Government and village commitment to support GERCEPS action of youth caring movement for stunting in Sampang

ABSTRACT


Introduction
Stunting is currently still a health problem in Indonesia.A chronic lack of nutritional intake causes stunting, both macro and micro, which results in irreversible growth and development of children, so they do not reach their maximum growth potential.The global target is to reduce the prevalence of stunting by 40% by 2025 from 2013 [1].In line with the "zero hunger" target of the Sustainability Development Goals (SDGs) in eliminating malnutrition and reducing the prevalence of stunting by 50% by 2030 [2,3].Based on the results of the 2022 Indonesian Toddler Nutrition Status Survey (SSGI), the prevalence of stunting is 21.6% with a reduction in stunting from the previous year of 2.8%.More efforts are needed to achieve the target of 14% in 2024.East Java Province in 2022 has 20 districts/cities with a stunting prevalence higher than the provincial average prevalence (>19.2%)[4].Penta-helix cross-sector engagement and commitment are needed as an effort to accelerate stunting reduction [2].
Referring to Minister of Health Regulation Number 25 of 2014, child health efforts are carried out through health services from fetuses, newborns, infants, toddlers, preschoolers, school age children, to teenagers.The existence of teenagers is one of the focuses of global policy to achieve development goals in 2030 [3].According to WHO, teenagers are residents aged 10-19 years.The world's adolescent population reaches 1.2 billion people (15.8%) out of a total population of 7.6 billion people.The population of teenagers in Indonesia is 46 million [5].
In Indonesia, the Adolescent Health Program has been initiated with the Adolescent Care Health Service (PKPR) approach since 2003.Then youth posyandu was developed from 2015 till now.Health problems that impact teenagers are very diverse, including infectious diseases, noncommunicable diseases, mental health, nutritional adequacy, anemia, reproductive health, child marriage, and mental health [6].The percentage of early marriages aged 10-17 years in Sampang Regency is higher, namely 25.71%, than the percentage in East Java province (20.64%) in 2019 [7] Sampang Regency, which is one of the districts in East Java, has the second lowest stunting prevalence after Surabaya City, namely 6.9%.The success of this reduction is a lesson in what steps have been taken to successfully reduce stunting.However, on the other hand, as many as 60% of the 172,007 teenagers in Sampang Regency suffer from anemia [7].In fact, one of the impacts of anemia on women of reproductive age is that they can give birth to babies whose development is not optimal.Anemia results in inadequate nutrition for the fetus, so that its growth and development is disrupted and triggers stunting [8].These findings novelty support further research for understanding the effects of government and village commitment to apply action youth caring movement for stunting through administering blood supplement tablets.
So far, the Regional Government of Sampang Regency has made efforts to reduce stunting across sectors, but the program targeting youth groups has not been optimal.Therefore, efforts are needed to strengthen adolescent health services that are adapted to the national stunting prevention program, one of which is the innovation of the Youth Movement to Prevent and Care for Stunting (GERCEPS action).Researchers want to understand the commitment of the government and village officials in supporting the GERCEPS action in Sampang Regency, East Java Province.

Method
This research design uses a qualitative approach with descriptive research methods.Data was obtained through primary data sources with in-depth interviews and participant observation.The selection of informants was carried out using purposive sampling.The question instrument refers to the modified Allen & Meyers theory.Organizational commitment is seen from three components, namely affective commitment, normative commitment, sustainable commitment [9,10].Indicators for affective commitment include emotional, identification, and involvement.Indicators for normative commitment include loyalty and responsibility.Indicators for sustainability commitment include impacts and benefits.
Data collection was carried out using method triangulation and source triangulation to maintain data credibility.The qualitative data analysis technique is carried out using narrative analysis.Information obtained from informants is retold narratively to study the participant conditions referring to research problem [11].

Results
This research collected information from interviews with 9 informants.The characteristics of the informants are shown in table 1 below.Table 1 shows that of the 9 informants, 5 people were > 40 years old (55.6%), 6 people were female (66.7%).then, 4 informants were high school graduates (44.4%), followed by 2 informants who had diploma/bachelor degrees (22.2%).

Discussion a. Commitment of Regional Government and Village in Youth Movement Action to Prevent and Caring for Stunting
Local government commitment can be developed from organizational commitment according to Meyers who divides commitment into three components, namely affective, sustainable and normative commitment [9,10].It is important to know the perceptions between stakeholders in explaining their respective interests and identifying various factors that can support collaboration [12].Creswell [13] suggests a qualitative approach to explore more in-depth information.[14] According to Meyer, the affective component is a form of commitment that refers to members' emotional tendencies and involves individual feelings and belief values [10].The regional government's commitment is aimed at a sense of ownership of the district and the entire community in Sampang Regency.The Sampang Regency Health & Family Planning Service, as the implementing arm of accelerating stunting reduction, is committed to reducing the number of stunting locus villages.This continues to be pursued by reducing the number of locus villages.The graph of the number of locus villages seen from 2020 to 2023 is shown in the following picture (Fig. 1).

Figure 1. Graph of the number of locus village in Sampang district
The Regent of Sampang and government officials have made efforts to reduce the number of stunting locus villages, although in 2023 the locus villages will increase again from 8 villages to 12 villages.

"Referring to the direction of the president & vice president which was forwarded to the National Population and Family Planning Agency and the Health Service. We continue to strive for Sampang to have zero stunting, if we don't work together, who will." (Informant 1).
Informants revealed that a sense of belonging to this region will give rise to love and loyalty, as well as concern for problems in the region.In line with McCunn & Gifford [15] that the dimensions of assessing a place can be seen cognitively or perception, affectively or emotionally, and conatively or behavior.

"We work together, the community is also happy to be invited and involved in this stunting reduction activity." (Informant 2).
A sense of togetherness is a form of commitment to the environment [16].Many literature mentions the relationship between environment and population density on a sense of belonging [17].
Besides affective commitment, there is also continuous commitment and normative commitment.The sustainable component refers to the costs obtained during the organization.Continuous commitment is a perceived economic value in an organization [10].Sampang Regency has a special budget for handling stunting both in terms of the health sector and the education sector.Although, from a health perspective, funding for stunting reduction is still higher than other sectors.
Sampang Health & Family Planning Service provides a stunting budget of over 100 million rupiah to 200 million when combined with stunting interventions for teenagers.In Sampang, crosssector involvement has been involved in reducing stunting.The sectors targeted include penta-helix although the proportion of involvement of each sector is not balanced.Implementation of the pentahelix can increase regional competitiveness and development innovation and economic development [18].Other research states that the penta-helix approach has been implemented optimally in Sumenep Regency [2].Penta Helix's involvement in Sampang includes: 1) Government (Health Service and Stunting Task Force), 2) Academics (surrounding campuses and involvement of lecturers and students), 3) Private (non-governmental organizations, foundations), 4) Community/Society (cadres of posyandu, PKK, infant cadres, teenage cadres), 5) Mass media (internet media, Madura radar, government website, communications, and information service).Several sectors stated their commitment and funding support in efforts to deal with stunting.

"We are very serious about paying attention to health problems, including stunting, especially since this is a national program. We are operating as a private sector, but we are making full efforts to support the government in reducing stunting and the villages that are the locus of stunting. Of course, we also allocate financial support for this problem" (Informant 3). "Non-government support is very important and necessary in overcoming stunting." (Informant 1).
On the other hand, funding support from the government is no less important.The government can maximize the use of APBD and special allocation funds for specific nutrition and nutritionsensitive intervention service programs, for villages that are less fortunate in terms of funding, in efforts to prevent stunting [19].

"We think that village funds such as BUMDES are optimized entrepreneurially but based on empowerment. This will certainly increase community independence." (Informant 6).
An organization's commitment is also demonstrated by its commitment to survive on moral, ethical and regulatory grounds.The normative component refers to individual obligations towards the government context.Normative commitment is an obligation to stay in an organization for moral and ethical reasons [10].The penta-helix sector is also committed to the Sampang Regent's regulations to accelerate stunting reduction.The existence of this regulation becomes an ethical reference in maintaining commitments.In implementing the GERCEPS action, commitment of the government and village was also gathered in a joint signing and integrated commitment ratified by agency leaders.Leaders who signed the commitment included village heads, heads of community health centers, heads of public health at the health service and people in charge of academics.This is in line with research by Aji et al. [20] that ratification of commitment is a form of unified vision and mission.

Stunting
GERCEPS action is an innovation in Sampang Regency in preventing stunting.This action approach refers to youth groups by optimizing peer education, empowerment, and prevention as early as possible.The government plays a role in supporting every activity that involves teenagers in efforts to prevent stunting.Apart from that, regional government, with the extension of the Health Service, has also intervened in providing blood supplement tablets to improve hemoglobin levels in teenagers.
"Many of our governments are involved in reducing stunting, including the education service, health service, communications and information service, environmental service, and TNI/ POLRI."(Informant 5).
Anemia in adolescents has a negative impact on reducing immunity, concentration, learning achievement, adolescent fitness, and productivity.White blood cells play a role in the body's immunity, if the number is low, they cannot work effectively, causing iron deficiency [21].Young women are prospective mothers who will give birth to babies.So, these teenagers must be healthy to become mothers-to-be and mothers.Healthy babies support good growth and development, thereby creating quality human resources.Teenagers who are anemic will have an impact when they become mothers-to-be.Anemic pregnant and giving birth mothers will increase the risk of maternal death during childbirth, premature births and low birth weight (LBW) babies [22].
"So far we have only targeted babies under five and pregnant women to reduce stunting."However, for teenagers themselves, we have carried out activities to provide blood supplement tablets targeting teenagers attending formal education."(Informant 2).So far, there has been no involvement of youth groups in health education.This is also shown by the very low number of youths posyandu in the locus villages, only 8.3% (1 out of 12 villages) have a youth posyandu.According to the Indonesian Ministry of Health [23], adolescent posyandu is a forum to facilitate adolescents in understanding adolescent health problems, finding alternative problem solutions, forming adolescent support groups, expanding the reach of health services, especially for adolescents who have limited access to health services.In line with the research and dedication of Ertiana et al. [24] youth posyandu plays a role in fostering positive activities and preventing deviant behavior so that teenagers can increase their health knowledge [24].

c. Role of Village in Youth Movement Actions to Prevent and Caring for Stunting
Village officials involved in the GERCEPS action include the village, village secretary, village midwife, PKK cadres, posyandu cadres, and youth organizations.Teenagers themselves have not been involved in actions to prevent and reduce stunting.GERCEPS action succeeded in confirming active teenagers who were worthy of becoming youth cadres by obtaining a Decree from the health office as youth posyandu cadres.
"We feel considered in the village, feel included and involved in community health.Moreover, we feel close to the midwives and can help directly during health checks."(informant 6).
These teenagers were very enthusiastic during the implementation of the youth posyandu which was packaged in the GERCEPS action."The existence of reporting via application makes it even easier in the digital era." (Informant 7).
Village play a large role or character in implementing GERCEPS action because they are the spearhead as implementers on the front line.This is in line with the statement that village officials are the front guard of government as implementers who carry out government techniques [25].Taking part as a form of commitment in supporting the program [10].
"This activity is still very new, so we all need to adapt."(Informant 8).
"We still need to learn a lot about how to consistently implement this youth posyandu."(Informant 9).
Implementation of the action has not been optimal because this program is still very new to the local community.Village officials and the community need comprehensive further training for the sustainability of youth posyandu.According to Permana & Purnomo [26] a good empowerment program needs to be evaluated periodically to see the success of the program.We hope further research can also capture the level of participation of village officials in their involvement in implementing the GERCEPS action.

Conclusion
Sampang Regency has demonstrated commitment and support for the GERCEPS action both effectively, sustainably, and normatively.The role of local government is strengthened by pentahelix approach.However, the role of village officials in implementing the GERCEPS action is not Sampling for this research called informant.Informants' criteria for this research are residents in Sampang Regency who have work and positions in government and in the village.The informants for this research were the Head of Public Health in Public Health Service, Health Service Staff, Stunting and Nutrition Task Force, Village Head, Head of Community Health Center, Village Midwife, Family Empowerment and Welfare Cadre, Posyandu Cadre, and Youth Cadre.The research was carried out in 12 stunting locus villages in Sampang Regency including: Tamberu Laok, Tolang, Masaran, Asem Jaran, East Jatra, Buker, Jrengik, Bajrasokah, Palenggiyen, Astapah, Sawah Tengah, Paopale Laok villages.Research time October-December 2023.

Table 1 .
Characteristics of The Informants