Community engagement to manage acute malnutrition: implementation research in Kupang district, Indonesia

OBJECTIVE: To improve the low coverage and performance of a programme on community-based management of acute malnutrition, implemented between October 2015 and April 2018 in Kupang district in rural Indonesia. METHODS: To investigate why the coverage and performance were low in the first year of the programme, we conducted a semiquantitative evaluation between August and September 2016. We used the results from the evaluation to inform programme improvement, by developing and modifying community mobilization strategies. We employed a multipronged approach to improve community awareness on acute malnutrition and on community-based services for such condition. This approach involved workshops, focus discussion groups in the community and sensitization events at health posts that had issues with community engagement. Community health workers increased their efforts in active case finding by visiting households with children who had missed the community health post sessions. We measured the performance using three Sphere minimum standard performance indicators: proportion of children recovering (> 75%); defaulting (< 15%); and dying (<10%). RESULTS: The community mobilization efforts increased the screening rate from 17% (564/3278) in October 2015 to 66% (6793/10 251) in March 2018. In 2017, the programme met the three performance indicators: 79% (256/326) of children recovered; 10% (34/326) defaulted; and less than 1% (2/326) died. CONCLUSION: In Indonesia, community mobilization is central for addressing severe acute malnutrition in children younger than five years. This strategy includes securing political leadership and effective messaging alongside locally tailored strategies and continuous ground-level support.