Analysis of the Effectiveness of the Infant and Child Feeding

Program (IYCF) in Disaster Emergency Situations in

Lumajang Regency, Indonesia

Hilda Carmitha Panjaitan

, Sumardiyono

and Sapja Anantanyu

Postgraduate Program of Nutrition Sciences, Universitas Sebelas Maret, Surakarta, Indonesia

Vocational School, Universitas Sebelas Maret, Surakarta, Indonesia

Universitas Sebelas Maret, Surakarta, Indonesia

Keyword: CIPP Model, Emergency Nutrition, Infant and Young Child Feeding Program.

Abstract: The IYCF program primarily aims to protect mothers, infants, and toddlers from malnutrition and other

diseases. Unfortunately, the majority of IYCF have shown no significant success. The preliminary study found

that during the eruption of Mount Semeru in December 2021, IYCF program was discovered. This study

aimed to analyze the effectiveness of the IYCF program in disaster emergency situations in Lumajang

Regency. This study was evaluative research using the CIPP model, with a mix-method approach. Data

collection was carried out through in-depth interviews regarding the needs (context), resource use (input), and

activities (process) with 7 informants, as well as measuring the nutritional status of toddlers (product). Data

analysis was carried out through content analysis in the form of frequency based on indicator assessment. The

context aspect of the success of the IYCF program is 75% (effective) related to limited time for local food

and nutrition services; input aspect 83% (effective) related to lack of trained nutritionists; process aspects

67% (quite effective) related to the focus only on IYCF kitchen; product aspects 100% (very effective) related

to normal nutritional status in toddlers. It is still necessary to increase the effectiveness of the IYCF program

which can directly affect the nutritional status.

1 INTRODUCTION

Disaster emergency conditions are closely related to

the emergence of problems in the nutrition section,

especially for infants and toddlers as a vulnerable

group. This specifically occurs in Indonesia which is

among the top 3 countries at the highest risk of natural

disasters, after the Philippines and India (World Risk

Report, 2022). Therefore, to address the nutritional

problems of infants and toddlers in disaster situations,

the Government is implementing the Infant and Child

Feeding Program (IYCF). The IYCF program

primarily aims to protect mothers, infants, and

toddlers from malnutrition and other diseases that

arise as a result of disasters. Activities in the IYCF

program include organizing IYCF kitchens,

providing support for breastfeeding and IYCF

counseling, offering counseling orientation and

training on breastfeeding and IYCF, ensuring access

to mother and child-friendly spaces, and enhancing

IYCF coordination (RI Ministry of Health, 2020).

Unfortunately, several previous studies have

found that the majority of emergency nutrition

programs, specifically IYCF, have shown no

significant success. According to Siagian (2014),

during the eruption of Mount Sinabung in Karo

District in 2014, the provision of toddler food menus

was minimal, as public kitchens did not prepare

special menus adapted to the needs of toddlers.

Additionally, there was no management to control the

assistance of breast milk substitute products, which

influenced the occurrence of 15.5% of cases of

malnutrition in toddlers. Similar findings were shown

in the results of research by Nasrul et al. (2019),

which found that food for toddlers became irregular

and lacked nutritional value during the earthquake in

Palu City in 2018, resulting in 9.1% of toddlers

experiencing severe wasting and 22 .7% experiencing

wasting. The results of the research by Sulistiawati &

Taufiqqurrahman (2020), also found that during the

earthquake in West Lombok Regency in 2018, the

provision of food for toddlers and adults was not

differentiated, and toddlers tended to consume instant

Panjaitan, H. C., Sumardiyono, and Anantanyu, S.

Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency, Indonesia.

DOI: 10.5220/0012898400004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 30-39

ISBN: 978-989-758-727-6; ISSN: 2975-8297

food, such as instant noodles and snacks, that lack of

nutrients.

The preliminary study found that during the

eruption of Mount Semeru that occurred in Lumajang

Regency in December 2021, a feeding program for

infants and children was discovered. In this regard,

the evaluation of program effectiveness can be carried

out using one of the evaluation models, namely the

Context, Input, Process, Product (CIPP) model. The

CIPP model in the evaluation format is more

comprehensive at each evaluation stage, especially

for IYCF programs that involve planning,

implementation, monitoring, and evaluation stages.

As for the evaluation of IYCF programs in Indonesia,

there is still a tendency to solely focus on the final

results neglecting the assessment of each stage of the

program, as observed in the research by Widaryanti

and Rahmuniyati (2019). Based on this, this study

aimed to analyze the effectiveness of the Infant and

Child Feeding Program (IYCF) in disaster emergency

conditions in Lumajang Regency, East Java.

2 METHOD

This research is evaluative research using the

Context, Input, Process, Product (CIPP) model, with

a mixed method approach. The research was

conducted in Lumajang Regency, Penanggal Village,

and Sumbermujur Village Relocation Settlement. The

research was conducted from March to April 2023.

The research is part of the thesis research that

comprehensively analyzes the effectiveness of the

emergency nutrition program on the nutritional status

of toddlers after the disaster in Lumajang Regency.

However, to evaluate the effectiveness of the IYCF

program, this study focuses on evaluating programs

related to IYCF, including the needs of toddlers

(context evaluation), resource utilization (input

evaluation), and activities in the IYCF program

(process evaluation). The evaluation data was

collected from 7 informants selected through a

purposive sampling technique, including 2 nutrition

officers, each from the district and village, as key

informants, as well as 1 cadre and 4 parents of

toddlers who have survived the disaster, as supporting

informants.

Furthermore, the collection of data related to the

nutritional status of infants and toddlers,

encompassing an assessment of parental knowledge,

attitudes, and skills toward toddler nutrition (product

evaluation). A total of 44 respondents, identified as

toddlers, participated in the measurement.

After collecting the data, the results of the in-

depth interviews were carried out for content analysis

using a triangulation technique to answer each

indicator in terms of context, input, and process.

Meanwhile, the results of completing the

questionnaire were assessed using score

interpretation criteria, with scores ≤ 33% falling into

the poor category, 34 – 67% into the sufficient

category, and ≥ 68% into the good category.

The results of the analysis of the context, input,

process, and product aspects were further analyzed by

frequency based on the indicator assessment criteria

sheet developed by researchers. The criteria sheet was

formulated based on the guidelines for implementing

nutritional responses during the emergency response

period (Indonesian Ministry of Health, 2020), a

pocketbook for nutritional emergencies for toddlers

after the disaster (Fahmida et al., 2019), Regulation

of the Minister of Health of the Republic of Indonesia

Number 75 of 2019 concerning Health Crisis

Management, Regulation of the Head of the National

Disaster Management Agency Number 7 of 2008

concerning Guidelines for Procedures for Providing

Assistance to Fulfill Basic Needs, and Law of the

Republic of Indonesia Number 24 of 2007 concerning

Disaster Management.

The assessment of each indicator was categorized

into 3 levels: high (score 3), moderate (score 2), and

low (score 1). Determination of the effectiveness

assessment was calculated based on the percentage of

the total score obtained for each aspect sub-

component. Based on the results of calculating the

percentage interval of all indicators, the effectiveness

criteria are presented in Table 1 below.

Table 1: IYCF Program Effectiveness Criteria in

Emergency Conditions.

No. Effectiveness criteria (%) Category

a. 86-100 Very effective

b. 73-85 Effective

c. 60-72 Quite Effective

d. 47-59 Less effective

e. ≤46 Ineffective

3 RESULTS AND DISCUSSION

3.1 Characteristics of Research Subjects

The qualitative approach of this study managed to

collect data from various informants, including 1

district nutrition officer (DN)(n=1) and 1 nutrition

officer in one of the villages which became the center

of relocating shelter (VN) (n=1) as key informants, 1

cadre (C) (n=1) and parents of toddlers who lived in

Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency,

Indonesia

the Sumbermujur Village Relocation Settlement (PT)

(n=4) as supporting informants.

In the quantitative approach, this study

successfully identified 44 infants and toddlers as

recipients of the IYCF program since the onset of the

Mount Semeru volcanic eruption disaster in

December 2021, residing in the Sumbermujur Village

Relocation Settlement. The research findings

revealed that 59% of the toddlers were females. The

most prevalent age group (34%) was 3 years old. A

majority (39%) of the toddlers' mothers were aged

between 31 and 35 years, and 91% of them were

employed as daily wage laborers. The characteristics

of the toddlers can be observed in Table 2 below.

Table 2: Characteristics of Infants and Toddlers’s Parents

Receiving the IYCF Program in Lumajang.

General Characteristics n = 44 %

Age (years)

21-25

26-30

31-35

36-40

>40

Level of education

Elementary school

Junior high school

Senior high school

Bachelor

Ethnicity

Jawa

Madura

Jawa-Madura

Work

Mechanic

Trader

Operator

Teacher

Daily laborer

3.2 Effectiveness of the IYCF Program

from the Context Aspect

tThe evaluation of the success of the IYCF program

from the context aspect involves several indicators,

including the availability of nutrition services, the

availability of special local food for toddlers, the

timing of providing assistance with local food for

toddlers, and the suitability of program goals and

priorities.

As shown in Table 3, the study's results reveal

that, from the context aspect, the indicator of local

food assistance for toddlers meets the high category

of assessment. However, other indicators, namely the

availability of nutrition services, the duration

coverage for providing food assistance, and the

suitability of program goals and priorities, exhibit

moderate values. The fulfillment of needs reaches a

score of 78%, which is classified as effective while

program goals and priorities attained 67% which is

classified as quite effective. Considering all aspects

of the context, the overall assessment reached 75%,

classifying it as effective.

Table 3: Assessment of Context Aspects of the IYCF

Program in Lumajang Regency.

No. Context Aspect Rating

Information

Fulfillment

1) Availabil

ity of nutritional

services

ffective

2) Local

food assistance

for toddlers

3) Length

of time for food

assistance

Program goals and

priorities

Quite

Effective

Average 75 Effective

3.2.1 Fulfillment of Needs

The availability of nutrition services falls within the

moderate category, indicating that nutrition services

are available for toddlers, but do not cover all

toddlers.

Quote 1 “Because of our shortcomings there, we

are unable, I mean the government is also confused

about spreading it. Because we also don't know. If we

want to gather everyone in one place it's not enough.”

(VN)

Based on the above quotation, it can be observed

that the limited coverage of nutrition services is

related to a lack of resources, and the fact that the

community as disaster survivors are not displaced at

the 7 designated evacuation points, such as the

Penanggal Village Field, the Village Hall in

Penanggal, the Village Hall in Candipuro, Candipuro

Field, The Pasirian Village Hall, Pasirian Middle

School 2 and Pronojiwo Middle School 2. Instead,

they chose to evacuate independently in rented houses

or relatives' houses. This decision was caused by the

uncomfortable living conditions, especially for

toddlers.

Quote 2 "The point is, I lived in a rented house for

7 months and then moved here (Permanent Residents

in Sumbermujur Village) after Eid Al-Fitri." (PT 3)

ICSDH 2023 - The International Conference on Social Determinants of Health

Quote 3 "Arrived at Sumbermujur Village Hall

just after sunset, then stayed at a relative's house last

night, right the next day." (PT 4)

Quote 4 "It's hot there, so it’s uncomfortable." (PT 1)

Regarding nutrition services in the form of

counseling, only one session was carried out for

breastfeeding mothers. However, counseling for

toddlers was not carried out due to the lack of

monitoring of their nutritional status.

Quote 5 "Well, you know, there was a pregnant

mother, and when it was time for her to give birth, her

breast milk didn't come out, so we provided

counseling for breastfeeding." "...Those toddlers are

not mine, you know, so I don't really know. I mean, I

can't really understand their needs either." (VN)

Apart from this, according to the Indonesian

Ministry of Health (2020), nutrition services in the

IYCF program include IYCY and breastfeeding

counseling, as well as access to appropriate, safe, and

age-appropriate food. The suboptimal

implementation of nutritional counseling and the low

coverage of its implementation can indirectly affect

the nutritional status of toddlers. According to Ariati

et al. (2019), providing nutritional services to

toddlers, including counseling and nutrition

education to parents, can significantly increase

toddlers' weight. In this case, the limited coverage of

nutrition services may pose a risk for toddlers'

nutritional status.

One of the nutrition services in the IYCF program

is local food assistance through IYCF kitchens. The

assessment of the implementation of the IYCF

kitchen indicated a high rating, suggesting that local

food is available and sufficient to meet daily needs,

with the provision of local food 3 times a day.

Unfortunately, the availability of the IYCF kitchen

only lasts for 3 weeks, limited to the emergency

response period.

Quote 6 "3 full weeks complete meal is provided,

3 times a day." (VN)

The provision of local food through IYCF

kitchens, which is only provided during the

emergency response period, poses potential risks to

the nutritional status of toddlers. Indeed, the condition

of the people affected by the disaster not having fully

recovered economically plays a crucial role in their

ability to fulfill their food needs independently

(Panjaitan et al., 2021). According to National

Disaster Management Agency Regulation number 4

of 2020, the disaster emergency status consists of

three phases: emergency alert, emergency response,

and the transition period from emergency to recovery.

The emergency response period itself represents a

phase where threat still disrupts the lives of

community groups. In this case, the provision of local

food should continue until the recovery period, in the

form of support for IYCF practices through

counseling and home visits (Widaryanti &

Rahmuniyati, 2019).

3.2.2 The Goals and Priorities Program

The fulfillment of inappropriate needs ultimately

affects the goals and priorities of the IYCF program.

In this case, the assessment is classified as moderate,

which means that the program's goals and priorities

are still not appropriate and do not meet the needs of

toddlers.

According to the Indonesian Ministry of Health

(2020), IYCF during a disaster aims to protect groups

of mothers, babies, and children from malnutrition

and other diseases that can arise as a result of

disasters. However, in Lumajang Regency, the goals

and priorities of the program were classified as

inappropriate due to the unpreparedness of

implementing the program for toddlers. At the

beginning of the disaster, the program only focused

on the general public. The IYCF program

commenced after an NGO assistance initiative was

implemented one week after the disaster.

Quote 7 "Well, on day 2 until, I mean, the first

day, H+1, the children get their food from the public

kitchen until H+7. That's because we haven't received

any donations yet." (VN)

Even after the NGOs stopped running the IYCF

program during the emergency response, the

Department of Health and the Community Health

Centers were unable to continue the IYCF program

independently. As a result, feeding for toddlers was

once again diverted to public kitchens, where the food

provided did not consider the type of food and

nutritional adequacy required for toddlers.

Quote 8 "The public kitchen, yes. Because there

are limitations, you know, hahaha, with the donations

we receive." (VN)

The focus on the general public from the

beginning of the disaster in Lumajang Regency

indicated that toddlers, as a vulnerable group, did not

receive direct attention. According to the Ministry of

Health (2012), the IYCF program should have been

implemented from the start of the disaster by

providing food menus that were classified as durable,

such as meat floss and biscuits, while still considering

Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency,

Indonesia

toddler nutritional needs and adequacy. According to

Sulistiawati and Taufiqqurrahman (2020), providing

local food to toddlers through public kitchens is

insufficient to meet the nutritional needs in terms of

quantity, quality, and type of food given. This is also

supported by the results of research findings of

Siagian (2014), which revealed that the provision of

food for toddlers through public kitchens minimally

meets their nutritional needs for growth and

development. The menu available in public kitchens

is specifically tailored for adults, lacking diversity

and limited in choices suitable for toddlers.

3.3 IYCF Program Effectiveness Level

from Input Aspect

The study results presented in Table 4 show that, from

the input aspect, the lowest rating is attributed to the

indicator of resources implementing the IYCF

program, with a total percentage of 67%, which can

be considered quite effective. Regarding supporting

sources, including the role of the government and

nutrition officers, it is classified as effective, with a

total percentage of 83%. In terms of infrastructure and

facilities indicators, the IYCF program achieved a

score of 100%, which is classified as a very effective

rating. Consequently, the overall effectiveness of the

input aspect is 83%, which is classified as effective.

Table 4: Assessment of Input Aspects in the IYCF Program

in Lumajang Regency.

No In

ut As

ects Ratin

% Information

IYCF Program

Implementing Resources

)

Education

Quite

Effective

2) The number of

implementers

. Su

ortin

sources

)

Government role 3 Effective

)

The role of the nutritionist 2

IYCF Program Infrastructure

and Facilities

1) Physical facilities

100 Very effective

2) Nutritional supplies or

ment

Avera

e 83 Effective

3.3.1 IYCF Program Implementing

Resources

The education assessment of the program

implementing resources was moderate, meaning that

only a few implementers were nutrition implementing

staff who had received special training in emergency

nutrition management, specifically IYCF in disaster

conditions.

Quote 9 "Yes, so at that time, the incident

happened suddenly. We hadn't received any training

from the Health Department regarding nutrition

during disasters." (VN)

Based on the interview excerpts, it is evident that

all nutrition workers in Lumajang Regency have not

received special IYCF training in disaster conditions.

Some nutrition workers who have undergone training

are part of volunteers or NGOs. The number of

nutrition officers who received the training was only

2 people, so the assessment for the indicator of the

number of implementing staff was classified as

moderate.

However, it should be noted that training obtained

directly in the field through learning from volunteers

or NGOs does not necessarily address all issues in the

implementation of IYCF. The training received from

NGOs only emphasized food processing for toddlers

and was specifically provided to Cadres, lasting for 2

days. The temporary and shallow training related to

IYCF also caused the Department of Health and the

Community Health Centers to be unable to

independently run the IYCF program, which should

include more than just IYCF kitchen activities.

Quote 10 "Yes, it was just for two days. Cadre is

used to cooking, but this time, she was asked to add

carrots and white tofu to the usual soto (soup), as

there were no carrots in it. That was the only

additional menu item requested." (C)

The lack of trained nutrition officers in IYCF can

affect the decline in the nutritional status of toddlers.

According to Sunguya et al. (2013), nutrition training

can improve feeding practices for toddlers, including

practices related to meal frequency, energy intake,

and food diversity. The training provided must also

consider local food availability to ensure its

practicality. The results of this study were also

supported by Wijayanti and Fauziah (2019), who

found that IYCF training enabled health officers,

including cadres, not only to improve food processing

skills but also able to provide counseling and change

parenting patterns regarding providing toddler food

based on balanced nutrition rules, which may

improve the nutritional status of toddlers.

3.3.2 Supporting Sources

Concerning supporting sources, namely the

government, a high rating was obtained. This pertains

to the government's role in assisting the IYCF

program by establishing policies, granting permits for

program implementation, participating directly in the

field, and allocating funds. However, despite

fulfilling all of these responsibilities, it was found that

there was suboptimal allocation of funds concerning

ICSDH 2023 - The International Conference on Social Determinants of Health

the length of time the emergency funds were to be

disbursed.

Quote 11 "...Actually, we had the local funds

available at that time. It's called emergency funds,

and we did allocate them, but the process of accessing

local funds takes a long time." (NO)

According to Law Number 24 of 2007 concerning

Disaster Management, the Government and local

governments have the authority to determine policies,

including disaster management planning,

guaranteeing the rights of communities and refugees

according to minimum service standards, protecting

disaster-affected communities, implementing

development programs, and allocating disaster

management funds. Maximum funds allocation in the

program is required to achieve better outcomes in the

nutrition program. This is in line with the results of

research by Pearson et al. (2018), which emphasizes

the importance of adequate program funding

balanced with the promotion of improved IYCF

practices in reducing nutritional problems, especially

stunting.

Regarding other supporting sources in the IYCF

program, namely nutrition officers, a moderate rating

was obtained. This means that the nutrition officers

have not fully met the needs and resolved the

problems faced by toddlers as a whole in IYCF. This

is related to the lack of nutrition officers who receive

emergency nutrition training, limited nutrition

services that are unable to reach all toddlers, and the

inability to follow up on IYCF implementation until

the recovery transition period.

3.3.3 IYCF Program Infrastructure and

Facilities

Regarding the facilities and infrastructure of the

IYCF program, namely the availability of physical

facilities, a high rating was obtained, indicating that

≥68% of adequate facilities were available. In this

instance, there is a special food storage area for

infants and toddlers that meets the standards. This

storage area is separate from the general food storage,

shielded from direct sunlight, stored on pedestals, and

supervised by competent staff. During the IYCF

kitchen implementation process, the availability of

cooking utensils and distribution is guaranteed.

However, regarding physical facilities, access to

mother and child-friendly rooms is lacking and is

only available in one of the evacuation sites.

According to the Indonesian Ministry of Health

(2020), the person in charge of nutrition should

ensure that mother and child-friendly spaces are

available in various evacuation centers and accessible

to pregnant and breastfeeding women, allowing them

to practice IYCF comfortably. The unavailability of

mother and child-friendly spaces can be a factor in the

discomfort of mothers residing in evacuation sites,

caused by concerns and the stressful conditions they

experience. This is following research by van Dellen

et al. (2022), who found that quality-friendly spaces

for breastfeeding mothers can help alleviate stress,

positively impact milk production, foster a sense of

organizational support, and enhance subjective well-

being. Metzler et al. (2019), also found that the

establishment of child-friendly spaces has a long-

term impact on psychosocial well-being.

Besides physical facilities, the availability of

nutritional supplies or equipment also exhibits a high

score in supporting the IYCF program. However,

during IYCF implementation, the nutritional

equipment, in the form of IYCF kits, belonged to

NGOs. The assistance provided to the Community

Health Centers in the form of IYCF kits was still

incomplete. Furthermore, the nutrition kit did not

provide the IYCF survey study form, which is

required to maximize the process of monitoring and

evaluating the program (RI Ministry of Health, 2020).

Quote 12 “None (IYCF survey review form). That

is also not available (IYCF kit). We don't have any,

that's why we asked Wahana Visi for them. The

community health center received some, but they

were incomplete.” (VN)

3.4 IYCF Program Effectiveness Level

from Process Aspect

The evaluation of the level of effectiveness of the

IYCF program in terms of the process can be

observed through program planning, forms of

activities, timing of program implementation, and

reporting of IYCF program activities. Based on the

research results in Table 6, the level of effectiveness

of the IYCF program from the process components in

Lumajang Regency is as follows: program planning

reached 50%, which is classified as less effective; the

form of activity reached 67%, classified as quite

effective; program implementation time reached

67%, also classified as quite effective; while the

reporting of IYCF program activities reached 100%,

classified as very effective. Overall, the effectiveness

of the IYCF program from the process aspect reached

67%, which is classified as quite effective.

Table 5: Assessment of Process Aspects in the IYCF

Program in Lumajang Regency.

Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency,

Indonesia

No Process Aspects Rating % Information

a. Program Planning

1) IYCF intervention

plan

Less

effective

2) IYCF evaluation

plan

b. Forms of activity

Quite

Effective

1) IYCF

intervention

c. Program implementation

time

1) IYCF kitchen

implementation time

Quite

Effective

2) Implementation time

for breastfeeding

counseling and IYCF

3) Implementation time

for breastfeeding

counseling and IYCF

training

d. Reporting on IYCF

program activities

3 100

Very

effective

Average

Quite

Effective

3.4.1 Program Planning

The assessment of planning for the IYCF intervention

is moderate, as it focuses on ensuring the output of a

policy plan and management mechanism for

donations of breastmilk substitutes, access to

nutritious food, support from related sectors, and

coordinated IYCF interventions. However, there is

uncertainty in the output of access to mother and

child-friendly spaces. Currently, mother and child-

friendly spaces are only available at one of the

evacuation sites, making them inaccessible to all

breastfeeding mothers and toddlers.

Regarding the policy plan and mechanism for

managing the donation of breast milk substitute

products, the government has formulated a policy

plan, but the Department of Health and the

Community Health Centers are facing challenges in

managing it. A large amount of formula milk

assistance made the Community Health Centers

unable to control the circulation of milk products,

especially for infants under 6 months. This issue can

harm the nutritional status of these infants, as research

by Lestari et al. (2014) has shown a positive

relationship between the dose mismatch of giving

formula milk and nutritional status, as well as a

negative relationship between the sanitation of

serving milk and the duration and frequency of

diarrhea, which can cause a decline in the nutritional

status of infants under 6 months.

Despite those challenges, access to nutritious food

for toddlers has been ensured through joint planning

with NGOs, involving local health officers and cadres

to discuss area coverage, availability of staple foods,

and the implementation mechanism for IYCF.

Quote 13 "Yes, before the training, the people

come here. It means that no matter the shifts, just do

everything. I mean, there are no designated shifts for

cooking. It’s 3 times a day. There's no need to divide

the responsibilities; we do it collectively to avoid

overwhelming anyone at home." (C)

Regarding the evaluation plan of the IYCF

program, the assessment was classified as low. This

is related to the evaluation process which is only

carried out for one activity, namely the IYCF kitchen,

including how cadres prepare food for toddlers.

According to the Indonesian Ministry of Health

(2020), the evaluation of the IYCF program should be

carried out in all series of IYCF program activities,

including mechanisms for managing donations of

breastmilk substitute products, bottles and baby

pacifiers, IYCF kitchens, access to breastfeeding and

IYCF counseling, access to mother and child-friendly

spaces, as well as IYCF coordination.

Quote 14 "Yesterday, we did this, and the

evaluation mainly focused on the implementation of

the kitchen." (DN)

Quote 15 "Yes, so the evaluation was about

whether the cadres' way of cooking was appropriate

or not." (VN)

An evaluation plan that solely focuses on one

activity can lead to neglect of other activities and run

suboptimal, thereby affecting program achievement.

In this case, it can have implications for the

nutritional status of toddlers.

3.4.2 Forms of Activity

In practice, the assessment of the IYCF program

intervention was classified as moderate. This is

related to the implementation of activities, such as

IYCF kitchens, breastfeeding and IYCF counseling

support, access to mother and child-friendly spaces,

as well as IYFC coordination. However, training on

breastfeeding and IYCF counseling was not

conducted during the disaster situation.

Quote 16 "Not if they are trained in this way, but

according to their knowledge they are capable." (DN)

According to the Indonesian Ministry of Health

(2020), training in breastfeeding counseling and

IYCF in disasters must target health and non-health

officers, including cadres and the community. This is

ICSDH 2023 - The International Conference on Social Determinants of Health

to ensure the availability of human resources capable

of continuing counseling activities, especially during

the rehabilitation and reconstruction period after the

assignment of counselors from outside the area or

from NGOs ends. The absence of this training is a

contributing factor to the unsustainability of the IYCF

program and can affect the decline in the nutritional

status of toddlers. This is in line with the findings of

research by Syihab et al. (2021), which revealed that

the level of education and the attitude of the counselor

significantly influences IYCF counseling practices.

Therefore, providing training to improve the

knowledge and attitudes of IYCF counselors is an

important factor in supporting the improvement of the

nutritional status of toddlers.

The implementation of counseling with NGOs

cannot cover all cases of nutrition issues that occur.

According to the Ministry of Health of Indonesia

(2020), in the planning of emergency nutrition

responses, a situation analysis is required, which

includes the nutritional status before and after the

disaster. The lack of data or information related to the

nutritional status of toddlers also identifies

insufficient planning in the nutritional response in

Lumajang Regency. As a result, activities within the

program, such as counseling, cannot be carried out to

their full potential.

3.4.3 Time of Program Implementation

Regarding the timing of activities in the IYCF

program, a relatively high score was obtained in the

IYCF kitchen activities, which were carried out every

day throughout the 3-weeks, providing staple food

three times a day. However, moderate scores were

obtained in the implementation of counseling support

as it ran erratically, and low scores were obtained in

counseling training activities as they were not carried

out.

Quote 17 "The staple food is sufficient, three

times a day, every day." (DN)

Regarding the implementation of counseling, it is

carried out at uncertain times. Two months after the

disaster, the community no longer received direct

nutrition services at the evacuation sites. However,

individuals who felt they needed nutritional services,

including weighing and counseling, were directed to

go to the Community Health Centers.

Quote 18 "Yes, only for specific cases. So, after

February in the following months, we conduct

outreach in the community within the evacuation

area. If there are any health issues, they can directly

go to the community health center (Puskesmas). For

example, if they want to know the weight of their

toddlers or any other health concerns, they can visit

the community health center right away." (VN)

According to Panjaitan et al. (2021), during a

disaster situation, the community's condition is not

yet stable, both psychologically and economically.

Therefore, the program becomes unsustainable,

which may trigger public distrust. This, in turn, will

also influence the level of community participation in

utilizing nutrition services at the Community Health

Centers. Research by Fatimah and Hidayah (2022)

revealed that factors supporting the participation of

mothers of toddlers in utilizing nutrition services at

the Community Health Centers include work, support

from health officers and family, as well as the

availability of facilities and infrastructure.

3.4.4 Reporting of the IYCF Program

Activities

Regarding program evaluation, the assessment rsults

for reporting IYCF activities are high, indicating that

reporting is consistently carried out. In this case,

reporting is conducted every week through online

meetings for three consecutive weeks, focusing solely

on IYCF kitchen activities.

However, despite conducting an evaluation, the

recording and reporting of the evaluation results were

not performed due to a lack of guidelines. According

to Haniarti and Yusuf (2020), the absence of these

guidelines also indicates that during a disaster, the

handling of toddlers' nutrition has not been handled

specifically. In this case, the responsibility for

preparing SOPs for handling toddler nutrition in post-

disaster conditions should lie with the Department of

Health.

3.5 IYCF Program Effectiveness Level

from Product Aspect

An assessment of the level of effectiveness of the

IYCF program can be observed by examining the

nutritional status, which is indirectly influenced by

the knowledge, attitudes, and skills of parents of

toddlers in fulfilling and improving toddler nutrition.

The findings of the study by Ayed et al. (2021)

revealed a significant positive relationship between

knowledge, attitudes, and skills of mothers on weight

for age (W/A) and height for age (H/A) for toddlers.

In other words, a mother's knowledge, attitudes, and

skills have a positive effect on toddler growth. These

findings are further supported by the research

conducted by Tanuwijaya et al. (2018), which also

identified a significant relationship between mothers'

Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency,

Indonesia

knowledge about IYCF and the nutritional status of

infants and toddlers.

Concerning this, the results of the study found that

among the 44 infants and toddlers who survived the

disaster in Lumajang Regency, the majority (91%)

had normal nutritional status after the disaster.

Consequently, the effectiveness of the IYCF program

from the product aspect could be classified as very

effective.

This study has limitations in attaching supporting

data in the form of real reporting results of infant and

young-child feeding programs during disasters,

related to the lack of program reporting by the

Department of Health so that research data is only

based on informant statements.

4 CONCLUSIONS

Apart from the results of the product aspect which is

classified as very effective, there is still a need to

enhance effectiveness in context aspects, including

nutrition services and local food provision, input

aspects, especially implementing resources, and

process aspects, including planning, intervention, and

implementation time of the IYCF program which can

directly affect the nutritional status of infants and

toddlers.

ACKNOWLEDGEMENTS

We would like to thank the nutrition officers and

cadres in Lumajang district, as well as disaster

survivors, especially mothers and toddlers in

Sumbermujur village permanent housing for their

participation in this research.

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Analysis of the Effectiveness of the Infant and Child Feeding Program (IYCF) in Disaster Emergency Situations in Lumajang Regency,

Indonesia