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Study Overview

Evaluation of the Quality of Gammarana for Stunting Prevention in Children aged 0-24 Months in Enrekang District
Study is 3ie funded:
Study ID:
Initial Registration Date:
Last Update Date:
Study Status:
In Development


Evaluation of wide-scale stunting interventions in Indonesia has never been carried out, because it found limited sensitive and specific interventions that were carried out massively at the village level. The provincial government of South Sulawesi Indonesia in 2020 has implemented a stunting intervention model called Gammarana. The objective of this evaluation is to analyze the impact of Gammarana on changes in stunting at the project site. The project location is 30 villages with an estimated population of 60,000.

methods and analysis

Evaluation In this study uses retrospective methods and internal and external audits of potential documents, then validated post-Gammarana field visits in the first phase of 2020. Basic evaluation of the Logic Model evaluation model with 22 indicators (input, process, secondary output and primary output). Proving the effect of Gammarana on changes in stunting by comparing the phenomena in the comparison village. The comparison villages were set as equal and comparable in 13 indicators that could disturb the study conclusions. The result of the initial condition is that the conditions of both Gammarana and Comparison Villages are seen as the same in various characteristics, so whatever the results of this evaluation study are believed to be the impact of Gammarana. 

Ethics and Dissemination The

ethics of this study were from the Makassar Health Polytechnic and Hasanuddin University. This evaluation study has been registered with the Registry for International Impact Evaluation.

Registration Citation:
Health, Nutrition, and Population
Public Sector Management
Additional Keywords:
stunting, evaluation
Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:
Sirajuddin Sirajuddin
Health Polytechnic of Makassar, Indonesia
Name of Second PI:
Saifuddin Sirajuddin
Department of Nutrition Public Health Hasanuddin University, Indonesia

Study Sponsor

Health Polytechnic of Makassar
Study Sponsor Location:

Research Partner

Name of Partner Institution:
Health Department Province South Sulawesi Indonesia
Type of Organization:
Government agency (eg., statistics office, Ministry of Health)

Intervention Overview


The Gammarana intervention consisted of micronutrient supplements for children, macronutrient supplements for pregnant women, and education on child feeding by village nutrition workers for 5 months. The number of villages was 30 as intervention and 30 villages for comparison.

Theory of Change:
  1. Classical evaluation theory is a comparison between input, process, outcome and impact criteria with standard criteria that are set before a system or intervention is carried out. Its robustness is a standard criterion which is often not always linear with the fact that the process travels in the best conditions. A more flexible evaluation theory is the Realistic theory or known as the Realist Theory by Pawson & Tiley 1987.

  2. Improved parenting behavior is a logical reason for improving children's nutritional status and health, including stunting. The theory used in this study is the "I Change Model" theory. The strength of this theory is in its ability to explain dynamic positions of behavior. Behavior in is the difference between the pressure of new habits and old habits or vice versa.

  3. The analysis that can be used to find the accelerator of stunting reduction in the pilot area is the Analysis Hierarchy Process (AHP). The argument for using AHP to identify accelerator components of intervention is their suitability with multiple variables in the stunting intervention and the limitations of the unit of analysis.

  4. The stunting intervention package is a tangible and intangible product. This product needs to penetrate leading sector organizations that are mandated to lead the acceleration of stunting reduction. Penetration of stunting intervention packages such as Gammarana, requires the right method. This study uses SWOT analysis theory to formulate a gammarana strategy in preventing stunting. 

Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
Health Department Province South Sulawesi Indonesia
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:
Health Department Province South Sulawesi Indonesia
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Intervention Timing

Intervention or Program Started at time of Registration?
Start Date:
End Date:
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Instrumental variables
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

The Evaluation Framework of GP

The number of indicator are 22 established. Fourteen (14) composite indicators become quality indicators with the village level unit of analysis, and 8 indicators with the individual caregiver analysis unit (qualitative sub-sample study)17. The qualitative study was selected in the village with the highest (1 village) and lowest (1 villages) reduction in stunting. This subsample study is to elaborate the implementation of the I change Model as the reason for changes in stunting at the caregiver level.18 The I Change model was studied in a sub-sample of mothers who succeeded in preventing stunting in their children during the mentoring period, and also mothers who had not succeeded in preventing stunting in their children during the mentoring period. The activities evaluated and the data collection methods are named according to the nomenclature in GP as follows (Rubric Instrument)

Outcomes (Endpoints):

Primary outcome

1. Reducing stunting

2. Quality Intervention of Gammarana

3. Accelerate of Nutrition Intervention

4. Strategy of  Gammarana Intervention

Unit of Analysis:
Child, Villages

The hypothesis in this study is to test, if a number of underline stunting interventions are carried out with maximum conditions, the reduction in stunting will be able to reach> 4% per year. The result of a systematic review by Hossain 2017 is that if an intervention combines sensitive and specific interventions with a strong basis for political support, community involvement and program factors, it will be able to achieve a decline of 3% per year.23 The results of the systematic review of researchers for the 2015-2020 publication period specifically for the Randomized Control Trial study found a decrease in annual decline for the effective intervention group was 3.23 ± 3.73 percentage points. If the intervention is effective it can reach 6.58 ± 1.99,% percentage points and if it is not effective it will only reach 0.57 ± 2.42 percentage points per year

Unit of Intervention or Assignment:
individual, and villages
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Number of Individuals in Sample:
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Outcomes Data

Household survey for Baseline and End line anthropometric data of children are recorded from the 2020 Gamarana Projet report document. Comparative data were taken from 30 Non GP Villages14. Anthropometric data (height, weight) for August 2020 were recorded from the Community Based Nutrition Reporting Recording Big Data Indonesia
Data Already Collected?
Data Previously Used?
Data Access:
Restricted -- Access requires a formal approval process
Data Obtained by the Study Researchers?
Data Approval Process:
Access requires a formal approval process been done to Health Department South Sulawesi Province Indonesia. This data has been accessible to researchers, because they have been given full permission for study purposes from January 2021 until the completion of this study.
Approval Status:
Yes-obtained approval and have received the data

Treatment Assignment Data

Participation or Assignment Information:
Data Obtained by the Study Researchers?
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:
Rubric Instruments: Matrix_I_Fix.docx

Registration Category

Registration Category:
Non-Prospective, Category 4: Data for measuring impacts have been obtained/collected by the research team and analysis for this evaluation has started

Completion Overview

Intervention Completion Date:
Data Collection Completion Date:
Unit of Analysis:
Clusters in Final Sample:
Total Observations in Final Sample:
Size of Treatment, Control, or Comparison Subsamples:


Preliminary Report:
Preliminary Report URL:
Summary of Findings:
Paper Summary:
Paper Citation:

Data Availability

Data Availability (Primary Data):
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Other Materials

Survey Instrument Links or Contact:
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Description of Changes:

Study Stopped