Vol. 15 No. 1 (2026): January - June

Introduction: Stunting remains a persistent public health challenge in Indonesia despite comprehensive national policies and multisectoral strategies. The primary issue lies not only in policy design but in its implementation at the primary health care level. This study aimed to examine how stunting policies are communicated, interpreted, and implemented, and to identify factors influencing implementation effectiveness within primary health care settings.

Research Methodology: A qualitative, theory-informed design was employed using Edwards III’s policy implementation framework. Data were collected through semi-structured in-depth interviews with 25 purposively selected health workers, including nurses, midwives, nutritionists, and public health officers. Additional data sources included document reviews and observational notes. Thematic analysis was conducted to explore patterns related to communication, resources, implementer disposition, and bureaucratic structure.

Results: Findings indicate that policy communication is predominantly top-down, with variable clarity and limited feedback mechanisms. Interpretation of policies is highly context-dependent, shaped by workload and local conditions. Implementation is largely integrated into routine maternal and child health services, with limited emphasis on preventive and multisectoral approaches. Key barriers include human resource constraints, insufficient funding, and rigid bureaucratic procedures. Despite these challenges, strong professional commitment among health workers emerged as a critical enabling factor supporting policy execution.

Conclusion: The effectiveness of stunting policy implementation depends on strengthening communication clarity, resource allocation, and intersectoral coordination. Enhancing frontline engagement and reducing bureaucratic rigidity are essential to align policy intent with practice. A process-oriented approach to implementation improvement is necessary to achieve sustainable reductions in stunting.

引言：尽管印度尼西亚已出台全面的国家政策及多部门战略，但儿童发育迟缓（stunting）仍是该国持续存在的公共卫生难题。核心问题不仅在于政策制定本身，更在于初级卫生保健层面的政策落地执行。本研究旨在剖析儿童发育迟缓政策的传播、解读与实施流程，并识别初级卫生保健场景中影响政策实施成效的各类因素。

研究方法：本研究采用基于理论的质性研究设计，以爱德华兹三世（Edwards III）政策实施框架为分析依据。研究数据来源于对25名经目的性抽样选取的医疗卫生人员开展的半结构化深度访谈，受访人员涵盖护士、助产士、营养师及公共卫生官员。额外数据来源包括文件审查与观察记录。本研究采用主题分析法，围绕政策传播、资源配置、执行者态度及科层结构四大维度探究相关模式。

研究结果：结果显示，政策传播主要采用自上而下的模式，信息清晰度参差不齐且反馈机制有限。政策解读高度依赖具体场景，受工作负荷与当地实际情况影响。政策实施大多融入常规妇幼保健服务中，对预防性及多部门协同举措的重视程度不足。主要阻碍因素包括人力资源匮乏、资金投入不足以及僵化的科层流程。尽管面临诸多挑战，但医疗卫生人员强烈的职业使命感成为支撑政策落地的关键赋能因素。

结论：儿童发育迟缓政策的实施成效，取决于提升政策传播清晰度、优化资源配置以及加强跨部门协同。增强一线人员参与度、降低科层体制僵化程度，是使政策意图与实际执行相契合的关键举措。若要实现儿童发育迟缓率的可持续下降，需采用以流程为导向的方法来改进政策实施工作。