-five children.

The NGTS Program: Developing AWESOME School-Aged Children

School Environment

AWESOME
SchoolChildren(Active, WellNourished,
and Smart Of

Extra Curricular

Policy & Management
Supportregular Classroom

School Environment

The NGTS Program targets school-aged children because it is in this period when eating habits aredeveloped and/or acquired either within or outside the household and school environments that could
affect their nutritional status later during adulthood. Thus, it is the opportune time to help improvedietary behaviors of this group of children. The program aims to develop AWESOME (i.e., Active, WellNourished, and Smart Of Me) school children that is expected to be manisfested in their school
performance both in class and extra curricular activities. An active student means performing any formof physical activity everyday in a week for at least 30 minutes per day as recommended by the Ministryof Health of Indonesia (2014). A student is well-nourished if his/her body mass index (BMI) fall in thenormal range as indicated in the growth curve published by WHO (2006). Being smart is measured
through the improvement in the academic performance of the students in class. The Program frameworkhas three components, namely: nutrition education, policy and management support, and school
environment improvement (Fig. 4). Policy and Management Support component refers to existing schoolrelated regulations and those that need to be developed as well as decision-making processes to makethe school environment and curricular activities address the health and nutrition needs of school children.
The school environment component refers to the socio-physical environment and the different
interactions taking place within the classroom, within the school campus, and in the immediate vicinity
outside the school. The nutrition education component refers to the integration of nutrition concepts
and principles in both the classroom and extra curricular activities of the students in relation to theirschool environment and policy and management support situation. These components are expected toplay critical roles when integrated in both classroom and extra curricular activities of school children to
become AWESOME.

Nutrition Education
Figure 4. NGTS Program Framework
The NGTS Program has the following activities that are categorized into nutrition-sensitive and nutritionspecific according to the DSPIS Framework:Classification in
DSPIS
DemandNutrition-Specific

Nutrition-Sensitive• Generation and implementation offood-based recommendations fromlocally available nutrient-dense foodsources for adolescent female
school children• Learning module development• Capacity building of school teachers,
local government education officials
on nutrition education and WASH
education• Continuous technical assistance via
social media• Establishment of Southeast Asia
School-Based Nutrition Promotion(SBNP) Working Group• Establishment of School Garden• Establishment of Health School
Canteen• Monitoring of Implementation of IFA
Supplementation• Establishment of Southeast Asia
School-Based Nutrition Promotion(SBNP) Working Group• Advocacy to mainstream NGTS
Program in schools partnership withlocal governments and academic
institutions in program sites• Establishment of Southeast Asia
School-Based Nutrition Promotion(SBNP) Working Group• Mapping of school readiness to
implement NGTS Program• Establishment of Southeast Asia
School-Based Nutrition Promotion(SBNP) Working Group

SupplyPolicy-Information
System-The NGTS Program supports several national government programs under the Ministry of Education andCulture and the Ministry of Health such as Usaha Kesehatan Sekolah (UKS or School Efforts for Health),
Program Sekolah Sehat (or Healthy School Program), Adiwiyata (or Green School Program), Program Gizi
Anak Sekolah (ProGas or School Feeding Program), etc.
After three years of implementation, the NGTS Program has accomplished the following:
1. School Readiness Mapping for NGTS Implementation
The Program sampled 664 schools (i.e. 74 percent government and 26 percent private) fromdifferent levels from the major islands of Indonesia in 2017 in relation to their readiness to
implement NGTS Program according to DSPIS framework. The results showed that around 78

percent of the schools surveyed were ready to implement an NGTS program. This enabled
SEAMEO RECFON identify and implement NGTS in certain program sites.
2. Learning Module Development
From 2017 to 2018, the NGTS Program developed five learning modules, namely:
•
•
•
•
•

Gizi dan Kesehatan AnaK Usia Sekolah Dasar (Health and Nutrition for Primary SchoolChildren)Gizi dan Kesehatan Remaja (Health and Nutrition for Adolescent School Children)
Panduan Gizi Seimbang untuk Remaja ( Balanced Nutrition Guide for Adolescent SchoolChildren)Kantin Sekolah Sehat (Health School Canteen)
Edukasi Gizi Berbasis Kebun Sekolah (Nutrition Education Based on School Garden)

3. Capacity Building of School Teachers and Piloting of NGTS with Partner-Schools
The NGTS Program had conducted Training of Trainers (face to face mode) for 396 teachers from114 partner-schools at all levels from six NGTS Program sites (i.e., Sambas, Malang, Cirebon,
Bogor, Klaten, Bandung, West Lombok) on nutrition, hygiene and sanitation education. It had also
trained 993 teachers from 105 schools via online mode. Both training modes required theparticipants to formulate action plans to implement any or a combination of NGTS activities (i.e.,
nutrition education, school garden, school canteen, physical activities, WASH) in their respective
schools.
4. Advocacy to Mainstream NGTS Program through Partnerships
Between 2018 and 2019, SEAMEO RECFON signed Memorandum of Understanding with eight
Health Polytechnic Institutes/University for implementation of NGTS Program in Bogor, Cimahi
and Cirebon Districts in West Java, Klaten District in Central Java, Malang City in East Java, andSambas District in West Kalimantan. Two partner-schools in Bogor sought to formalize theirpartnership with SEAMEO RECFON by signing an MOU in 2019.
5. Monitoring the Implementation of Iron Folic Acid (IFA) Supplementation under the Aksi Bergizi(Adolescent Nutrition) Project of UNICEF
Since NGTS Program targets adolescent school children, SEAMEO RECFON has been selected by
UNICEF as its partner-institution to carry out its Aksi Bergizi Project which includes the monitoringof the implementation of IFA supplementation among secondary school children.

Impacts Thus Far of SEAMEO RECFON’s Flagship Programs

on NGTS and ECCNE
A.

ECCNE Program
1. With the ECCNE Program experiences in developing learning modules,••

the Ministry of Education and Culture of Indonesia has endorsed the new set of 8 modules
on Holistic and Integrative Early Childhood Care and Education that the program teamdeveloped in 2019. The endorsement comes in the foreword from the Directorate
General of Early Childhood and Community Education. The modules are expected to be
published in March 2020.
the Ministry of Health of Indonesia requested SEAMEO RECFON’s ECCNE Program Teamto develop three guidelines on stunting prevention for District/City Governments,
Community Health Centers (Puskesmas), and Integrated Family Planning and HealthService Centers (Posyandu). The first drafts are expected to be ready before the end of2020.

2. The Ministry of Health of Indonesia has accepted, in principle, the recommendations containedin the policy brief developed by the ECCNE Program resulting from the research on formulating
local specific food-based recommendations for under-five children for stunting prevention in
Sambas and Malang sites in 2019. This policy brief will be launched in March 2020.
3. Two other district governments sought to formalize partnership with SEAMEO RECFON tostrengthen the implementation of the ECCNE model on stunting prevention. The Centre will besigning an MoU with the District Government of East Lombok in Nusa Tenggara Province, andTanjung Jabung East SubDistrict in Jambi Province in March 2020.
4. With the ECCNE Program team expertise and experiences in formulating local specific food-based
recommendations for under-five children, the Ministry, through funding support from GAIN and
the Government of United Kingdom, has requested SEAMEO RECFON to train local academe of
37 priority districts for stunting prevention on formulating local specific FBRs for their respective
localities. The training will be conducted in February 2020.
5. The Ministry of Religious Affairs of Indonesia and SEAMEO RECFON agreed to allocate slots forteachers of Islamic schools under the Ministry to join the online course on ECCNE for Early
Childhood Teachers in implementing the concept of holistic and integrative early childhood
education through parenting session. This online course will be conducted starting March to April
2020.

B.

NGTS Program1. At least 83 schools that have received NGTS training (face-to-face and online modes throughout
Indonesia) joined SEAMEO RECFON’s NGTS Awards to recognize those that have integrated
nutrition concepts and principles in their lesson plans for classroom and extra-curricular activities.
Ten schools became awardees from primary, junior, and senior/vocational levels.
2. With the progress made by the NGTS Program in various sites with partner-schools under the
Ministry of Education and Culture of Indonesia, the Universitas Muhammadiyah andMuhammadiyah Organization sought the partnership of SEAMEO RECFON to initiate the same
program to Madrasah schools to be piloted in Jakarta City starting in March 2020.
3. Some partner-schools have become finalists in the Healthy School Award at district/city,
provincial and national levels. In Cirebon site, two primary schools became finalists at the
district/city level, one junior high school at provincial level, and one junior high school at national
level in 2019. In Sambas, one junior high school is a finalist at national level for 2020.
Some Lessons Learned in Implementing SEAMEO RECFON’s
Flagship Programs on ECCNE and NGTS
1. Painting the bigger picture of the NGTS and ECCNE Programs including their relevance to global
protocols and national policies and programs is critical to obtain the buy-in of stakeholders
2. Clarifying the specific roles of partners, emphasizing shared ownership of the Programs, andformalizing the partnership help facilitate program implementation
3. Support/Endorsment from top provincial/district government officials helps ensure program
sustainability and wider coverage of implementation
4. Using existing national government programs as one entry point can boost the relevance andacceptance among partners
5. Research results provide for better evidence/informed-based decision making from among thepartners involved thus strengthening their commitments to the Programs
6. Selection of schools by district education offices and consensus with academic partnerinstitutions enhances program ownership and commitment to implement planned activities
7. Encouraging academic and government partners to integrate NGTS and ECCNE programs in theirregular activities could help reinforce implementation
8. Sustained and timely technical assistance to school teachers, ECE teachers, and community healthworkers is critical to ensure achievement of program objectives and targets
9. Aside from the face-to-face monitoring, the proper use of social media maintains continuous
communication, sharing of experiences, and documentation of progress between and among
partners

10. Providing proper recognition of efforts by school teachers/EC educators deepens their personaland school advocacy to promote NGTS and ECCNE activities.

References
Global Nutrition Report 2018
Lancet Early Childhood Development Series, 2016
WHO Child Growth Standards, 2006