THE ROLE OF ACTORS IN ACCELERATING STUNTING REDUCTION IN INDONESIA: A PENTAHELIX PERSPECTIVE

Objective: The problem of reducing stunting rates cannot only be addressed through a health service approach. Approaches to poverty alleviation, public awareness of the environment and knowledge of the dangers of stunting must also be implemented. So that the government accelerates the reduction in stunting rates through policy interventions and begins involving many actors so that the government's target figures are achieved. Therefore, this research aims to find out the extent of the role of the actors involved in accelerating the reduction in stunting rates in Indonesia. Theoretical framework: This research uses the pentahelix perspective in identifying the involvement of stakeholders. in the policy process, these stakeholders have a role according to their respective actor positions as regulators, conceptors, enablers, accelerators or expanders. Method: This research is a qualitative research with a case study approach. data and information obtained from observation and literature study. Results and conclusions: collaboration between stakeholders in accelerating the reduction of stunting in Bekasi district is effective. the stunting prevalence rate from year to year tends to decrease, especially from 2021 which reached 21.5% to 17.8%. the decline in the rate occurred due to the involvement of stakeholders. they have strategic roles that complement, support and perfect each other. the pattern of cooperation between actors, especially government, academics and business, has concretely alleviated and controlled stunting in several sub-districts and villages in Bekasi. Apart from that, community participation has not been optimal and there has been no collaboration in activities with other actors. Another drawback is that the role of media as an expander is not yet concrete. The media in Bekasi, including radio, print and electronic media, only report the news in a perfunctory manner. The actors actually provide information about their activity agenda, disseminate it through their respective websites and social media. Research implications: This research has implications for the involvement of stakeholders in the implementation of policies to accelerate stunting reduction. Originality/Value: The value of this research lies in multi-stakeholder collaboration in efforts to accelerate the reduction of stunting rates. The results of this research provide new value regarding the roles of multi-stakeholders as strategic actors who determine the success of a program or policy in improving the quality of life of the community.


INTRODUCTION
Stunting is a serious problem for the Indonesian government.In 2010 the stunting rate reached 35.6%.Then in 2013 it rose to 37% and in 2018 it fell to 30.8% (Kemenkes RI, 2018).Stunting according to WHO is a condition where a child's height is less than the height of a child of the same age and is one of the crucial nutritional problems, namely the condition of growth failure in children under five due to chronic malnutrition.Malnutrition in the fetus and early childhood will have an impact on children's brain development, poor cognitive abilities that will affect academic achievement and ed ucational success (Kemekes RI, 2018).
Short-term symptoms of stunting include developmental barriers, impaired immune function, impaired cognitive function, and impaired combustion system, while long-term symptoms include obesity, impaired glucose tolerance, coronary heart disease, hypertension, and osteoporosis.The stunting problem that occurs in poor and developing countries, especially Indonesia, requires health services to prevent or overcome stunting cases that occur in our country In response to this phenomenon, the Government of Indonesia issued Presidential Regulation of the Republic of Indonesia number 72 of 2021 concerning the Acceleration of Stunting Reduction and derived in the National Action Plan for the Acceleration of Stunting Reduction (RAN-PASTI) to be implemented simultaneously to all regions in Indonesia.The National Strategy for Accelerating Stunting Reduction is implemented to meet the targets of the Sustainable Development Goals (SDGs) by 2030.In order to achieve the national target of stunting prevalence, the target that must be achieved is 14% (fourteen percent) by 2024.
In achieving this, the government must carry out collaborative work involving other stakeholders with a penta helix scheme.Collaboration is a flexible effort because it involves many parties that are driven on the basis of social and voluntary awareness.In addition, collaboration also makes between one actor and another actor have a mutually supportive role according to their capacity.With collaborative work like this, it will be easy to accelerate the reduction of stunting in Indonesia.
Stunting cases in Indonesia are prevalent in many areas, both urban and rural.Bekasi Regency (West Java) is a unique area.The salary standard in this area is the highest in Indonesia because it is the center of factories from large companies.However, the prevalence of stunting in this area is also high.In 2017 it reached 23.7% then in 2019 it dropped to 22.55%.After the President's policy and the RAN PASTI program were implemented, from 2021, which was still at 21.5%, it fell to 17.8% in 2022.Policy interventions were able to reduce this figure, and by 2023 it is expected to reach 14% (stunting.bekasikab.go.id).The significant decline in stunting rates in Bekasi underlies the question of whether existing actors (stakeholders) contribute and collaborate in these efforts.

THEORETICAL FRAMEWORK
Penta helix is a problem-solving innovation model that prioritizes collaboration between actors as stakeholders.This concept is a development of the triple helix concept consisting of academia, business sector and government (Etzkowitz & Leydesdorff 1998;Leydesdorff & Meyer, 2006).This model works to fill the gaps.Academics fill in the research and development, the business sector fills in the financing and the government makes the regulations.Then it developed by adding civil society to become the Quadruple Helix that accommodates community participation.The latest development is by adding the role of the media.The five actors have their own specializations that collaborate to fill their respective roles in solving a problem (Gideon, 2021).
The pentahelix concept is known as ABCGM (Academician, Business, Community, Government, and Media) (Slamet et al., 2017).The government as a regulator and responsible for problems in society, the community as individuals or institutions with an interest in certain issues, academics as knowledge providers who will have important tasks.Media as an information provider and socialization agent regarding a problem (Gideon, 2021).Strong commitment is the main key to collaborative work with this penta helix model.Through synergistic cooperation, it is hoped that the program achievements will be supported by resources that synergize optimally.Pentahelix collaboration has an important role in supporting the common goal of accelerating the reduction of stunting prevalence in Indonesia.The pentahelix model can be a reference to see the role of stakeholders in reducing stunting by developing synergies between actors in an effort to achieve the common goals set (Ananda Putri, et.al., 2023).
Actors who are components of pentahelix have their own interrelated roles.First, the government.the government has the power and authority to make policies or regulators.In addition to making, the government is also the leading sector in implementing, monitoring and evaluating the implementation of programs and policies.Second, academics.Academics have stocks of knowladge which in this case act as conceptors.Research conducted by academics with the ability to analyze concepts and theories can contribute to providing input for policy makers.Third, the private sector (business).This group has a role as an enabler.They carry out business processes that have revelation with government programs and policies.they are required to participate in developing society through social responsibility programs.Fourth, society (community & civil society).Community involvement in policy processes indicates that democratic life is going well.The presence of communities or civil society as a form of political forces that help formulate, implement and evaluate programs and policies.Fifth, the media.The power of the media is an actor whose influence is quite large, especially in terms of political socialization.People will more easily and quickly get any information that is useful for them.The level of public knowledge has an impact on social education and realizes how important the role of the media is.

METHODOLOGY
This research is a qualitative type of research with a case study approach.In this approach, the researcher carefully investigates a program, event, activity, process or group of individuals.Cases are limited by time and activities and researchers collect complete information using various data collection procedures based on specified time.This research focuses on the program to accelerate stunting reduction which is limited from the issuance of the Regent's Regulation in 2022 until the end of 2023.Data and information were obtained from observations and literature studies (Creswell, 2013).

Government
The government is an actor who acts as a regulator who has regulations and is responsible for implementing programs and policies (Awaluddin et al., 2016).To achieve the goals of programs and policies, the government cannot run them alone, the government needs to involve other parties (Sabilla & Kriswibowo, 2021).In the context of accelerating stunting reduction, the government's task is to supervise, socialize, improve coordination, proclaim commitment between stakeholders, and ensure that the budget is channeled.
The budget for the acceleration of the stunting reduction program comes from each region's revenue.As directed by Indonesian Vice President Ma'ruf Amin, this program must run nationally and be integrated.At the central level, government intervention starts from the issuance of Presidential Regulation (Pepres) Number 72 of 2021 concerning the Acceleration of Stunting Reduction with a priority budget from Bappenas.At the regional level, it is carried out by Bappeda (Andayani et al., 2022).
Based on the Bekasi District Health Office report, in 2019 it reached a prevalence rate of 20.93%.Then the figure rose to 21.5% in 2021.In order to continue the central policy, the Bekasi Regency Government issued Regent Regulation (Perbup/Peraturan Bupati) Number 205 of 2022 concerning the acceleration of Integrated Stunting Reduction.The Perbup aims to further intervene in the acceleration of stunting prevalence reduction in Bekasi Regency in an integrated manner with a coordinated, integrated and joint scheme involving cross-sectors in program planning, implementation and monitoring.This Perbup also requires the involvement of actors (stakeholders) including individuals, communities, academics, professional organizations, the business world, mass media, civil society organizations, universities, community leaders, religious leaders and development partners.So the actors mentioned in the regulation are in accordance with the actors in the pentahelix collaboration.
Based on the Perbup, the Regent formed the Stunting Reduction Acceleration Coordination Team (TPPS/ Tim Koordinasi Percepatan Penurunan Stunting) from the district, sub-district to village levels.Programs related to district government intervention are top down, as is the funding.The district and sub-district TPPS only function as coordination, monitoring and evaluation.The frontline of this program is at the village level, where many elements of village officials and the community are involved, such as health workers such as village midwives and village health workers, family planning cadres, the Family Welfare Empowerment Movement Team (TP-PKK/ Tim Penggerak Pemberdayaan Kesejahteraan Keluarga), Village Family Planning Helpers (PPKBD/ Pembantu Pembina Keluarga Berencana Desa), Family Hope Program (PKH/ Program Keluarga Harapan) assistants and Posyandu (Integrated Service Post) cadres.In addition, the Bekasi Regency Government also issued an order from the Regional Secretary with number KP.11.01/9883/DPPKB regarding the establishment of the Stunting Child Foster Father Program (BAAS) in Bekasi Regency.The BAAS program is aimed at 115 regional apparatus / related institutions to participate in overcoming 2997 cases of stunted children spread across 23 regions in Bekasi Regency.The BAAS program aims to improve the nutritional status of children under five through supplementary food following predetermined standards.
The Bekasi Regency Government through the Regional Apparatus conducts supervision and continuously monitors the progress made by each element by holding and attending coordination meetings.Policy socialization is conveyed through coordination meetings with elements of the village government which the village government will then convey to its citizens.The coordination meetings held are the government's efforts to improve coordination between elements despite the busy schedules experienced by each related element.Regional apparatus involved in accelerating stunting reduction include Bappelitbang, the Health Office, the Population Control and Family Planning Office, the Women's Empowerment and Child Protection Office, the Food Security, Agriculture and Fisheries Office, the Education Office and the Social Office.

Academia
Academics in this collaboration are universities.In this case, the members of the pentahelix collaboration in accelerating stunting reduction in Jombang Regency are President University (PU) and Pelita Bangsa University (UPB).Academics play a role as conceptors.Academics have a source of knowledge with relevant theoretical concepts (Awaluddin et al., 2016).In addition, academics also play a role in and encouraging the delivery of ideas and implementing innovations (Halibas et al., 2017).The implementation of higher education activities is based on the Tri Dharma of Higher Education.The implementation of the Tri Dharma of Higher Education includes education, research, and community service (Lian, 2019).
In this pentahelix collaboration, Universitas Presiden (PU) and Universitas Pelita Bangsa (UPB) carry out their duties based on the tri dharma of higher education, which includes analyzing the situation, identifying factors related to stunting, and carrying out community service activities.The Faculty of Engineering team of President University (PU) conducted a triple helix collaboration agenda for community service with PT Jababeka Infrastruktur and the Regional Technical Implementation Unit (UPTD) of Puskesmas Lemahabang (East Cikarang).They developed a mobile application for early detection of stunting prevention and alleviation.The application they developed is called Pancaran Mas Penting (Monitor and Search Together with the Stunting Care Community).This application works for recording from previously relying on health workers to being done directly independently by each child's parents or closest neighbors.For the monitoring process, this application is equipped with a special mechanism, a comprehensive performance index and data will be automatically updated by the system (www.president.ac.id).Meanwhile, Pelita Bangsa University (UPB) plays a role through the Institute for Research and Community Service (LPPM).They conduct research related to stunting and mobilize students to conduct counseling and socialization agendas in the Real Work Lecture (KKN) program in various villages and sub-districts in Bekasi Regency (https://www.bekasikab.go.id/).
What was done by Universitas Presiden (PU) and Universitas Pelita Bangsa (UPB), the academic element in the implementation of efforts to reduce stunting rates was carried out by involving lecturers and students (Andayani et al., 2022).Another study conducted by (Hertati et al., 2023) shows that the involvement of academics in the implemented program is by conducting research based on concepts.They determine situation analysis indicators based on the results of the research so that it can be seen which villages or sub-districts are considered appropriate to be the locus of stunting reduction acceleration activities.Furthermore, for community service activities, it is carried out by sending KKN students to the stunting locus village or sending lecturers and students to do community service.

Business
The private sector or businesses are actors that can act as enablers.They run business processes that have relevance to related programs.Their contribution can be in the form of goods, financial assistance and services following their respective business scope (Andayani et al., 2022).However, it does not rule out the possibility that companies or the private sector are involved in the program even though their business processes are not relevant but have social responsibility for the community and the environment around their business, office or factory.In running the program, they usually involve the government.This is because the government acts as a facilitator that bridges the interests of the parties in optimizing regional development (Firdaus, 2020).
The private sector or companies involved in the stunting reduction acceleration program in Bekasi Regency are members of the Corporate Social and Environmental Responsibility Forum (TJSLP), which is divided into at least two forms of activities.First, they implement the programs launched by the Bekasi Regency Government, namely the BAAS Program and the independent programs of each company.PT Bina Bangun WIbawa Mukti (PT BBWM), as a Regional-Owned Enterprise (BUMD) company of Bekasi Regency has a program called Bapak Angkat Anak Stunting (BAAS).Through a coordination process with the village and sub-district level Stunting Reduction Acceleration Team (TPPS) in Babelan (Bekasi), this program targets 99 children under five who fall into the stunting category.Periodically, this program distributes eggs and milk (https://www.bekasikab.go.id/).The same action was also carried out by CSR PT Hankook Tire which was involved in the BAAS Program by distributing packages worth 221 million for 100 pregnant women and 150 babies (http:/www.aksi.co.id/).PT Damai Putra Group also took the same action by distributing milk and egg packages.
Second, mentoring, training and capacity building activities for Posyandu cadres and the community.This activity involves the local community health center.PT Lippo CIkarang, PT Fajar Paper, PT Cikarang Listrindo and PT Jababeka Tbk conducted training and capacity building activities for Posyandu cadres around their respective companies.While PT Jababeka Infrastruktur is involved with the President University and UPTD Puskesmas Lemahabang to create and assist health service innovations in the form of the Pancaran Mas Penting application.The main role of PT Jababeka Infrastruktur in this collaboration is funding in the service innovation process including the application maintenance process (www.president.ac.id).

Community
The community, in another context, is also referred to as civil society, which acts as an accelerator.The community in this case is people who have an interest and are relevant to the program to be run and play a role as an intermediary or liaison between stakeholders (Awaluddin et al., 2016).In this element of the community, professional organizations and community cadres are incorporated.Professional organizations that are incorporated are professional organizations in the health sector and carry out tasks in accordance with their respective functions.
There are two types of communities involved in the accelerated stunting reduction program in Bekasi District.First, non-organic communities, one of which is the Bekasi Women and Children Advocacy Forum (FIRASI).This community consistently conducts socialization about stunting prevention and its dangers to child growth.The targets of their activities are pregnant and breastfeeding mothers.They do this in collaboration with Puskesmas, Posyandu and TPPS at the village and sub-district levels (https://bekasi.pikiran-rakyat.com/).The Indonesian Employers Association (APINDO) also held the same action but more on providing aid packages for toddlers who indicated stunting.
Second, organic communities at the village level such as Posyandu cadres, PKK cadres and family planning cadres.They are institutionally part of the village institutions but the people involved are volunteers from the community.Activities carried out by organic cadres include collecting community data at posyandu activities and conducting small campaigns related to stunting prevention to the community present at posyandu activities.Cadres also visit homes to provide assistance to pregnant women.Then, to support the smooth running of the activities carried out, development efforts are made to cadres by organizing training.Because as cadres, it is important to get the right understanding (Andayani et al., 2022).
Regarding community participation, it was found that the participation of the community was considered quite good.This is because when the community has been given education about the dangers of stunting, it will increase community awareness, which in turn will make the community more aware of the dangers of stunting in toddlers and how to prevent it.The community actively attends socialization or workshops related to stunting that are held.Thus, it is found that the community element that acts as an accelerator, which includes communities that have interests and functions that are relevant to the activities carried out, has been well implemented.The existence of professional organizations and community cadres can assist the government in collecting data on the community.However, there is no role of the community as a liaison between elements.This is because pentahelix collaboration activities are under the control of the government, especially Bappeda as the leading sector.

Media
Media has a role as an expander.The media has a supporting role in terms of publication on the program being run.Information dissemination can be done either through print media or online media (Awaluddin et al., 2016).Information presented by utilizing existing media, especially online media, will allow readers to enjoy information effectively and efficiently (Ready & Rumyeni, 2016).
In an effort to accelerate stunting reduction, the Bekasi Regency Government involves mass media networks, especially online media.Socialization and information related to stunting are disseminated to journalists to be published in their news columns.But so far, the role of the media as an expander has not been officially established with the government.they are only used as information tools.The district government should be able to establish more serious cooperation in involving the media as an important actor.This lack also occurs with media such as radio.So far, there is no official cooperation between radio owners and the government in stunting prevention.This is quite unfortunate because Instagram is a social media that can be categorized as an easily accessible social network with complete features and easy to use (Abidin et al., 2021).Thus, it is found that the media element that acts as an expander, namely making publications related to the stunting program and disseminating information, has been carried out well.The main media used by the Bekasi Regency Government is only the official website of the agency, especially www.bekasikab.go.id, official social media on Instagram, Facebook and Youtube applications.Cooperation that occurs between the media and the government is carried out only through coordination meetings whose presence is represented by the Office of Communication and Information.

CONCLUSION
Based on the results and discussion, this research found several conclusions.first, Penta helix collaboration in accelerating stunting reduction occurs in Bekasi Regency. the actors involved such as government, academia, business, community and media show collaborative work, support each other, complement each other and perfect each other.The regulations made by the government have covered all elements of the Penta helix.the role of companies in Bekasi has contributed to the Bapak Anak Angkat Stunting program, strengthening and training for cadres at the sub-district and village levels.the academic element also made a real contribution.the shortcoming of this research in the field is the contribution of the media that does not exist.media involvement is only limited to making news from stunting activities that have not been strengthened by the commitment between the Penta helix elements, especially with the government.So, the advice that can be given for the implementation of this collaboration is that media actors who are expected to make a real contribution are part of the Penta helix actors who are interrelated and officially intertwined in the problem of stunting in Bekasi Regency.

Figure 1
Figure 1 Penta Helix Model in Social Innovation and Public Policy Source: Awaludin et.al,.(2016)