Local innovations and systemic barriers in stunting reduction: a qualitative analysis of food and social assistance programmes in Indonesia.

Abstract

Reducing stunting remains a pressing global challenge, particularly in low and middle-income countries (LMICs), where nutrition insecurity and limited access to health services persist. With its large-scale national social assistance and health programmes, Indonesia offers valuable insights into implementing integrated strategies for stunting prevention. This study examines the substantive elements of food and social assistance interventions as well as the contextual and structural factors that influence their implementation. It also assesses how multisectoral collaboration contributes to the implementation process of nutrition-specific efforts aimed at reducing stunting. We conducted a qualitative case study in two districts of West Java Province, representing contrasting urban and rural contexts. Data were collected through 78 in-depth interviews with policymakers, implementers and primary beneficiaries. The policy implementation framework developed by Edward was used as a guide for the thematic analysis. We identified key factors influencing programme delivery, including communication, resource availability, commitment of implementers and bureaucratic structure. Urban settings demonstrated better outreach, service utilisation and intersectoral coordination while rural areas faced logistical and administrative barriers. Innovative local practices, such as digital health monitoring and women's farmer groups helped bridge implementation gaps. However, structural constraints, such as inflexible eligibility criteria, poor data integration and fiscal dependency on the central government, limited the programme's reach. Indonesia's experience demonstrates that effective stunting reduction requires national policy frameworks and locally adapted, multisectoral approaches that address system-level barriers. The practical lessons from this study can empower LMICs aiming to scale up integrated nutrition, health and social protection programmes, equipping them with the necessary knowledge and insights.