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Journal on Education

Volume 05, No. 04, Mei-Agustus 2023, pp. 13218-13227


E-ISSN: 2654-5497, P-ISSN: 2655-1365
Website: http://jonedu.org/index.php/joe

Analysis Of Policy Formulation And Implementation Of Stunting


Reduction In Penajam Paser Utara District In 2021

Tri Utami1 , Kosasih2 , Rukhiyat Sayidin3


1,2,3
Universitas Sangga Buana, Jl. Phh. Mustofa No.68, Cikutra, Kec. Cibeunying Kidul, Kota Bandung, Jawa Barat
[email protected]

Abstract
One of the most crucial nutritional problems is stunting or short toddlers, especially in poor and developing
countries. Of the 100 districts with special stunting locations set by the central government in 2018, one of them
is Penajam Pasar Utara District. The local government has issued a policy through Regent Regulation No. 34 of
2019 concerning the Acceleration of Reducing and Prevention of Stunting which is a guideline for the
implementation of integrated stunting reduction and prevention programs. This research aims to analyze the
formulation and implementation of stunting reduction policies. The approach used in this study is a qualitative
approach. The research data were obtained from interviews and observations. The results of this study indicate
that the formula for accelerating the reduction of stunting includes integration of cross-sectoral programs to
accelerate, reduce and prevent stunting ; implementation of policies to accelerate reduction and prevention of
stunting implementation across sectors in a convergent manner and with comprehensive behavior change
communication.
Keywords : Formulation, Implementation, stunt

Abstrak
Salah satu masalah gizi yang sangat krusial adalah stunting atau balita pendek, terutama di negara miskin dan
berkembang. Dari 100 kabupaten lokasi khusus stunting yang ditetapkan pemerintah pusat pada tahun 2018,
salah satunya adalah Kabupaten Penajam Pasar Utara. Pemerintah daerah telah mengeluarkan kebijakan melalui
Peraturan Bupati Nomor 34 Tahun 2019 tentang Percepatan Penanggulangan dan Pencegahan Stunting yang
merupakan pedoman pelaksanaan program penanggulangan dan penanggulangan stunting secara terpadu.
Penelitian ini bertujuan untuk menganalisis perumusan dan implementasi kebijakan pengurangan stunting.
Pendekatan yang digunakan dalam penelitian ini adalah pendekatan kualitatif. Data penelitian diperoleh dari
wawancara dan observasi. Hasil penelitian ini menunjukkan bahwa formula percepatan penurunan stunting
meliputi integrasi program lintas sektor untuk percepatan, penurunan dan pencegahan stunting; implementasi
kebijakan percepatan penanggulangan dan pencegahan stunting implementasi lintas sektor secara konvergen dan
komunikasi perubahan perilaku yang komprehensif
Kata kunci : Formulasi, Implementasi, aksi

Copyright (c) 2023 Tri Utami, Kosasih, Rukhiyat Sayidin


Corresponding author: Tri Utami
Email Address: [email protected] (Jl. Phh. Mustofa No.68, Cikutra, Kec. Cibeunying Kidul)
Received 13 March 2023, Accepted 20 March 2023, Published 20 March 2023

INTRODUCTION
One of the most crucial nutritional problems, especially in poor and developing countries, is
the nutritional problem of stunting or short toddlers. Stunting is a form of growth and development
failure that causes linear growth disorders in toddlers as a result of the accumulation of inadequate
nutrition that has lasted for a long time from pregnancy to 24 months of age. Malnutrition during early
childhood growth and development will hinder physical development, increase morbidity, hinder
children's mental development, and even become a cause of death. The stunting nutritional problem
experienced by toddlers has a risk of decreasing productivity, intellectual abilities, and the possible
risk of experiencing degenerative diseases in the future (Ministry of Health, 2019) . Policies in
overcoming the problem of reducing stunting must focus on the first 1000 days of life or what is
Analysis Of Policy Formulation And Implementation Of Stunting Reduction In Penajam Paser Utara District In 2021,
Tri Utami, Kosasih, Rukhiyat Sayidin 13219

called Scaling Up Nutrition (SUN) until the age of 24 months. WHO (world health organization)
provides a recommendation of 3.9% reduction in stunting per year to meet the target of 40% or in the
last ten years it must decrease to 40%. Throughout the life cycle, the forms of intervention involved
various parties, both in the health and non-health sectors, such as the central and regional
governments, the private sector, and civil society. The United Nations through collective action in
efforts to improve nutrition both short-term (specific and long-term) interventions (sensitive
intervention) (Yanti, 2018) .
Monitoring of Nutritional Status (PSG) for the last three years, short toddlers have the highest
prevalence compared to other nutritional problems such as underweight, even obesity. the prevalence
of short toddlers has fluctuated from 2015, namely 29.0%, decreased in 2016 to 27.5% and increased
in 2017 to 29.6%, based on Basic Health Research (Riskedas) data showing that the proportion of
stunting in toddlers Short and very short nutritional status in Indonesia has decreased from 37.2% in
2013 to 30.8% in 2018 (Ministry of Health, 2019) . Government Regulation Number 83 of 2017
concerning Food and Nutrition Strategic Policy which emphasizes the preparation of the National
Action Plan for Food and Nutrition (RAN-PG) and the Regional Action Plan for Food and Nutrition
(RAD-PG) to create quality and competitive human resources in development of food and nutrition.
Furthermore, Presidential Instruction Number 1 of 2017 concerning the Healthy Living Community
Movement (Germas) which is able to improve education regarding balanced nutrition and the
provision of healthy food and accelerate nutrition improvement. According to the Nutrition Status
Monitoring (PSG) results, the percentage of stunted toddlers in East Kalimantan province in 2015 was
33.2% with the proportion of short toddlers being 17.8% and the proportion of very short toddlers
being 15.4%. One of the districts that has become a focus for reducing stunting in East Kalimantan is
Penajam Paser Utara where the district is ranked first with a prevalence of stunting in 2018 of 55.48%
(Ministry of Health, 2019)
The regional government of North Penajam Paser Regency issued a policy through Regent
Regulation Number 34 of 2019 concerning the Acceleration of Stunting Reduction and Prevention
which is intended as a guide in implementing the integration of stunting reduction and prevention
programs. Arrangements for accelerating the reduction and prevention of stunting aim to improve the
nutritional status of the community and the quality of human resources including improving
consumption patterns of a variety of balanced and safe nutrition based on local resources and
nutrition-conscious behavior, increasing access to food and the quality of nutrition services in
accordance with advances in science and technology, increasing food security and nutrition systems,
capacity building of human resources through communication, information, communication,
information and education (IEC) as well as training and increasing access to basic sanitation.
stunting prevention will be more effective if specific nutrition interventions and sensitive nutrition
interventions are carried out in a convergent manner. Service delivery convergence requires integrated
planning, budgeting and monitoring processes of government programs/activities across sectors to
13220 Journal on Education, Volume 05, No. 04, Mei-Agustus 2023, hal. 13218-13227

ensure the availability of each specific nutrition intervention service for priority target families and
sensitive nutrition interventions for all groups of society, especially the poor. In other words,
convergence is defined as an intervention approach that is carried out in a coordinated, integrated and
joint manner in target geographic areas and priority households to prevent stunting . Implementation
of convergent interventions is carried out by combining or integrating various resources to achieve a
common goal. Convergence efforts will be realized if national, regional and village
programs/activities as providers of specific and sensitive nutrition interventions are carried out in an
integrated and integrated manner according to authority, services from each specific and sensitive
nutrition intervention are available and accessible to groups of people who need it, especially homes.
households in the first 1,000 days of life (pregnant women, nursing mothers and children aged 0 – 23
months) and priority target groups use and benefit from these services. Convergence efforts to
accelerate stunting prevention are carried out starting from the planning, implementation, monitoring
and evaluation stages of programs/activities. The number of stunting cases can be seen from the
following table:
Table 1. Data on stunting in North Penajam Paser District
Target Projection of Stunting
Public health
No. Pusdatin Toddlers Toddlers Amount
center
0 – 59 months L P
1. Babulu 1692 21 6 27
2. mt. Diamond 630 39 23 62
3. Sebakung Jaya 359 24 18 42
4. waru 1475 8 5 13
5. Sharpener 3181 141 124 265
6. Petung 2093 17 7 24
7. cut 995 30 23 53
8. Kick 1 730 48 63 111
9. kick 3 580 47 41 88
10. Maridan 891 43 30 79
11 Semoi 2 333 15 1 16
Amount 12896 439 341 780
In carrying out the policy of accelerating reduction and prevention of stunting, the North
Penajam Paser District Health Office is trying to implement it optimally. The health profile in the
district, on average, that the existing posyandu is carrying out its main activities has not yet reached
80% by 2020, then the human resources in the health sector or health workers in quantity are still not
sufficient so that health services are not maximized, the number of doctors and midwives on duty at
the puskesmas not fully evenly distributed in every sub-district. This makes the implementation of the
stunting prevention policy implemented not optimal. The lack of coordination between agencies or
agencies is also one of the obstacles in implementing stunting reduction and prevention policies.
Successful policy implementation may fail ( frustrated ) when the executors are not fully aware of the
basic measures and policy objectives, both of which have a close relationship with the dispositions of
the implementers ( impletors ). The direction of the disposition of implementers ( impletors ) towards
Analysis Of Policy Formulation And Implementation Of Stunting Reduction In Penajam Paser Utara District In 2021,
Tri Utami, Kosasih, Rukhiyat Sayidin 13221

basic measures and policy objectives is also a "crucial" thing. Implementors may fail in implementing
the policy, because they refuse or do not understand what is the purpose of a policy. The goal of
health policy is to improve the health status of a country's population (Ayuningtyas, 2018) . The
meaning of the policy as a number of decisions that have been made by the parties responsible in the
health sector to act on a problem. Policies can be arranged at all levels from the lowest to the highest,
from the private sector and the state (Aryastami & Tarigan, 2017) . Policy is generally used to show
the behavior of an actor from the emergence of a policy, for example an official, organization or
institution or a number of actors in a particular field (Winarno, 2017)

Figure 1. Conceptual Framework of Integrated Stunting Reduction Intervention


The conceptual framework for the integrated stunting reduction intervention above is a guide
for city/district governments in reducing the incidence of stunting in which the city/district
government is given the opportunity to innovate by adding other effective intervention activities based
on experience and practice, both those that have been implemented in each each city/district with a
focus on reducing stunting.
The purpose of this study is to examine and analyze the extent to which the formulation and
implementation of policies to accelerate stunting reduction by the Health Office in North Penajam
Paser Regency have been formulated.

Figure 2. Eight Integrated Stunting Prevention and Reduction Actions


13222 Journal on Education, Volume 05, No. 04, Mei-Agustus 2023, hal. 13218-13227

Eight action integration intervention prevention And decline stunting on is instrument in form
activity or action Which used For increase implementation integration intervention nutrition in
reduction of stunting in the area .
Previous research related to stunting policies has been carried out both in the context of
research and community service. Research on stunting is carried out using a quantitative method
(Prihatini & Subanda, 2020) entitled Implementation of the Nesa Fund Allocation Policy in Integrated
Stunting Prevention Efforts with 100 respondents. The results of the study show the results of the
recapitulation of village fund policy implementation indicators, namely 78% which are carried out
according to priority funds village. Community service was carried out by (Bedasari, 2021) with the
title community service Implementation of Stunting Prevention Policies in Sepdas Village, Pasir
Panjang Karimu Village. While qualitative research was conducted by (Aditri, 2021; Damayanti,
2021; Fallo, 2020; Febrian & Yusran, 2021; Hermawati & Sastrawan, 2020; Wiguna, 2021; Yunus,
2018)

METHODS
Qualitative methods were used in this study with a phenomenological approach, namely
individual interpretation of the experiences of the informants (Sugiarto, 2018) . The research location
is in Penajam Paser Utara Regency, East Kalimantan for the period September – December 2022. The
resource persons in this study are Head of the Health Service, Convergence for the Acceleration of
Stunting Prevention ( KP2S), Head of the Family Health and Community Nutrition Section,
Balitbang, Social Service Program Holders, Program Holders Health Center Nutrition, Food Security
Service.

HASIL DAN DISKUSI


Policy Formulation for the Acceleration of Reduction and Prevention of Stunting
Stunting and other nutritional deficiencies that occur in the first 1000 days of life not only
cause barriers to physical growth and susceptibility to disease, but also threaten cognitive
development which will have an impact on the level of intelligence and productivity of children in
adulthood. As a result of stunting in the workforce in Indonesia, economic losses are currently
estimated at 10.5% of gross domestic product, or equivalent to Rp. 386 trillion. In North Penajam
Paser Regency, which consists of 30 villages and 24 sub-districts, based on the 2018 Riskesdas there
was an increase in stunted children from 36.8% in 2013 to 37.2% in 2018. The analysis results from
the Health Service showed that various behaviors in the community were found not to be optimal.
Referring to “The Conceptual Framework of the Determinants of Child Undernutrition , “
The Underlying Drivers of Malnutrition ”, and “Factors Causing Nutritional Problems in the
Indonesian Context”, the direct causes of nutritional problems in children including stunting are low
nutritional intake and health status. Stunting reduction focuses on addressing the causes of nutritional
Analysis Of Policy Formulation And Implementation Of Stunting Reduction In Penajam Paser Utara District In 2021,
Tri Utami, Kosasih, Rukhiyat Sayidin 13223

problems, viz factors related to food security, especially access to nutritious food (food), the social
environment related to the practice of feeding infants and children (care), access to health services for
prevention and treatment (health), and environmental health which includes the availability of clean
water facilities and (environmental) sanitation. These four factors affect nutritional intake and health
status of mothers and children. Intervention on these four factors is expected to prevent nutritional
problems, both deficiency and excess nutrition .
Efforts to accelerate stunting prevention will be more effective if specific nutrition
interventions and sensitive nutrition interventions are carried out in a convergent manner. Service
delivery convergence requires integrated planning, budgeting and monitoring processes of
government programs/activities across sectors to ensure the availability of each specific nutrition
intervention service for priority target families and sensitive nutrition interventions for all groups of
society, especially the poor. In other words, convergence is defined as an intervention approach that is
carried out in a coordinated, integrated and joint manner in target geographic areas and priority
households to prevent stunting. Implementation of convergent interventions is carried out by
combining or integrating various resources to achieve a common goal. Convergence efforts will be
realized if national, regional and village programs/activities as providers of specific and sensitive
nutrition interventions are carried out in an integrated and integrated manner according to authority,
services from each specific and sensitive nutrition intervention are available and accessible to groups
of people who need it, especially homes. households in the first 1,000 days of life (pregnant women,
nursing mothers and children aged 0 – 23 months) and priority target groups use and benefit from
these services. Convergence efforts to accelerate stunting prevention are carried out starting from the
planning, implementation, monitoring and evaluation stages of programs/activities.
Various stunting reduction policies are supported by North Penajam Paser Regent Regulation
number 34 of 2019 concerning the Acceleration of Stunting Reduction and Prevention, which
regulates the acceleration of stunting reduction and prevention. aims to improve the nutritional status
of the community and the quality of human resources including improving consumption patterns of a
variety of balanced and safe nutrition based on local resources and nutrition awareness behavior;
increasing access to food and quality of nutrition services in accordance with advances in science and
technology; improvement of food security and nutrition systems; increasing the capacity of human
resources through communication, information; communication, information and education (IEC) and
training; and increasing access to basic sanitation.
Penajam Paser Utara Regent Regulation number 34 of 2019 concerning the Acceleration of
Reduction and Prevention of Stunting explains that the strategy to accelerate stunting reduction
includes integration of cross-sectoral programs to accelerate, reduce and prevent stunting; and
monitoring and evaluation. Integration of cross-sectoral programs to accelerate, reduce and prevent
stunting is carried out through the implementation of family planning and family development
population programs; healthy living community movement; health of both mother and child;
13224 Journal on Education, Volume 05, No. 04, Mei-Agustus 2023, hal. 13218-13227

improving community nutrition and preventing stunting in villages and sub-districts; population
administration; religious coaching through the Taklim Assembly and Couples of Reproductive Age;
strategic issue of stunting; stunting publications; Food self-sufficiency; development of business
support systems for micro, small and medium enterprises; drinking water and sanitation; and
improving the quality of nutrition and food safety.
To implement the strategy to accelerate reduction and prevention of stunting, the local
government has formed a Convergence Team for the Acceleration of Stunting Prevention (KP2S).
The KP2S Team at the Regency Level as referred to in paragraph (2) functions: a) to carry out
effective coordination and communication across program lines and across sectors in an effort to
reduce stunting; b) review and analyze stunting problems and improve nutrition; c) planning stunting
reduction goals, objectives, priorities, strategies and programs; d) implementing and allocating
stunting reduction programs in the form of sustainable activities; e) provide socialization and
guidance to sub-districts, villages and sub-districts in relation to stunting reduction programs; f)
monitoring and evaluating stunting reduction programs in the regions; and submit a report to the
Regent once a year.
Convergent Implementation of Policies for the Acceleration of Stunting Reduction and Prevention
Policy implementation can be assessed for its performance through the success of a measure
and realistic policy goals. When the size and policy goals are too ideal to be implemented, it will also
be difficult to be able to implement them. So that in order to be able to see the performance of policy
implementation, the level of success can be measured through standards and targets in providing
explanations regarding regulations that form the basis for implementing policies to accelerate
integrated stunting prevention and whether policy implementers know and understand well what is the
goal in implementing the policy. Based on the results of interviews with informants, information was
obtained that the standard in carrying out the accelerated stunting prevention policy, the government
already had standards, namely the Penajam Paser Utara Regent Regulation No. 34 of 2019 concerning
the Acceleration of Integrated Stunting Prevention in accordance with the mandate of RI Presidential
Regulation No. 42 of 2013 concerning the National Movement for the Acceleration of Nutrition
Improvement which has now been replaced by Presidential Regulation of the Republic of Indonesia
Number 72 of 2021 concerning Accelerating the Reduction of Stunting. If you look at the regulation
of the Regent of North Penajam Paser Regency No. 34 of 2019 concerning the acceleration of
integrated stunting prevention, it is effective enough to be used as a basis for implementers in carrying
out an integrated stunting prevention policy.
The Health Office has carried out efforts to accelerate the reduction and prevention of
stunting through the following efforts: a) Monitoring growth and nutritional status through the
Community-Based Electronic Recording and Reporting of Nutrition application (EPPGBM), which is
an online application from the Ministry of Health of the Republic of Indonesia; b) Management of
Malnutrition for malnourished children handled by the team at UPT Puskesmas; c) Provision of iron
Analysis Of Policy Formulation And Implementation Of Stunting Reduction In Penajam Paser Utara District In 2021,
Tri Utami, Kosasih, Rukhiyat Sayidin 13225

supplement tablets for pregnant women; d) Provision of supplementary food for pregnant women,
both those who lack chronic energy and those who do not (as counseling); e) Provision of additional
food to toddlers; f) Implementation of Early Breastfeeding Initiation (IMD) for newborns; g)
Exclusive breastfeeding counseling for mothers who breastfeed their babies less than 6 months; h)
Provision of iron tablets to young women in schools; i) Provision of Vitamin A for toddlers 6 – 59
months every February and August; j) Triggering Community-Based Total Sanitation (STBM) at
stunting locus and non-stunting locus involving sub-district heads, village heads, Kodim staff, sub-
district and village PKK as well as Scout members followed up by health center sanitation workers. k)
Implementation of Youth Care Health Services Program (PKPR); l) Counseling on the First 100 Days
of Life carried out by cross-programs at the Puskesmas; m) Increasing the number of deliveries in
health facilities through Jampersal financing; n) Increasing complete basic immunization in infants
In addition, implementing policy implementation is very important in the performance of
policy implementation. This is important because the performance of policy implementation will be
greatly influenced by characteristics that are very precise and match those of the implementing agents.
The characteristics of implementing agents are the attitudes of each policy implementer. The
characteristics of implementing agents in this study are related to the division of authority, applicable
SOP ( Standard Operational Procedures ), and supervision. Based on the results of interviews with
informants, the distribution of authority has been explained through the Regent's Regulations and
supporting Decrees. Besides that, the distribution of authority in the policy to accelerate stunting
prevention integration has been carried out quite well and has involved various sectors. Regarding
SOPs, based on the results of interviews with informants at the district level, namely Bappeda, the
Health Office, and the Social Service, they already have their own SOPs in implementing policies to
accelerate stunting prevention. integrated. In addition, regarding the availability of SOPs in North
Penajam Paser Regency, based on the results of interviews with informants, namely, the Secretary of
the Sub-District Head, the Nutrition Officer of the Community Health Center, and the Nutrition
Officer of the Health Service, explained that in carrying out the policy of accelerating stunting
prevention Integrated SOPs already have SOPs that are in accordance with their respective work
fields, but the availability of SOPs has not yet reached the level of cadres who are also policy
implementers at lower levels. Implementation of supervision in implementing policies to accelerate
stunting prevention Integrated work has been carried out in each OPD as well as through the
implementation of monitoring and evaluation which is carried out routinely once every 3 months with
the convergence coordination team for the acceleration of stunting prevention and reduction.
Supervision and evaluation in implementing policies to accelerate integrated stunting prevention at
the North Penajam Paser Regency level are also carried out routinely through monthly workshops and
mini-workshops once every 3 months.
In implementing the program to accelerate the reduction and prevention of stunting, there are
several obstacles. Some of the existing obstacles are the ineffectiveness of stunting prevention
13226 Journal on Education, Volume 05, No. 04, Mei-Agustus 2023, hal. 13218-13227

programs, the not yet optimal coordination in the implementation of specific and sensitive nutrition
interventions at all levels related to planning and budgeting, implementation and monitoring and
evaluation, not yet being effective and efficient in allocating and utilizing resources and funding
sources , limited capacity and quality of program implementation and still minimal advocacy,
campaigning and dissemination related to stunting and various prevention efforts. Seeing the existing
obstacles, the North Penajam Paser district government continues to make efforts to improve cross-
sectoral communication and coordination so that the program to accelerate the reduction and
prevention of stunting can run optimally.

CONCLUSIONS
The formula for accelerating the reduction of stunting includes the integration of cross-sector
programs to accelerate the reduction and prevention of stunting; monitoring and evaluation, referring
to the Regent Regulation No. 34 of 2019 concerning the Acceleration of Decreasing and Prevention of
Stunting where the purpose of this policy is to improve the nutritional status of the community and the
quality of human resources including improving consumption patterns of a variety of balanced
nutrition funds based on local resources and nutrition awareness behavior; increasing access to food
and quality of nutrition services in accordance with advances in science and technology; improvement
of food security and nutrition system; increasing the capacity of human resources through
communication, information and education as well as training; and increasing access to basic
sanitation. Convergent implementation of stunting acceleration reduction and prevention policies in
North Penajam Paser Regency with convergent cross-sectoral implementation. One of the causes of
stunting is the poor behavior of the community, so that in addition to cross-sectoral integrated
programs, the local government is also implementing the North Penajam Paser Regency Behavior
Change Communication Strategy, this strategy aims to increase public awareness and change key
behaviors to prevent stunting through strategies comprehensive behavior change communication

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