SAVING

LIVES
CHANGING
LIVES

2017 Endline Survey of

Indonesia’s School Meals
Programme (Pro-GAS)
March 2018
Endline Survey of the National School Meals Programme
(Pro-GAS)
1. Background

Indonesia faces issues of undernutrition, overweight and obesity. Nutrition indicators

have shown little improvement since 2007, with one in three children aged under five
are stunted; in 15 of 34 provinces this exceeds 40 percent. High levels of stunting in
early life may impact children’s academic performance and ultimately the quality of
human resources. Moreover, a significant number of children from 6 to 14 years old
consume insufficient calories and protein for healthy growth and development.
Undernourishment in school age children may impact their ability to concentrate and
lead to absenteeism due to vulnerability to illness.

With support from Cargill and WFP, the Ministry of Education and Culture helps poor
students across the country enjoy healthy meals and learn about nutrition and hygiene
through Indonesia’s home-grown school meals programme (known as Pro-GAS). We
are leveraging school meals not only as a source of nutrition, but also as an economic
opportunity for local farmers. WFP in partnership with Cargill foster sustainable
school meals supply chains and at the same time promote nutritious, balanced diets
with a particular focus on primary aged students, women and youth.

This partnership is aligned with the Sustainable Development Goals (SDGs) 2 (zero
hunger) and 4 (quality education), while also impacting SDG 17 (partnerships to
achieve the SDG goals).

Through funds from Cargill in 2017, WFP was able to provide capacity strengthening
support for the Ministry of Education and Culture. Targets for the national school
meals in 2017 have increased across five provinces to 100,000 students and 563
primary schools across 11 stunting priority districts, as compared to 38,500 students
and 150 primary schools across four districts in 2016 when Pro-GAS started.

Under the 2017 WFP-Cargill partnership, Pro-GAS model was replicated in three
districts –- Serang, Pasuruan and Belu -- in addition to the 11 priority districts selected
by Indonesia’s Ministry of Education and Culture. The WFP-Cargill partnership was
extended to one primary school in Serang district, Banten province, two schools in
Pasuruan district, East Java province and one primary school in Belu district, Eastern
Nusa Tenggara province.

The three main components of Pro-GAS includes nutrition education, provision of

nutritious meals and community participation. The nutritious meals, nutrition, health
and hygiene education are intended to address the low nutritional status of primary-
age children, improve health and hygiene behaviours, attendance rates, as well as
students’ active participation in class.

In order to measure the impact of Pro-GAS in schools supported by Cargill, WFP

conducted an endline survey using a quasi-experimental (pre and post intervention
and control groups) approach. The control schools were selected from neighboring
areas of the target schools of Cargill-led school meals programme. For the purpose of
this endline survey, Serang and Pasuruan districts were selected as locations of the
population sample.

More specifically, the endline survey compared the findings between baseline and
endline data of the following indicators:
a) Students’ knowledge of nutrition, health and hygiene
b) Personal hygiene of school chidlren;
c) Students’ food consumption habits;
d) Students’ access to safe drinking water;
e) Students’ academic performance;
f) Students reported ill in the past month;
g) Attendance Rates’ (number of absences in the past six months);
h) Students concentration in class;
i) Physical fitness of school children; and
j) Nutritional status of school children;

A separate study was conducted by SEAMEO, a research institution on the impact of

Pro-GAS implemented directly by the Ministry of Education and Culture in 11
districts.
2. Methodology

2.1. Sample Population and Locations

A baseline was established with 185 students from six schools. The endline survey
was conducted from 7 to 12 February 2017 amongst 175 students (97 boys/79 girls)
selected from the same six primary schools in Serang and Pasuruan districts surveyed
in the baseline. The endline survey collected data from 175 of 185 students across six
primary schools in the two selected districts. Hence, children’s participation during
the endline survey stood at 89.2 percent of the total number of students. The
assessment took place at school therefore only students who were present at school
on the day of assessment were included.

Table 1. List of schools and number of respondents

Number of subjects
District School name Treatment
Boys Girls Total
Serang SDN Citawa Intervention 5 10 15
Serang SDN Gorda I Control 12 20 32
Pasuruan SDN Ngerong Intervention 27 18 45
Pasuruan SDN Wedoro 2 Control 13 3 16
Pasuruan SDN Gunung Sari 2 Intervention 10 3 13
Pasuruan SDN Pogar 2 Control 29 25 54
Total 97 79 175

2.2. Data Collection Methods

The same procedure of data collection as the baseline survey was used to ensure that
the results comparison remains accurate between baseline and endline surveys.
However, additional information was added in the endline questionnaires where
relevant.

The procedures and tools that were used are described as follows:
1. In-depth interviews using structured questionnaires for school children in order
to collect general information such as date of birth, reported illness, personal
hygiene, concentration and hunger, activity during class session, food
consumption habits, as well as nutrition, health and hygiene knowledge;

2. Observation of personal hygiene, in particular nail condition;

3. Anthropometry measurement consisting of body weight and body height
measurement. The body weight was measured using digital weighing scale SECA
Clara 803 while height was measured using stadiometer SECA 213;

4. Hemoglobin was measured using HemoCueHb 301+ Analyzer from finger-prick

blood; and

5. Self-administered questionnaires for headmasters assessed a series of relevant

habits and behaviours of children.

Anthropometry measurement was conducted by the lead researcher. Data was

collected by trained enumerators from the local areas under the supervision of the
lead researcher. Meanwhile, the hemoglobin measurement was conducted by local
health center personnel.

The lead researcher provided a training for enumerators prior to the start of data
collection. The enumerators were also responsible to check the completeness of
information in the questionnaires, hemoglobin measurement and anthropometry
measurement. All completed questionnaires were then compiled for data entry and
analysis.

Data was entered and analyzed using SPSS 20 to obtain students’ nutritional indices,
a macro for SPSS of the WHO Anthro v.1.0.2 was used for this purpose. Subsequently,
data was checked and cleaned to prepare for data analysis.

Bivariate analysis was used to assess the different findings of the baseline and endline
surveys and between intervention and control groups using chi-square test for
categorical data and independent T-test for continuous data.

A p-value of <0.05 was considered as significant. In the results section, a sign of *

indicates the significant level of p<0.05, ** indicates p<0.01, and *** indicates p<0.001.

Anemia status was obtained from data on hemoglobin measurement.

Table 2. Criteria of anemia status based on hemoglobin concentration (WHO,
2011)

Anemia Status Hemoglobin

Concentration
Normal/No >=11.5 g/dL
anemia
Anemia <11.5 g/dL
- Mild anemia 11.0 - <11.5 g/dL
- Moderate 8 - <11 g/dL
anemia
- Severe <8 g/dL
anemia

The nutritional status of children was categorized according to the WHO cut-off
values for public health significance:
1. Stunting prevalence
- Low: < 20 percent
- Medium: 20-29 percent
- High: 30-39 percent
- Very high: 40 percent

2. Wasting prevalence
- Acceptable: 5 percent
- Poor: 5-9 percent
- Serious: 10-14 percent
- Critical: ≥ 15 percent

The food consumption score was calculated based on consumption of several food
groups consumed in the preceding week. These food groups include: (i)
Cereals/staple; (ii) Vitamin A rich vegetables and tubers; (iii) Green leafy vegetables;
(iv) Other vegetables and fruits; (v) Vitamin A rich fruits; (vi) Meat; (vii) Eggs; (viii)
Fish.

Nutrition and health knowledge and practice was assessed through questions on food
for breakfast, balanced diets, food groups as source of energy and protein, safe
drinking water, personal hygiene, food safety/hygiene, and food purchased outside
(from street and/or school vendors).

Children considered with good knowledge if they could answer correctly at least 75
percent of the questions on nutrition and health.
3. Results

3.1. Students’ Knowledge of Nutrition Improved

In the intervention group, there was a significant increase in the proportion of children
who demonstrated good nutrition, health and hygiene knowledge and practice during
the endline survey as compared to baseline survey: 87.7 percent as compared to 71.2
percent.

Figure 1. Nutritional Knowledge, Attitude and Practice among Children

Percentage

87.7 87.3 92
71.2

Intervention Control

baseline endline

In particular, students demonstrated good understanding of types of nutritious food

for breakfast, the importance of having nutritiously balanced meals every day, types
of food which contains protein, energy and vitamins.

Table 4. Detailed Nutritional Knowledge among Children

Percentage
Description Intervention Control
BL EL Sig. BL EL Sig.
Breakfast should contain
nutritious, healthy and safe 87.7 96.9 * 94.1 99.0 NS
foods
Nutritionally balanced diets
consumed 3 times a day helps
86.3 92.3 * 93.1 92.0 NS
you to maintain your health

Without 3 meals a day, you will

not have the energy your body 80.8 84.6 NS 78.0 89.0 *
required
Fish, egg and meat are sources
of protein 75.3 93.8 ** 89.2 90.0 NS
 Percentage
Description Intervention
BL BL BL
Rice, corn, cassava and tubers
78.1 84.6 * 90.2 93.0 NS
are sources of energy
Vegetables contains protective
ingredients which keeps the
84.9 92.3 * 94.1 94.0 NS
body healthy and prevent
illnesses
Fruits contain protective
ingredients which keeps the
89.0 95.4 * 94.0 95.0 NS
body healthy and prevent
illnesses
Food purchased outside is (not)
67.1 70.8 NS 66.7 68.0 NS
good for health

3.2. Students‘ Personal Hygiene Improved

In the intervention group, the proportion of children who brushed their teeth before
bed time every night was significantly higher during endline survey: 96.7 percent as
compared to 74 percent. Meanwhile, the number of students who washed their hands
before eating increased to 95.4 percent from 93.2 percent and students who trimmed
their nails regularly also increased to 66.2 percent from 54.8 percent.

Figure 2. Personal Hygiene: Intervention Group

Percentage

96.7 93.2 95.4

74 66.2
54.8

Brushing Teeth Handwashing Nail Trimmed

baseline endline
Table 5. Personal Hygiene and Grooming Habits amongst Students

Percentage
Description Intervention Control
BL EL Sig. BL EL Sig.
Brushing teeth before
sleeping
- Every *** NS
74.0 96.7 88.1 92.0
day/sometimes
- Never 26.0 3.3 11.9 8.0
Nail condition 54.8 66.2 ** 76.5 53.8 **
Students who washed their
hands with soap and
running water prior to
NS NS
eating and after defecating
- Always/often 93.2 95.4 99.0 98.0
- Never 6.8 4.6 1.0 2.0

3.3. More Children Consumed Regular Balanced Meals

Pro-Gas was not intended to replace breakfast or lunch at home. The design of the
programme aimed to complement breakfast provided at home.

In the intervention group, there was a significant improvement in the number of

students who consumed breakfast at home: 63.1 percent as compared to 52.1 percent.

Figure 3. Food Consumption Habits amongst Children

Intervention Control
Percentage

Percentage

63.1 53.8 58 58.8

52.1 48 48 45.1 43
38.4 39.7 41.5

Breakfast Lunch Dinner Breakfast Lunch Dinner

baseline endline baseline endline

In the intervention group, the proportion of children who consumed a balanced meal
three times every day was significantly higher during the endline survey: 47.7 percent
as compared to 24.7 percent. Meanwhile, the proportion of children who purchased
food outside from street and/or school vendors every day was significantly lower
during the endline survey in the intervention group: 78.5 percent as compared to 91.8
percent.

In addition, more students in both groups consumed fruits and vegetables: 13.1
percent as compared to 6.8 percent.

Table 6. Types of Food Consumed by Students and Frequency

Percentage
Description Intervention Control
BL EL Sig. BL EL Sig.
Consuming
balanced diets
- Every day 24.7 47.7 44.1 34.0
** *
- 3-6x/wk
32.9 16.9 29.4 25.0

Habits of eating
fruits and
6.8 13.1 * 8.0 14.0 *
vegetables every
day
Habits of buying
food outside 91.8 78.5 * 84.8 73.1 *
home

In the intervention group, the endline survey found the consumption of green leafy
vegetables significantly increased to 46.2 percent from 33.3 percent.

The number of children who consumed mango and papaya as fruits increased
significantly in the intervention group during the endline survey to 23.1 percent from
13.7 percent. These fruits were the most consumed ones amongst children in the
intervention group. Usually, children in the intervention group consumed mango
during breakfast and papaya as snacks.

Consumption of meat or poultry rich in protein also increased significantly to 27.7

percent from 19.2 percent.
Table 7. Food Group Consumption in the Preceding Week

Percentage
Description Intervention Control
BL EL Sig. BL BL Sig.
Porridge, bread, rice,
noodle, vermicelli, 80.8 90.8 ** 85.3 87.0 *
corn, bose corn, biscuit
Potato, sweet potato,
12.3 1.5 ** 16.7 5.0 **
cassava, yam, taro
Green leafy vegetables 33.3 46.2 ** 54.9 38.0 **
Mango, papaya 13.7 23.1 ** 25.5 12.0 **
Meat, beef, pork,
mutton, chicken or 19.2 27.7 * 27.5 14.0 **
duck
Eggs 41.1 40.0 NS 47.1 35.0 **
Fresh or dried fish,
24.7 12.3 ** 25.5 38.0 **
oyster, seafoods

3.4. More Children Drank Cleaner Water

During the endline survey, observation was made on children’s housing situations
where 75.8 percent of the children had access to a clean water source while another
94.5 percent had access to latrine at home.

In addition, 63 percent of the households used a commercial water refill service to

access drinking water while another 30.9 percent of the households were using boiled
tap/well water for drinking.

The number of students in the intervention group who drank more or less six glasses
of water every day significantly increased to 34.5 percent from 22.5 percent.
Significant improvement was also observed in the number of students who brought
boiled water to school at 55.4 percent from 31.5 percent.
Table 8. Access to Safe Drinking Water

Percentage
Description Intervention Control
BL EL Sig. BL BL Sig.
Drinking water
- ≥6 glasses/day 22.5 34.5 * 29.7 53.2 **
- <6 glasses/day 77.5 65.5 70.3 46.8
Drinking water at school
- Brought boiled
31.5 55.4 *** 33.3 63.8 ***
water from home
- Other sources 53.4 9.2 45.1 14.9
Drinking water at home
- Boiled water 61.6 78.5 *** 52.0 73.7 ***
- Other sources 38.4 9.2 48.0 19.2

3.5. Students’ Food Safety Habits Improved Significantly

The food safety habits of children in the intervention group improved significantly
with more children practiced washing fruits prior to eating: 95.1 percent as compared
to 79.5 percent.

Table 9. Food Hygiene Habits amongst Children

Percentage
Description Intervention Control
BL EL Sig. BL EL Sig.
Students who washed fruits
prior to eating
** NS
- Always/sometimes 79.5 95.1 92.2 97.0
- Never 20.5 4.9 7.8 3.0

3.6. Students’ Academic Performance Slightly Increased

Overall, the scores for Bahasa Indonesia, Mathematics and Science studies slightly
increased. In the intervention group, the score of Civics study significantly increased
to 76.2 as compared to 70.8.
Table 10. Grade on Selected Courses
Intervention Control
Description
BL EL Sig. BL EL Sig.
Civics 70.8 76.2 * 81.6 83.5 NS
Bahasa Indonesia 71.9 74.6 NS 81.1 82.8 NS
Mathematics 69.1 72.5 NS 78.3 83.2 ***
Science 71.3 74.1 NS 81.2 82.6 NS

3.7. Fewer Students Reported Feeling Ill

The number of students in the intervention group who reported being ill in the last
month decreased significantly during the endline survey to 38.5 percent as compared
to 75.3 percent. In particular, the prevalence of common cold and fever decreased
significantly in the intervention group to 7.7 percent from 35.6 percent and 13.8
percent from 32.9 percent respectively.

Table 11.Prevalence of Illnesses amongst Students

Percentage
Description Intervention Control
BL EL Sig. BL EL Sig.
Diarrhea 11.0 9.2 NS 15.7 3.0 ***
Cough 27.4 16.9 NS 37.3 25.0 *
Common cold 35.6 7.7 *** 29.4 28.0 NS
Fever 32.9 13.8 ** 33.3 11.0 ***
Headache 16.4 7.7 NS 11.8 4.0 *
Ill 75.3 38.5 *** 71.6 51.0 **

3.8. Attendance Rates Improved Significantly

The number of recorded days of absence from school due to illness in the past six
months reduced significantly to 56 days from 61 days.
Table 12.Prevalence of Illnesses amongst Students: Intervention Group

Days of Absence due to Illness

School Name
BL EL
SDN Citawa 25 27
SDN Gunung Sari 5 4
SDN Ngerong 31 25
All schools 61 56

3.9. Students were Able to Concentrate Better in Class

In the intervention group, the number of students who reported feeling hungry and
sleepy in class during the endline survey reduced to 23.1 percent from 27.8 percent
and 13.8 percent from 14.5 percent respectively.

Meanwhile, the proportion of children who experienced hunger and sleepiness in

class in the intervention group was significantly lower than that in the control group.

Figure 4. Experience of Hunger and Sleepiness among Children

Intervention Control
Percentage

Percentage

27.8
23.1 53.5
14.5 13.8 38.8 31.6
16.3

Hungry Sleepy Hungry Sleepy

baseline endline baseline endline

3.10. Too Early to See Changes in Nutritional Status
In the intervention group, there was no statistically significant change in the stunting
prevalence which stood at 15.4 percent (low). Meanwhile, the acute malnutrition
(weight for height) also remained the same at 9.2 percent (acceptable). Similarly, the
hemoglobin concentration remains the same at <8 g/dL (moderate).

The prevalence of overweight increased to 12.3 percent from 8.3 percent while obesity
remains the same at 4.6 percent. Given the increasing number of overweight children,
it is important to consider making an adjustment to the composition and portion of
meals provided across four schools in Cargill intervention areas.

Considering these findings, it is concluded that a follow up survey is needed after a

longer intervention period (beyond the current 10 months implementation period) to
measure improvement in students’ nutritional status in the long run.

Table 13. Nutritional Status of Students in Both Groups

Nutritional Status
Groups
Stunting Wasting Overweight Obesity
Intervention 15.4 9.2 12.3 20
Group 11 8 10 4.6
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Cover page photo: WFP\Fauzan Ijazah

For further information please contact: Nikendarti Gandini

WFP Country: Indonesia
nikendarti.gandini @wfp.org