Stunting reduction acceleration program implementation in a high-performing Indonesian city: a qualitative Logic Model-based evaluation in Tomohon, Indonesia
This qualitative study evaluates the implementation of Indonesia's stunting reduction program in the high-performing Tomohon City using a Logic Model framework, revealing that while leadership and local culture drive success, the program remains fragile due to resource constraints and behavioral intervention gaps, ultimately proposing a context-enriched evaluation model to better guide multisectoral efforts.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, a child's height is more than just a measurement of growth; it is a signal of how well a community is functioning. When children are too short for their age, a condition known as stunting, it usually means they have faced a mix of challenges: not enough nutritious food, poor sanitation, limited access to healthcare, and a lack of resources for their families. Because these problems are so deeply woven into daily life, fixing them requires more than just doctors handing out vitamins. It demands a coordinated effort from schools, water departments, social workers, and local leaders all working together. Governments often create big plans to bring these different groups together, but a common question remains: does the plan actually work on the ground? Often, officials only look at the final number of stunted children to decide if a program is a success. If the number goes down, the program is praised. If it stays the same, it is criticized. However, this approach misses the messy, complex reality of how the work is actually done. It fails to see whether the right people are talking to each other, if the money is reaching the right places, or if the local culture is helping or hindering the effort.
A team of researchers in Indonesia decided to look past the final numbers to understand the machinery behind a successful program. They focused on Tomohon, a small city in the north of the country that had managed to lower its rate of stunting below the national target. Instead of just celebrating the low number, the researchers wanted to know how the city achieved it and where the cracks might still exist. They interviewed fifteen senior officials from various government departments, including health, education, agriculture, and housing. These were the people responsible for planning and running the programs. The researchers asked them to describe exactly how the work was done, what resources they used, and what obstacles they faced. They used a tool called a logic model, which is essentially a map that connects the resources a program has, the actions it takes, and the results it produces. By mapping out the city's experience, they hoped to create a better way to evaluate these complex efforts in the future.
The researchers found that the city's success was not just a result of having money or a good plan, but of a specific system of connections. They discovered that the program relied on six main parts that worked together like gears in a machine. First, there were the needs and the starting conditions. This included the national laws that mandated the program, but more importantly, it included the genuine commitment of local leaders to make it a priority. The researchers also found that a local tradition called Mapalus, which is a form of mutual cooperation where neighbors help each other, acted as a powerful social force. This tradition helped mobilize volunteers and fill gaps when official resources were short. The second part involved the assumptions the officials held, such as the belief that all different government departments would work together seamlessly. While this was the goal, the researchers noted that in reality, coordination was sometimes uneven.
The third part of the system involved the actual resources, or inputs. The city had human resources, facilities, and funding, but the officials admitted these were often stretched thin. There were not enough technical staff, and the budget rarely matched the full scale of the needs on the ground. This is where the Mapalus tradition became crucial, as it allowed the community to step in and help where the government could not fully reach. The fourth part was the activity itself. The researchers realized that the specific actions taken, such as giving iron tablets to teenagers or improving sanitation, were not just resources sitting on a shelf; they were active processes that required constant management. The city had successfully covered the entire population with basic health services, but they struggled with behaviors that were harder to change, such as ensuring mothers practiced exclusive breastfeeding or that teenagers took their supplements consistently.
The fifth part was the output, or the immediate results of the work. The city had achieved high coverage in routine health checks, but the deeper, behavior-based changes were lagging. The final part was the outcome, which included both the drop in stunting rates and the administrative success of following the rules. The researchers found that even though the city was performing well, the system was not perfect. There were gaps in how different departments evaluated their work together, and the digital tools they used to track progress were still developing. They had apps to record data, but these tools were not yet sophisticated enough to help leaders make quick decisions or predict problems before they happened.
One of the most important findings was that a good result does not mean the system is flawless. Even in a city that had beaten the national target, the researchers saw that the program was fragile in certain areas. The reliance on voluntary community help, while powerful, meant the system could be unstable if that spirit faded. The lack of a permanent, dedicated community group specifically for stunting meant that participation was sometimes temporary and dependent on existing groups rather than a structured, long-term institution. Furthermore, the coordination between different government sectors was not as smooth as the plan required, with some departments working in isolation rather than as a unified team.
The study concluded that to truly understand if a program is working, we need to look at the whole process, not just the final number. The researchers built a new framework based on their findings, one that includes the local culture, the way different sectors converge, and the role of digital technology. This framework suggests that leadership commitment is not just a resource to be spent, but a fundamental condition that shapes the entire effort. It also shows that specific interventions are active processes that need constant attention, not just items to be distributed. By understanding these details, other cities can learn from Tomohon's experience, seeing not only what worked but also where the system is vulnerable. The study serves as a reminder that behind every success story, there is a complex web of human effort, local culture, and systemic challenges that must be carefully managed to ensure the progress lasts.
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