Empatika facilitator Mr. Krisman and Ms.

Thalia were delivering the first day of the Human Centered

Design (HCD) trial to the Posyandu Cadre in Cilangari village, Gununghalu sub-district,
West Bandung district on August 17, 2020. Photo by Fajar Yulianta.

BISA Bulletin
1st Edition, January – August 2020

Greetings from BISA

“Your kid is stunted.” Many people in Indonesia considered this statement
a joke, referring to how short a person is. Parents do not really
understand that a stunted child does not only have implications for her
physical abilities compared to other children, but also their productive
capacity in the future.
This integrated program is supported by the Power of Nutrition,
According to World Health Organization, “Stunting is the impaired growth the Department of Foreign Affairs and Trade (Government of
and development that children experience from poor nutrition, repeated Australia), the Asian Philanthropist Circle and Global Affairs
infection, and inadequate psychosocial stimulation.” Canada, through the Government of Canada.
(https://www.who.int/nutrition/healthygrowthproj_stunted_videos/en/).
Children are defined as stunted if their height-for-age is more than two The goal of BISA is to reduce stunting among children under two
standard deviations below the WHO Child Growth Standards median. years of age. BISA is designed to directly address the drivers of
stunting and to identify sustainable solutions to its reduction.
The Better Investment for Stunting Alleviation (BISA) project, a USD 10
Recognizing that the drivers of stunting span household,
Million integrated programme, is designed to support the National
Strategy for Stunting Alleviation (2018-2024) of the Government of community, the public health system, and policy levels, BISA is
Indonesia (GoI). BISA is implemented in partnership by Save the Children structured to intervene across each of them. The interventions
(SC) and Nutrition International (NI) in two provinces: East Nusa are summarized into three Strategic Objectives (SO).
Tenggara (ENT) and West Java (WJ).
BISA aims to improve access and quality of services as well as
knowledge and practice, influence behavior change and policy
“Ministry of Health welcomes BISA to support and the availability resources to prevent and reduce stunting.
government’s programs in in stunting alleviation.
We would encourage BISA team to optimize the
existing Government modules and support us in
reaching out to the grass roots", Dr. Kirana
Pritasari, MQIH, General Director of Public Health,
Ministry of Health.
Our Main Story expressed ‘masuk ke hati’ (‘I can feel it’). Their babies became
Breastfeeding with joy quiet and fell asleep. As the folk song was not familiar to the
mothers, they transcribed the lyrics into the Shalawat format
which was easier to follow. They made 12 verses which can be
"How might we make breastfeeding enjoyable?" Breastfeeding is
adapted into more verses. The mothers said, ‘it really captures
often seen as a duty attached to the mothers and should be an
what it is like to be a mum – really can feel it’.
easy task. But in fact, breastfeeding is a complicated matter. The
formative research conducted by EMPATIKA (a research
The mothers hoped the lullaby would help ‘my baby to be happier,
agency) for the BISA Project explored the breastfeeding
increase weight, feel better’ and would look for indications of this
experiences of mothers in two districts (TTU in NTT and West
over the next few weeks.
Bandung in West Java). During a five-day workshop as part of
Human Development Design (HCD) series of activities, eight
lactating mothers were invited to share their experiences in
breastfeeding.

HCD was used at the community level to problem-solve and find

solution that can trigger behavior change, adapted from the
design thinking approach of IDEO (www.ideo.com). The HCD
process was started with immersion and structured research in
several villages in West Java and NTT. The findings from the
research were used as themes for the next stage of the research.
namely ideation and testing of an facilitation prototype.

On 17-21 August 2020, a workshop was held in Mandalamukti

Village, Cikalongwetan sub-district, West Bandung. The
workshop brought together mothers from different project areas,
who had participated in the research: first-time breastfeeding
mothers and those that had more experience, mothers who lived
with caregivers/grandmothers or who did not.
Grandma Rosida (dressed in pink) shares her experience with lulling
What do mums say about breastfeeding? her baby by Shalawat during breastfeeding; the baby becomes quiet
Participants were asked about the challenges they faced in and then fall asleep. Photo by: Mukarramah.
breastfeeding. The mothers wrote their challenges on cards,
which showed common challenges such as pain and discomfort,
stress and worry (“my breastmilk is not enough”), the burden and
chore of breastfeeding and the absence of joy in doing so. Other Stories
Mothers felt that introduction of formula and complementary Coordination Meeting with Bappeda and Public
feeding was a solution to their anxiety and discomfort (“so the Health Office (PHO) of West Java before COVID-19
baby stops crying”). They shared that they need to eat more,
especially rice, during their pregnancy, but did not mention that On March 10, 2020, the BISA Team met at the office Bappeda
they needed to eat well – a more diverse diet. Older mothers and West Java (WJ) with Mr. Ahmad Ghufron, the Head of Sub-
grandmothers said that breastfeeding mothers should drink a lot Division of Government and Human Development II and other
more water or soup, observing that young mothers did not senior staff.
observe the practice.
NI Country Director Dr. Sri Kusyuniati introduced BISA project
At the end of the workshop, participants were asked ‘how can we and explained how the team would work closely with Bappeda
make breastfeeding more comfortable?’ One of the ideas coming WJ, PHO WJ and other related Government Offices at
from the mothers was singing a lullaby. The mothers practiced provincial and district level.
various kinds of lullabies. One is the Shalawat (Islamic rhythmic
prayer) that relates to their wishes for their babies to be healthy,
religious and be kind.

The mothers tried other songs that are common locally, such as
Pupuh Sinom (folk song) and Hareudang-hareudang (dangdut
music song) and observed together how babies reacted. The folk
song did not mirror what the mothers wanted to say at first and
the dangdut was too loud. Some suggested it was enough to play
music to the baby (e.g. through mobile phone), but it was
recognized that the mother’s voice was familiar to babies even
before birth and that this would be more soothing.

The mothers were then asked to compose their own lullaby that
would help make the breastfeeding more enjoyable. They
composed words expressing their sentiments and then asked a
local renowned Sundanese composer to put the words into a NI Country Director Dr. Sri Kusyuniati describes the BISA project to some
song. senior staffs of Bappeda West Java province, March 10, 2020.
Photo by Firmansyah MS.
The next day the composer came with a song with lyrics taken
from the words constructed by the mothers. Some mothers
Mr. Ghufron said that the government of WJ had initiated some
programs related to stunting reduction that are included in the Ministry of Health (MoH) and BAPPENAS
development priorities of the WJ Governor. Mr. Ghufron warmly
welcome the BISA project. He expected that the project and
team would have regular coordination and communication
with Bappeda, and that the BISA project be aligned with the
West Java Provincial development programs.

In the Provincial Health Office (PHO), the BISA team held a

meeting with the head of Public Health Division and senior staff.
The Head of Public Health Division, Sri Suhartini, MPS, who has
strong passion for stunting alleviation in West Java expected the
BISA project to trigger more initiatives and creative actions by
district governments and communities to prevent and reduce
stunting.

Ms. Suhartini has been working closely with NI and SC in West

Java and was a key resource person in the design of the BISA
project. She emphasized that since BISA project is a joint
project between NI and SC, it would be better to register as
BISA Project rather than as a project of each of the two
agencies. She also expected strong and intensive Dr. Kirana Pritasari, MQIH, General Director of Public Health, Ministry of
Health – top left in a meeting with BISA team on August 6, 2020, said that
coordination between PHO and DHOs and the BISA team. there have been many agencies working on stunting reduction, and
coordination among them and with the Ministry is a must.
Photo by Firmansyah MS.

Dr. Kirana also emphasized that since BISA include capacity

building and behaviour change, modules and materials from the
Ministry can be used and optimized to educate the public and
communities. “The Ministry also has developed SBCC materials
that BISA Project can use,” Dr. Kirana said.

“BISA project should refer to the Government’s STRANAS

Stunting to avoid redundancy. The government welcomes
partnership with CSOs and private sectors in reducing
stunting in Indonesia.”, Dr. Ir. Subandi, MSc, Deputy
Minister of National Development Planning/ Head of
Human, Community and Culture Development.

BISA team meets with the PHO West Java represented by the Head of
Public Health Division, Ms. Sri Suhartini, MPS and other senior staff,
March 10, 2020. Photo by Umi Sofiyana.

“We welcome BISA team to work together with us in

reducing and preventing stunting in our district. Your
presence will become a stimulus for us to work harder and
more intensively in stunting alleviation in Bandung Barat.
We want Bandung Barat without stunting as soon as
possible”, Drs. Asep Wahyu, S.IP, MM, The Head of
Bappelitbangda, West Bandung District.

Dr. Ir. Subandi, MSc, Deputy Minister of National Development Planning/

Head of Human, Community and Culture Development – top right,
welcomes Mr. Prima Setiawan, BISA Chief of Party – top middle, and the
BISA project team in an online coordination meeting, August 25, 2020.
Photo by Prima Setiawan.
BISA in the Fields

Below are some of BISA activities during the period from March
to August 2020.

Cadre and moms in a Posyandu session in Timor Tengah Utara, East Nusa
Tenggara. Photo by EMPATIKA.

In the field visit in Cimerang village, West Bandung District on March 11,
2020, the Secretary of the Cimerang Village, Mr. Wahyudi explained the
activities that have been carried out together with the Puskesmas in
stunting prevention efforts. Some of the activities are supported by village
fund such as are posyandu cadre fees, supplementary feeding for toddlers,
and posyandu operational costs. Photo by Kunaeni Asri.

Ms. Rahmadia,
an enumerator of
SEAFAST IPB
interviews a
young mother to
collect the data
BISA West Java team participated in a stakeholders meeting in Sumedang
for the baseline
district, West Java, July 8, 2020. BISA team also presented project to the
survey in stakeholders in this meeting. Photo by BISA Team.
Banjarsari village,
Sumedang district
on March 12,
2020. Photo by
Firmansyah MS.

BISA coordination meeting in East Nusa Tenggara province. BISA team

BISA program socialization at the TTU DHO. This activity aims to provide
information about the BISA project, and initial coordination with DHO to
accelerate stunting reduction in the district, August 10, 2020.
Photo by TTU DHO team.
in NTT, June 23, 2020. The meeting was attended by The Head of
Bappelitbangda East Nusa Tenggara, representatives of PHO, PEO, etc.
Photo by BISA Team.
Stories from Partners
SEAFAST
Southeast Asian Food and Agricultural Science and Technology
(SEAFAST) is a Center at IPB/ Bogor Agricultural Institute, with
the main objective to bring together the university, government,
donor and business sectors to focus on improvements in
nutrition, food science and technology in Indonesia and where
appropriate, in other ASEAN nations. Since 1979, Food
Technology Development Center has been involved in nutrition
and food research and education programs.
YAYASAN CIPTA
Established in 2008, Yayasan Cipta, formerly known as YCCP,
is a nonprofit organization with expertise and long experience in
strategic communication such as advocacy, community
mobilization, social and behaviour change communication, social
marketing and social research for social development issues.
This year, Yayasan Cipta collaborated with the BISA to develop
the project’s Social Behaviour Change (SBC) Strategy. This SBC
strategy marks the first collaboration between Yayasan Cipta, NI,
and SC.

Mother's data
collection
process and
field
supervision in
Oeltua village,
Kupang
district, East
Nusa
Tenggara on
February 10,
2020. This
process was
carried out by Yayasan Cipta team works on the BISA Desk Review Report at their Office,
the February 2020. Photo by Yayasan Cipta.
enumerators
and the IPB
SEAFAST
team Yayasan Cipta developed a participatory approach and evolving
accompanied process to develop the SBC strategy to ensure that it could be
by BISA team. improved, based on routine monitoring and evaluation.
Photo by Development of the SBC strategy started with an extensive desk
SEAFAST review to analyze stunting-related issues and MIYCN practices
team.
in BISA intervention areas.

As part of our commitment to nutrition improvement efforts in
Indonesia, SEAFAST Center in collaboration with Nutrition
International and Save the Children conducted a baseline survey
for the BISA project in West Java and East Nusa Tenggara
Province.
The survey area conducted in four districts, namely West
Bandung, Sumedang, Kupang, and North Central Timor, and
included a total of 14,429 respondents. Our knowledge and
insight had been enriched by the opportunity to visit and meet
with respondents from different areas of the country. We learned
that each district was unique in terms of natural sources, culture
and nutritional challenges.
Despite the excitement we experienced in the survey, we
encountered some challenges such as access to some study
areas due to bad weather or/and infrastructure, weak internet
signal that hindered the data collection process, and obtaining
school approval prior to starting the research. Nevertheless, we
believe that these challenges were insignificant when compared
to the benefit the BISA project is expected to provide – the
improvement in the nutrition of children and women nutrition in
Indonesia. We hope that the result of this baseline survey will be
taken as a foundation to build the best approaches for project
implementation.
In the process of developing the SBC strategy, some conditions
posed challenges and, at the same time, also provided lesson
learned opportunities. The Covid-19 pandemic that hit Indonesia
when the collaboration started, caused travel restrictions and
made data and information collection in the project area
impossible, as well as limited direct communication and
discussion with the BISA team and other stakeholders.
Nevertheless, Yayasan Cipta adapted to the new context and
evolved different strategies. Moreover, the development of the
SBC strategy took place in parallel to the BISA formative
research process, we needed explore other related and right-on-
target sources to fulfill the gap of information. We were fortunate
to be facilitated by the good collaboration between NI and SC
teams, so productive discussion and brainstorming was
continuous.
Currently, the SBC strategy is in the SBCC communication
material prototype development phase. The SBC strategy and
SBCC material produced by Yayasan Cipta is expected to
support the implementation of the BISA project in an innovative
and versatile way and contribute to improving the nutrition status
and MIYCN practices in BISA intervention areas.

EMPATIKA
Empatika is an international people-centered research and
training organization. It has its main office in Jakarta but has
worked in various countries e.g. Lebanon, Nepal, India and
Bangladesh, and Indonesia. It specializes in innovative
qualitative research such as immersion research and supporting
people-driven development such as citizen-led monitoring and
evaluation and human-centered design.
It is passionate about sharing its innovative approaches with
others and providing bespoke training and mentoring to enable
other organizations to adopt empathy-led research and
facilitation. Empatika benefits from more than a decade of
experience in conducting participatory studies and community
engagement.
Value added in formative research
Immersion research involves researchers living in people's
homes and joining in their everyday lives. Although widely
insightful for a range of purposes, the immersion research is an
especially appropriate formative research method to inform the
design of programme interventions. Living with families enables
trust to be built and for insights to be generated through informal
interaction, observation and firsthand experience. For
programmes focusing on social and behavioral change,
immersion provides an opportunity to understand the difference
between what people say or claim they do and their actual
behavior. It enables the researcher to engage with the social
norms which shape behavior and to empathize with the
challenges people face in changing behavior.
Shared experience and context provide an important platform for
discussing with people their motivation for change and
understanding the helping and hindering factors to sustainable
positive behavior change. Coupling immersion research with
participatory research adds further value in the formative
research phase. Once trust and rapport have been built in
immersion and authentic insights into everyday life have been
gathered, it is then possible to explore these insights further
facilitating people to ask themselves about their motivations how
change happens in their own communities.
Immersion research was conducted in November 2019 in West
Java and Nusa Tenggara Timur and provided a detailed
situational assessment of the knowledge, attitudes, and practice
of BISA’s intended target groups. Further detail was explored
through a follow up research phase two months later (February
2020) which utilized participatory methods to help communities
and local health service providers to analyses for themselves the
values which underpin behavior change, information gaps faced
and preferred sources of information and support needed.
Partnering in BISA
Empatika was
pleased to partner
with YSTC to
undertake formative
research for the
BISA project. The
formative research
was undertaken in
three stages:
exploratory phase
comprising stage
1). immersion
research and stage,
2). participatory
research followed
by stage, and Cadre in West Java using tailors' cloth tape to
3). design phase measure the height of baby in Posyandu
using the principles session during the Immersion Research in
of human centered November 2019. The baby looks distressed
and makes large measurement errors, they
design. need several people to hold the baby.
Photo by Empatika.
It also provided an opportunity to record detailed 24-hour food
diaries and activity diaries for CU2 and pregnant women. The
insights from both the immersion and participatory research not
only provided the basis for the co-creation of prototype
interventions using human-centered design principles but also
informed the development of BISA’s communication strategy. It
helped identify key target audiences, key behaviors for focus and
the kinds of communication channels and support which people
indicated they trust and might respond to.
Moving forward together
As the partnership has developed, it grows a deeper understanding
of the merits of taking people-centered approaches.
Empatika is ready to support the implementation phase through
mentoring and coaching to ensure the principles and practice of
people centered SBC are embedded in interventions undertaken
by BISA.
The formative research is just a beginning.
Challenges and lessons learned
Although this was a new partnership, we approached the work
from somewhat different experience and perspectives,
everyone was highly motivated to learn from each other and to
try to work in as collaborative way as possible. The partnership
has grown over the nine months, especially during the
human-centered design phase where partners worked together
both at central and field level and positive results of taking
a people-centered approach are emerging.