Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
APPLYING AN IMPLEMENTATION RESEARCH LENS TO
INDONESIAAoS FREE NUTRITIOUS MEAL PROGRAM Aplikasi Riset Implementasi untuk Program Makan Bergizi Gratis Indonesia *Mochamad Iqbal Nurmansyah1,2.
Anna Fitriani3,4 1Faculty of Health Sciences.
Universitas Islam Negeri Syarif Hidayatullah Jakarta.
Tangerang.
Indonesia 2Centre for Business and Economics of Health, the University of Queensland.
Brisbane.
Australia 3Faculty of Health Sciences.
Universitas Muhammadiyah Prof.
DR.
Hamka.
Jakarta.
Indonesia 4Institute for Physical Activity and Nutrition.
Deakin University.
Melbourne.
Australia Correspondence*:
Address: Centre for Business and Economics of Health, the University of Queensland.
Brisbane.
Australia | e-mail: m.
nurmansyah@uq.
Abstract Background: The Makan Bergizi Gratis (MBG, or free nutritious mea.
program was designed by the Indonesian government to enhance community nutrition, particularly for students.
Ensuring the effective implementation of programs is essential to achieving various objectives.
In general, implementation research serves as a method to identify implementation determinants, formulate strategies, and assess outcomes within the specific context of the MBG program.
Aims: Therefore, this research aims to investigate the potential use of implementation research methodology for improving the MBG program.
Methods: Research in the area may rely on the application of frameworks, theories, and models within implementation science.
The methodology covered three areas: .
delineation of the implementation process.
identification of factors affecting implementation, and .
assessment of implementation outcomes.
The research can concentrate on the phases of formulating implementation strategies and converting research into practice during the identification of the implementation process.
Results: Further opportunities for inquiry include investigating the factors influencing implementation, the effectivenessimplementation hybrid design, outcomes of implementation, economic evaluation, and the phases of scaling up the strategies within the MBG program.
Conclusion: The active role of end-users can help ensure that the results are relevant and applicable in practice, thereby increasing the possibility of adoption.
Keywords: Free nutritious meals, implementation science, perspectives, school-based program.
Abstrak Latar Belakang: Program Makan Bergizi Gratis (MBG), yang dirancang untuk meningkatkan gizi masyarakat, khususnya pelajar, saat ini merupakan program prioritas pemerintah Indonesia.
Implementasi program yang efektif sangat penting untuk mencapai tujuan program tersebut.
Riset implementasi berfungsi sebagai metode bagi peneliti untuk mengidentifikasi determinan implementasi, merumuskan strategi implementasi, dan menilai hasil implementasi dalam konteks spesifik program MBG.
Tujuan: Artikel ini menyelidiki potensi peningkatan program MBG melalui metodologi riset implementasi.
Metode: Identifikasi riset dapat bergantung pada penerapan teori, model, dan kerangka kerja dalam ilmu implementasi.
Riset dapat dikategorikan menjadi tiga bidang: .
penggambaran proses implementasi.
identifikasi faktor-faktor yang memengaruhi dan .
penilaian hasil implementasi.
Penelitian dapat berkonsentrasi pada fase-fase perumusan strategi implementasi dan konversi riset ke praktik selama identifikasi proses implementasi.
Hasil: Investigasi faktor-faktor yang memengaruhi implementasi, desain hibrida efektivitas-implementasi, luaran implementasi, evaluasi ekonomi, dan fase-fase peningkatan skala strategi dalam program MBG dapat menjadi bidang riset tambahan.
Kesimpulan: Peneliti dapat melibatkan pengguna akhir dalam penelitian mereka untuk meningkatkan relevansi dan adopsi temuan penelitian.
Kata kunci: Makan bergizi gratis, ilmu implementasi, perspektif, program berbasis sekolah.
Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301.
Volume 13 No.
DOI: 10.
20473/jaki.
Received: 2025-07-10.
Revised: 2025-12-8.
Accepted: 2025-12-16.
Published: 2025-12-16.
Published by Universitas Airlangga in collaboration with Perhimpunan Sarjana dan Profesional Kesehatan Masyarakat Indonesia (Persakm.
Copyright .
2025 Mochamad Iqbal Nurmansyah.
Anna Fitriani.
This is an Open Access (OA) article under the CC BY-SA 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
How to cite:
Nurmansyah.
, and Fitirani.
Applying An Implementation Research Lens to IndonesiaAos Free Nutritious Meal Program.
Indonesian Journal of Health Administration, 13.
, pp.
133Ae141.
doi: 10.
20473/jaki.
Applying An Implementation.
Nurmansyah.
Fitriani Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Introduction tended to focus more on its impacts on education, social and the economy (Institute for Development of Economics and Finance, 2024.
Basit and Ramadani Rozak.
Izzah and Chusna, 2.
highlights a huge gap in understanding Aowhat went wrongAo with the programAos Implementation research represents a promising approach to address this gap.
It is used to systematically explore multilevel factors that affect program adoption, implementation, and sustainability, as well as to design and test strategies to support program integration in real-world setting (Shelton et al.
, 2.
Therefore, this research paper aims to narratively describe the potential of implementation science and research to improve the MBG program.
AuGood nutrition is the bedrock of child survival and developmentAy (UNICEF).
One of the political commitments of the Indonesian government is the Makan Bergizi Gratis (MBG, or free nutritious mea.
initiative, which provides free nutritious meal in school settings.
This program was planned for implementation over the next five years and intended to assist 82 million children, expectant mothers, and infants.
In the first year.
IDR 71 trillion .
round US$5 billio.
, equivalent 29% of Indonesia GDP, has been set aside (Elyssa and Marihot, 2.
to improve the nutritional status of toddlers, school-aged children, as well as pregnant or lactating women by supplying nutritious food in accordance with the daily Nutritional Adequacy Rate standards.
It also prioritizes nutrition education for the community (Badan Gizi Nasional, 2.
Evidence from various countries has reported the advantages of the schoolbased free meal initiatives.
Research in New Zealand showed that the fresh school meal program in the first 2 years offered well-being and financial benefits for students and families (McKelvie-Sebileau.
Swinburn et al.
, 2.
Another research in India reported that the mid-day meal attainment and some nutritional status of (Raveenthiranathan.
Ramanarayanan and Thankappan, 2.
In the United States, universal free school meal showed effectiveness in improving dietary composition, food insecurity, and economics for low-income families (Marcus and Yewell, 2.
However, since its official launch in early January 2025, a study has reported several limitations in the implementation, such as the quality of planning, monitoring, and evaluation inefficiency of program budget, and issues of fulfilling nutrition and food security (CISDI, 2.
This situation might linked to numerous cases of food poisoning, with one source reporting that as of November 2025, the number of cases has exceeded 10,000 people (Setuningsih and Dirgantara, 2.
On the other hand, instead of examining the implementation of the MBG program, existing research has Applying An Implementation.
The significance of implementation Implementation deliberate integration of evidence-based interventions into everyday practice .
linical or community setting.
with the aim of enhancing the quality and effectiveness of programs (Eccles and Mittman, 2.
Implementation science remains a rising and evolving discipline (Peters.
Adam et , 2013.
Curran, 2.
National Cancer Institute defines implementation science as AuThe study of strategies to facilitate the adoption and incorporation of evidencebased procedures, interventions, and regulation into standard health care and public health environments to enhance population health outcomesAy (Norton.
The core objective is to generate evidence that mitigates the know-do gap by identifying and addressing the obstacles that impede the adoption of proven health evidence-based practices, as well as designing and testing strategies to support implementation (Shelton et al.
, 2.
Implementation research is designed for identifying contextual factors that may affect program efficacy, as an intervention or treatment cannot achieve effectiveness without proper execution (Shelton et al.
In contrast to effectiveness research, which evaluates the impact of interventions on health, implementation research examines the outcomes with Nurmansyah.
Fitriani Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
more focus on measuring the extent and quality of fidelity to the interventions, and how it is integrated within routine practice in real-world settings (Estabrooks.
Brownson and Pronk, 2018.
Shelton et al.
, 2.
In implementation research, key .
ndividual-level program uptak.
, adoption .
he initial organizational decision to implement an evidence-based progra.
, implementation .
idelity to the intended interventio.
, maintenance .
he extent to which the program becomes sustained or institutionalise.
, and cost-effectiveness (Reilly et al.
, 2.
In addition, although feasibility are not classified as core implementation outcomes, they are important antecedents that shape the likelihood of successful implementation and therefore warrant investigation (Reilly.
Kennedy et al.
To examine implementation science provides 143 theories, models, and frameworks (TMF) in order to understand and identify outcomes, process, determinants and strategies for effectively integrating and adopting practices at the clinical, health service system, and community (Peters et al.
Wang et al.
, 2023.
Skolarus and Williams, 2.
A detailed explanation of the practical tools and approaches from implementation science is presented in the following section.
and the Indonesian Pedoman Gizi Seimbang (Balanced Nutrition Guidelines for Indonesi.
(Kemenkes RI, 2.
to ensure policy coherence and consistency On the ground, this requires clarity on the material and organizational .
infrastructure, staffing, food supply chain.
, recognizing that these may vary substantially across regions.
It also requires understanding the target users .
the age groups served, their nutritional requirements, food preferences, ethical considerations .
, parental consen.
, and safety concerns such as allergies and Equally important is identifying multi-level actors involved in the program implementation on the ground, such as quality-control personnel, and delivery systems (Durlak and DuPre, 2.
Stakeholder mapping is also essential: at the school level, decisions must consider leadership, teachers, and the broader school community.
at the system level, cross-sector engagement .
, education and health department.
is required to ensure coherent governance and support (Wandersman et al.
, 2008.
Koorts et al.
, 2.
This stage provides a critical opportunity to evaluate the programAos efficacy, acceptability, appropriateness, and feasibility before wider implementation (Koh et al.
, 2020.
Reilly et al.
, 2.
After proving effective in a pilot or small-scale, highly controlled setting, program can then be introduced to a larger population in realworld settings by testing both effectiveness and implementation.
Although traditional models reserve implementation research for final stages, current best practices support hybrid effectiveness (Curran et al.
These allow for simultaneous evaluation of both outcomes and implementation processes as described deeper in the next section.
Preparing for Real-World Implementation: Design.
Contextual Fit, and Early Stage Testing A fundamental first step in designing any large-scale meal program is to develop the intervention, assess the context in which it will be implemented, and undertake early testing to ensure feasibility and fit (Koh, 2.
It may include aligning the design with existing nutrition regulation, available resources, user characteristics, stakeholders involved (Koh, 2.
For MBG, it is important to ensure that the programs align with the existing national framework, such as Gerakan Nasional Percepatan Perbaikan Gizi (National Movement for the Acceleration of Nutrition Improvemen.
(Indonesian Government.
Applying An Implementation.
Advancing the MBG Program Through Implementation Research The identification of implementation research needs can be guided by the taxonomy of Nilsen .
, which Nurmansyah.
Fitriani Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
distinguishes several categories of theories, models, and frameworks (TMF).
The use of TMF in implementation research serves three objectives, namely .
describing or showing process of translation of research into practice, .
Process models can be used to achieve the first objective, determinant implementation theories for the second, and evaluation frameworks for the third (Nilsen, 2.
Within the MBG program, when an intervention lacks efficacy and effectiveness, the subsequent step is to research to establish a strong evidence base, rather than proceeding with However, implementation issues could be examined and analyzed at this stage (Lane-Fall.
Curran and Beidas, 2.
First, research aimed at describing the process of translating outcomes into practice can serve as a focal point to comprehend the implementation phase, along with the enablers and barriers.
This in turn facilitates the identification of strategies that may prove most suitable within the specific context of the MBG By definition, implementation strategies are characterized as approaches or techniques used to support the adoption, delivery, and long-term maintenance of a clinical program or practice (Proctor.
Powell and McMillen, 2.
In this context, research may concentrate on identifying the implementation of the MBG program through diverse frameworks, including the EPIS and the dynamic adaptation process (Aarons et al.
, 2012.
Moullin et al.
, 2.
For instance, by using the EPIS framework, research can explain the phases of the MBG program according to exploration, sustainment stages.
It also facilitates easy identification of external system and internal organizational contexts along with determinants associated with the attributes of the implementation (Aarons.
Hurlburt and Horwitz, 2.
To strengthen this process, it is essential to explore and map out the stakeholders and roles using Applying An Implementation.
Interactive Systems Framework (Wandersman et al.
This framework identifies three interrelated systems that play critical roles in implementation namely .
the Synthesis and Translation System, which includes program developers who synthesize and adapt scientific evidence of the MBG program.
the Support System, which consists of stakeholders such as education authorities and other parties who facilitate the integration of MBG into school routines, and .
the Delivery System, comprising any school stakeholders who engage in program in daily practice.
The framework is important for MBG because it helps identify barriers and strategies across different stakeholder levels, which is valuable for designing, implementing, and Second, research can focus on implementation through three approaches.
the use of determinant frameworks such as the CFIR and PRISM, .
classic behavioral-organizational theories, namely the health belief model, theory of planned behavior, or social cognitive theory,.
implementation theories comprising COMB and organizational readiness (Nilsen.
Determinant frameworks focus on identifying barriers and facilitators for the implementation of the MBG program in a multilevel manner.
This includes the individual, local, regional, and central Furthermore, organizational theories can be used to identify implementation, such as identifying healthy eating behaviors of students and the acceptability of school menus (Santana et al.
, 2.
Other areas that can be identified include organizational readiness, organizations associated with the MBG program, such as schools, food providers, government nutrition agencies, related entities and organizations, namely families, health services, and social organizations.
For example, the implementation of food safety or school health promotion may be identified as an inseparable activity from the MBG program.
Third, research may concentrate on Nurmansyah.
Fitriani Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
The outcomes can be identified through various frameworks, including Proctor et al.
, .
which emphasized a taxonomy of eight distinct implementation outcomes, as well as the RE-AIM framework (Holtrop.
Estabrooks et Proctor.
Silmere et al.
Domains appropriateness, sustainability, and fidelity have been used in another similar previous As introduced in the previous section, an alternative measurement concept in implementation research is termed the effectiveness-implementation hybrid design.
This design uses one of three methodologies.
The first type is by evaluating the effects of a clinical intervention on pertinent outcomes while simultaneously documenting and analyzing the implementation process (Type I).
The second is by conducting a concurrent assessment of both the clinical intervention and the implementation strategies applied (Type II).
The third is by examining the implementation strategy while concurrently monitoring and assessing the clinical outcomes (Type .
(Curran et al.
, 2.
This design facilitates research to evaluate the MBG program simultaneously in terms of both effectiveness and implementation.
For large-scale programs such as MBG where political urgency and public demand are high, a Hybrid Type 2 design could assess both the intervention outcomes .
, nutritional and health outcomes, health behavior, academic performanc.
and the feasibility of different delivery Alternatively, a Hybrid Type 3 design could focus primarily on testing implementation strategies, namely delivery through schools, health centers, or community kitchens, while monitoring An additional important aspect is economic evaluation, which differs from the The assessment of implementation research is crucial for the efficient allocation of organizational resources (Raghavan, 2017.
Eisman et al.
, 2.
Consequently, individuals or institutions can perform an economic evaluation of the MBG program implementation to ascertain the most cost- Applying An Implementation.
effective strategy.
Ultimately, research may also concentrate on expanding the implementation strategy on a larger scale.
Barker's strategy scale framework can be used, which comprises four stages, namely setup, development of the small unit, testing for scale-up, and full scale.
Another alternative is the nine-step guide for formulating a scaling-up strategy by World Health Organization (World Health Organization, 2010.
Barker.
Reid and Schall, 2.
Within the framework of the MBG program, once a successful implementation strategy for the innovation is formulated, the innovation can be disseminated to reach a broader population and maintain sustainability.
Conclusions We identified a wide range of research through implementation research lens to examine the implementation of MBG program.
The academic and other sectors can contribute to program success by conducting various research, particularly by engaging end-users, such as students, governments, food providers, and other parties to ensure that the research conducted is relevant to needs (Moore et , 2.
Given the current contextual barriers and facilitators of the MBG program, implementation research can help identify the most useful and effective Moreover, decision-makers could integrate implementation research principles into the design and rollout of the program to ensure that delivery strategies are feasible, context-responsive, and capable of achieving sustained impact on Implementation research provides a crucial approach to improve the design, delivery, and scale-up of the MBG program.
Identifying barriers, testing strategies, and assessing implementation outcomes will help bridge the gap between evidence and The use of frameworks and hybrid designs can implementation in real-world settings.
science will support long-term impact, scalability, and sustainability.
Nurmansyah.
Fitriani Indonesian Journal of Health Administration Commentary (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
adaptation process to implement an evidence-based child maltreatment Implementation Science 7.
: 32.
Aarons.
Hurlburt and S.
Horwitz .
"Advancing a Conceptual Model of EvidenceBased Practice Implementation in Public Service Sectors.
Administration and Policy in Mental Health and Mental Health Services Research 38.
: 4-23.
Badan Gizi Nasional.
"BGN akan Memulai Program MBG Secara Bertahap.
"Retrieved 09 March, 2025, https://w.
id/news/artikel/b gn-akan-memulai-program-mbgsecara-bertahap.
Barker.
Reid and M.
Schall .
"A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa.
" Implementation Science 11.
: 12.
Basit.
and H.
Ramadani .
"Analisis Implementasi Program Makan Bergizi Gratis Terhadap Perkembangan Ekonomi.
" Journal of Economics Development Research 1.
: 49-54.
Brown.
Curran.
Palinkas.
Aarons.
Wells.
Jones.
Collins.
Duan.
Mittman.
Wallace.
Tabak.
Ducharme.
Chambers.
Neta.
Wiley.
Landsverk.
Cheung and G.
Cruden .
"An Overview of Research Evaluation Designs Dissemination and Implementation.
Annu Rev Public Health 38: 1-22.
CISDI .
Pentingnya Penguatan Tata Kelola.
Regulasi, dan Monitoring Evaluasi pada Program Makan Bergizi Gratis.
Policy Paper Series:
Mengkaji Program Makan Bergizi Gratis.
Jakarta.
CISDI.
Colditz.
The Promise and Challenges of Dissemination and Implementation Research: 3-22.
Curran.
"Implementation science made too simple: a teaching Implementation Science Communications 1.
: 27.
Curran.
Bauer.
Mittman.
Abbreviations CFIR: Consolidated Framework for Implementation Research.
COM-B:
Capability.
Opportunity.
Motivation.
Behavior.
EPIS: Exploration.
Preparation.
Implementation.
Sustainability.
MBG:
Makan Bergizi Gratis / Free nutritious meal.
PRISM: Practical.
Robust Implementation and Sustainability Model.
RE-AIM: Reach.
Effectiveness.
Adoption.
Implementation and Maintenance.
WHO: World Health Organization.
Ethics Approval and Consent Participant Not applicable.
This study synthesizes information from previously published literature and does not include human Conflict of Interest The authors declare that there are no competing interests.
Availability of Data and Materials No new data was generated or analysed in this study.
All data used in this review are derived from previously published sources, as cited in the manuscript.
AuthorsAo Contribution MIN and AF wrote the manuscript and reviewed the final version of the Funding Source This research received no specific grant from any funding agency.
Acknowledgment The authors are grateful to the Faculty of Public Health.
Universitas Airlangga, for the technical support and all the contributors who helped in this research.
researchers whose work formed the basis of this review.
References