Generasi: Improving the Health and Future of Indonesia’s Children

February 19, 2016

  • Indonesia has made great strides in improving certain health and education outcomes over the past decade. However, Indonesia failed to achieve its Millennium Development Goal of reducing its maternal mortality ratio (MMR) to 102 deaths per 100,000 live births with the 2015 MMR at 126.
  • Alarmingly, 37% of children aged 5 or below are stunted, meaning Indonesia has the fifth highest incidence of stunting in the world (Stunting is defined as <-2 standard deviations height-for-age, and indicator of chronic malnutrition). Rates are even higher among children in rural and remote provinces.
  • In 2007, the government of Indonesia launched PNPM Generasi, a program aimed at improving maternal health, child health, and universal access to education.
  • Active in 11 provinces, the program provides incentivized grants to communities who work with facilitators in order to improve health and education services.  More than half of the 4.9 million beneficiaries annually are women or girls. So far, participating villages experienced a 10% reduction in childhood malnutrition compared to non-participating communities.

Results of Generasi

  • The block grants, averaging at some Rp 110,000,000 per village annually (approximately US$8,150), are allocated through a facilitated community decision-making process. Communities work with facilitators and health and education service providers to improve access to and use of these services.
  • The government determines the size of the village's Generasi block grant for the subsequent year partly on the village's performance on each of the 12 targeted health and education indicators. The more progress a village demonstrates towards 12 health/nutrition and education targets, the larger the block grant allocation during the subsequent year of implementation.
  • A randomized impact evaluation of Generasi over the period 2007-2010 showed statistically significant positive impacts on the 12 indicators the program was designed to address. On average, Generasi was twice as effective in areas with very low health and education status.
  • The program’s main long-term impact was a 10% decrease in childhood malnutrition (underweight and severe underweight) levels in villages participating in the program compared to villages that did not participate. Overall reductions were strongest in areas with higher malnutrition rates prior to project implementation.
  • Health indicators which showed the largest gains include:

- Increased frequency of weight checks for young children. Parents whose children are not gaining weight receive counseling on follow up actions;

- Increase in the number of iron sachets pregnant mothers received through antenatal care visits;

- Dramatic increases in participation by mothers and children at local health clinics, in order to receive maternal, neonatal, and child health services. 

  • The biggest improvement in education was higher school participation rates among primary school students.
  • In East Nusa Tenggara, one of Indonesia’s poorest provinces, Generasi produced the strongest nutrition-related results, according to a three-year impact evaluation completed in 2011:
    - Decreased incidences of underweight and severe underweight children, by 20% and 33% respectively. Stunting decreased by 21%.
    - Increased the enrollment rate for junior secondary school by 29%.
  • From 2007 to 2015, Generasi produced additional results on a cumulative basis across 11 provinces, which include:

- Over 3.5 million women and children received nutrition counseling and support;

- Over 2.4 million children received vitamin A supplements;

- Over 2.3 million pregnant women received iron supplements;

- Over 915,000 children received immunizations;

- Over 500,000 cases of underweight children were eliminated;

- Over 218,000 community health volunteers trained and assisted;

- Over 660,000 poor primary and junior secondary students obtained textbooks;

- Over 1 million poor primary and junior secondary students were provided assistance, in the form of scholarships, transportation money, and uniforms;

- Included women in basic health and education service planning and decision-making processes—on average 67% of participants in program socialization, planning, and monitoring meetings were women.

  • Impact evaluation findings, performance evaluation surveys, data from the project Management Information System, and direct observations in the field have led to substantial refinements in Generasi’s design. In 2014, two nutrition-sensitive community-level targets were added, for participation of women and male caregivers in nutrition counseling sessions.
  • Primary school enrollment and attendance targets were dropped and replaced by a target for transition from primary to junior secondary school, and a target for inclusive education. Communities are also able to make investments in Early Childhood Education and Development (ECED) services.
  • Generasi is now accompanied by health and education supply-side efforts at improving the quality of maternal and child health and nutrition, and ECED services available in Generasi districts.
  • Support for PNPM Generasi has come from several development partners, including Australia’s Department of Foreign Affairs and Trade, The Millennium Challenge Authority-Indonesia, Danida, the United Kingdom Department for International Development (DFID), the Embassy of the Netherlands, the European Union, USAID, and the World Bank.